The Name Change

[PAstudent]

PAStudent...you are a remarkable resource-thank you. And everything I've heard from you so far seems true (I ask my friends Dad, who is an ER Physician that works with a PA in Ontario!). So in my books, you're reliable and correct

 

 

No worries

[future_doc]

You have a disrespectful tone about you, A Stark, that has now reminded me of how disrespectful and inappropriate you were in previous threads about PAs.

 

I will no longer engage you.

 

I am on here to answer questions about PAs to those who honestly are seeking that knowledge, not to debate with troublemakers.

 

He is in a league of his own. Don't waste your time.

[A-Stark]

You have a disrespectful tone about you, A Stark, that has now reminded me of how disrespectful and inappropriate you were in previous threads about PAs. I have already explained to you what PAs are and what PAs do yet you persist. You can easily read about PAs online or take me up on my offer to work with one yet you don't.

 

I'm happy to be misinformed but you mistake bluntness for disrespect. It is certainly not straightforward to figure out what the role is in the Canadian context when it is essentially limited to two provinces and the military. There are no PAs here and I never encountered any (that I knew of) in Hamilton or Toronto hospitals. Examples from the US are not necessarily instructive.

 

I know PAs who do appendectomies and I know PAs who do a lot of other surgical procedures. I do not personally know for certain a PA who does whipples from start to finish and, whether that is the case or not, is hardly relevant to what I said. And, as I already said, I do know PAs who sign off on radiology reports (and echos).

 

Again, I don't understand the scope of practice then, as it's surprising to me that radiologists or cardiologists would pass off those kinds of billable studies to mid-levels.

 

I think I will now take the approach to you that I took in previous threads when you were behaving in this way, an approach I would have continued if I had remembered you before you so kindly reminded me by demonstrating this unprofessional behaviour once again. The approach is to ignore you. I will not be directly answering any of your posts any more. When I first decided to ignore you my private message box filled-up with supportive messages from people telling me what they thought of you (including some who claimed to know you in-person). I will no longer engage you.

 

I'm sorry that you feel that way. And I apologize if I have ever come across to you as personally hostile - that has not been the intent, though I hope you realize that skepticism toward the increasing use of midlevels is not an illegitimate viewpoint.

 

I don't think that PAs represent any kind of "threat" in that respect; nor do NPs or Anesthesia Assistants (who I suppose are to PAs as dentists are to MDs - similar in principle but with a very, very specific scope). But in light of recent rhetoric and action from the McGuinty government, there is considerable tension and concern about "cost-saving" measures and mid-levels are frequently touted as a solution. Physician "extenders" are but some of the boosterism comes off as sounding like physician "replacements".

[maritimer]

Hey A-Stark,

 

Maybe you are already aware of this, but maybe not. Just thought I'd throw some interesting links out there for you for more understanding, if you want.

 

A map of all the communities PA's are working at in Ontario (this document isn't quite current, and there are more communities now). I gave Ontario, as it has a huge pilot project going on, that has been very successful in PA integration and has spread all over the province.

 

http://www.healthforceontario.ca/upload/en/work/pa_map_11_22_2010_eng.pdf

 

PA Scope of Practice-It is very exhaustive, but the info is there if it's what you are looking for to gain a better insight into the role and scope.

 

http://capa-acam.ca/user_files/users/25/Media/Scope%20of%20practice%20and%20national%20competency%20profile/NCP_en_sept2009.pdf

 

This toolkit has been put together for Canadian Physicians to get a better understanding and gain more knowledge on the profession, for those who do not know.

 

http://www.healthforceontario.ca/upload/en/work/pa-toolkit_en.pdf

 

Anyways, I just put these links here since from your post it seemed you were not quite clear on the extent of the role or the PA place in healthcare perhaps (I could be wrong, but I see you signtaure is Dal Med, so those from the Maritimes probably wouldn't know what a PA does/role is-only NB uses them so far). But you're right, a lot of Physicians do not know what they are, but then again....a lot do.

 

I do know they work in the provinces of BC, Alberta, Manitoba, Ontario, New Brunswick, and the other provinces are looking into them now as well.

[jerkstore]

Stark I assume you're familiar with the Nurse Practitioner, it's the same thing. PA's have been practicing for 40 years in the states, and are now just catching on here.

