Meanwhile in Ontario

[PAstudentCanada]

"From CAPA:

Dear Ontario Members,

 

Today, CAPA received formal notice from the Ministry of Health and Long-Term Care that the Minister of Health, Deb Matthews, has made a decision regarding CAPA’s Application for Regulation of the Physician Assistant profession.

 

I am not going to sugar coat the bottom line; the decision was to not regulate the PA profession in Ontario. The CAPA Board of Directors has not had the opportunity to review the document to thoroughly interpret the decision before making any quick judgements or statements.

 

I encourage you to visit HPRAC’s web site and review the document as a whole and submit your comments and questions to me once you have had the chance to digest the document.

 

http://www.health.gov.on.ca/en/common/ministry/publications/reports/hprac/201208.aspx

 

 

Please be patient as we review this document over the weekend and we welcome your input on how this will affect your practice. We will share our perspective as soon as possible."

 

 

 

 

My thoughts (and those of several physicians I work with are)

 

 

Physicians can't really bill for what we do, we are unable to be responsible for our own actions, and we cannot order or prescribe medications (things that are necessary to do our job, indeed, this is part of our job description. NPs cant do all of these things and, indeed, many physicians have said to me "I would rather have an NP" for many of those reasons.

 

The Government has created PAs without understanding what we are; healthcare professionals who practice medicine with negotiated supervision. Practicing medicine entails prescribing and order and without being regulated we cannot really do either. Doing so with medical directives means that SPs are still 100 per cent responsible and puts everyone on shaky legal framework. The Government has tied our hands and told us to clap.

 

PAs must be regulated.

 

docs can't bill for what we do and now we're unable to be responsible for our own actions. This government has no idea what to do with PAs or any understanding of how we're actually working!

 

 

This is essentially making PAs work like Clinical Clerks which makes having a PA around almost pointless.

[jdenning]

So you and all your classmates will be heading south?

[PAstudentCanada]

So you and all your classmates will be heading south?

 

No. We are not allowed to work as PAs in the USA; they (NCCPA) won't let us write the licensing exam.

[PAstudentCanada]

I just read through some of the document. So far, pearls include: "The PA practice is similar to that of NPs (nurse practitioners), although training is considerably less rigorous." and "It is unclear whether the profession will continue to grow at the close of the demonstration projects. Physicians who participated in the projects indicated that funding and grants were “highly influential” in their decision to hire a PA and that they would be unlikely to hire a PA if no government funding was provided"

 

Well, gee whiz, apparently my thousands of hours of clerkship combined with my preclerkship curriculum that, together, make up about 85 per cent of the M.D. program, and my sitting some of the same exams as the MD students, and my having to perform at the level of an MD clinical clerk during my clerkship and my reading the same books as MD students and residents, and my degree in medical science just are not as rigorous as a degree in nursing and a masters program that is mostly nursing theory, research, and some medical science and clinical hours. Oh yah, those NPs obviously have way more rigorous medical training than I do.

 

And, HPRAC, don't you think that regulating the profession could lead to more physicians wanting to work with PAs and lead to better funding (for example, inclusion with OHIP somehow, the way most docs get paid now, even if the Govt wants to move toward salaries).

 

And HPRAC: do you really not see that almost 50 new PAs are graduating EVERY YEAR and thus the profession is growing (plus Forces members becoming civilians) and the need for regulation due to size is indeed nigh?

[PAstudentCanada]

In my job as an emerg PA at a Toronto hospital I am essentially functioning just like I did when I was a PA clinical clerk. I have no actual authority. I basically take a hx and a px and then go talk to my SP who RARELY even wants to hear my plan. They usually grab the chart from me, write their own plan, then go see the patient and carry our their plan and d/c them /admit them and all without every talking to me about them again. At least I get paid now. :(

[True Anomaly]

Wow. I can't imagine how frustrated you must be. Sad news from up north.

 

I'm assuming that "clinical clerk" is the equivalent of a current student, whether MD or PA?

[PAstudentCanada]

When I tell some of the docs in my group that the job of a pa is to practice medicine under supervision with negotiated autonomy they look at me like I am insane. When I tell them that in many places docs do not physically see the patients the pa treats they look at me in horror. When I tell them that in the USA there are experience pas who work with no doc on site they practically go into convulsions.

