Working as a PA in Occupational Health

How I became a PA

I joined the military 1985 as a medical assistant where I progressed to the rank of Sergeant prior to being trained as Physician Assistant training in 2000 through the Canadian Armed Forces PA training in Borden, Ontario.

What I enjoy about being a PA

It’s the variety of clinical opportunities that being a Physician Assistant has afforded to me. When I first started, I was in the military where I was stationed across Canada and deployed to different areas around the world. I worked in different leadership roles from educational to clinical practice, all as a PA.

In my current role as an Occupational Health PA, I like working in a team environment and working in a remote setting. For instance, right now I’m working at the Diavik diamond mine, 300 kilometers North of Yellowknife which is a fly in, fly out operation. As a health care provider in remote settings like this, you are responsible for the care of the patient with limited resources / assistance onsite with the risk of weather delays of up to 71 hours.  We are practicing at that high level of autonomy and with a broad scope of practice providing both occupational and emergency care.

I have another PA who is on nights here with me now, but some mining sites there is just one PA where you’re solely responsible for the care of the personnel.

Before working in Occupational Health

I left the military in 2006 just after a little over 20 years but left on very good terms. I’ve deployed numerous times both as a medical assistant and then as a Physician Assistant to Bosnia twice, Israel and Canadian Forces Station in Alert. I completed by military career as a PA within the Canadian Forces special operations community.

Work after a Career in the Military

This was probably the most stressful part of my whole career as a PA – having to leave the military and going to practice in a civilian setting. That was back in 2006 as part of the Ontario PA Implementation project

There were four PAs chosen for the Pilot Project, and I had been working as a reservist at the time. I left the regular force and I was working in Ottawa and I took that position in Emergency Medicine in Brockville, Ontario.

I started seeing patients in the ER and noticed an immediate difference in patients from a military to civilian setting. In the military, generally people aren’t that sick. There are no paediatrics, and less chronic disease like Diabetes.  The complexity of patient care in this Civilian Emergency Department was tenfold and as my PA program had limited exposure to the civilian health care. Setting the learning curve was high.

I think emergency medicine was a great career for me. I loved the fast pace and the change. I worked Brockville for almost 2 years and then moved to Winnipeg, Manitoba where I was the first PAs to work emergency medicine in Manitoba.

My Involvement in Teaching

In the military I was a first aid/CPR instructor trainer, advanced medical first responder and tactical combat and casualty care. Education has and continues to be a passion of mine.

I was a faculty member at the University of Manitoba Masters of PA Studies Program. I was working 0.5 in Emergency and 0.5 at the university teaching curriculum integration, patient assessment and other topics. The ability to teach while still remaining clinically active was a great balance.

It was very interesting to go from the military education system, which is very structured to the university model which is more open and fluid. I worked with Ian Jones, Program Director and thoroughly enjoyed that experience.

Now, I still do a lot of teaching here at the mine with our emergency response members. In fact, I’ve got a lecture tomorrow on airway management and ERT integration.

Involvement in CAPA

I started with Canadian Association of Physician Assistants (CAPA) early on with Tom Ashman. When he first started, he was stationed at the Canadian Forces Medical Services school. Tom was the founder and has led the way for all of us and I can’t give him enough credit for that.

I started as the Ontario PA Chapter president and then then transitioned to VP of CAPA I later worked as Pacific PA Chapter President when I moved to BC.

24/7 Occupational Emergency Medicine Services

The Start of 24/7 OEMS

In speaking to colleagues of mine working in occupational medicine, I quickly found out that there’s a wide variety of care that’s being provided at a various standard in occupational medicine and that some sites don’t have the support they need.  The PAs were not provided the remuneration, they weren’t afforded the tools and the medications to provide the training and more so, or they were provided with the support.

I thought, “maybe there’s a better way to do it.”

I approached Dr. Nick Withers, an outstanding physician and administrator five years ago to start 24/7 OEMS.

Since starting we have acquired numerous contracts in various settings. We are actually seeing that good care doesn’t cost more and that’s what we’re proving to the different sites. 24/7 OEMS can not only save an organization money but provide better a higher standard of care.

We put together strict guidelines around PA scope and utilization, much like the requirements of Manitoba’s PA regulation. Although in occupational medicine, you do not need to be regulated, you do not even need to be certified to work in most places. We incorporated those caveats that include liability insurance, certification and the support for PAs working with us.

My Role at 24/7 OEMS

I am the Chief Operations Officer at 24/7 OEMS and Dr. Nick Withers is the Medical Director. My role is to over-see operations, research potential projects. I recruit Physician Assistants for projects and then help train the PAs. I also work at the sites as a practicing PA to ensure our policies / standards are put in place and we are providing the client the services they require and recommending system changes as required.

Starting in March, we’ll be starting a new project with myself going in first for the set up and then bringing on other PAs, train them to the standards that we want, and then hopefully onto the next project.

