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.
- 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
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PAs work to extend physician services and can work autonomously, but are not independent practitioners
What can PAs do? Canadian PA Scope of Practice Explained
PAs can perform 12 Entrustable Professional Activities (EPAs). Canadian EPA-PAs outline the tasks or responsibilities that can be entrusted to a Physician Assistant once they have attained sufficient specific competence (AFMC 2016).
In other words, Canadian EPA-PA answers the question: “What can a PA do when they see a patient?”
EPA #1: The PA practices patient-focused, safe, ethical, professional, and culturally competent medical care across the healthcare continuum.
EPA #2: The PA obtains histories and performs physical examinations, demonstrating the clinical judgement appropriate to the clinical situation
EPA #3: The PA formulates clinical questions and gathers required clinical evidence to advance patient care and communicates those results to the patient and medical team.
EPA #4: The PA formulates and prioritizes comprehensive differential diagnoses.
EPA #5: The PA develops and implements patient-centred, evidence-based treatment plans within the formalized physician, clinical team and caregiver relationship.
EPA #6: The PA accurately documents the clinical encounter incorporating the patient’s goals, caregiver goals, decision-making, and reports into the clinical record.
EPA #7: The PA collaborates as a member of an inter-professional team in all aspects of patient care including transition of care responsibility.
EPA #8: The PA recognizes a patient requiring immediate care, providing the appropriate management and seeking help as needed.
EPA #9: The PA plans and performs procedures and therapies for the assessment and the medical management appropriate for general practice.
EPA #10: The PA engages and educates patients on procedures, disease management, health promotion, wellness, and preventive medicine.
EPA #11: The PA recognizes and advocates for the patient concerning cultural, community, and social needs in support of positive mental and physical wellness.
EPA #12: The PA integrates continuing professional and patient quality improvement, lifelong learning, and scholarship.
The PA Role as Explained by Practicing PAs:
“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.”
“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.”
“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.”
“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…”
“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.”
“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.”
How are PAs Educated in Canada?
There are 3 Accredited PA Programs in Canada:
- McMaster University’s PA Education Program
- University of Toronto’s PA Program
- University of Manitoba’s Master of PA Studies
Although programs may differ slightly with how they deliver the curriculum (e.g. Problem based learning vs. Spiral Curriculum), each Canadian PA program trains and evaluates their students on a competency-based medical education with outcome-based goals through Competencies and on the Entrustable Professional Activities (Canadian EPA-PA).
Education of PAs in Canada:
Each PA program trains its PA students within 2 years:
PA School Year 1 (Students are often referred to as PAS1) consists of didactic, classroom learning supplemented with hands-on clinical skills where students learn medical foundations. There is also early exposure to health care through clinical placements in the 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.
Canadian PA Certification and Obtaining Employment
Obtaining Your PA Certification/CCPA Designation:
New PA graduates then challenge the PA Certification Exam administered through the Physician Assistant Certification Council of Canada (PACCC) to become Canadian Certified Physician Assistants (CCPA).
Once PAs have obtained their PA Certification, they will obtain PAs then maintain their CCPA designation through Continuing Professional Development (CPD) hours through CAPA.
Obtaining PA Employment:
PA Job postings will often outline the following requirements for Physician Assistant Positions.
Step 1: Graduate from an accredited Physician Assistant Program in Canada or the United States
- Note: PA programs are accredited by Accreditation Canada, or in the United States by ARC-PA.
Step 2: Be Certified – Canadian Certified Physician Assistant (CCPA), Eligible to write the PA Certification Exam through PACCC.
- Employers can verify if a Canadian PA is certified through CAPA’s List of CCPAs. CCPA’s will have a CAPA ID number as well as a certificate once they have passed their PA Certification Exam. This can be forwarded to the employer.
- Eligible to Write the PA Exam: New PA graduates can also obtain employment BEFORE they write and pass their PA Exam, however employment is often contingent on PA candidates passing their PA Certification exam. If PA is hired at a job before they have completed their PA exam, the PA can then submit proof of certification once they have passed their PA Cert exam to the employer (CAPA ID#, CCPA Certificate).
Step 3: Be a Member with the Canadian Association of Physician Assistants (CAPA)
In order for a PA to keep their CCPA designation once they have passed their exam, they must earn annual minimum requirements for Continuing Professional Development (CPD) by tracking their CPD hours you must have a CAPA membership,
Access to PA liability and malpractice insurance is also through membership with CAPA
Note: American PAs are able to work in Canada, but depending on the province they can apply to jobs with just their PA-C license (e.g. in Ontario), or may have to obtain their CCPA designation by challenging the Canadian PA Certification Exam through PACCC. Check regulations for local provinces to find out what certification is required to work in your province of interest, you can contact admin@capa-acam.ca for more information.
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:
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Physician offices (solo or group practices)
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Community clinics
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Family Health Teams or Organizations
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Long-term care
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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.
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.”
“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.”
“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.”
“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.”
“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.”
“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.”
Maggie Hitchon, CCPA, Canadian PA in Physical Medicine and Rehabilitation
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.