 

They see me as their assistant. They are my job as to collect data for them and do procedures for them. When I tell them that Yale has a physician Associate program they seem to be very uncomfortable.

 

When I told one of them that I intubated a pt the other day (while with a different doc) they told me PAs should not be doing that and she would never let me do that.

 

It's te name!!!!!!! We need to change our friggin name!!!!

[PAstudentCanada]

Wow. I can't imagine how frustrated you must be. Sad news from up north.

 

I'm assuming that "clinical clerk" is the equivalent of a current student, whether MD or PA?

 

Yah. Clinical clerk is a med or pa student doing clinical rotations.

[physasst]

Well, I'm going to be in Ottawa next week, but it's for a research thing...some of the ministry folks might be there though.....

[mackjacks]

Wow that all sounds terrible. Basically they think of you as a "super ER tech?"

 

If you don't mind me getting off topic, I'm curious as to how you found/got into the PA profession since it is so small in Canada? Sorry if you have talked about this before in a different thread. Also does the hospital pay you a salary? Is it "good"? What is the hospital or your group's incentive for hiring you since you don't get to do much? By you doing the H&P/procedures, do the docs get to see a lot more pts?

 

Is there any chance the PA profession will be brought to the Ministry of Health again soon or is it a done deal now? Do you know/think that the NPs or MDs or another interest group lobbied against PAs?

[SocialMedicine]

when i read this i think about the benefits of name change and creating PA academic centers of excellence to promote the profession. Rather than build 8 PA prgrams around the corner from each other ... create one large school that can generate research and policy, and influence change. Lets have places where Ontario can contact policy leaders and academics for guidance ... Rather than 180 PA schools with 5 faculty each that are swamped with administrating students. We should have PA schools fighting for a guy like PhyAsst to help create PA research and train interested students/faculty in research methods. I am not just a complainer .... I have been saying this stuff for awhile .... Im joining a PA school faculty part time this month and hope to create the change I desire.

[MedicinePower]

Is there any chance that you can convince a PA program in the states to fill in the gaps and thus be allowed to take the PANCE?

[balsam88]

I'm from Ontario, and after reading this I'm very glad that I'm going to PA school in Michigan. The road for Canadian PA's is going to be extremely long and difficult. Many folks in healthcare still don't know what PA's are. It's still relatively a new profession and we've got a long way to go..

[ICRob0351]

It seems to me that a PA in Canada, as far as the law goes, isn't really a PA. This is not to be detrimental in any way to our friends up north, but why even bother becoming a "PA" when you know the profession is stymied in clinical ambiguity and apparently residing in a regulatory wasteland? I feel so unbelievably frustrated for all in that position, and it seems to be such a completely disappointing end to an incredibly intense medical education. I feel like if you really want the opportunity to be a PA, in title and in clinical scope of practice, your only choice is to come to the U.S. and practice here. It's almost an insult to the profession the way the Canadian government categorizes PAs. Anyway, for those of you who are trying to make a go of it up there, I wish you the best of luck and hope things get better.

[jdenning]

I think the sad part here is that the Ontario government started up training programs for PAs before really figuring out how a PA would be utilized or regulated and what the scope of practice would be. It's quite sad really because there are now a couple of graduating classes with limited prospects and a government system that hasn't figured out how to fit a new profession into an existing hierarchy. It sounds like the Ontario Medical Association isn't on board, and we know for sure that the nurses are territorial and thinking that any mid level type of provider should be a nurse practitioner. People need to remember that the practice of medicine is far different in Canada than in the US and that the concept of the PA is an entirely new thing - there isn't a history to PAs like there is in the US except in the Canadian military and that's an extremely small numbers.

 

I think the only province that has really been able to get things off the ground has been Manitoba where PAs are called "clinical assistants" and have a very specifically defined scope of practice.

 

I've been waiting for things to change in Alberta so I could go home ...:-) but it's going to be a long while.

[PAstudentCanada]

I knew about PAs from the USA and when I found we had them here I jumped at the idea.

The hospital pays me and has some funding from the government. I make okay money but not as much as I would make in the USA.