 

The whole point of these two professions is to relieve work of the generalist/family physician. You don't do that by handing the physician tools, like the dental assistant.

[maritimer]

Stark I assume you're familiar with the Nurse Practitioner, it's the same thing. PA's have been practicing for 40 years in the states, and are now just catching on here.

 

You sort of have it right jerkstore! A NP has an independent scope of practise, so (s)he is able to open their own clinic/practice, if they want. A PA can't-and must work in collaboration with the Physician in whatever practise setting they are in. A NP works primarily in primary care trained in the nursing model, whereas a PA can work in any specialty and is trained in the medical model. Most PAs (in Canada) work in family med, ER and OR (ortho).

 

The whole point of these two professions is to relieve work of the generalist/family physician. You don't do that by handing the physician tools, like the dental assistant.

 

Agreed! A PA can relieve the work of not only generalists/family Physicians, but also of any other type of Physician (depending on the specialty of the PA).

 

On that note, let's all just get along. It's so disheartening/dismaying to see people in related health care/similar fields bickering with each other. We're all in school/working for the same reason-to be in the health care field and help others.

[what]

I have a hard time believing a general surgeon is letting a PA do an appy from start to finish regularly, nor do I believe that PAs are signing off on echos or radiology reports. They may do things such as vein harvesting for CABGs or helping out with ortho surgeries, but to be in charge of a procedure from start to finish, I find to be highly unlikely and I'd like to see proof of this. Nothing I've encountered on the american physician assistant boards have shown me otherwise. Making such controversial statements like that without backing it up might be why you're getting attacked by Stark.

[jerkstore]

I have a hard time believing a general surgeon is letting a PA do an appy from start to finish regularly, nor do I believe that PAs are signing off on echos or radiology reports. They may do things such as vein harvesting for CABGs or helping out with ortho surgeries, but to be in charge of a procedure from start to finish, I find to be highly unlikely and I'd like to see proof of this. Nothing I've encountered on the american physician assistant boards have shown me otherwise. Making such controversial statements like that without backing it up might be why you're getting attacked by Stark.

 

 

Stark I assume you're familiar with the Nurse Practitioner, it's the same thing. PA's have been practicing for 40 years in the states, and are now just catching on here.

 

The whole point of these two professions is to relieve work of the generalist/family physician. You don't do that by handing the physician tools, like the dental assistant.

 

Does anybody listen anymore?

[future_doc]

By whatever name, the PA is here to stay and is presently in its infancy in Canada. The PA is already in 5 provinces and there are 3 university programs in Canada (please correct me if I am incorrect). There have been only a tiny number of graduates but as more and more come on stream, they will be noticed due to their numbers, their impact in relieving/assisting physicians and in terms of cost effectiveness for the healthcare system.

[PAstudent]

 

The whole point of these two professions is to relieve work of the generalist/family physician.

 

That's not quite correct. While PAs are trained as generalists, lots of PAs work in specialties.

[leviathan]

I have a hard time believing a general surgeon is letting a PA do an appy from start to finish regularly, nor do I believe that PAs are signing off on echos or radiology reports. They may do things such as vein harvesting for CABGs or helping out with ortho surgeries, but to be in charge of a procedure from start to finish, I find to be highly unlikely and I'd like to see proof of this. Nothing I've encountered on the american physician assistant boards have shown me otherwise. Making such controversial statements like that without backing it up might be why you're getting attacked by Stark.

I second this. I have experience with lots of PAs in the United States and they are not doing surgeries by themselves. PAs can basically do whatever their supervising MD is comfortable allowing them to do but I've never seen that extend to fully independent surgeries or reading echos. They are working as first assists and as you said, I've seen them in cardiac surg doing vein harvests and closing everything but the sternum after the surgery is over. In the ED they usually work in the fast track area while the acute beds are covered by the emerg MDs. As you said, I don't see how A-stark is being disrespectful by simply questioning the legitimacy of these claims.

