What is a PA?

1. What is a PA?

Physician Assistants (PAs) are regulated healthcare professionals who practice medicine in collaboration with physicians to provide patient care.

PAs assess patients, diagnose and manage medical conditions, order and interpret tests, prescribe medications, perform procedures, and assist in surgery.

PAs work across medical specialties, bringing clinical expertise to healthcare teams caring for patients.

2. PA Scope of Practice

PAs are trained as medical generalists to practice across a range of clinical settings and specialties in a formalized supervisory relationship with physicians. Specific responsibilities depend on a PA’s clinical training, practice setting and arrangements under which they work.

  • PAs are trained to approach patient assessments with strong clinical reasoning and attention to detail.

    They gather key information through focused history-taking and physical exams, interpret test results, and use that data to understand what might be causing a patient’s symptoms.

    This process allows them to form a clear, accurate picture of the issue and contribute meaningfully to timely diagnosis and care planning

  • PAs are qualified to order and interpret a wide range of diagnostic tests, including blood work, imaging studies (such as X-rays, CT scans, MRIs, and ultrasounds), and other investigative procedures.

    Their findings help determine whether further investigation or a change in treatment is needed.

    PAs can help move the diagnostic process forward, reduce avoidable delays in decision-making, and inform timely treatment and follow-up.

  • PAs apply medical knowledge and clinical reasoning to develop differential diagnoses and management plans.

    This involves weighing a patient's history, examination findings, and investigation results to determine appropriate next steps. This may include treatment, further testing, referral, or follow-up.

    Or in a hospital setting, responsibilities could also include coordinating admissions, managing inpatient care, and discharge planning. This supports continuity of care and helps the healthcare team coordinate investigations, treatment, and transitions between care settings.

  • Prescribing responsibilities depend on the PA's practice arrangements and applicable requirements which vary across Canada.

    Where authorized, PAs may prescribe medications as part of a patient's treatment plan, including medications for acute conditions and ongoing management of chronic disease.

  • PAs may perform procedures based on their training, clinical experience, and practice setting.

    These may range from wound care, suturing, and injections to lumbar punctures, joint injections, casting, and fracture reduction.

    The procedures performed vary by specialty and patient needs, as well as the PA’s demonstrated competence and authorized responsibilities.

  • In surgical practice, PAs may work alongside surgeons before, during, and after procedures.

    In the operating room, assigned responsibilities may include patient positioning & draping, surgical exposure, handling instruments, maintaining sterile field and closing incisions. The role may extend to pre-operative preparation and postoperative handover in the post-anesthesia care unit.

    Unlike medical trainees or surgical assistants who rotate between surgical services, PAs may work consistently with the same surgical team. Over time, they develop familiarity with specific procedures, surgeons’ preferences, and the equipment and implants used. This continuity helps them anticipate the team's needs, support efficient operating room workflow, and facilitate postoperative handover.

  • Some PAs provide on-call or pager coverage for clinical concerns raised by other hospital teams. This can be especially valuable when physicians are in the operating room, caring for other patients, or unavailable due to competing responsibilities, as well as when learner rotations leave gaps in service coverage.

    When paged, the PA assesses the patient, initiates appropriate next steps within their role, and communicates recommendations to the treating team, involving a physician when needed.

    This additional clinical capacity helps hospitals respond to patient needs without unnecessary delays, maintain service continuity despite staffing changes, and potentially prevent avoidable delays in treatment or discharge.

3. Where PAs Work

PAs practice across a broad range of medical specialties and healthcare settings. Their generalist medical education provides a foundation for this variety, while their day-to-day responsibilities reflect the needs of the specialty, the patients they serve, and the clinical team.

Medical Specialties

  • Primary Care: Family medicine, emergency medicine, internal medicine, and geriatrics

  • Surgical Specialties: General surgery, orthopaedics, urology, plastic surgery, and ENT

  • Medical specialties: Cardiology, dermatology, neurology, oncology, gastroenterology, and rheumatology

  • Other areas of practice: Paediatrics, psychiatry, obstetrics and gynaecology, sports medicine, and palliative care

Lateral Mobility

Unlike physicians, whose residency and fellowship training prepares them for specific specialties, PAs receive broad medical training that can be applied across different areas of medicine. Rather than completing a new professional degree to change specialties, PAs can build on their existing foundation through specialty-specific learning and clinical experience. This allows them to pursue different areas of practice throughout their careers.

Clinical Settings

PAs work in different environments depending on the role and the patients they serve.

