Second in a series of articles looking at the issue of physician assistants, and the role they could play in British Columbia.
Physician assistants are respected members of many provincial health-care systems across Canada.
The B.C. health-care system is not among them.
Physician assistants (PAs) are health-care professionals who work with physicians. Under the overall supervision of a physician, PAs take histories, conduct physical examinations, order and interpret tests, diagnose and treat illnesses, counsel on preventive health care, and may assist in surgery.
They can apply their profession in clinical settings, or fieldwork, such as work camps, mines, etc.
PAs are currently able to work within the public health-care system in five provinces: Manitoba, New Brunswick, Ontario, Alberta, and a pilot project in Nova Scotia.
Black Press reached out to the B.C. Ministry of Health for an explanation as to why the profession is not recognized in this province and was told the situation is being “monitored.”
“The introduction of a new health profession requires careful consideration, management, and significant resources to properly understand and address the inevitable team function issues that emerge from overlapping scopes of practice,” the ministry said in an email to Black Press.
Alberta opened its doors to physician assistants in April 2021 under the Health Professions Act. As such, they are now subject to the same legislative framework as other regulated health professionals in Alberta — a move that province’s Ministry of Health says has immediately paid dividends.
“The regulation of physician assistants … improves the quality of services delivered, and promotes practice excellence in the profession. It also assists with workforce planning and greater utilization of physician assistants that have the potential to improve patient care, reduce wait times, and contribute to cost savings in the health system,” the Alberta Ministry of Health said in a statement.
Port Hardy doctor has seen the benefits firsthand
Dr. Alex Nataros recently opened a practice in Port Hardy.
He’d relish the opportunity to hire a physician assistant, not only because of their reputations, but more so due to his own experience.
Nataros worked with a PA during his time in Dauphin, Man., a community of 10,000 people in northwestern Manitoba with a small hospital. He said the assistant he had was invaluable, not only to the practice, but to the community as a whole.
“The physician assistant was working primarily with our two surgeons … (He) would see the patients in the emergency room, would do the consults, would assist with the surgeries, and would do the closures in the operating room, allowing for the surgeons to move on to the next case.”
In Port Hardy, a second-year residency student is running the ER, as well as a Practice Ready Assessment BC candidate (a physician who worked in South Africa) at Nataros’s clinic, both under his licence.
“They are examples of physician extenders for me. Currently, we are covering three roles under my licence. That’s a much more efficient way to deliver care … and a lot more cost-effective than saying we need an individual physician for every single patient, at all times, in person. It’s much better if I can be in multiple places at once, with a team.”
The Canadian Association of Physician Assistants estimates that 86 per cent of the care provided by a physician can safely be provided by a physician assistant, under the supervision of a physician.
There is also the advantage of a PA becoming part of the community, as opposed to a locum (temporary fill-in), who would cover for a vacationing, or otherwise absent doctor, then leave upon the doctor’s return. A physician assistant becomes a permanent resident of said community.
“That is something I believe has not been fleshed out enough,” said Nataros. “Kevin Healy, who was the physician assistant I was working with (in Dauphin), led the squash group, he led the tennis group, he was as loved, or more, than any of the doctors in town. And that just reflects so keenly on the role they can play, and the continuity they can bring to the community. … There can be a real loss of trust in the medical system when there is a revolving door (of health-care workers). We all know your care is better when there is continuity in it.”
Nelson physician assistant travels to U.S. for work
Greg Sayers is a dual-citizenship physician assistant who resides in Nelson.
He graduated from the University of Utah 22 years ago, and has been in the profession ever since. For the past seven years, he has been commuting to Montana for work — nearly 11 hours away from Nelson.
“One location is 10 and a half hours away, and the other location is three hours away,” he explained.
He works mostly at critical access hospitals (community-owned hospitals in rural areas), spending most of his time either in the emergency departments or the extended care departments. Although under the auspice of a physician, most of Sayers’ work is done with no physician present.
He said being able to work in his home community would make a big difference, not only to him, but to those in need.
“First of all, my career would be more satisfying, because I would be able to help out in my community. That, to me, is a very important part of my career that is lacking,” said Sayers. “Right now I am going to another community that doesn’t even need care as much as Nelson needs care … which is kind of backwards. It’s ridiculous to me that I am here (in Nelson), where I could help out my neighbours, I could write a prescription, I could take care of a broken arm, but I can’t. It’s extremely frustrating.”
He said the added stress his family experiences from his absence due to work is taking its toll.
“When you think about the mental stress that goes on in a family, when the father, or someone, has to leave for extended periods of time, for the duration of the child’s life, that’s unhealthy. I feel trapped.”
Sayers said he has witnessed life-and-death situations where he was not allowed to intervene. Early in his career he lived in Bella Coola, and commuted to Alaska for work.
“In Bella Coola one time, I lived next door to a lady who was dying of renal disease, and needed medication management. I knew what to do to help her, but I couldn’t. It was just terrible. In another instance, a man was in a logging accident and I could have saved his life, I know I could have, but I couldn’t. The paramedics had to drive the fellow 35 miles for him to receive care.
“It’s a waste of a resource. I could see hundreds of patients right in this area (Nelson) when they are struggling to find health-care providers, and the patients are not being seen.”
Sayers said the cost savings alone should be enough for the province to rethink its position on physician assistants.
“If you can get three physician assistants (in a community) and pay them $100,000 each, instead of $350,000 (for one doctor), why wouldn’t you? And that’s just the tip of the iceberg. That could be happening all over the province, and sooner or later it is going to happen.”
Change not coming soon: CAPA
The Canadian Association of Physician Assistants continues to advocate for a change in B.C. policy, and says its efforts are gaining support from the various groups and associations within the health-care system.
“We do have ongoing discussions about PAs with many stakeholders in B.C.,” CAPA said in a prepared statement to Black Press. “The good news is that many groups within the provincial health-care system view the addition of PAs to the B.C. workforce as a good thing, including those within health authorities and physicians, etc.”
But CAPA warned against expecting a resolution any time soon.
“We do not think a change is imminent (in the next year, for example). The current government has invested significantly in expanding the nurse practitioner model, which is benefiting many patients in the province, but it means that there is limited desire to introduce a new health-care profession.”
Part three of the series will look at how other countries make use of physician assistants to help alleviate the strain on doctors.