 

I fully support PAs as a model of midlevel providers. If we have midlevels they should be monitored by an MD and granted a level of autonomy that is commensurate with their assessed competence. That is the case with PAs but not with NPs, who can work independently. I have seen some excellent NPs but I have also worked with many who functioned more at the level of a clinical clerk. To let them all loose on the general population is a bit reckless as their licensing exams are clearly not able to differentiate between those who do and do not have the knowledge and ability to work independently.

[PAstudent]

I'd be glad to introduce you to 6 emergency medicine PAs, all working in major Ontario hospitals, who see all levels of acuity and work in every emerg zone doing everything from running codes in the resuscitation room to managing DKAs, to everything else in emerg.

 

Sure there are PAs that just do fasttrack and there are PAs that just do this procedure or that procedure, just as there are physicians who limit themselves to certain things. But those things do not define the scope of practice of a PA. As you pointed out, PAs may do whatever their supervising physician is comfortable with them doing.

 

It is indeed rare to see PAs performing complex surgeries from start to finish; it is the exception rather than the rule, but it does occur and it is something a PA can do. In particular I know some ortho PAs that work with one orthopod where they set-up multiple ORs, have a PA in each OR, where one PA specializes in say knee arthroplasty, another in hips, etc., etc. and the orthopod pops from room to room to make sure everything goes well and to do anything complicated/requiring his expertise if the need arises.

 

I second this. I have experience with lots of PAs in the United States and they are not doing surgeries by themselves. PAs can basically do whatever their supervising MD is comfortable allowing them to do but I've never seen that extend to fully independent surgeries or reading echos. They are working as first assists and as you said, I've seen them in cardiac surg doing vein harvests and closing everything but the sternum after the surgery is over. In the ED they usually work in the fast track area while the acute beds are covered by the emerg MDs. As you said, I don't see how A-stark is being disrespectful by simply questioning the legitimacy of these claims.

[what]

My experience has been that PAs in ortho will prep, open, and close hips and whatever else. And they do a great job of it. In fact one of the studies I looked at found that use of PAs in a canadian community ortho OR setting found that they were more useful at that specific scenario (prep, open, close, post-op care) than the GP assists and often times the senior residents as well. But they were used so that the orthopod could run 2 rooms simultaneously and go in and do the actual surgery himself, and leave the extra stuff (prep, open, close, post op care) to the PA, thus increasing the number of surgeries that could be done. Again, none of this involved the PA actually doing the surgery itself. And I find it hard to believe a surgeon with their limited OR time as it is allowing anyone than themselves to do the surgery. These people are anal-retentive perfectionists who love to cut - there's no way they're letting someone else get that satisfaction.

[leviathan]

I'd be glad to introduce you to 6 emergency medicine PAs, all working in major Ontario hospitals, who see all levels of acuity and work in every emerg zone doing everything from running codes in the resuscitation room to managing DKAs, to everything else in emerg.

I've trained at many hospitals in Ontario and I never ran into any PAs at any ED. Which hospitals in Ontario are they providing ALL levels of care?

 

For what it's worth, my only experience with Canadian PAs was working with a student while I was at McMaster. Nice guy, though knowledge was a bit lacking. I believe he was still a "pre clerk" if you guys call yourselves that, so it's not fair to compare his abilities yet.

[PAstudent]

I've trained at many hospitals in Ontario and I never ran into any PAs at any ED. Which hospitals in Ontario are they providing ALL levels of care?

.

 

The ones I know for certain are Sunnybrook and Timmins and District Hospital and the ones I am not 100 per cent on, but understand from what I have heard are Guelph General Hospital and Oakville-Trafalger.

 

Sunnybrook and Timmins in particular are well-known in the Ontario PA world to be leaders in the use of emergency medicine PAs. The PAs at Sunnybrook are on the resident schedule and work shifts in all the zones (purple, blue, and green/orange) and all the different shifts (overnights, evenings, days, etc., etc.).

 

I did my core emerg rotation at Sunnybrook and have done multiple horizontal electives (a McMaster term I think) there so that's how I know about the 'Brook. I know about Timmins because of Dr. Chris Loreto, the emerg chief there, having talked about it.

 

This video of a webinar might interest you: http://epresence.med.utoronto.ca/1/watch/900.aspx it features Dr. Loreto and Dr.Paul Hawkins (Director of Emergency Services, Sunnybrook Health Sciences Center). Dr. Hawkins is the main driving force behind the PAs at Sunnybrook.

