CBC health reporter graduates as physician assistant

[ploughboy]

Yay (???) for two years of training and no residency

 

http://www.healthzone.ca/health/newsfeatures/article/893435--cbc-health-reporter-graduates-as-physician-assistant

 

 

Edit: I guess I should expand on my semi-snarky comment. I posted this article to generate some discussion, which I hope it does.

 

I've worked with military PAs and they've all been top-notch (maybe because most of the ones I worked with were ACPs before becoming PAs). I have never met or worked with Ms. Taylor and I'm not commenting specifically on her.

 

While there is a place for mid-levels, I think we need to be careful about integrating people into the system who potentially have (if the article is accurate) less training than an RN or even a clincial clerk. Comments?

[leviathan]

I think midlevels are a great addition to the health care team, but they shouldn't be replacing doctors when they have far less education and training. Canada is about 10 years behind US with these mid-level providers and if we want to prevent our country from seeing the same encroachment they have experienced, we should learn from their mistakes and nip this in the bud now.

[future_doc]

Well, assuming that Mac and U/T know what they are doing in their programs for P.A.s and are not idiots setting themselves up for having egg all over their professional faces and seeing that the physicians who direct them are ultimately responsible for their actions, it is win/win for the physicians, patients and government (being cost effective) - no matter what premeds or med students think to the contrary. They have a role to play and it is happening, a good thing for all.

[Apixaban85]

Well, assuming that Mac and U/T know what they are doing in their programs for P.A.s and are not idiots setting themselves up for having egg all over their professional faces and seeing that the physicians who direct them are ultimately responsible for their actions, it is win/win for the physicians, patients and government (being cost effective) - no matter what premeds or med students think to the contrary. They have a role to play and it is happening, a good thing for all.

 

So others are not allowed to question the decisions of universities?

[Gerrardfan]

I think PAs could be properly utilized in the Canadian Health Care system if those entering into it have some sort of health care experience. For example, nurses, RTs, X-Ray, all those people would have a good base knowledge for something like this. As someone who works at a major hospital in Canada, I think it has the potential to help relieve physicians of high work loads and insanely long hours, but not to replace them. It is almost like when anesthesia assistants first came into the mix, and everyone was up in arms about them replacing the techs, but ask any anesthesiologist how much they appreciate being able to leave during a case and actually eat something! Anyway, I get sick of the stat calls on floors to go assess a patient who "isn't doing well" only to find that the doc isn't even near the hospital nor willing to come in, but has asked the nurses to page the RT. I know hours are long and sometimes when the nurse says a patient is sick they really aren't, but what if there was a physician assistant who could be on hand instead (who is paid much less than a physician)? They would have the skill and ability to actually order appropriate tests and be able to tell the doctor if its worth them coming in or not. Anyway, if PA's could actually be utilized properly I think they would be a fantastic addition to Canadian health care system IF the admission criteria would change to people already involved in health care.

 

This post turned out way longer than I expected, sorry for the rant!

[future_doc]

So others are not allowed to question the decisions of universities?

 

I ddin't mean to imply that, sorry. I was thinking that the powers that be across the board have given the P.A. approach its blessing (the academics, the medical profession, the government that holds the purse strings), its a done deal and time will give us a more complete answer as to the effectiveness of P.A.s in the healthcare system.

[in2bat0r]

I can't believe how big their scope of practice is! I just did some researching after reading this post, I had no idea this position existed. They are well compensated as well, the U of Manitoba website said the salary range was 80,000-100,000. Thanks for the insight, don't know if the increase in PA's is a good thing or a bad thing though..

[bpp]

i researched the role of PA's a little bit more, and it seems(not emphasized in the article) that they only have the scope of what the doctor asks them to do. presumably the doctor would assess the PA's skill and only assign them tasks they feel the PA can perform well. i think overall it is a good idea to for the PA to help relieve some of the doctor's workload, so long as they don't have close to the same level of independence as a doctor or nurse practiotoner.