24/7 OEMS works with four Emergency physicians, and they help provide our 24/7 on-call support advice on the PA formulary. We’ve designed a formulary, medical directives, care maps, and tools that are specific for Physician Assistants working at these remote sites.

How to Apply to Occupational Medicine PA Positions

On our website we have a section for PAs to submit their resumes. There are also job listings on other sites like CAPA’s Job Listings page (members only site).

I’m always open to having a discussion with PAs about whether they think Occupational Medicine is a specialty for them. For various reasons it works well for some and not for others.

When you look at the roles Occupational Medicine PAs play- it’s a high level of autonomy working at remote sites with physician oversight over the phone (rather than on sight or in person availability of the physician like in many civilian settings). PAs need to be comfortable providing emergent care and occupational-related injuries. This can range from ACS, cardiac arrest, strokes and traumas. You’re dealing with situations where there are no imaging facilities, labs or specialist support, or other health care personnel available.

Matching PAs to Occupational Medicine Opportunities

When a contract is awarded, we attempt to fine the right PA for that position based on project needs. PA qualification and experience.

Job postings do come up on the CAPA Job Listings Page (members only) or other job sites as well.

Services we Provide

24/7 OEMS is new, and when other PAs ask, I explain that setting up a business is a steep learning curve and something that requires patience. There wasn’t a lot of business for their first few years.

There is the occupational medicine part of 24/7 OEMS. We provide medical oversight, and medical support for a jail in Surrey, BC which was one of our first clients.

We also provide online medical support, 24/7 Emergency Medicine advice to the Royal Canadian Navy. When the ships are deployed East or West coast of Canada, or anywhere around the world the clinicians (mainly PAs) call our 1-844 number for clinical support.  All of these docs are ex-military, they have all worked with Physician Assistants and have been instrumental in the development of our formulary.

Another side of 24/7 is education and training division.  We were asked by company out of Ontario with ex-special forces members that provide training services etc. and they needed a medical aspect to it. We started doing some onsite medical support and training, but then we’ve developed a unique tactical medicine program that combines Red Cross first aid with a tactical medicine component.

PAs in Occupational Medicine

Where do PAs in Occupational Medicine Work?

When I first started up here eight years ago in the Northwest Territories and some senior personnel from the mine, I met with the Minister of Health for the Northwest territories. And I thought, “this is great! We’re going to go in, we’re going to push regulation and we’re going to do this.

And all the mines did not need to be certified, there is very little physician oversight at most sites. They liked the Physician Assistant model because PAs could work at a full scope, provide emergent and primary care.

I was told that they felt industries can self-regulate the medical care they provide to employees. This concept helped drive the thought process on getting a company started because I thought, “Who’s overseeing that regulation of the actual company?”

There’s no PAs practicing in any areas outside of industry in the North.

Where Occupational Medicine PAs work in Canada:

  • Yukon
  • Nunavut
  • Alberta
  • Northwest Territories
  • Ontario
  • British Columbia* – primarily in admin role, not yet clinical role

Introducing Occupational Medicine PAs in Other Provinces

At present Manitoba does not have any active mining sites where PA could be employed.

We haven’t seen opportunities for PAs in Saskatchewan yet as the government has resisted PA integration.

In Alberta there has been some challenge with implementing some PAs in occupational medicine due to pending PA regulation. There is a lot of potential for PAs to be working in Alberta in occupational medicine setting especially in places like the oil sands project that have large remote camps.

In Nunavut and Northwest territories, PAs are well-established in Occupational Medicine settings and PAs have been working on these sites for some 15+ years. We’ve had PAs over at the Ekati mine for 15 plus years. The PA model here allows for a broad scope of practice and autonomy with off-site medical director oversight.

The Yukon is opening and we’re hopeful to be placing PAs there within the next few months.

What is Occupational Medicine?

Occupational Medicine is a specialty emphasizes prevention. It looks at the maintenance of health in the workplace.  PAs in this specialty provide total care at this remote mine sight for example – both primary and emergent care. PAs in Occupational Medicine do not replace a patient’s family physician (nor do we want to), but people are here in these remote sites presenting with many common conditions – and we see everything from injuries, to cold, to dealing with acute presentations of chronic diseases.

We work a lot on injury prevention, treat on-site injuries and disease management. There’s both clinical role, and administrative health role that are required for workers on site. And then of course we do recognition, evaluation, control, management, and rehab of occupation-related diseases and injuries.

It’s a full spectrum of care – from some primary care to emergent care, to health surveillance, case management – and all aspects rolled into one

Working as an Occupational Medicine PA is unique in that it offers one of the widest ranges of one’s scope of practice to responsibility and administrative duties.

Typical Schedule of an Occupational Medicine PA

The lifestyle and schedule of an Occupational Medicine PA is variable.