 

The group's incentive for hiring me is to improve metrics. When I sign up to see a patient it counts as reducing waiting times which looks good on the hospital and then the hospital will be given more government money.

 

Yes, docs get to see more patients.

 

Not a done deal, but won't be revisited for a long time (many years I suspect).

 

The College of Physicians and Surgeons of Ontario would be the regulating body (as suggested by CAPA) and they said they don't want to do this now because there are so few of us (less than 200 now). They prefer to make a registry instead. Doris Greenspun, the RN group rep for Ontario is also anti-PA.

 

 

 

Wow that all sounds terrible. Basically they think of you as a "super ER tech?"

 

If you don't mind me getting off topic, I'm curious as to how you found/got into the PA profession since it is so small in Canada? Sorry if you have talked about this before in a different thread. Also does the hospital pay you a salary? Is it "good"? What is the hospital or your group's incentive for hiring you since you don't get to do much? By you doing the H&P/procedures, do the docs get to see a lot more pts?

 

Is there any chance the PA profession will be brought to the Ministry of Health again soon or is it a done deal now? Do you know/think that the NPs or MDs or another interest group lobbied against PAs?

[PAstudentCanada]

Is there any chance that you can convince a PA program in the states to fill in the gaps and thus be allowed to take the PANCE?

 

 

I wish. Any ideas?

[PAstudentCanada]

It seems to me that a PA in Canada, as far as the law goes, isn't really a PA. This is not to be detrimental in any way to our friends up north, but why even bother becoming a "PA" when you know the profession is stymied in clinical ambiguity and apparently residing in a regulatory wasteland? I feel so unbelievably frustrated for all in that position, and it seems to be such a completely disappointing end to an incredibly intense medical education. I feel like if you really want the opportunity to be a PA, in title and in clinical scope of practice, your only choice is to come to the U.S. and practice here. It's almost an insult to the profession the way the Canadian government categorizes PAs. Anyway, for those of you who are trying to make a go of it up there, I wish you the best of luck and hope things get better.

 

Thanks. :)

[Contrarian]

Is there any chance that you can convince a PA program in the states to fill in the gaps and thus be allowed to take the PANCE?

 

 

NO...!!!!

Would have to attend the entire accredited US PA program to sit for the PANCE...

 

Just as PA students here in the US can't jump in ... in the middle of other PA programs to "fill in the blanks" then sit for the PANCE.

 

Allowing Canadians to sit for the test and be certified by the NCCPA would set a terrible precedent.... re-opening the door for IMG/FMGs, and everyone else that claim equivalent training.

[CAdamsPAC]

NO...!!!!

Would have to attend the entire accredited US PA program to sit for the PANCE...

 

Just as PA students here in the US can't jump in ... in the middle of other PA programs to "fill in the blanks" then sit for the PANCE.

 

Allowing Canadians to sit for the test and be certified by the NCCPA would set a terrible precedent.... re-opening the door for IMG/FMGs, and everyone else that claim equivalent training.

 

Agreed. What about the establishment of an "international" standard of PA trianing, since the UK , Australia and New Zealand are also seriously looking at the profession?The English speaking world seems to be tracking our profession's progress, so I think this would be a viable option.

[PAstudentCanada]

The key is to make the Michael G. DeGroote School of Medicine, McMaster University and University of Toronto PA Programs accredited by the US Accreditation Review Commission on Education for the Physician Assistant.

I don't see any reason why this can't happen.

 

NO...!!!!

Would have to attend the entire accredited US PA program to sit for the PANCE...

 

Just as PA students here in the US can't jump in ... in the middle of other PA programs to "fill in the blanks" then sit for the PANCE.

 

Allowing Canadians to sit for the test and be certified by the NCCPA would set a terrible precedent.... re-opening the door for IMG/FMGs, and everyone else that claim equivalent training.

[matticus]

To the Ontario/Canadian PAs,

 

This definitely seems like a colossal blow to Ontario/Canadian PA prospects. While extremely interested, I have been holding off applying to McMaster's PA program for the last couple years to see how this 'new' profession progressed in Ontario. Frankly, I don't want to spend $25k+ and make the associated life adjustments for something that isn't worthwhile or has no job prospects. I already earn $75k+ in the health care field, however there is no direct patient care, which is what attracts me to PA. I was all set to apply this year until I read this forum and HRPAC's decision.

