CBC health reporter graduates as physician assistant

[cardiomegaly]

I've heard in Manitoba they've been using some PA's to open and close cases so that the surgeon can be more efficient. But in all honesty, if I'm a surgeon and I have the option of a PA assisting me or my R2 surgical resident, doesn't it make more sense to be training my resident? Or even take on a medical student? In terms of training years it would make more sense to have the 4th year clerk seeing patients and making diagnoses and plans under the supervision of the attending? I just think with the recent expansions (especially in Alberta) there is an overload of students and a shortage of willing preceptors - throwing in PA's could take away some valuable learning experiences.

[A-Stark]

Exactly. The notion that physicians in large teaching hospitals (like, say, at Mac) are so hard done by for extra help seems rather silly. I've been in some clinics (maternal-fetal, for example, or family planning) with 2-3 clerks, a PGY-1, fellow, and staff. It's still busy, but between them and the nursing staff there is absolutely no need for a PA. Similarly, occasionally a 2nd assist is "necessary" for a C-section, but you'd be hard pressed to pay someone $75,000/year for that kind of work, let alone the usual kinds of "surgical assist" tasks that family docs or students take on. The odd bit of retracting and cutting suture wires isn't much work.

 

As a CC3, I don't dictate OR cases, but I write the note and round on patients later. The resident usually dictates. Where does a PA fit in? Only at non-teaching hospitals? I was under the impression that family docs who do surgical assists actually want to do that too. Exactly who is pushing this? For a family doc patient having a section, for example, the GP takes my role. Otherwise I'll retract, cut suture wires, place the odd subq stitch and put in staples. There really isn't any more work to do.

[NLengr]

PA's main use is going to be at smaller community hospitals where residents/students aren't available. There they can provide surgical assists, help in clinics and manage minor floor issues. Roughly like a CC would normally do in a teaching center. They won't be replacing residents at teaching centers so I don't think there is a reason to worry with respect to training.

 

As for PA's opening and closing, this will probably soon come to an end, if it even happens. Many centers are now requiring that the lead surgeon remains in the room throughout the entire procedure. Liability concerns are driving this. The days of the surgeon leaving while someone else closes are rapidly coming to an end.

[Cher]

Easy answer: The Canadian government.

 

PAs are a far, far cheaper option to do simple tasks like paperwork and surgical assist than family doctors. They are not cheaper than residents but the community does not have a lot of residents so the work has to come from docs or PAs. Guess who the bean-counters would rather hire?

 

All hail the noctors!

 

Just out of curiousity, what does a PA make in a year?

[hking03]

Just out of curiousity, what does a PA make in a year?

I think they mention earlier in the thread that it's anywhere from 70-100k depending upon province and experience.

[PAstudent]

Just out of curiousity, what does a PA make in a year?

 

In the USA, where the profession is well-established and has been around for decades, the median is around $90,000/year (I've seen figures that very around that mark) with a range from the low 70s up to about $140,000/year. Really, this differs from state to state and depends very-much on the PA's experience, specialty, and type of work (do they take call, etc., etc.). In Manitoba things are similar and in Ontario we don't know how things are going to pan-out. The subsidies being offered by the Ontario Government is for PA employment seem to be between $75,000.00/year and $92,000.00/year. The minimum acceptable salary is set at $75,000. I have spoken to PAs who make about $130,000/year. But I would imagine most newly graduated PAs to be making less, likely between 75-100.

 

Some of the links I posted earlier in the thread give salary information.

[Cher]

In the USA, where the profession is well-established and has been around for decades, the median is around $90,000/year (I've seen figures that very around that mark) with a range from the low 70s up to about $140,000/year. Really, this differs from state to state and depends very-much on the PA's experience, specialty, and type of work (do they take call, etc., etc.). In Manitoba things are similar and in Ontario we don't know how things are going to pan-out. The subsidies being offered by the Ontario Government is for PA employment seem to be between $75,000.00/year and $92,000.00/year. The minimum acceptable salary is set at $75,000. I have spoken to PAs who make about $130,000/year. But I would imagine most newly graduated PAs to be making less, likely between 75-100.

 

Some of the links I posted earlier in the thread give salary information.

 

It is a lot more then I expected. I currently live on $14.065.00 a year so it is a heck of a lot better then that. Thanks for the reply and info. I should have read the thread more thoroughly beforehand however. (I also live in Hamilton, Ontario)

[GatewayMD]

To my point, regardless whether or not you think doing nursing work is a good use of PA's time, the fact is they have the ability to do it (administering drugs, talking drugs etc.), same as a CC or PGY-1. So if a family doc in a community setting wishes to use you in that manner they can. I see PAs as nurse+, you can do nurse work plus history/physicals, I question how many doctors are comfortable having their PA's be sole diagnosticians outside of maybe military settings.

 

All I'm trying to say is we should be very clear what this program is for, its not going to provide superior care to patients it's a government maneuver to save money. A sustainable solution that keeps patient care and good outcomes high would be training more nurses and physicians end of story. But money calls the shots, in this case government wants to save money. As you were saying PA's are more established in the US, this is not surprising since they run on a for-profit model.

[PAstudent]

I see PAs as nurse+, you can do nurse work plus history/physicals, I question how many doctors are comfortable having their PA's be sole diagnosticians outside of maybe military settings.

 

 

Have you ever had the chance to work with a PA (I am assuming from your nickname that you are a physician)?

 

PA programs give no nursing training whatsoever. Nursing is a profession unto itself with a theoretical framework and construct and most nurses worked very hard and completed nursing degrees to learn nursing. PAs don't learn nursing. PA students learn medicine.

