I first met Deniece when I was in my very first year at the McMaster Physician Assistant Program back in September 2010. She was an American trained Physician Assistant who was recruited from California to teach at the PA program at McMaster by our then dean, Dr. John Cunnington. Deniece taught our PBL courses and IER (interview, examination and reasoning) classes. She now practices in Family Medicine, and Orthopaedic Surgery, while also teaching at the PA Consortium Program.
In addition to being one of the first PA clinical instructors in Ontario, Deniece has taken on a multitude of initiatives to help move the PA profession forward as Ontario’s Physician Assistant Chapter President.
I often get asked, “How is the PA profession doing in Ontario?” Deniece is probably the best person to answer this question. I’ve gotten to know Deniece as a colleague now since she was recently hired to replace a maternity leave at my clinic. Through some small talk I quickly learned about her involvement with different PA initiatives and important stakeholder meetings. Recently I had an opportunity to sit down and interview Deniece, and had a great conversation about her contributions and vision for the PA profession moving forward.
Update: Deniece was also re-elected as Ontario Chapter President and will be serving Ontario PAs for another 2 years!
Ontario PA Chapter President Role
Why did you decide to take on the role of the Ontario Chapter President?
I was encouraged by many former Ontario Physician Assistant students that I had previously taught to run for the position. Also I was very frustrated with the slow movement of the profession in Ontario over the last 6 years since moving to Ontario. I had great difficulty getting and keeping clinic positions due to the lack of funding. My employers always wanted me to stay but could not navigate the system without funding to support my salary. I have had many part time PA jobs to create full time work over the last 8 years. This year alone, I had 4 different PA jobs at the same time to create full time work. I realized I had the skills and abilities for leadership, to network, and a strong desire to move the PA profession forward. The role of Ontario Chapter President has been so rewarding in the last 2 years that I would be honoured to serve for another 2 years in this role
What are your specific roles and responsibilities?
Overall I would say:
- responding to the needs and concerns of practicing PAs, PA students, and those interested in the PA Profession.
- develop and manage different initiatives and projects to help integrate PAs into practice
- provide additional PA networking opportunities
- personal one-on-one mentoring and support for PAs and Physicians interested in utilizing a PA in their practice
- meeting with health care stakeholder groups and consulting with the PA integration committee about PAs
In addition, I perform roles as outlined in the CAPA Bylaws, pp. 19:
“Each Regional President or his Delegate shall:
- sit as a voting member of the Board of Directors;
- serve as a liaison between the Board of Directors and their regional membership;
- present regional concerns to the Board of Directors for consideration;
- attend all meetings of the Board of Directors;
- be a member of CAPA in good standing for the duration of his or her term;
- uphold the policies and procedures of CAPA;
- preside over meetings of the regional Board of Directors (the Regional Board);
- approve agendas for all meetings of the Regional Board;
- submit to the Board of Directors any resolution originating in the Region that requires review and approval by the whole membership, at the prior meeting closest to the annual meeting of the CAPA;
- inform the membership of the region about programs and developments relevant to their chapter;
- keep abreast of changes within the Chapter;
- appoint all standing committees of the Regional Board and designate their chairperson;
- ensure that regional structures, policies and procedures align with national structures, policies and procedures of CAPA; and
- oversee Elections for Chapter Executive at a minimum of every two years.”
PA Initiatives in Ontario
What committees or projects have you started during your time here?
Frequently Asked Questions for Ontario Chapter President
You’re frequently contacted by PA students and practicing PAs – what kind of questions do they tend to ask?
Students who are interested in applying to PA school have questions about the job market, the role of a PA in the health care system, and shadowing a PA in their community. First and second year PA students usually have concerns and questions about employment, regulation, and funding – especially when they get closer to graduation. I talk with these students to figure where their passion lies and provide answers to their questions and help navigate the system.
Practicing PAs have many of these same questions including the lack of job opportunities, lack of growth in their positions, challenges moving to new practices and questions around specialty practice. Due to the lack of funding some PAs have left their positions and returned to school or their previous careers. In addition, people have contacted me and CAPA for advice on unions, employment concerns, hospital privileges, and many other individual concerns regarding their employment and career as a PA. Both PAs and physicians are confused about how to fund a PA position with the multitude of different billing methods for reimbursement in Ontario. I work hard to help all the PAs with any information I can provide or refer their questions on when needed. In the last few years, I have also heard from American PAs interested in moving to Ontario, Canada.
Physicians who are interested in working with a PA often contact you, what is usually discussed?