 

So my questions to you are:

 

1. What tasks do physicians allow you to perform? I am interested in IVs, giving meds, intubation, 12 leads/rhythm interpretation/cardioversion/pacing/defib, casting, etc, you name it. Understandably as you are working under a physician, they would have to be comfortable with you performing these tasks, but how many of you/or your colleagues are allowed to do these things? Is there trust and confidence from the doctor?

 

2. Are doctors generally welcoming of you or adverse to you? How about managers/administrators? Do they feel you are a good investment or only brought you on because of the free government money?

 

3. Now that there are no prospects of regulation and since doctors can't bill for your services, do you feel that after the demonstration project concludes and hospitals/clinics no longer receive funding, your jobs will disappear? Have your schools/the government/CAPA/etc given you any information on job prospects should this situation occur?

 

4. If you had to do it all again, knowing what you know now, would you pursue this career again? If not, what profession would you have pursued instead?

 

Please feel free to include any other advice you feel would benefit someone who is seriously considering pursuing this career. I would welcome WHATEVER comments you have that would help me make a decision.

 

Thanks to all!

Matt

[PAstudentCanada]

What PAs on Ontario do varies from place to place but, for the most part: histories, physicals, ordering/interpreting investigations, prescribing medications, and performing procedures.

Placing IVs is really a nurses job though you can certainly do it as a PA. Yes, you can intubate, I intubated a pt a few days ago.

 

Most physicians I meet don't have a clue what a PA is and just want a hx and px and for me to perform procedures for them. huge waste. Free government money is the key for most I meet.

 

There are prospect of regulation, just not for many years now. I suspect our jobs will, mostly, remain, but who knows.

 

Yes, I would pursue this again.

To the Ontario/Canadian PAs,

 

This definitely seems like a colossal blow to Ontario/Canadian PA prospects. While extremely interested, I have been holding off applying to McMaster's PA program for the last couple years to see how this 'new' profession progressed in Ontario. Frankly, I don't want to spend $25k+ and make the associated life adjustments for something that isn't worthwhile or has no job prospects. I already earn $75k+ in the health care field, however there is no direct patient care, which is what attracts me to PA. I was all set to apply this year until I read this forum and HRPAC's decision.

 

So my questions to you are:

 

1. What tasks do physicians allow you to perform? I am interested in IVs, giving meds, intubation, 12 leads/rhythm interpretation/cardioversion/pacing/defib, casting, etc, you name it. Understandably as you are working under a physician, they would have to be comfortable with you performing these tasks, but how many of you/or your colleagues are allowed to do these things? Is there trust and confidence from the doctor?

 

2. Are doctors generally welcoming of you or adverse to you? How about managers/administrators? Do they feel you are a good investment or only brought you on because of the free government money?

 

3. Now that there are no prospects of regulation and since doctors can't bill for your services, do you feel that after the demonstration project concludes and hospitals/clinics no longer receive funding, your jobs will disappear? Have your schools/the government/CAPA/etc given you any information on job prospects should this situation occur?

 

4. If you had to do it all again, knowing what you know now, would you pursue this career again? If not, what profession would you have pursued instead?

 

Please feel free to include any other advice you feel would benefit someone who is seriously considering pursuing this career. I would welcome WHATEVER comments you have that would help me make a decision.

 

Thanks to all!

Matt

[MedicinePower]

Unsure what would prevent Canadian PA programs from being accredited by US authorities. Canadian med schools are already accredited by the LCME.

[SocialMedicine]

when i read this i think about the benefits of name change and creating PA academic centers of excellence to promote the profession. Rather than build 8 PA prgrams around the corner from each other ... create one large school that can generate research and policy, and influence change. Lets have places where Ontario can contact policy leaders and academics for guidance ... Rather than 180 PA schools with 5 faculty each that are swamped with administrating students. We should have PA schools fighting for a guy like PhyAsst to help create PA research and train interested students/faculty in research methods. I am not just a complainer .... I have been saying this stuff for awhile .... Im joining a PA school faculty part time this month and hope to create the change I desire.