Physician Assistants in Canada: The Cure to Our Healthcare System?
With the population of doctors dwindling under the increasing strain of the healthcare industry, could Physician Assistants be the answer?
Physicians are often viewed as the only type of medical practitioner who can provide meaningful care to patients. However, in practice, this is not entirely true. Physician Assistants (PAs) are healthcare professionals that work together with doctors and other healthcare professionals to care for patients. PAs therefore add to the health model of team-based care, rather than simply relying on physicians as individual healthcare providers. PAs have also often been promoted as a solution to addressing the gaps in our healthcare system. But what do PAs actually do? And perhaps more importantly, what are the the logistical and financial implications of integrating PAs into the health system?
PAs originated in the Canadian Armed Forces, and have been integrated into the Canadian healthcare system over the last 40 years. Currently, PAs practice in six provinces which include Manitoba, Alberta, Ontario, New Brunswick, Nova Scotia, and Newfoundland.
Growth of PAs in Canada from 2012 to 2019
The primary principle behind the use of PAs was initially to help mitigate the effects of a shortage of physicians in the healthcare system. PAs therefore undertake a broad range of medical tasks. Essentially, PAs act as an extension of the physician by whom they are supervised. In doing so, PAs are able to act as de-facto physicians, with the exception of leading a major surgery. Specifically, PAs can diagnose patients, assess patients, and formulate and prescribe treatment plans. These practices, along with many others, have been noted to have a substantial effect on the healthcare system by reducing waiting times, addressing the shortage of physicians, and being a more cost effective initiative for healthcare expenditure in general. It has been noted that Canada will face a shortage of about “40,000 primary care doctors by 2050” (Jones, 2023). Furthermore, studies have shown that the average Canadian waits about 18.2 weeks to get a specialized care appointment after being referred by their doctor.
Canada is second-most expensive in the world among countries that provide universal healthcare. Health Insurance for the average Canadian has grown by 176.6% from 1997 to 2017. Since PAs can be trained more quickly than physicians and have the potential to grow at a quicker rate, it seems that PAs would be able to help address many of the issues cited above. However, the question that arises from this is how PAs can be integrated into our system? And specifically in a province without any licensed PAs, like British Columbia.
One of the essential elements of PAs being successfully integrated into provincial systems is the relatively shorter schooling and certification required for PAs, as opposed to Physicians. PAs are only required to complete 2 years of further schooling after an undergraduate, after which they must pass the Physician Assistant Certification Council of Canada test to receive their license. There are currently around 1,000 PAs working across Canada, the majority of whom in Manitoba. As PAs seem to be a relatively small and new profession within the medical system, compensation models are currently varied. The Canadian Association of Physical Assistants website outlines compensation of around $50 to $65 dollars per hour for PAs. However, some provincial sources, such as HealthForceOntario, provide 10 year old compensation reports which recommend $75,000 per year for new PA grads. This therefore serves as a key factor for the implementation of PAs in BC, as a clear compensation models must be made available not only to attract individuals to pursue becoming a PA, but also to set a standardized model for PAs that begin working once it is implemented.
As mentioned, British Columbia currently does not have any licensed PAs. This is directly due to the lack of any post-secondary programs for individuals to start on the path towards becoming a PA. This is the first step in the implementation process for PAs in the BC medical system. Once a clear educational path is made available to individuals in BC, a clear compensation model must be provided by a provincial health authority in order to give security to new grads. While BC has introduced a new medical role similar to a PA, called Associate Physician, the current process to become an associate physician is being hired on a “case by case” basis depending on the individual’s experience and competencies. This is an unsustainable practice, because in order for the health system to receive the benefits of PAs (or Associate Physicians) they must be qualified through a standardized provincial program in order to realistically grow the population of PAs within the health system. The benefits that PAs provide to the healthcare system is very clear; The path to becoming a PA is not. As integration begins from the ground up, BC must create standardized career opportunities through post-secondary programs and clear compensation models in order to create space for PAs to make a change for the better in our health system.
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