PA PRACTICE • BY MAUREEN TAYLOR, CCPA

Although civilian PAs have been working in Canada since 2006, there’s no question that integrating them is still a work in progress.  If you are lucky, you’ll be applying for jobs where the supervising physicians and hospitals already have PAs and have worked out some (but probably not all) of the bugs in the system.  Most of the time, however, you’re likely to be the first PA your potential employer has ever met.  But if he/she/they want a PA, they should at least have thought through why they want a PA and how they’ll use one.  If they don’t offer up that information during the interview, here are some questions you may want to put to them:

1. How much direct experience have you had with PAs in Canada or the US?
2. How do you intend to use a PA in your practice (history and physicals only?  Filling out paperwork?  Will there be any procedures?   Telephone follow ups with patients/pharmacies/referrals?)
3. Will the PA see all types of patients (including those with acute, complicated medical problems?)
4. What are your expectations for transitioning a PA into your practice (i.e. how much time will you spend training, how much supervision, transition to more autonomy)
5. Why are you seeking a PA for this position rather than an RN or NP?
6. How many physicians would the PA work with?  Are there any physicians who are opposed to hiring/supervising a PA?

1. (If they have an RN or NP or other allied health)  How do other staff members feel about your decision to hire a PA?  What type of interaction/relationship would the PA have with them?  How will you educate/prepare staff for the addition of a PA to the team?
2. What types of orders will the PA be able to write (medication, diagnostic tests, discharge instructions etc.)?  Will there be any exceptions (i.e. narcotics)?
3. How will you obtain or create medical directives for the PA (and how much of this will fall on the PA’s shoulders???)
4. Do you envision any problems with allied health carrying out these directives?
5. If you take medical clerks/residents in your practice, how would you divide the responsibilities between them and the PA?  Would the PA be supervising any of these clerks/residents?  Would the PA at any time fall under the supervision of a resident?

1. MOHLTC, how will you fund the position when that program ends (in one to two years)?
2. How do expect hiring a PA will affect your billing/salary?  How important is it to you that the PA improves your bottom line?  What if the PA proves to be revenue neutral?  How important are other benefits such as improved quality of life, improved patient access/continuity of care, etc?
3. How will you approach the issue of billing for services/procedures provided by the PA?
4. What kind of liability insurance will the PA need?  What will you provide?
5. What are the benefits you are offering (vacation days, sick leave, drug and dental coverage)?
6. What access will the PA have to continuing medical education?  Will the PA be included in rounds? Teaching? Will the PA be given time and funding to attend a practice-appropriate conference during the year?
7.  (If office or clinic-based) Do you have hospital privileges?  Would you expect to use the PA in the hospital?  How would you approach the hospital about obtaining privileges for the PA?

1. How would you describe your patient population?
2. How would you describe your philosophy/approach to patient care?

1. How open would you be to preceptoring PA students/clerks in partnership with your PA?
2. I’m very interested in _______________ (social media, research, teaching, procedures etc.).  How open would you be to helping me develop that interest as part of your practice?

Pick and choose from the questions above depending on the job situation you are interviewing for (i.e. hospital versus family health team versus solo practice).  Some of these questions may be more appropriate in a second interview or after a job offer, but if some of the answers are very important to you, then go ahead and ask them in the first meeting.  Otherwise, you may be wasting everybody’s time.

If you are a new graduate, or applying in a new field, be sure the employer/physician supervisor understands that PAs require several weeks (usually months) of training on the job.  This is the nature of the condensed program and is an accepted fact of life in the US.

Obviously once there is a job offer, you will want to enquire about salary, hours, overtime, call etc.  The experience of many Canadian and US PAs is that while salary and benefits are important, they do no make up for a poor working environment where the PA feels unwelcome, underused or overworked.