Learn about the PA Profession in Canada

What is a Physician Assistant?

Physician Assistants (PA) are highly skilled health care professionals educated in the medical model who practice medicine. 

PAs graduate from a Baccalaureate or Master’s Degree program that may be affiliated with a medical school. PAs practice medicine under the supervision of a licensed physician within a patient-centred health care team.

PAs can work in any clinic setting to extend physician services, complement existing services and aid in improving patient access to health care.1

  • PAs conduct histories, physical examinations, order and interpret investigations, perform diagnostic and therapeutic interventions, diagnose and treat illnesses, and educate patients on treatment options and counsel on preventative health
  • PAs assist in surgery, prescribe medications, and perform procedures that fall within their scope of training and experience, as long as it falls within the scope of their supervising physician
  • A PA’s practice mirrors that of their supervising physician
  • PAs work to extend physician services and can work autonomously, but are not independent practitioners

View the PA National Competency Profile PDF
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The PA Role as Explained by Practicing PAs:

“Physician Assistants are health care providers that practice medicine, first and foremost. We have different training than physicians and operate differently because of that.

PAs don’t have regulated, mandatory and formalized residencies. So even though we can work in every specialty of care, we do so in collaboration with physicians that are specialized (or not). That collaborative relationship is great because it gives us safety and flexibility, but it allows for a pretty wide range of autonomy depending on the particular PA.

It’s important for people to know that PAs are always learning and growing.

An experienced PA can do a lot, and a lot more than people expect.”

Harrison Reed, PA-C, Critical Care PA

“When I actually researched the PA Profession, I saw in fact that the Physician Assistant name is almost a misnomer in that PAs are not doing  clerical work or typical tasks than an “assistant” is doing, but you are a PHYSICIAN EXTENDER where you practice medicine, you see diagnose, treat illness, you prescribe medications, you assist in surgeries and perform procedures…”

Sahand Ensafi, CCPA, Canadian Emergency Medicine PA

“A PA is an extension of the physician’s role. This term has been used often, but I do find that PA’s are an extension of the entire health care team.

A physician sometimes gets bogged down with work that only they are capable of doing, whether it’s being the primary surgeon, or it’s being the radiation oncologist who has to plan their patient’s radiation treatment.

A PA can bridge the gap between the admin side of things, nursing side of things and the clinical side things.”

I tell people, that Physician Assistants are like the residents who never go away. So that’s really works well with physicians and nurses and other people in the healthcare profession. You have to massage that a little bit for the lay public who may not even understand what a resident is at the end of the day.

But when you think about it, and I’ve been told this by physicians that I’ve worked with in both emergency medicine as well as ID, that we reached the level of a senior resident, a very senior resident. And what’s nice about it is we provided those physicians that we work with  that continuity, and they can teach us  like they do residents. The main difference is that residents leave after a few weeks, while PAs stay on on the service.”

Maureen Taylor, CCPA, Canadian Infectious Disease PA

“The PA role has been extremely well received by the ER staff, nursing staff on the surgical ward, and the multiple health care providers that I provide consultations for. My supervising physicians are 100% on board with working alongside a PA.

As are educated in the same/similar medical model as a physician, however it is a more accelerated program. They require more precise on-the-job training.

Training a new PA grad is very similar to training an early/junior resident. If it is a PA that is new to an Orthopaedic practice or organization, the expectation is to train the PA in diagnostic imaging, Orthopaedic testing, developing a diagnosis and implementing a plan of care. Guide them to resources that they can use to learn.”

“There are a few differences between me (as an experienced PA) and the residents:

  • Junior residents rotate on the service 1-2  months at a time, as a PA I am there full time and permanent, and have built relationships with nursing staff and staff physicians of different departments. For instance, I’ll be less hesitant to get on the phone with the Interventional Radiologist when there is a specific question or a request, like inserting an urgent cholecystostomy tube for management of cholecystitis.
  • Residents typically prioritize time gaining surgical experience in the OR, as a PA I do occasionally assist in the OR if required, however I typically spend more time in surgical clinic, seeing consults in the emergency department and on the ward, managing patients pre- and post-op  and liaising with the interprofessional team to provide quality, patient-centred care.
    • Note: In large academic teaching centres, surgical first assists typically include fellows, residents, and other medical learners. In community hospitals without residents to rely on as surgical first assists, hospitals typically rely on surgical nurses, or physicians in the community (i.e. family physicians) to assist in the OR if required – there is certainly a role for PAs to step in as surgical first assists)

I also do teaching and orientation with junior residents and medical students/PA students. We review conditions with the gallbladder, small bowel obstructions, hernias, colon cancer, diverticulitis and more.”