Hospitals
Private Office or Clinic
Emergency Room & Urgent Care Centres
Occupational Health
Correctional Facilities
Telemedicine
Retail Health Clinics
University/Academic Hospitals
Long-term care facilities
International Humanitarian Missions
- Family Medicine
- Emergency Medicine
- Internal Medicine
- Orthopaedic Surgery
- General Surgery
- Neurosurgery
- Oncology
- Physical Medicine & Rehabilitation
- Dermatology
- Nephrology
- Rheumatology
- Interventional Radiology
- Cardiology
- Cardiovascular and Thoracic Surgery
- Endocrinology
- Gastroenterology
- Geriatrics
- Hematology
- Infectious Disease
- Obstetrics/Gynecology
- Paediatrics
- Plastic Surgery
- Psychiatry
- Urology
- and more!
Where PAs Work in Canada
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. On April 27, 2021, Ontario’s Minister of Health introduced legislation, once passed, to regulate PAs in Ontario. On June 3, 2021 Bill 283 Advanced Oversight and Planning in Ontario’s Health System Act received Royal Assent. Regulation of PAs in Ontario will be through the College of Physicians and Surgeons of Ontario (CPSO).
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). As of April 1, 2021, Alberta’s Government passed legislation regulating the PA profession in Alberta through the Health Professions Act.
Nova Scotia – In 2019 Nova Scotia announced a pilot project to introduce PAs into the province. In January 2020, three Physician Assistants joined Orthopaedic Surgery as part of a pilot project in Nova Scotia. The first reading of the Physician Assistant Act was passed in Halifax, giving the Minister of Health authority to make regulations around PAs.
PA Schools – In 2008, McMaster University and the University of Manitoba launched the first two civilian PA programs. This is followed by the Consortium of PA Education (the University of Toronto, Northern Ontario School of Medicine, and Michener Institute for Applied Health Sciences) who introduced another PA program in Ontario in 2010.
Frequently Asked Questions about PAs
References and Resources
PA Programs:
- McMaster PA Education Program: What is a PA?
- PA Consortium: University of Toronto’s BScPA Program
- University of Manitoba Master of PA Studies: What is a PA?
Canadian Association of Physician Assistants (CAPA):
- Entrustable Professional Activities (EPA-PA) Competency Framework
- CAPA PA Facts
- CAPA PA Historical Timeline
- CAPA PA Legislation
From Health Organizations:
- Health Force Ontario: Physician Assistants
- College of Physicians and Surgeons of Ontario (CPSO): Delegation fo Controlled Acts
- College of Physicians and Surgeons of Manitoba: Physician Assistant (Regular Associate Member)
- College of Pharmacists of Manitoba: Clinical and Physician Assistant: Prescribing Authority
- Ontario College of Pharmacists: Ontario’s Physician Assistants: An Update
From Canadian PA/PA-Student Organizations:
- Manitoba Society of Physician Assistants
- Manitoba PA Fellowship
- McMaster PA Student Resource
- Physician and Clinical Assistants of Manitoba (PCAM)
Journal of Canada’s Physician Assistants (JCanPA)
Conference Board of Canada Studies: PDFs free to download with free registration
- Value of Physician Assistants: Understanding the Role of Physician Assistants Within Health Systems
- Gaining Efficiency: Increasing the Use of Physician Assistants in Canada
Other Studies and Papers about PAs in Canada:
- Bohm, E. R., Dunbar, M., Pitman, D., Rhule, C., & Araneta, J. (2010). Experience with physician assistants in a Canadian arthroplasty program. Canadian journal of surgery. Journal canadien de chirurgie, 53(2), 103–108.
- Bowen, S., et al. (2016). Potential of physician assistants to support primary care: Evaluating their introduction at 6 primary care and family medicine sites. Canadian Family Physician, 62(5), e268–e277.
- Burrows, K. Vanstone, M. & Jones I. Physician Assistants, Introduction to the Health Workforce in Canada.
- Decloe, M., McCready, J., Downey, J., & Powis, J. (2015). Improving health care efficiency through the integration of a physician assistant into an infectious diseases consult service at a large urban community hospital. The Canadian journal of infectious diseases & medical microbiology, 26(3), 130–132.
- Fréchette, D; Shrichand, A. Insights into the physician assistant profession in Canada, JAAPA: July 2016 – Volume 29 – Issue 7 – p 35-39
- Johal, J., & Dodd, A. (2017). Physician extenders on surgical services: a systematic review. Canadian journal of surgery. 60(3), 172–178.
- Jones, I; St-Pierre, N. Physician assistants in Canada, JAAPA: March 2014 – Volume 27 – Issue 3 – p 11-13
- Jones, I. W., & Hooker, R. S. (2011). Physician assistants in Canada: update on health policy initiatives. Canadian family physician 57(3), e83–e88.
- Mertens, J; Descoteaux, M. The evolution of PAs in the Canadian Armed Forces, JAAPA: January 2017 – Volume 30 – Issue 1 – p 1-6
- Taylor MT et al. Qualitative study of employment of physician assistants by physicians: benefits and barriers in the Ontario health care system. Can Fam Physician. 2013;59(11):e507-13.