[leviathan]

The ones I know for certain are Sunnybrook and Timmins and District Hospital and the ones I am not 100 per cent on, but understand from what I have heard are Guelph General Hospital and Oakville-Trafalger.

 

Thanks for the info.

[maritimer]

The ones I know for certain are Sunnybrook and Timmins and District Hospital and the ones I am not 100 per cent on, but understand from what I have heard are Guelph General Hospital and Oakville-Trafalger.

 

Sunnybrook and Timmins in particular are well-known in the Ontario PA world to be leaders in the use of emergency medicine PAs. The PAs at Sunnybrook are on the resident schedule and work shifts in all the zones (purple, blue, and green/orange) and all the different shifts (overnights, evenings, days, etc., etc.).

 

I did my core emerg rotation at Sunnybrook and have done multiple horizontal electives (a McMaster term I think) there so that's how I know about the 'Brook. I know about Timmins because of Dr. Chris Loreto, the emerg chief there, having talked about it.

 

This video of a webinar might interest you: http://epresence.med.utoronto.ca/1/watch/900.aspx it features Dr. Loreto and Dr.Paul Hawkins (Director of Emergency Services, Sunnybrook Health Sciences Center). Dr. Hawkins is the main driving force behind the PAs at Sunnybrook.

I actually watched this video (not all at once-it's long) and it's really very informative and gives good insight into the PA profession in Canada, how they operate, and where it is going in the future, since it's in it's infancy in civilian life. Very cool!

[Yellowhead]

The title of, "Physician Assistant" misrepresents what PA's actually do. The general public (I would argue), and I for one, think of 'assistants' as synonymous with the word 'helpers." 'Helpers' or 'assistants' rarely exercise autonomy and/or decision making by themselves. They certainly would not diagnose or treat one's ailments; yet, this is precisely what PA's do-one of many reasons a name change is needed. 

[CharmingHedgehog]

This thread has been super helpful in providing information about PAs, thanks everyone! It sounds like PAs are similar to R3/R4 residents in a specialty to me. Regardless, I try to judge a person based on their ability to provide care when I encounter them, and not have a stereotypical view on what they do. The PAs I've seen working with orthopods are awesome at what they do. The one PA student I met in a GP clinic was very new and unsure, but that's to be expected since they are still learning. 

Not sure if Physician Associate is any more clear than Physician Assistant. I somehow have the image of a business partner when thinking of an associate, and not necessarily someone who provides clinical care. Regardless of the wording, I don't think the role of a PA will be explained even remotely by just their job title because it's so new in Canada. Literature in the waiting room is definitely the best way to go to educate patients and other health care providers

[Mithrandir]

I like it? I feel like they are very educated people with a pretty large scope of practice to be called "assistants".

[ralk]

I like it? I feel like they are very educated people with a pretty large scope of practice to be called "assistants".

 

PAs have a large scope of practice because it's defined by the physicians they work with. It's not a regulated health profession in Ontario (not sure about other jurisdictions) - a PA derives their entire legal authority to practice medicine from the physician's delegation powers, essentially working off that physician's license. A PA has no independent scope of practice.

 

I'm pretty ambivalent about the name, I think either assistant or associate would be fine. Assistant fits to me - while a PA isn't necessarily handing tools to a physician or that sort of thing, they are performing tasks at a physician's direction in one form or another, presumably assisting them in their practice in some way. Certainly there's some autonomy, but it's supervised autonomy - if a PA makes a poor management decision, it's the overseeing physician who's ultimately liable.

[danijaq]

I personally feel that the name changing process is more about PA's inferior complexity syndrome and would like to have a cooler tittle

 

If a person want to become a doctor, then study medicine. Why apply to another profession with the mentality of "this is almost like a doctor too"

I think your comments just highlight your lack of education on what physician's assistants actually do, the value they bring to optimizing patient care and the strain they relieve from full physicians in the Canadian health care system. Any physician working with a PA will not undermine the SUPERIOR complexity of their PA and will be thankful for their work. Your pure simple minded thinking about the health care system being made up of "doctors" and "not doctors" is really disgraceful and I hope you aren't planning to become a doctor yourself.