PAs are trained in the medical model and learn to think and clinically reason like doctors. I completed my clinical rotations alongside fellow PA clerks, medical clinical clerks and residents. We saw the same patient case loads and often had the same responsibilities as clerks.
I graduated in 2011, and at time of writing (2017), it has been 6 years of what I would call a successful PA/MD relationship. This evolved over time, as a new grad getting to know the practice, to a respected regular member of staff who plays an important role in keeping the clinic running on time, and the practice running smoothly. With time the PAs at the practice have expanded their time to working with other physicians in the same clinic, and now the supervising physicians hesitate to run a clinic without a PA by their side.
During my early years of working, my supervising physician often compared having a PA like a “resident/fellow that would never leave his side” (residents stay on for several months at a time before moving onto another clinic for their next rotation).
During clinic hours when we are seeing patients, I arrange for all referrals and investigations, complete all dictations of patients I see, and am able to help keep the clinic running on time. With tracking EMR data, I learned that with the introduction of PAs into clinic, we were able to more than double the number of patients seen in a clinic day, reduce the amount of time spent in clinic, and the PAs took on medical documentation and completion of forms during the clinic, freeing the physician from catching on paperwork following the clinic.
Outside of seeing patients in clinic, I am able to help my supervising physician take a large workload off their hands, which includes taking time to answer patient/allied health/provider questions, triage referrals, completion of medical legal documents, worker’s compensation forms and other letters required due to illness/injury. The staff often appreciate having easy access to someone who is a “representative of the physician” to answer their questions about patients.
The supervising physician can enjoy non-monetary benefits of a PA, such as more free time that can be used for academic or research endeavours, teaching, seeing more patients, and/or more time for leisure activities and family. If patient volume is increased while maintaining quality patient care, the PA may also help increase the practice’s revenue to cover other overhead or operational costs of the clinic.
I always asked for feedback and consulted the physician for complex cases. With time, I became extremely comfortable with Orthopaedic assessments and treatment plans. I knew all of the surgical procedures he performed, recovery time, and protocol for rehab following all procedures. I learned all the protocols for routine pre-op and post-op visits, as well as what investigations he preferred to order and when to refer. When we had medical learners on with us, I played a role in orientating the student to the clinic but also in teaching Orthopaedic Principles which supplemented what the medical learner was getting from my supervising physician.
We developed a lot of patient education materials to reduce the number of questions the administrative assistant would receive on the phone if something was not explained clearly, and I was able to spend time answering patient questions about return to work/activities after an intervention or surgical procedure.
In return, I get a long-term mentor who is very approachable and willing to answer any patient questions, or whom I can consult for complex cases. There are opportunities for continuing medical education (e.g. attending conferences, workshops), as well as direct teaching from my supervising physician and I get time to get involved with teaching and mentoring for PA students as part of my contract.
In the United States, PAs can bill for patients, even with a physician physically present. Due to limitations of billing rules in Ontario, this is not possible and physicians cannot bill for services rendered by a PA in a fee for service model without being actively involved in the patient encounter. This is why we have the physician participate in every patient interaction, however in our instance there is little duplication in work (e.g. asking the history over again, repeating the entire physical exam) as we have an established PA/MD relationship and he has trust in my ability to assess patients and present concisely pertinent details about the patient before he goes in to finish off the interaction.
If the model was similar to the United States, the PAs in fee-for-service setting could run clinics for non-complex patients, and/or routine follow-ups while, for example, the MD is in the operating room. With an established set of medical directives and supervisory agreement, there is a mutually agreed up set of guidelines and understanding of what the PA’s scope of practice and when to refer to the physician as outlined above.
There are PAs in family practice settings in a rostering model that have their own panel of patients, which has allowed easier access to a health care provider and decreased wait times.