This includes:

  • Hospitals: Inpatient units, emergency departments, intensive care units, and operating rooms

  • Outpatient care: Specialty clinics, surgical follow-up, and ambulatory care

  • Primary and community care: Family medicine practices and community health centres

  • Remote and rural healthcare: Services in communities with limited access to healthcare

  • Occupational and industrial health: Workplace health services, including remote mining operations

  • Military healthcare: Clinical roles within the Canadian Armed Forces

  • Long-term care: Settings supporting people with ongoing or complex health needs

4. PA Education and Training

In Canada, PA training is 2 years in a full-time Masters Program. PA education follows the same medical model physicians use, meaning students learn to assess patients, understand and diagnose medical conditions, interpret diagnostic tests, and develop treatment plans. The curriculum combines medical sciences with clinical skills and supervised patient care, preparing graduates to work across a range of medical specialties.

Year 1: Medical Foundations

The first year combines classroom learning with hands-on clinical skills training and early clinical exposure. Students study subjects such as medical sciences, clinical medicine, pharmacology, ethics, and patient communication. They learn to take medical histories, perform physical examinations, interpret diagnostic tests, and develop clinical reasoning skills.

Although the structure varies by program, the goal is to build the foundational knowledge and practical skills students need for clinical practice.

Year 2: Clinical Rotations

The second year focuses on clinical placements in core specialties and elective areas. Students gain experience in settings such as family medicine, emergency medicine, internal medicine, psychiatry, pediatrics, women's health, and surgery.

Working under the guidance of experienced clinical preceptors, students apply their knowledge to patient care, strengthen their clinical decision-making, and gain experience with different patient populations and healthcare teams.

Canadian PA Programs

5. Becoming PA Certified

In Canada, Physician Assistants (PAs) are certified through the Physician Assistant Certification Council of Canada (PACCC). This certification is essential for PAs to practice in Canada and demonstrates that they meet the national standards for competency and practice in the profession

  • Candidates must graduate from a Physician Assistant program that is accredited by the Canadian Medical Association’s Conjoint Accreditation Services (or an equivalent recognized by PACCC).

    • After completing the PA program, graduates must pass the PA Certification Examination (PACE) administered by PACCC. This exam is typically offered once a year and tests the candidate's knowledge and skills across various areas of medical practice.

    • The exam is comprehensive, covering topics like clinical medicine, diagnostics, therapeutics, and professional practice.

  • Upon passing the certification exam, candidates are awarded the Canadian Certified Physician Assistant (CCPA) designation. This credential signifies that the individual has met the national standards for entry-level PA practice in Canada.

    • Continuing Professional Development (CPD): CCPAs must participate in ongoing professional development to maintain their certification. This includes completing a minimum of 40 CPD credits every two years.

    • Certification Renewal: The CCPA designation must be renewed every five years, which includes demonstrating ongoing professional development and maintaining a current practice.

6. PA Regulation & Practice

PA practice in Canada is shaped by provincial and territorial requirements, the PA’s education and experience, and the clinical arrangements under which they work. Regulatory frameworks are not identical across the country.

Certification and Registration

National certification and provincial registration serve different purposes. The Physician Assistant Certification Council of Canada (PACCC) administers the Canadian PA certification examination. In provinces where PAs are regulated, they must also meet the applicable registration or licensing requirements to practise.

PA Practice Across Canada

The rules governing PA practice differ by province and territory. Requirements may affect registration, the use of the PA title, delegated medical acts, prescribing, and the settings in which PAs can practise. Anyone considering PA school or hiring a PA should consult the relevant provincial regulator for current requirements.

7. Sources & Further Reading

  1. Canadian Association of Physician Assistants (CAPA). PA Profession. National professional information about the PA role and its development in Canada.

  2. College of Physicians and Surgeons of Ontario (CPSO). Regulation of Physician Assistants. Ontario registration requirements and scope-of-practice information.

  3. College of Physicians and Surgeons of Ontario (CPSO). Delegation to Physician Assistants. Ontario-specific information about delegation, controlled acts, supervision, and prescribing.

  4. University of Toronto PA Program. About the PA Program. Program structure and clinical education.

  5. University of Manitoba. Physician Assistant Studies, M.P.A.S. — Academic Calendar. Curriculum, academic-year structure, and clinical rotations.

  6. Physician Assistant Certification Council of Canada (PACCC). Certification Examination Eligibility Criteria. Current eligibility requirements for the national entry-to-practice examination.