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.