How are PAs Educated in Canada?

PAs are trained in the same medical model as doctors. Programs consist of intensive classroom study focusing on establishing the medical foundations across different areas (e.g. cardiorespiratory, GI, anatomy/physiology, etc.), clinical and communication skills, clinical reasoning, while gaining clinical exposure with concurrent placements in clinical settings.

PAs are trained as medical generalists and are able to practice in any area of medicine upon completion of their studies.

  • PA School Year 1 (Students are often referred to as PAS1) consists of didactic, classroom learning supplemented with hands-on clinical skills. There is also early exposure to health care through clinical placements in first year.
  • PA School Year 2 (Students in year two are referred to as PAS2) consists of clinical placements in core and elective rotations. This takes place in different areas of medicine such as Family Medicine, Emergency Medicine, Internal Medicine, Psychiatry, Geriatrics, Women’s Health, Paediatrics, Surgery and more.

After completion of studies, new PA graduates then seek employment.

List of Canadian PA Programs
Canadian PA Program Admissions Criteria
6 Steps to Become a PA in Canada

What settings can PAs practice in?

PAs work in hospitals, this includes departments like:

  • Emergency Medicine
  • Hospital wards / inpatient floors

  • Intensive Care Units (ICU)

  • Complex Care Units

  • Complex Continuing Care (CCC)

  • and more!

In the hospital, PAs can found in:

  • ambulatory outpatient clinics
  • inpatient clinics
  • hospital rounds
  • multidisciplinary rounds
  • academic teaching centres, and
  • acting as surgical first assist in the operating room.

PAs also perform on-call duties taking on consults from different services.

PAs can be found in hospital and non-hospital settings such as:

  • Physician offices (solo or group practices)

  • Community clinics

  • Family Health Teams or Organizations

  • Long-term care

  • Nursing homes

PAs may also work in occupational settings, correctional facilities and retail clinics.

Why introduce PAs into Canada?

Physician Assistants (PAs) are PHYSICIAN EXTENDERS and FORCE MULTIPLIERS:

  • PAs increase a department/practice’s capacity to see MORE patients while delivering HIGH QUALITY health care
  • PAs help reduce wait times
  • PAs increase access to health care services
  • PAs reduce physician burnout
  • PAs are involved in resident and medical learner teaching
  • The flexibility of PA Scope of Practice means PAs can cater their practice and work to filling in the gaps in any given service, department or practice setting
  • PAs enhance health care team coordination and communication, AND
  • PAs save the Canadian health care system money*

References: Value of Physician Assistants. Conference Board of Canada Report. CAPA-ACAM

View the Conference Board of Canada PA Studies

Want to learn more about adding a PA to your practice or department?
Click here to view resources for PA employers.

The Impact of Adding a PA to a Practice

“A supervising MD should hopefully expect that a PA eases their cognitive load, helps clear some of those patients and really helps with the flow of the department.

As a PA, I can help manage some of these lower acuity patients and then have the physician come in. The physicians then shift to focusing on those more acutely ill patients.”

“Since I have started in my current practice 4 years ago, the clinic is able to have many more patients each day.  Each day in the clinic is quite busy, but also very rewarding to help patients. I enjoy working with my team and caring for our patients.

There has been an improvement in the coordination of care and we are able to do much more preventative care since I joined the practice. The patients frequently tell me they enjoy coming to the clinic (which is a strange thing to hear from patients).

They do express feeling comfortable discussing their concerns and getting medical advice. Recently I have had some transgender patients open up about their care and health concerns to me. As I get to know patients and their families more the trust continues to build.”

Deniece O'Leary, PA-C, Canadian Family Medicine PA

“I think that’s really what a PA can offer is efficiency within the clinical role. We have changed the way that clinics have ran since I’ve started. Whether that’s changing the length of appointments or the number of patients that are being seen in a day or the type of patients that are being seen to allow the clinic to run a little bit smoother and allow my supervising physician to do the work that needs to be done during the day and not have to stay late afterwards.”

