Selling PAs to Canadian Family Physicians

[PAstudentCanada]

Hi all,

 

As many of you know PAs are becoming a part of the Canadian medical landscape, mostly in emerg and orthopedics. We are trying to sell family docs on hiring PAs with most of them saying they won't do it unless the Government pays the bill. We have socialized medicine where family docs are fee for service and they bill the Provincial Government for their work. They way the regulations are currently written (they will hopefully be changed eventually), a family doc may NOT bill for work done by a PA. The doc must have seen the patient himself. So it is hard to convince a family doctor to spend an extra hundred grand or so a year on hiring a PA.

 

I am hoping that some of you fine folks on this board might have some ideas as to how we can sell family docs on hiring PAs and on how we can show it to be cost-effective. Thoughts?

[rcdavis]

Is hard to sell the PA as cost effective if the doc cannot bill/ charge for the PA's services.

 

The only other sales point that PAs represent is that having one frees up the doc and increases his time off...letting him go home sooner. This was a big selling point when I spoke with cardiovascular surgeons.. They didn't care whether or not they could bill for me.. My value was in getting them home 2-4 hours earlier every evening. Let the. Wives find out about that and you're hired for sure.

 

But I do not think famprac docs are in the income bracket to afford to lose 20-30 % of their income.. Regardless of how early they get home every day.

 

Of course, until they can charge for the PA, the other main selling point of the practice being able to see more patients a day becomes mute.

 

Which makes me wonder about the PAs in emergency medicine.. How are they being paid? By the institution as employees.. And working as a " adjunct" to the em physicians ( procedure boy,).

 

I imagine the Ortho guys may be paying for their PA's out of their pocket, and probably skimming off the bill by billing for casting, and follow ups done by the PA as being done by themselves. Or approaching the PA as would the CVS.

 

Regardless, the key is to convince the government to allow Billing for PA services. Although I hate he rule, maybe approaching the lawmakers on the "incident to" 85% of the

Physician's fee for PA services may be a way to get your foot in the door.

 

Perhaps the forum expert on matters billing david carpenter...pm him and see I'd he has any ideas he may want to share with you ( or us).

 

Another policy wonk is physasst, who no doubt has some valuable opinions on the Canadian system and whether or not there is a place for PAs within that system.. And, if so, maybe some recommendations as to how.

 

Good luck, by chilly brother.

 

Davis

[PAstudentCanada]

Is hard to sell the PA as cost effective if the doc cannot bill/ charge for the PA's services.

 

 

Which makes me wonder about the PAs in emergency medicine.. How are they being paid? By the institution as employees.. And working as a " adjunct" to the em physicians ( procedure boy,).

 

 

Davis

 

 

Hi Davis,

 

PAs are currently employed by hospitals/physicians on a salaried contract basis. The Government is subsidizing these salaries so, essentially, the government is footing the bill. While the OHIP (Ontario Health Insurance Plan) regulations stipulate that a physician must see the patient, how much this is actually happening or not is up for debate. Physicians ARE billing for work done by PAs, it's just sort of under the radar from what I can tell. Or the physician justifies this by being involved in the patient care somehow while the PA is doing 95 per cent of it.

 

See a discussion on this at http://premed101.com/forums/showthread.php?t=47305&page=13

 

It's a murky issue and PAs are not yet officially a regulated profession in Ontario so we don't know how things are going to go.

[Guest ral]

As a Canadian citizen who attended PA school in the U.S., and currently living and working in Texas, I was invited a few years ago when the Canadian folks were looking for PA's for the pilot project in the Toronto area. I didn't attend the recruiting gala in Houston because the project was set for two years, after which, there was no promise of continuing employment. That would mean risking packing up the family, only to face the possibility of having to leave again after two years if the pilot proved unsuccessful. My cousin is involved in recruiting PA's for a hospital, again in Toronto, and told me the salary. I will not divulge that info but, suffice it to say, I laughed. I'm not rolling in the money down here, however I am doing better than I could back home, when one takes into consideration, the cost of living difference. I haven't looked up the politics recently but, I recall that PA's were to be 'registered' rather than licensed in Canada. YMMV

[PAstudentCanada]

Yup, this concerns many of us. As for salary, Manitoba is more on par with the USA in this regard and I have no qualms about going there or to the USA (if/when this becomes possible) if things don't improve in Ontario.

 

 

As a Canadian citizen who attended PA school in the U.S., and currently living and working in Texas, I was invited a few years ago when the Canadian folks were looking for PA's for the pilot project in the Toronto area. I didn't attend the recruiting gala in Houston because the project was set for two years, after which, there was no promise of continuing employment. That would mean risking packing up the family, only to face the possibility of having to leave again after two years if the pilot proved unsuccessful. My cousin is involved in recruiting PA's for a hospital, again in Toronto, and told me the salary. I will not divulge that info but, suffice it to say, I laughed. I'm not rolling in the money down here, however I am doing better than I could back home, when one takes into consideration, the cost of living difference. I haven't looked up the politics recently but, I recall that PA's were to be 'registered' rather than licensed in Canada. YMMV

[jdenning]

I too am a Canadian practicing in the US. I have lived in the US for a long time, and considering the grief I went through to get a green card, I won't be heading back up north any time soon, even though I would love to be closer to my family. I think the PA profession will get itself established in Canada eventually, but it certainly is interesting that there are programs producing PAs before the profession is actually recognized by the provincial health care establishments. As far as I know, there isn't a "practice act" in Ontario and there isn't a regulatory body either. So the proverbial cart seems to be before the horse. And certainly the nurses, who are far more organized, have put up quite a fuss about these "unregulated PAs" threatening what they see to be the territory of nurse practitioners, and maybe rightfully so.

 

Until there is a way for PAs or clinical assistants or whatever they are going to be called to bill provincial health care directly, or indirectly through their supervising physicians, I'm not sure why a primary care doc would think of bringing a PA on board. PAs have a fairly unique history in the US that just doesn't exist in Canada.

 

I may be missing part of the argument, so those of you who actually do know the details should chime in.

[UllrPrincess]

A lot of these issues are exactly why as a Canadian I am looking into applying only to schools in the states. I am lucky that I live right on the border so I plan to live in Canada and practice in Washington eventually. Currently the province I live in does not have PAs but even if we do soon I probably won't practice in Canada unless things change. The salary of a PA in Canada is a lot less than in the US and the autonomy is amazing in Washington compare to Canada (ie: every patient having to see the doctor rule in Ontario).