[PAstudent]

Reading through the thread I see some negativity about Physician Assistants (but am happy to also see some positive remarks), most of it based on ignorance. I am a PA student in Ontario and would be happy to answer any questions anybody has. PA training is fairly intense and PAs function in very-much the same way a resident does. Most physicians who have worked with PAs like them. The program at McMaster is modeled directly on the M.D. program and includes 12 months straight of clerkship rotations where the PA students are expected to perform at the same level as the M.D. students with whom they are clerking alongside. Indeed, PA students at McMaster even take many of the same examinations as the M.D. students (Personal Progress Index, Clinical Reasoning Exercise, OSCES) and, during the first 12 months, complete an almost identical PBL tutorial case-based course of basic medical sciences and clinical skills learning.

 

Indeed, the Director of the Physician Assistant Education Program at McMaster, Dr. John Cunnington M.D., developed both the current M.D. and PA programs at McMaster and has stated that at the end of the P.A. program the students should be (and the first graduating class is!) performing at the same level as the graduating M.D. students. The main difference is that the M.D. students spent the extra time they had (about 6 months more of clerkship and 2.5 months more of basic sciences) looking at the Zebras so to speak (more rare diseases) and delving slightly deeper into the basic science of things.

 

Of course, the graduating M.D. students go onto residency training and eventually become licensed to practice medicine without supervision. PAs, on the other hand, will always function under supervision and so, in that sense, they are like lifelong residents.

 

Imagine if every physician had a resident working with them. Now, imagine that, even though that resident starts out at about the level of PGY1, after a few years they have progressed and learned just as one does in residency. A PA with many years of experience in a particular specialty should become a high-functioning provider just as an M.D. would at the end of their residency training.

 

 

Please, feel free to ask me questions, I will try my best to answer. In the meantime, here are some good links:

 

http://www.cma.ca/index.php/ci_id/86599/la_id/1.htm

 

http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Advocacy/Physician_Assistants/PA-Toolkit_en.pdf#page=20

 

http://en.wikipedia.org/wiki/Physician_assistant

 

And just for fun:

 

http://fhs.mcmaster.ca/physicianassistant/index.html

[in2bat0r]

It's sounds very appealing, becoming a critical care flight medic has been my main back-up plan for medicine (having a background in pre-hospital care), but this seems even better.

[in2bat0r]

What provinces are PA's limited to?

[lostintime]

I think PAs could be properly utilized in the Canadian Health Care system if those entering into it have some sort of health care experience. For example, nurses, RTs, X-Ray, all those people would have a good base knowledge for something like this. As someone who works at a major hospital in Canada, I think it has the potential to help relieve physicians of high work loads and insanely long hours, but not to replace them. It is almost like when anesthesia assistants first came into the mix, and everyone was up in arms about them replacing the techs, but ask any anesthesiologist how much they appreciate being able to leave during a case and actually eat something! Anyway, I get sick of the stat calls on floors to go assess a patient who "isn't doing well" only to find that the doc isn't even near the hospital nor willing to come in, but has asked the nurses to page the RT. I know hours are long and sometimes when the nurse says a patient is sick they really aren't, but what if there was a physician assistant who could be on hand instead (who is paid much less than a physician)? They would have the skill and ability to actually order appropriate tests and be able to tell the doctor if its worth them coming in or not. Anyway, if PA's could actually be utilized properly I think they would be a fantastic addition to Canadian health care system IF the admission criteria would change to people already involved in health care.

 

This post turned out way longer than I expected, sorry for the rant!

 

The problem is that you can't exactly separate the clinical knowledge and skills you pick up from "experience" and recognizing zebras takes a lot of time to gain knowledge/skills. Sometimes even PGY5's may get a diagnosis wrong so it's not really practical for a PA to go and assess a patient and tell a consultant whether or not they need to go in.

 

If PA's function at the level of graduating MD students, then they should be able to write the same exams MD students write and be able to pass them. Otherwise, their role seems kind of in between and they obviously only function LIKE a resident, but without the clinical knowledge which is really dangerous when you have SOME knowledge, but not really enough not to miss important diagnoses. Simply knowing when to seek help requires a solid knowledge base that you can't always just get from experience.

[future_doc]

The key is that the PA is under the supervision of the physician who will not use the PA beyond his/her capabilities.

[Mourning Cloak]

The key is that the PA is under the supervision of the physician who will not use the PA beyond his/her capabilities.

 

True dat.

 

There are PAs in my home province (more NPs, though) and the way it seems to work (quite well, by the way) is the NP/PA is like a first year family medicine resident. They handle patients on their own, write prescriptions, counsel, but are supervised (to a greater or less degree based on their own competence) by a preceptor. If they have questions, their preceptor is always around to help them out.

