GUIDE FOR PA EMPLOYERS
How to Hire a Physician Assistant
Physician Assistants (PAs) can help improve the efficiency of a clinic, improve access to a health care provider, enhance student learning, offload physician workload, and reduce wait times. Here you’ll find information about adding a PA to your practice
Working with a Canadian Physician Assistant
What are PAs?
Canadian Certified Physician Assistants (CCPAs) are trained in the same medical model as physicians. In Canada, they function as physician extenders and work to improve efficiencies in practice while reducing physician workload and burnout. This includes seeing & assessing patients, medical documentation (including dictations), completing insurance and work forms, performing procedures, resident teaching & orientation, engage in quality improvement projects & research.
What are the Benefits of Adding a PA to a Practice?
Adding a PA can help increase roster size, decrease wait times, improve clinic work flow & efficiency, and help you improve important metrics you are tracking.
- Decreasing wait times to be seen by a primary care provider, specialist or in the ER
- PAs can cover the entire spectrum of care of a patient’s experience in surgery – pre-op care, patient education around consent, intra-operative care, surgical first assist, post-op care, discharge and follow-ups.
- PAs work in inpatient and ward management in surgical and non-surgical specialties, freeing up physicians to be in the operating room, see consults, get involved with teaching, or seeing other patients simultaneously on the ward. This is not a duplication of services, but extending the reach of medical care while decreasing physician workload.
- In the ER can perform many procedures – sutures and laceration repair, I&D, casting and splinting, paracentesis, thoracentesis, lumbar punctures, splinting, reduction of fractures & dislocations and see patients in a timely manner to reduce bounce back rates, wait times and other quality improvement metrics.
To see more examples of PAs working in different practices, read the Canadian PA Profiles page.
Ensuring a PA Candidate is Certified
Certified PAs are tested to a national standard – Physician Assistants who graduate from an accredited program may challenge the PA Entry to Practice exam, as organized by CAPA to become a Canadian Canadian Certified Physician Assistant (CCPA) with a certification number.
- A member in good standing has kept up with Continuing Professional Development (CPD) requirements and must complete CPD/CME hours similar to physicians.
- To check if a PA is certified in Canada, use CAPA’s PA Certification Search.
Certified PAs have access to Professional Liability Insurance – Through CAPA, certified PAs can Professional Liability Insurance of which benefits include $ 10 million per incident criminal defence costs, loss of documents, full prior acts coverage and post-career extended coverage. Be sure to ask your Physician Assistant hire to provide Proof of Liability Insurance Coverage (provided through Bradley Insurance).
Certified PAs are members of CAPA – PAs who are members of CAPA have access to practice resources, network and support for integration into your practice – including contract templates, medical directive templates, continuing professional development (CPD/CME) resources and more.
Canadian PA Education in Canada
There are 4 official PA programs that educate Physician Assistants in Canada:
- McMaster University PAEP
- PA Consortium (University of Toronto, Northern Ontario School of MedicineMichener Institute of Applied Health Sciences)
- University of Manitoba
- Canadian Forces
All official Canadian PA programs are affiliated with a university.
PAs are trained in the same medical model as physicians.
CanMEDS-PA is a framework that outlines competencies of a Physician Assistant within a patient-centred team. This was adapted from the Royal College of Physicians and Surgeons of Canada’s CanMEDS Framework.
What is PA Scope of Practice?
PA Scope of Practice is outlined in the National Competency Profile and Scope of Practice PDF offered on the CAPA website.
PA Scope of Practice is flexible, as they can practice in any specialty and can perform what is in the scope of practice of their supervising physician. PAs can delegated the same clinical duties as a physician: history taking, physical exam, order/interpret imaging & investigation, formulation of diagnosis and differential, plan and prescription of medications. PAs can also perform procedures including casting, joint injections, nerve blocks, reductions, biopsies, lumbar punctures and more.
Can PAs prescribe medications?
In Manitoba and New Brunswick, PAs are regulated health care providers and can prescribe medications.
In Ontario, PAs are unregulated, however can prescribe medications through medical directives or with physician co-signature
- For more information, read the Ontario College of Pharmacists. Ontario’s Physician Assistants: An Update.
- Note: PAs cannot prescribe narcotics or controlled substances in Ontario.
- PAs can work independently, but are not completely autonomous. They work in collaboration with the entire health care team within the patient’s circle of care (allied health).
- PAs can work with indirect supervision or direct supervision
- It is recommended that new PA graduates practice START with closer supervision, mentoring & guidance, not unlike working with a junior resident.
- In Ontario, medical directives are strongly recommended to allow PA to carry out treatment, interventions & procedures.
- Free Medical Directives Templates are available through any PA who is a member of the Canadian Association of Physician Assistant.
- PAs can work with multiple supervising physicians, and one supervising physician can work with multiple PAs
- e.g. one PA can work for a Department of 9 Orthopaedic Surgeons. Similarly, one solo Physician can supervise 2-3 PAs.
The PA/MD Supervisory Agreement
- The PA/MD supervisory relationship is formalized in a practice agreement. This includes what the MD can expect from a PA, what the PA can expect from the MD.
- Contact email@example.com if you’d like a template copy of the supervisory agreement.
PA Funding in Canada
In Canada, PAs are funded publicly or privately. PAs can and have worked in occupational health settings and in industry. Visit 24/7 Occupational Emergency Medicine Services to learn more.
In Ontario, there is not different methods for funding a PA’s salary.
- In Ontario, PAs have several funding sources in family medicine, but can be hired through grants, department budget, hospital budget, out of physician pocket.
