The future

[Suranest]

How do you view the scope of practice of np and pa s in 15-20 years? 

How will the physician-np/pa relationship be? Do you see midlevels taking the place of family doctors? What will they do then?

[VivaColombia]

In Canada for PAs? No better than it is today. There's all this talk and advocacy for the profession but nothing ever happens. People have been waiting for regulation and recognition for years yet nothing has occurred. Sure being a PA is great with a good work/life balance but positions are usually contracted in ON, there are funding issues in MB (heard from a friend C/O 2020 which graduated in June still has multiple people unemployed), and barely any jobs outside MB/ON. You really have to sell yourself and after paying 40-50k for a degree with no stable job prospects, got to rethink your career choice. In the US though, best career choice in being a PA

[Bluestreak55]

I disagree. The change is slow and gradual (in the media and in policy and in regulation) but we're closer to regulation today than we've ever been. There's a few pathways to regulations so when one pathway doesn't work and we have to pursue another one it can seem like there is no perceptible progress. Funding and job prospects are an issue in every profession even with doctors, nurses and nurse practitioners. Have people suffered from these issues? Absolutely. But looking at the big picture the problem is more systemic rather than profession specific. 

[Bueno]

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[Bluestreak55]

The next couple of years will be slightly more interesting that usual to see if regulation plays out for ON and AB, yes, and how that will impact the PA profession. This is a topic I've been reading about for some time so I will summarize some thoughts below. 

It's very difficult to compare the timeline of regulation/legislation of PAs in the USA versus Canada. The easiest comparison is at the national level: it took almost 30 years (from mid 1960s to early 1990s) before American PAs were recognized by the American Medication Association. If we take the same starting point of "first PA education program", then Canadians are just over 10 years into PA development nationally and we are obviously not at the level of well-established national recognition. If we look at it state by state and by province/territory, it gets more complicated. It's clear the idea of PAs was picked up much quicker in the USA but the development was still gradual. For example, the first legislation/regulation for PAs was in Colorado but only for "child health associates" in 1969. PAs did not start prescribing until 20 years later (1980s). A uniform rate payment for American PAs was not established until 1997. I can't find any data that would allow for comparison of PA employment rates of American PAs in the 60s-90s compared to Canadian PAs now (would need to take into consideration population and economical differences and I am not sure this comparison is even possible). Sources: https://www.aapa.org/wp-content/uploads/2017/01/History_Milestones.pdf; https://capa-acam.ca/wp-content/uploads/2018/01/JAAPA-50-Years-PA-History-ebook.pdf

As for job prospects of PAs compared to doctors, nurses and NPs. I have not seen any reviews that allows for comparison so if anyone has some information and insight on this, feel free to share. I just know that there are common themes when you hear about the issues raised among nursing unions and medical associations. I suspect that PAs are probably more impacted by the same issues given our lower numbers (and thus representation in financial budgeting) and in-development infrastructure. I get the sense that if you are willing to relocate, compromise on hours and pay, be flexible with your field of practice, then you will find a job as a nurse, NP or doctor no matter what. This may not always be true for PAs given provincial restrictions to practice and lack of pre-existing infrastructure in some cities/hospitals even though PAs are practicing in the province. But if we are talking about people finding a full time position with good pay and hours in their field of choice, I'm seeing the same problems in all health care professions. 

[Bluestreak55]

Oh I should add that some Ontario PAs are pushing forth unionization 

[i_saw_things_i_imagined]

Christine Elliott, the minister of health for the government of Ontario came on record (on October 16) to say that the government was committed to making PAs a regulated and licensed profession, registered under the College of Physicians and Surgeons of Ontario.

 

This process will probably unfold over the next several years, but this promise is the best thing to have happened in terms of stabilizing the future of the profession.