“Some of the anecdotal impacts I have heard of incorporating a Physician Assistant into the Internal Medicine team include/I have heard are:

  • Improved documentation
  • More consistent and timely assessments
  • Improved medication reconciliation
  • More consistent use of protocols,
  • Improved continuity of care
  • Reduced physician stress
  • Fewer patients deteriorating upon leaving our unit
  • Improved patient flow
  • Improved patient communication upon discharge

There is currently a retrospective matched cohort study underway in our hospital to empirically evaluate some of these and other potential impacts of adding a PA to a community hospital critical care unit.”

“Very similar to the study that was done by the Sunnybrook Surgery team, there are fewer surgeries being cancelled, because as a PA I am able to free up the beds earlier in the day. There are faster discharges.

We’ve seen a decrease in the amount of complaints coming in from the families, just because there has been somebody that has been able to sit down and talk with the families and guide them through the process.

The overall coverage of inpatient/ward, the nurses are finding that demands are met easier because you are somebody that is able to get onto the wards sooner than the residents can.”

Kirsten Luomala, CCPA, Canadian PA in Neurosurgery

“Having a PA on staff who essentially functions like a physician, but under supervision. Staff PAs do not leave after 1-2 months (like a resident) would and knows the organization and resources within the hospital.

With an extra clinician who can tackle the same workload you do, you are decreasing physician workload while increasing access to a provider.”

Learn more about the Day in the Life of PA

from Canadian Physician Assistants practicing in different specialties across Canada: 

What Specialties do PAs work in?

PAs practice across almost all specialties in medicine, including Family Medicine, Emergency and Internal Medicine. There are also PAs practicing in Orthopaedic Surgery, Neurosurgery, Neurology, Physiatry, Cardiology, Surgery, Gynecologic Oncology, Oncology, Cardiology, Gastroenterology, Psychiatry, Respirology, Nephrology Plastic Surgery, Dermatology, Pain Medicine, Addictions and more.

Each PA role differs depending on where they are hired.

Hear from real practicing Canadian PAs:
Click here to see Canadian PA Profiles

At present civilian PAs practice in four provinces- Alberta, Manitoba, Ontario and New Brunswick – with a pilot project starting in Nova Scotia in 2019.

Military PAs and PAs who work in occupational health (e.g. mines) may have job postings outside of the provinces listed (e.g. BC, Nunavut and the North West Territories).

The Canadian Association of Physician Assistants is working on rolling out PAs in more provinces and territories.

Military – Military PAs can be stationed across Canada (including remote places such as the North Pole), as well as overseas and in the navy.  Canada PAs have a long history in the Canadian armed forces (CAF), and the term ‘Physician Assistant’ was first used in 1984 to describe senior medics. In 2002, a 2 year PA Education program is re-designed and launched by the CAF.  This was accredited in 2004. In 2016 PAs were commissioned to officer status.

A glance at the PA profession in Canada

Manitoba – It was in 2003 that Canada’s first civilian-licensed  Physician Assistant started practice in Manitoba. In 2009 the Manitoba Medical Act was changed to include title protection and a separate registry for Physician Assistants.

Ontario – In 2006 the Ontario Ministry of Health and Long-Term care announced the introduction of PAs into its province, with the start of the Ontario PA Demonstration Project in 2007. Ontario now has the largest number of PAs in Canada.

New Brunswick – In 2009, New Brunswick introduced legislation for PAs to work with the introduction of two ER PAs in Fredericton. In 2014 PAs were awarded prescriptive rights in Alberta.

Alberta – In 2009 the Minister of Health requested that the CPSA include PAs in the Health Professions Act as a regulated health profession and to develop a voluntary registry under the College. This was released by the college in 2010, and in 2013 the Alberta Health Services with the MOH launched a PA demonstration Project, with PAs employed in rural primary care, urban hospital settings (e.g. surgery, internal medicine, and obstetrics).

Nova Scotia – In 2019 Nova Scotia announced a pilot project to introduce PAs into the province.

PA Schools – In 2008, McMaster University and University of Manitoba launched the first two civilian PA programs. This is followed by Consortium of PA Education (University of Toronto, Northern Ontario School of Medicine, and Michener Institute for Applied Health Sciences) who introduced another PA program in Ontario in 2010.

Read FAQ about PAs:

For more information about PAs in Canada,

visit the Canadian Association of Physician Assistants (CAPA) website: 

References