PA ADVOCACY • ONTARIO

On September 13, 2017 50+ PAs descending upon the Ontario Legislative Assembly in Queen’s Park, Toronto to speak to their local Members of Provincial Parliament (MPPs) about the Physician Assistant profession and how the health care system needs to better integrate PAs.  This event was called “PA Awareness Reception”, or informally “PA Lobby Day”.

The purpose of this day was for practicing PAs, PA students, and supervising physicians to speak to MPPs about successes and struggles of PA practice in Ontario, and speak to how PAs could be better integrated into Ontario’s health care system.

Ontario Physician Assistants from across the province gathered at the Legislative Assembly in Queen’s Park, Toronto to discuss the PA profession with their MPPs.

Lobbying is when groups or individuals bring issues and concerns directly to their government. This would involve speaking with MPPs (elected public officers) in their local riding, to party leaders and health critics,  with regard to developing or changing government policy. The Lobbying Act states there should be “free and open access to government is an important matter of public interest”. This communication is an opportunity to advocate or influence politicians to positively affect change in policy.

What is a  Member of Provincial Parliament (MPP)? These are individuals belong to one of the major political parties in Canada (NDP, PC, Liberals, Green Party, or independents with ny party affiliation). They are elected by the residents in their riding (electoral district of Canada). MPPs meet with residents of their riding to listen to concerns, resolve issues related to provincial government, and attend community events.

Organization of Ontario’s Ministry of Health and Long Term Care

What will meeting with an MPP do? MPPs are legislators, which means they will attend meetings at the Legislative Assembly (Parliament) and participate in the debating and development of laws. Physician Assistants can meet with their MPPs face to face (whether on one-on-one meetings that you can arrange by contacting the MPP’s office) or attend Lobby Days that are arranged by CAPA (Canadian Association of Physician Assistants). MPPs will be aware of issues facing PA profession and can bring issues of regulation and funding to the table during meetings at the Ontario Legislative Assembly.

What does the Minister of Health do? Dr. Eric Hoskins is the Minister of Health and Long Term Care in Ontario at present. This means delivery of the Ontario Drug Benefit Program, Ontario Health Insurance Plan (OHIP), Long Term Care, Home Care, Community and Public Health, and Health Force Ontario to name a few. The Ministry also regulates emergency health services, nursing homes, hospitals, and medical laboratories.

Ontario Physician Assistants including myself, my supervising physician Dr. Benjamin Smith, Deniece O’Leary Ontario PA Chapter President, Sahand Ensafi incoming Ontario PA VP, and Patrick Nelson, executive director of CAPA posing with Dr. Eric Hoskins at PA Awareness Reception on Sept 13, 2017.

What are NDP and PC Health Critics? Had the NDP or PC party won the election, their “Health Critic” would have been the Minister of Health and Long Term Care.

• The NDP Health Critic is France Gelinas
• The PC Health Critic is Jeff Yurek

NDP Health Critic France Gelinas (@NickelBelt) speaking with Ontario Chapter President Deniece O’Leary, and Ontario VP Sahand Ensafi about integrating PAs into the Ontario Health Care System. 

Almost everyone lobbies. That may include individuals, corporations, interest groups (i.e. health care professions, disease-focused research groups, etc.) and non-profit organizations. In Canada, the Lobbying Act outlines a code of conduct, types of lobbying, and registration for Lobbyists.

Different health care provider groups lobby, including Physicians, Nurses, Pharmacists and Physician Assistants. These groups help to advocate for their patients and their profession, which includes expanding scope of practice and integration of the profession.

• Physicians Lobby – There are several lobbying groups representing physicians in Ontario, including Ontario Medical Association, Concerned Ontario’s Doctors and the Coalition of Ontario Doctors.
• Pharmacists Lobby – Ontario Pharmacist Association (OPA) does lobbying and advocacy work in behalf of its Pharmacist members. For example, in 2009, the provincial government approved Bill 179 expanding scope of practice for pharmacists.
• Nurses Lobby – Registered Nursing Association (RNAO) lobbies on behalf of nurses and nurse practitioners in Ontario. Individual members or groups lobby Ontario’s Minister of Health to positively influence patients and the nursing profession on different matters – for example relocation of nurses to under serviced areas, providing sustainable funding for health care clinics, etc.
• Physician Assistants Lobby too – The Canadian Association of Physician Assistants (CAPA) exists to advance the PA profession to lobby federal and provincial governments to positively influence in terms of introduction, integration, funding, and regulation of Physician Assistants in order to benefit the health of Canadians.

