Kevin Dickson treats dozens of patients a day in the emergency department of the Dr. Everett Chalmers hospital in Fredericton.
He does physical exams, takes medical histories, develops treatment plans and discharges patients.
But Dickson is not a doctor, a nurse or a surgeon. He’s a physician assistant.
Working in a hospital that, like most others across Canada, is struggling to cope with health care staffing shortages and increased patient demand, Dickson says he is pleased to have the opportunity to help address gaps in the system — namely, seeing more patients who need medical care.
“We’re seeing unprecedented wait times here in the emergency department on an almost daily basis,” he said.
“I see 20 to 30 patients that wouldn’t otherwise be seen, and that in and of itself is rewarding.”
Physician assistants, or PAs, are medical professionals who have been part of Canada’s military medic system since the 1960s, but they are relatively new to provincial and territorial health systems.
There are fewer than 1,000 certified physician assistants in Canada.
But now, with many front-line health workers calling for urgent action to address a “crisis” of staffing shortages that have caused a host of emergency room closures across Canada in recent months, physician assistants are uniquely situated to help, says Patrick Nelson, executive director of the Canadian Association of Physician Assistants.
However, many are frustrated by an overall lack of awareness about their profession and a deficit of training opportunities in Canada, he said.
Only three universities in the country offer training programs for PAs outside of the Canadian Armed Forces which, combined, offer only 69 seats. As a result, demand for these seats has become highly competitive. This year alone, 3,000 applicants were vying for those limited training availabilities, Nelson said.
“In this day and age, when the health system is seized with our health workforce challenges, it can be frustrating at times to know that there are literally thousands upon thousands of our young folks who are trying to get into training in Canada and there’s only 69 spots in the whole of the country,” he said.
Physician assistants work as part of the public healthcare system in Alberta, Manitoba, Ontario and New Brunswick, in addition to the military, and practise under the supervision of a licensed physician.
Physician assistants not yet implemented in Saskatchewan
Their training enables them to work in a wide array of health care settings, and they can perform many duties normally performed by a full-fledged doctor for routine or straightforward cases. This frees up time and availability of physicians and surgeons to treat more complicated cases and creates opportunities for both PAs and physicians to spend more time with their patients.
Doctors across Canada in almost every area of specialty are reporting higher than ever levels of burnout, according to the Canadian Medical Association, but physician assistants say they are ready and willing to do more to help, Nelson said.
“They’re not feeling overtaxed and tired. They’re feeling like they could contribute more and they’ve been unable to contribute more,” he said.
“That presents a pretty significant opportunity.”
Most provincial and territorial governments are open to the idea of extending legislative regulations to allow PAs to work within their health systems, and regulatory bodies such as physician colleges have been similarly open and receptive, Nelson said.
A number of universities with existing medical schools have also expressed interest in initiating new training programs for PAs, he added.
It’s simply a matter of governments making it a priority to increase funding for and attention to these advancements, Nelson said.
A 2016 analysis by the Conference Board of Canada looking at the value of physician assistants in Canada also pointed to remuneration mechanisms — notably fee-for-service models — as a barrier to introducing PAs into provincial health systems.
Demand for more physician assistants in health care
Meanwhile, the financial incentive of moving forward could be worth the time and effort.
Adding PAs to the health care system could save up to $1.1 billion, according to a separate 2017 analysis by the Conference Board of Canada.
Dickson says he understands adding new health practitioners to Canada’s existing system is not an easy or quick proposal. But PAs can lighten the load for doctors across Canada who have been repeating the refrain that their work and patient loads are unsustainable, Nelson said.
“In Ontario and Manitoba, adding (a PA) to a family doctor’s practice allows them to take almost an extra 900 patients that weren’t assigned physicians,” he said.
“When you face that kind of number, then it becomes a little bit more clear to provinces that haven’t legislated or regulated PAs to have a better look at it, to get involved.”
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