One of the most compelling sessions I attended at the CAPA conference was about the New Brunswick experience with Physician Assistants presented by New Brunswick Emergency Physician Dr. Graeme Young. The following is a summary of some of his points.
Dr. Young has had early exposure to military PAs during his training as a surgical resident in Ottawa. Seeing the competency and ability of PAs to essentially run many of the clinics and see patients established an early framework for how Dr. Young would later approach implementing hiring Physician Assistants in New Brunswick Emergency Department where civilian PAs had not worked in the province before.
Dr. Graeme Young outlined that encouraging interest to hire Physician Assistants in a province that has not had Physician Assistants before can be challenging.
From his early exposure to PAs as a surgical resident, he was already sold on the idea, and explained:
“As a Physician trying to convince other Physicians, I say there is a Health Care Practitioner Physician Assistants doing our jobs just as well as we do”.
Time for change – Overcrowded, long wait times in New Brunswick’s Emergency Department (ED)
Before Physician Assistants were implemented in this particular Emergency Department:
- In 2009, patients that would leave without being seen rate was 12-13%, which was six times the national expected rates. This led to frustrating, overcrowded working conditions and issues around safety.
- Dr. Graeme Young put together a proposal to hire Physician Assistants in the Emergency Department submitting it to the medical director of a New Brunswick hospital to address these issues. After careful review, his proposal for a Physician Assistant model in the Emerg Department was accepted
Proposing a solution: Introducing PAs into the New Brunswick ED
In 2010 a program to implement PAs into this New Brunswick Emergency Department was drafted and developed to include a job description and national scope of practice.
At the time, there were not many graduates of Canadian PA programs, many military and American PAs applied. The hiring committee also noted that there were a lot of foreign medical graduates (who did not have PA education/certification) that also applied, however may not have been aware that they do not qualify for the position and therefore not considered for the position. Two Physician Assistants were ultimately selected, one US PA grad and one military PA.
To ease the new PA hires into the Emergency Medicine practice, evaluations and feedback for performance and competencies were performed at the 2, 4, and 6 month mark with the goal of having the Physician Assistants comfortable at every level of triaged patients.
The result of implementing PAs:
This milestone was highlighted in the article “Physician assistants to work in Fredericton emergency department” published by the Government of New Brunswick website:
Excerpt from the article:
“We are pleased to welcome physician assistants Kathleen Harvey and Lori Jackson to our team and are excited to be part of the implementation of this new health care discipline in New Brunswick,” said Donald J. Peters.. “As a new health discipline, the physician assistants are currently being integrated into the multidisciplinary health care team. It is anticipated that when they are fully integrated early in the new year, patient care will be enhanced through improvements in wait times and reduction of patients leaving the emergency department without being seen.””We are fortunate to have such high qualified and experienced physician assistants join our team,” said Dr. Graeme Young, chief of Emergency Medicine at the Dr. Everett Chalmers Regional Hospital. “We are very positive about their arrival as they see up to 20 patients a shift and provide the full spectrum of emergency medical care.”
In 2013, with the resignation of one of the PAs the hiring process was started once again with the opportunity to hire a PA graduate from a Canadian school. Eventually a University of Toronto/PA Consortium graduate was selected. Note was also made that this time around no foreign medical graduates (with no PA studies/certification under their belt) applied, so the word about being a certified Physician Assistant is getting out.
Was there resistance to implementing the PAs into the ED?
Unlike other provinces, there seemed to be little to no push back from the nursing staff or associations in New Brunswick, in fact they were some of the fastest buy-ins for PAs in the ED. This especially became true as the PAs (who were both from outside of New Brunswick) became familiar with local community and health support networks and resources, becoming invaluable members and resources to the NB community at large. It was clear that the Physician Assistants were having an impact on quality care, work flow, and wait times.
There was some initial resistance from consulting physicians within the hospital who were unfamiliar with the role of Physician Assistants. Dialogue with these consultants and PAs started with “I need to speak to a doctor”, however as the PAs continued to develop competency and demonstrate their work ethic and dedication to patients, the conversations between hospital consultant physicians and PAs slowly became “Thank you for the consult, and your hard work.”
What progress has there been since the PAs have been implemented in New Brunswick?
- However, this prescription legislation came with a small hold on “controlled drugs” (read: Narcotics). Nonetheless, this has reduced barriers that prevent PAs from practicing within their full scope of practice.
The feedback from 2012 patient satisfaction surveys has been positive:
— Physician Assistants (@CanadianPA) October 25, 2014
Regulation and Registration:
If you go on the College of Physician and Surgeons of New Brunswick website, there is a Physician Assistant registration section, with a link to the medical act that outlines PA regulation (PAs are currently not regulated in Ontario).
What direction is the PA program in New Brunswick moving now?
Dr. Graeme Young and his team are putting forth a proposal to hire two additional Physician Assistants. Once funding is approved, they will hire more PAs.
In terms of other areas of medicine hiring PAs, there does not seem to be as much traction/interest in family medicine yet for hiring Physician Assistants. This may change in the future as CAPA on a national level, and Physician Assistants on an individual grassroots level continue to advocate and spread awareness about the great work PAs do and the difference we are making to Canadians in Health Care.
From Dr. Graeme Young:
“When I don’t have a Physician Assistant working with me, it feels like I don’t have one of my feet.”
It’s great to see Physician Assistants being implemented in other provinces and territories across Canada. The PA profession is still in its infancy, and in addition to being clinicians and treating patients we are still very much advocating for the profession – educating physicians, allied health care practitioners, patients and their families about what PAs are. American PAs have been around for 40+ years and are STILL acting as ambassadors for the profession and educating the public about the scope, role and benefits of having Physician Assistants in the Canadian health care system.
Much like Dr. Young’s early exposure to Physician Assistants during his medical training, I know that many current Canadian medical students are actually learning alongside PA students (often completing the same rotations, having the same roles and tasks as clinical clerks) and working with currently practicing PAs during medical school, residency and fellowship.
Although its hard to measure the potential impact this may have for the future, its certainly encouraging to see (anecdotally) that many health care professionals and patients I encounter in practice today have heard of Physician Assistants. Often, having physicians and allied health championing the PA profession alongside us will contribute to the case the case to expand the utilization of PAs across Canada.
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