Although this does not fall within the scope of my role as Ontario PA Chapter President, I am often guiding physicians on the hiring process for a PA. I welcome the opportunity to educate them on how a PA can add value to their practice. A few of the questions I ask are:
- Do you understand the PA role? I often explain what PAs can and cannot do in Ontario as well as establishing expectations for PAs.
- What are your clinic needs? Specifically, what is your motivation to hire a PA? Do they want to better serve their patients? Increase access while simultaneously decreasing wait time to being seen and increasing appointment availability? Do they want to start offering off-clinic hours? Do you want to finish clinic at a more reasonable hour?
- Do you understand billing and reimbursement for PAs in Ontario? Here I explain that in family health teams, and physicians with access to rostering of patients, physicians can be compensated for adding more patients to their roster through capitation model. However rules are different for physicians who bill Fee-for-Service. In fee-for-service setting this also includes having a meaningful participation in the patient encounter for the physicians. In Emergency rooms, there are many different ways to employ a PA and a few different ways for physicians to be compensated depending on the payment structure for the physician’s salary.
- How will you fund the PA position?
- To Family Physicians – Here the discussion takes place about different funding streams for hiring a PA – including the Health Force Ontario Career Start Grant program, funding through Family Health Teams, CHCs, Rostering, LHIN funding, or Research Funding. Other sources may include funding out of pocket – where the physician must calculate how much more billing is required to cover overhead of PA.
- To Specialty Physicians –Apart from funding obtained through the HFO Career Start Program as mentioned above, Research funding, Hospital funding and Department funding (e.g. Department of Orthopaedics, Department of Emergency Medicine) that may be used for funding the PA salary. Again, as mentioned previously, other sources may include funding out of pocket – where the physician must calculate how much more billing is required to cover overhead of PA.
- What resources would help you integrate a PA? I provide templates of medical directives, the Pharmacy Connection Article for Pharmacists about accepting prescriptions from Physician Assistants, CMA Toolkit, CPSO resources, CMPA information, CAPA-PA ToolKit, articles about the value of PAs and other resources from CAPA.
- If you don’t have a high patient volume to hire a PA full time, consider other alternatives – this may include sharing a PA with another physician, invoicing your full time PA to other physicians part time (and charging a set hourly rate), and hiring a PA part time.
Other concerns I tend to field from physicians inquiring about PAs seem to be around billing, hospital privileges, recruiting a PA, and challenges with understanding reimbursement of PA for patient care.
The Future of PAs in Ontario
What struggles does Ontario have in comparison with other provinces?
Regulation – Unique problems include not being regulated and not having a solid funding model for the different areas of medicine. PAs do want to be regulated, and applied for regulation through HPRAC in 2012. PAs did not meet criteria for “threshold to harm” because we work under the supervision of a physician. However, PAs in some clinics are practicing with remote supervision, therefore regulation is important. Provinces with practicing PAs (Manitoba, New Brunswick, and soon to be Alberta) have seen the value in regulating the profession.
Funding – In Ontario, there is a fairly good funding model for Family Medicine PAs.
As mentioned before, In Emergency rooms, there are many different ways to employ a PA and a few different ways for physicians to be compensated depending on the payment structure for the physician’s salary. However it is more challenging in hospitals and specialties.
In short, funding for PA positions is attached to physicians. However physician and hospital funding is not attached. For instance, physicians are paid directly by OHIP and hospitals are not involved in physician compensation (there may be a stipend for being department head, or academic research, but hospitals do not pay physicians for patient care). If OHIP does not pay PAs, then funding has to come from other resources or models. There have been a few resources – hospital funding, department funding, LHIN funding, and other grants (i.e. Health Force Ontario Career Start) but there is not a solid, consistent source of funding for PA positions – unlike Manitoba in which PAs are actually paid directly by the government in hospital settings.
Hospital Privileges – Due to the challenges in funding, it is difficult in some areas for physicians who pay their PAs privately to secure the hospital privileges. Some limitations are PAs in Ontario not being associated with the College of Physicians and Surgeons (CPSO), this is a unique concern in Ontario. In Manitoba, New Brunswick and soon to be Alberta the PAs are regulated under the provincial college of physicians and surgeons. Hospital Administrators worry about liability for PAs, if they are not a hospital employee, and there is concern that Ontario is the province with the most practicing PAs yet they are not regulated.
How is Employment Outlook for PAs in Ontario?
Physician Assistant Employment outlook is good, and continues to improve. There is more awareness of the PA profession amongst physicians, and with more awareness we have seen an increase in job postings. One of the biggest challenges to employment I see is that some PAs are not flexible with moving for a position or changing specialty to pursue a new position. Once a funding model for PAs is established this will only further job opportunities in Ontario.
Any questions or comments for Deniece? Let us know in the comments!