Other lobbying groups may include industrial companies, research institutes (i.e. Arthritis Research Centre of Canada), Ontario Korean Businessman Association, Ontario Pension Board, Ontario Teacher’s Pension. The Office of the Commissioner of Lobbying of Canada has an alphabetized list you can go through to see who is on there. I was surprised to see that my old internet provider was that list as an “in-house organization”. Even Tobacco companies have their own lobbying groups.

Although it is tempting (and comfortable) to solely focus on your clinical practice as a PA, its important to advocate for the profession to:

• expand PA scope of practice
• introduce the PA profession in other provinces and territories
• ensure PAs are being used at the top of their scope of practice (and to introduce legislation and policies to help facilitate this process)
• ensure that policies and regulations are in place to ensure longevity of the PA profession, so PAs can continue to provide safe, high quality care to Canadians – increasing health care access while decreasing wait times and physician burnout

If you have concerns about funding, regulation, integration and introduction of PAs into other provinces – rather than singing to the choir (i.e. speaking to your PA colleagues about your concerns), we should also be having these discussions with our legislators and our MPPs about our concerns. This is a way we can effect change.

Speaking to MPPs helps PAs establish a professional presence, and ensure that PAs are included in discussions around health care conversations. 

Bill Walker is MPP of Bruce-Grey-Owen Sound and met with a constituent (and PA!) in his riding, Rebecca Mueller. They discussed health care access concerns within his riding & about how PAs could help.

Although it is helpful to have national organizations “advocate” on our behalf, it is much more powerful when PAs, PA students and supervising physicians can speak to how the profession is impacting patient care on the front lines.

For the organization to say, “PAs increase access to health care, decrease wait times, save the health care system money, and decrease physician burnout” is great, but what is even better is when a PA can say, “since being added 1 year ago to the practice, we have been able to double the number of patients seen, decreased wait time to be seen from 8 months to 2 months, and by supervising physician has been able to decrease time spent in clinic and spend more time with family and academic/research endeavours.” See the difference?

Here my supervising physician speaks to PC Health Critic (and MPP) Jeff Yurek about how PAs in his practice made a difference, but the need to also better integrate PAs so he can increase his efficiency in hospital:

There are several ways you can get involved:

1. Use social media to communicate with your MPP and other health care stakeholders (e.g. medical associations, patient interest groups, local news media, etc.). The easiest platform for communicating publicly seems to be Twitter. You can also engage politicians on other platforms such as LinkedIn, Facebook and Instagram. Don’t forget to use relevant health care hashtags (e.g. #cdnhealth #cdnpoli #onhealth #onpoli #CanadaNeedsPAs).

Tweets and pictures are very easy for MPPs to notice and retweet to their following.

2. Arrange for a meeting or write to your local MPP. This is one of the most important and critical pieces of grassroots advocacy. Face to face meetings, followed by a letter/email to summarize the meeting is helpful. Be sure to use the “Resources” section of the CAPA site (members only) which includes “What is a PA?” Powerpoint presentation

• MPPs will meet with constituents in their riding (i.e. PAs practicing/living in their riding) to discuss challenges and concerns.
• MPPs can then bring this to the Legislative Assembly and speak with other MPPs, comparing notes.
• When discussing and debating introduction or amendments to legislation, they have the power to bring the topic of PA integration, regulation and funding to the table.

3. Attend your next PA Lobby Day

This would involve contacting CAPA to find out when the next PA Lobby Day in your province will take place.

4. Participate in National PA Day

We have some resources including PA infographics, profile photos, banners, and videos that you can share on social media for PA Day. Use hashtag #CanadaNeedsPAs.

You can also read our article for more ways on How PAs can Participate in PA Advocacy.