 

(By second year, the family med residents are pretty much functioning independently).

 

The problem, of course, will arise if the NPs/PAs aren't properly supervised. While 85% of family medicine practice (and most fields of medicine in general) is routine, the other 15% is not. If the supervisor isn't around when the other 15% crop up, bad things will result.

[future_doc]

It is important that the PA use professional judgment, common sense and not overstep his/her competencies, which is in nobody's interest to happen as regards the 15% to which you refer above. Presumably, there will be an alternate physisican to consult shpould the primary supervising physician not be available.

[PAstudent]

What provinces are PA's limited to?

 

Right now, Manitoba and Ontario are the main provinces pursuing the use of PAs. That said, Alberta has just started as well and there are some PAS working in other provinces where there is discussion about greater utilization. We have actually had PAs in the Canadian Military for many years and some of them are now in civilian positions through the Country.

 

In Manitoba, PAs are regulated by the College of Physicians and Surgeons of Manitoba and regulation in Ontario is currently being set-up with the CPSO likely to be involved (nothing has been done yet).

 

Check-out:

http://news.gov.mb.ca/news/index.html?archive=&item=6437

 

https://www.oma.org/Resources/Documents/2009PAOMAStatement.pdf

[PAstudent]

The problem is that you can't exactly separate the clinical knowledge and skills you pick up from "experience" and recognizing zebras takes a lot of time to gain knowledge/skills. Sometimes even PGY5's may get a diagnosis wrong so it's not really practical for a PA to go and assess a patient and tell a consultant whether or not they need to go in.

 

That is true, and that is why many physicians often miss the Zebras sometimes as well. There is no question that a newly graduated PA is not going to be as knowledgeable or as skilled as a PA with 5 years of practicing medicine behind her/him. This would be the same for a physician, as you have pointed out.

 

If PA's function at the level of graduating MD students, then they should be able to write the same exams MD students write and be able to pass them. Otherwise, their role seems kind of in between and they obviously only function LIKE a resident, but without the clinical knowledge which is really dangerous when you have SOME knowledge, but not really enough not to miss important diagnoses. Simply knowing when to seek help requires a solid knowledge base that you can't always just get from experience.

 

Though not eligible to sit for the MCCQEs, PA student at McMaster are evaluated in the same way, on the same internal exams, and by many of the same evaluators as are the MD students at McMaster. The PA clerkships have been integrated with the MD clerkships and the same expectations placed on the MD students are placed on the PA students. Prior to clerkship, the PA students go through the same case-based PBL tutorial learning of the basic medical sciences that the MD students go through. There is no good reason why a PA would be more likely to "miss important diagnoses" than an MD. All of our examinations are based-on clinical reasoning including differential diagnostics and we are taught to reason through patient presentations using the medical knowledge we are acquiring. This is the same thing that the MD students do.

 

And you are one hundred per cent correct that "knowing when to seek help requires a solid knowledge base that you can't always just get from experience." We do develop that knowledge base and we are taught to know our limits and involve our supervisor. This has been a hallmark of the profession in the USA. This is a great, mostly American, forum for PAs http://www.physicianassistantforum.com/forums/forum.php

 

In addition to my being available for questions here, I am sure the good folks on that board would be happy to welcome any inquiries.

[A-Stark]

Of course, the graduating M.D. students go onto residency training and eventually become licensed to practice medicine without supervision. PAs, on the other hand, will always function under supervision and so, in that sense, they are like lifelong residents.

 

That sounds really unappealing.

 

So do PA students do call as well?

[Jochi1543]

I know hours are long and sometimes when the nurse says a patient is sick they really aren't, but what if there was a physician assistant who could be on hand instead (who is paid much less than a physician)? They would have the skill and ability to actually order appropriate tests and be able to tell the doctor if its worth them coming in or not.

 

I don't really get it, though, if they have less training than a nurse, how could they help nurses figure things out? Why not just give nurses privileges for ordering tests, in that case? And rather than have these PAs, why not just train and hire more nurses? I must be missing something.

[PAstudent]

That sounds really unappealing.

 

So do PA students do call as well?

 

 

 

Yes, PA students take call during clerkship.

