Physician assistants? It shouldn’t be that hard. Really

The province has announced a pilot program to see if it’s safe to let physician assistants into our health care system. They already operate legally in much of the US, Ontario, Manitoba, New Brunswick and in the Canadian military. So why just a modest pilot project? We’re glad you asked.

Not exactly as illustrated (in Nova Scotia).

A September announcement that the province’s health department plans to launch a new pilot project to road-test the use of physician assistants had somehow passed over — or under — my Spidey-sense news radar until it popped up again, almost incidentally, near the end of a news report Friday.

Friday’s story focused on new data released to the legislature’s health committee that showed a spike in the number of hours provincial collaborative emergency centres (CECs) have been shuttered this year. Confirming what most of us could already intuit from the depressing daily drumbeat of news about this or that closure, the health department’s data — complete with a comparative chart — demonstrated closures had “increased significantly.”

What caught my attention, however, was an almost aside reference deep in the story.

The CBC’s legislative reporter, Michael Gorman had dutifully rounded up all the usual shocked-and-appalled responses from all the usual opposition party suspects.

For his part, Conservative leader Tim Houston mused it might be time for the province to review even the existence of the collaborative emergency centres. “The goal of providing care closer to a community is admirable,” he allowed. “We should be making sure that people can access care in a way that’s convenient, quick and that really improves health outcomes. But when you start to fade away from that goal, which it seems like we’re doing now, it’s definitely time to look at it.”

Tammy Martin, the NDP’s health critic, wasn’t buying that. No surprise there. During its one term in government, the NDP successfully pioneered the use of CECs to provide emergency services to citizens in underserved rural areas.

Now back in opposition, the NDP has been pressing and pestering the McNeil government to open even more CECs. Without success. Martin told Gorman the problem wasn’t with the concept of collaborative emergency centres but with its execution. “I think the model would work if it was staffed properly.”

One way to do that, she suggested, would be to consider using alternative staffing models, including physician assistants.

And then Gorman’s report continued:

“Right now, the health authority is doing a three-year pilot project using three physician assistants to work with orthopedic teams.”

We’ll come back to that.

First of all, what’s a physician assistant anyway?

According to Brittany Belair, a Halifax woman who graduated from the University of Toronto’s physician assistant program and currently works as a PA at Toronto Western Hospital — but would prefer to come home to work in Nova Scotia if we had a PA program — physician assistants are “physician extenders.”

They don’t replace doctors or nurses. Like medical residents, they work with doctors under their supervision, doing routine jobs like assessments, meeting with patients before and after surgery, helping out in the operating or emergency room and writing prescriptions.

Essentially, they’re well trained to do what they do at a lower cost, and help make the healthcare system work more efficiently and effectively.

“Everyone has their niche,” she says. “Everybody is important in taking care of patients. What we really need to focus on is patient care and providing more access to care quicker and in a more cost-effective way so we can take care of Nova Scotians better.”

Are physician assistants some new, never-tried idea?

No. In fact, Fred Wu, the California-based president of the Society of Emergency Medicine Physicians, told a Halifax conference in May that 70 per cent of American emergency departments employ physician assistants. So does the Canadian military. Ditto for New Brunswick, Manitoba, Ontario. There are currently 650 licenced, trained and ready to work physician assistants in Canada. They even have their own professional association.

So let’s revisit:

“Right now, the health authority is doing a three-year pilot project using three physician assistants to work with orthopedic teams.”

Uh… We have a five-alarm healthcare emergency in Nova Scotia. We have a shortage of doctors and nurses. Emergency rooms keep closing. It’s a mess. It’s a crisis…

And yet, the best we can muster in response is a pitiful three-year pilot project with just three physician assistants in just one medical discipline.

The holdup? Apparently, we can thank the College of Physicians and Surgeons of Nova Scotia, which had to give its blessing to a process for licencing and regulating PAs before the province could even begin the pilot project. And just getting the proposal to the piloting phase has taken “a number of meetings over the last year” between the College and the Nova Scotia Health Authority.


We aren’t talking about experimental brain surgery here. Surely, if the College was really concerned about licencing and regulation — and not, perhaps, just professional turf protection — someone could have simply picked up the phone and called their counterpart in one of the other jurisdictions where PAs already operate to ask how they managed to do it without endangering patients or the future of health care.

It shouldn’t be that hard. Really.

This column first appeared in the Halifax Examiner November 18, 2019.

  1. And we also have across Canada licensed Nurse Practioners who fill essentially the same roll as physician’s assistants. Tgectraining toute is different but the end result in qualification is almost identical to a PA. They are nurses who have a BScience in nursing who have gone on to do a Master’s degree qualifying them as Nurse Practitioners. They can practice and prescribe independently from physicians within certain parameters. They are often employed in multidisciplinary primary care practices or in specialty clinics where they become highly qualified in certain areas of expertise sych as heart failure, lung disease, kidney problems etc.

    Both NPs and PAs are underused in our health system. Funding seems to be an issue. It shouldn’t be rocket science……


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