If you are working at a remote site where you are flown in, the schedule is  2-3 weeks on, followed by 2-3 weeks off. The accommodation / facilities at most sites are adequate. On the other hand, a friend of mine who is an Occupational Health PA in Edmonton, works in a clinic in the city – and that is a Monday to Friday job.

Most of the PA’s that are working occupational medicine that I know of are working remote. There is the Diavik Diamond Mine where I am working on now.

Diavik Diamond Mine:

There is the Ekati Diamond Mine which is 30 kilometers away from the Diavik site:

There’s also the Hope Bay / TMAC Gold Mine North of us on Baffin Island:

These are all sites that would require flying in. So, you would fly into the mine, work 12-14-hour days, 7 days per week until you leave (2-3 weeks on ,2-3 weeks off, working 6 months of the year).

You are also on call during those times, for example a call with an example of a worker who presents with chest pain at 2 AM, or you may need to go in first thing in the morning to perform a drug and alcohol test for some workers- and then begin your day after that.

The PA/MD Relationship in Occupational Medicine

For us here at 24/7 OEMS, Dr. Nick Withers is our medical director who is off site, but actively engaged with PAs.

When PAs are looking to work in Occupational Medicine settings, it’s important to talk to companies and learn about the physician you’re going to work with prior to coming to a job site.

Call support from a supervising physician/medical director is another key thing to make sure is in if you’re working remotely. This physician should be available to you 24 hours a day, seven days a week and have an emergency medicine background. PAs tend to call in to supervising physicians for more urgent issues rather than minor issues like chronic knee pain, cough. The PA/MD relationship within 24/7 is excellent because the medical director Dr. Nick Withers was trained in the military and has worked with PAs throughout his whole career. He understands the scope of practice and allows PAs to practice at the top of their scope.

Attributes of PA who would do well in Occupational Medicine

A PA would do well in Occupational Medicine if they possess:

Flexibility and openness to learning new things

Being open to the administrative roles as there is a heavy administrative aspect to Occupational Medicine roles. Sometimes 70% of your day can be doing administration from case management, preemployment medical reviews health surveillance etc.

The biggest thing I think that that a PA needs to be when they come and work remotely is be able to, to manage emergencies. A background in Urgent Care, ICU or Emergency medicine is helpful. In Occupational Health, if someone comes in with cardiac arrest or chest pain, you’re the person dealing with it. You can have the physician on the line helping you, but sometimes there’s no time for that. I thinking having the ability and to manage emergencies is probably the big one of the biggest things for us.

Helpful Certifications:

Certification requirements will differ between different companies.

For 24/7 OEMS we require you have an ACLS and ATLS.

PAs also do Audiometric and Spirometry testing with online course through Grant MacEwan and other educational institutions.

The ability to do on site drug and alcohol testing site is also a requirement. I wouldn’t advise anyone to obtain the drug and alcohol testing competency until you actually confirm where you would be working because it’s such a variety between sites.

What Patients can Expect when being seen by an Occupational Health PA

Patients can expect comprehensive care from a PA while at a job site. Often when patients see us, we first get asked if we are a medic or nurse, and so we do education and advocacy around the Physician Assistant Role. Patients can expect to receive the highest quality of care.

One example is a patient I saw who we screened and was found to have undiagnosed hypertension with 220/130. The PA initiated him on medication, ordered relevant blood work, and wrote a letter to the family physician. The PA in this occupational health role acted as the conduit to their primary care provider – so it’s not just taking care of injuries on site, but we want to ensure that workers are well enough to return to job site, but also go home and be healthy with their family.

Benefits of Working in Occupational Health

Occupational Medicine PAs are among the highest paid Physician Assistants in Canada. It of course depends on site, and remuneration can vary.

Autonomy is excellent.

And for some scheduling allows for some flexibility. For the last eight years I have worked two weeks on, two weeks off, then I have six weeks off each summer. I work a total of six months each year. Many find it hard to go back to Monday to Friday position, 12months a year.

Can PAs work in Correctional Facilities?

This would be an excellent role for PAs to work in correctional facilities. 24/7 OEMS has the contract to supply on-call support for a jail in Vancouver because PAs not regulated in BC. We have had discussions with Corrections Canada and Corrections in BC regarding PAs but to date there has been no movement in this area.

Final Notes

For anyone interested in Occupational Medicine feel free to reach out to me. Always reach out, always talk to the PA’s that are working in Occupational Medicine.

I also recommend that you investigate the companies you are interested in working in. Ask about their medical directors, or whether they have medical directors, whether they require the PA to get liability insurance. Liability insurance is so important for PAs to obtain if working in Occupational Medicine, especially given the level of autonomy and responsibilities that we have.

Educate yourself on the setting you are going to be working in – and start by calling the PAs there or learning about the clinical site. Some PAs have gone into Occupational Medicine settings, and there was not a lot of controls put in place and that opens up the PAs to liability and risk.