[PAstudent]

So, PAstudent, what is the appeal of going into this career where you are evaluated on the same terms and eventually pick up the same knowledge and experience as a doctor when you don't actually become a doctor nor make as much money or have as much independence?

 

Also, what is the lifestyle like. Are you on call? Are you on shiftwork? Do you get yelled at by physicians and residents? Is there a lot of scutwork? Are you given the less popular procedures ?

 

 

The appeal for me is less time in school, greater flexibility within my career to change paths (for a physician to change specialties they would likely need to do a residency whereas a PA can work in multiple specialties or switch specialties if they like). Another part of the appeal for me is being a pioneer in developing the profession in Canada, getting to be a part of something new. Also, in terms of compensation, it is quite good, though, as you pointed-out, not necessarily as high as a physician's compensation.

 

As for being on-call, doing shift work, etc., etc. That will differ by specialty and by chosen place of work. The PA role is uniquely determined by the relationship between the PA and the physicians he/she works with and the parameters of the role are different from place to place as well. Most emerg PAs do shift work, most surgical PAs do call, etc., etc. PA students take call and do the same things MD students do at McMaster (other schools might be different).

 

So, the lifestyle of a PA, much like the lifestyle of an MD is determined by specialty and place of employment. Whether or not you get yelled at and get the scutwork is determined, again, by where you work and who you are. One member of the recently graduated class is an emerg PA at a busy hospital and she sees all types of patients in emerg and the physicians she works with think so much of her that they have placed no limitations whatsoever on her practice, even though she is straight out of school. They have recognized how good she is and that she will come to them if needed so they trust her like that. Another emerg PA I know has been limited by the physicians she works with and only does fast-track work (casting, sutures, UTIs etc., etc.). So, as you can see, so much is determined by who you are, who you work with, and where you work.

 

Some of the students at McMaster have great health care experience (FMGs, paramedics, nurses etc., etc.) and some have no background in medicine. Everyone brings there own unique skills and knowledge just as with MD students.

[PAstudent]

I don't really get it, though, if they have less training than a nurse, how could they help nurses figure things out? Why not just give nurses privileges for ordering tests, in that case? And rather than have these PAs, why not just train and hire more nurses? I must be missing something.

 

PAs are diagnosticians, like physicians. I wouldn't say that PAs necessarily have less education than RNs, PAs have different education. Usually 2-4 years of a university degree (most of my classmates have science degrees, as do I) plus 24 months straight (so about equivalent to 2.5-3 years of regular school with summer breaks) of PA/medicine training that is based on the MD model (i.e. we are trained as allopathic diagnosticians). Nursing is an entirely different profession than medicine/physician assistant. So PAs have at least about 5 years of school, many have masters degrees in medical sciences as well. But, even without that, the 24 months of training we get is basically almost the same as the training the MD students get with the main difference being about 6 months of clerkship more for them and 2 months more of basic science (my numbers might be a bit off as I am doing this off the top of my head so to speak).

 

I am assuming the NP comparison is going to come-up so, I took this from the Canadian Association of Physician Assistants web-site: http://www.caopa.net/images/stories/COMPARISON_PA_NP_final_aug2010.pdf

[future_doc]

Coming out after two years with $75,000/yr and virtual job security is not bad at all. Vets earn about the same and have to pay for their own practice, rent, equipment, employees, etc.

[PAstudent]

Coming out after two years with $75,000/yr and virtual job security is not bad at all. Vets earn about the same and have to pay for their own practice, rent, equipment, employees, etc.

 

Yes, that is part of the appeal for many as well. As an older student who wants to practice medicine, the PA route for me is appealing because of my financial situation and my age. In the USA, Physician Assistant often ranks as one of the best jobs in the country: http://money.cnn.com/magazines/moneymag/bestjobs/2009/snapshots/2.html and http://www.focus.com/images/view/7362/

[hastin11]

I really really dont get it--if they have "almost the same training as in med school," what is the rationale of NOT going to med school? Higher pay/responsible/influence for what you claim is not much more school--why wouldnt you just do an MD?

 

And I really dont buy the "have better job flexibility." Even if an MD is trained within an extremely specific specialty, they still have enormous flexibility. Is this actually a sort of "saving face" reason, with the real reason being that these programs are easier to gain admission to?