At a time when hospitals and clinics across Canada are overburdened by rising demand for health care, there are concerns health authorities are overlooking one possible solution: physician assistants (PAs).
PAs are trained medical professionals able to perform many of the same procedures as full-fledged doctors. These professionals, popular in the United States and some parts of Europe, could help to ease some of the strain on Canada’s understaffed health-care system, but experts say the country is dragging its feet on bringing them into the fold.
“We could do any part of the patient interaction that a physician would typically be doing,” says Sahand Ensafi, who has been a PA in Toronto General Hospital’s emergency department for six years. “So that could include anything like a history, a physical exam, ordering tests, interpreting those tests and making decisions based on our interpretations, prescribing medications.”
Ensafi’s supervising physician, Dr. Lucas Chartier, says PAs are crucial because they lighten his load and ease the backlog of patients.
“They basically work just like your mirror image of me, meaning that they are able to see a lot of the same patients that I would have seen. They are able to do a lot of their procedures, with the right supervision, that I would have otherwise done,” he said.
With most PAs’ annual salaries paying less than $120,000, they earn less than doctors. Monika Slovinec D’Angelo, a health researcher at the Conference Board of Canada, says PAs can save an overburdened system precious dollars if their services are used widely.
“According to our 2017 report, the estimated value of physician assistants was $1.1 billion over 13 years,” she said.
PAs are popular in the United States and western Europe, but in Canada, their numbers are still relatively low. According to the Canadian Institute of Health Information (CIHI), there were 308 PAs across Canada in 2013. CIHI’s latest numbers, from 2017, show an increase in that number, but the total is still fewer than 800.
In some provinces, PA positions are in the military only, not at civilian hospitals. Chartier says there should be thousands of PAs in Canada, not hundreds.
“Whether it’s 300 or 700, it’s not enough … to meet the needs of the ever-growing population, both in terms of the numbers of the population and the complexity of the population,” he said.
But, in Nova Scotia, where many emergency departments are routinely unable to remain open because of staff shortages, PAs are only now being adopted in civilian health-care facilities. The Nova Scotia Health Authority is adding three positions for a three-year trial period to help with hip and knee replacements. Critics, like Nova Scotia NDP Leader Gary Burrill, say the province is moving too slowly.
“Having a pilot project for a very small number of PAs, this is kind of a half-measure, a very tentative, tepid approach,” Burrill said.
When asked about its PA pilot project, the Nova Scotia Health Authority referred Global News to Dr. Bill Oxner, an orthopedic surgeon who is helping co-ordinate the pilot program. He says he’s looking forward to PAs joining his team.
“We’ve been looking at this for the last few years and advocating for it,” Oxner said. “Where the roadblocks have been, I guess, has been in the funding of the positions, for starters. And we really do know and think that they will add value and we do think they will help with productivity in the system.”
However, Oxner says that at the current rate, a meaningful impact on the health-care system is still several years away.