- A single PA’s salary may or may not come from one source, for instance, a hospital PA may be 50% funded by hospital budget, and 50% funded by department budget.
- Or in a private clinic, a PA’s salary can come from one physician, or shared between a group of physicians with one primary supervising physicians overseeing the PA’s contract/HR issues.
Billing for PAs in Canada
In Canada, PAs DO NOT have billing numbers and do not independently bill for services rendered.
The Canadian Medical Protective Association (CMPA) has a document on working with Physician Assistants. The CMPA also provides medical-legal assistance and advice for CMPA members, including billing audits and inquiries. MDs can seek medical-legal advice or consult the CMPA at 1(800) 267-6522 if they have questions.
Here are billing resources to learn more about how physicians/practices can bill for services rendered by a PA in Ontario:
- The document which outlines how medical services are billed is the OHIP Schedule of Benefits
- If you are a member of the Ontario Medical Association, you can email firstname.lastname@example.org to learn more.
- You can directly call OHIP Billing Claim Services (office hours & contact information/phone number)
- Contact the Canadian Association of Physician Assistants (CAPA) at email@example.com
For billing rules in Alberta, Manitoba and New Brunswick, contact firstname.lastname@example.org directly.
CAPA PA Compensation Report
In September 2019 the Canadian Association of Physician Assistants released a PA Compensation Report. Click here to access the report now.
Adding a PA can be feasible
It is a myth that PAs are “too expensive to hire”. First its important to identify what the needs of your practice are before deciding to hire a PA. You may want to start by hiring a full time PA, or a part time PA depending on your practice needs.
- Go through CAPA’s PA Employer Checklist to identify necessary steps in a Needs Assessment.
- Take time to understand how supervision and delegation works with PAs. PAs work in a collaborative relationship with their supervising physician which involves guidance, mentoring and feedback. The more time you invest into your PA in terms of orientation training and continuing professional development, the more benefit you’ll see with the PA being a force multiplier at your practice.
- Examine the business model of which you are adding a PA – this includes how many extra patient assessments you need to see in a day in order to make the PA at a minimum cost neutral.
For example, in Orthopaedic Surgery practice I work in, simply seeing 1 extra Consult in an Orthopaedic Surgery Consult more than pays for that PA salary. Of course we see much more than this since adding a PA.
Manitoba PA Salaries
Salaries do vary from province to province. The most readily available resource for PA salaries can be found here, which outlines Manitoba Regional Health Authority PA salaries, benefits, and pay scales.
Otherwise contact email@example.com to find out more information about PA salaries in Canada.
Finding out if a PA candidate is PA-Certified
To check if a PA is certified in Canada, use CAPA’s PA Certification Search.
New Canadian PA Graduates & PA Certification
New PA graduates may be hired BEFORE PA certification takes place, however contracts usually stipulate that the PA gets to stay in the job as long as they provide documentation that they’ve passed once the test has been written.
I recommend posting your position first with Canadian Association of Physician Assistants firstname.lastname@example.org. CAPA’s website has an internal job listing that is only viewable by Canadian Certified Physician Assistants, and will help you easily narrow.
Often posting on job sites like indeed.ca or monster.com will attract non-qualified candidates who are not PA certified.
Contact Canadian PA Programs
An excellent resource to get started with hiring a PA, is by contacting PA Programs:
- Manitoba PA Program email@example.com
- McMaster University PA Program firstname.lastname@example.org
- PA Consortium PA Program email@example.com
Contact Hospitals that have already incorporated PAs
If you are a hospital or hospital department looking to add PAs to your practice, it may be worth contacting hospitals that have already incorporated PAs into their practice (e.g. such as Sunnybrook Hospital and University Health Network in Toronto). To get in touch with hospitals near your area that have added PAs, contact firstname.lastname@example.org.
Get started with CAPA’s Hiring a PA Checklist PDF.
You can also email the Canadian Association of Physician Assistants who will put you in touch with someone who can help you get started: email@example.com.
Canadian PA Salary Report
PA Compensation Report from CAPA
Released by the Canadian Association of Physician Assistants.
From the CAPA website, “CAPA’s compensation report is a document that provides members, employers, and policymakers with information about the salaries and benefits of physician assistants (PAs) in different parts of Canada.
Three important factors have an impact on PA salaries – location, clinical setting, and skills or experience – and they influence supply, demand, and the salary a PA can command. As demand for PAs grows and job opportunities increase in the marketplace, this compensation document will help:
- PAs assess employment opportunities and negotiate employment contracts.
- Employers understand the landscape and remain competitive in their efforts to recruit a skilled PA workforce.
- Policymakers make more informed decisions about existing and future funding programs.”
Employing Canadian PA Guides
Here you’ll find links to PDF Guides about PA Employment some of which are from the Canadian Association of Physician Assistants.
The “Hire a PA” Blueprints or Google Docs – You can export this to PDF to print or download.
PAs in Clinics & Hospitals across Canada
PAs in Orthopaedic Surgery
- “PAs are “invaluable in their role” as they are one of the few disciplines involved across the entire continuum of care from orthopedic and fracture clinics to preoperative risk assessment, assisting with the surgical procedure and postoperative care.” @ Toronto Western Hospital, Toronto, ON
- Orthopaedic Trauma PA @ Sunnybrook Hospital, Toronto
- Orthopaedic Surgery PA @ The Shoulder Centre, Ajax, ON
- Orthopaedic Surgery PA @ Joseph Brant Hospital, Burlington, ON
- Pilot Project – Orthopaedic Surgery PAs @ QEII, Halifax, Nova Scotia