 

Most Ontario physicians I have spoken to are comfortable with the role of a PA and, in the USA, most physicians certainly are. I have several American cousins who are physicians, all of whom work with PAs (in fact, that is how I first encountered the role) and they all think a fair bit of them. One of my cousins, the chief of an ED, has two PAs and he says they are as competent as he is to practice emergency medicine and that he often consults them on his own cases.

 

I think that your concerns very-much echo the concerns of American physicians of the 1960s. But, once they actually experience working with PAs, most quickly changed their minds. That has been happening here as well.

 

The Director of the PAEP program at McMaster has been getting phone calls from physicians and surgeons asking how they can hire a PA and are quite disappointed to find out they will have to wait for the next graduating class.

 

As more and more physicians work with PAs, the word is spreading and more and more physicians want to work with PAs. And, having spoken to several of the newly graduated PAs and former military PAs/American trained PAs that having been working in Ontario for a while, I find that they are indeed performing the role of a PA and not simply being used for what you are calling nursing work.

[Mourning Cloak]

Personally, I think NPs are the way to go.

 

You've got a person who already has a whole basketful of useful skills - they're really good at that whole emotional support thing that keeps people out of trouble in family medicine, they understand drugs & dosing, they know how to chart, they can do 90+% of the basic procedures in family medicine, and most importantly, they already have that nursing mentality drilled into them: check, double-check, be precise and document.

 

Why bother teaching a few years' extra stuff to a random student? I say run experienced nurses through. You'd get a whole lot more bang for your buck. If I were a family doc (I'm not) I'd want an NP because you'd know you'd be getting somebody who already had an established level of competence and the ability to work in a team.

 

We have NPs out west, and they do a really good job at what they have been assigned to do.

[A-Stark]

Have you ever had the chance to work with a PA (I am assuming from your nickname that you are a physician)?

 

PA programs give no nursing training whatsoever. Nursing is a profession unto itself with a theoretical framework and construct and most nurses worked very hard and completed nursing degrees to learn nursing. PAs don't learn nursing. PA students learn medicine.

 

It seems like PA students do a bit of medicine anyway. I'm not sure what "theoretical framework" or "construct" nurses learn that physicians don't - certainly, you'd be hard pressed to fund much teaching of the "philosophy" or "theory" of medicine. One RN friend of mine considered courses like that to be tedious fluff.

 

When you get down to the actual scope of practice of nurses, there is still substantial overlap with what you describe as the roles of PAs. Nurses and NPs take histories and vitals, do exams, and tend to work independently in many, many settings (emerg, birth unit, etc.). They may still be under the supervision of a physician when it comes to management decisions and (most) orders. It's certainly true that nurses have a different sort of job than physicians, but I think you grossly overstate the differences between them and the well-paid CC4s/PGY1s that PAs seem to be.

[A-Stark]

Personally, I think NPs are the way to go.

 

You've got a person who already has a whole basketful of useful skills - they're really good at that whole emotional support thing that keeps people out of trouble in family medicine, they understand drugs & dosing, they know how to chart, they can do 90+% of the basic procedures in family medicine, and most importantly, they already have that nursing mentality drilled into them: check, double-check, be precise and document.

 

Why bother teaching a few years' extra stuff to a random student? I say run experienced nurses through. You'd get a whole lot more bang for your buck. If I were a family doc (I'm not) I'd want an NP because you'd know you'd be getting somebody who already had an established level of competence and the ability to work in a team.

 

We have NPs out west, and they do a really good job at what they have been assigned to do.

 

I completely agree. We don't need pseudo-residents, we need experienced health care professionals to function as permanent housestaff, as opposed to constantly rotating clerks and residents. That, of course, is what happens in acute care units in many major centres. I don't see the need for some additional mid-level; it's not going to change the nursing shortages/lack of funding for OR time or opening new beds.

 

What we don't need are second-career dilettantes entering "medicine" in their 50s. What's the point?

[PAstudent]

We don't need pseudo-residents, we need experienced health care professionals to function as permanent housestaff, as opposed to constantly rotating clerks and residents.

 

Exactly! And that is what you get with a PA. A few years after graduation a PA will be an "experienced health care professional" and will be able to function as permanent house-staff.

 

I think that it is very difficult for someone to appreciate the role of a PA until they have experienced it themselves. Work with a few PAs and then get back to me

 

What we don't need are second-career dilettantes entering "medicine" in their 50s. What's the point?

 

 

Just for the record, I am 27 and many of my classmates are younger than me. We do have students older than me and I don't see anything wrong with that. Even if you do have someone in their 50s, that person can still practice medicine for 10,20,30 years even. I know several physicians in their 80s still going strong.

 

I am a bit taken back by your opposition to PAs without, so far as you have shared, having had the opportunity of working with them or of seeing how they are implemented in different settings.

 

I joined this thread to offer some facts/knowledge about PAs form those who have many misconceptions or simply don't know much about us. I feel as though it is turning more into a debate between myself and a few others and I think it somewhat pointless so I am going to try to avoid debating and simply go back to answering questions/offering information if the opportunity arises.

 

I hope that what I have shared has been helpful.

[A-Stark]

Exactly! And that is what you get with a PA. A few years after graduation a PA will be an "experienced health care professional" and will be able to function as permanent house-staff.

 

I think that it is very difficult for someone to appreciate the role of a PA until they have experienced it themselves. Work with a few PAs and then get back to me

 

I think you have more than adequately described the roles of PAs in different settings. This is not about their competence, but about the introduction of another class of professionals who cannot work independently yet are touted as replacements for "overworked" family docs. It seems nothing so much as an attempt to lower the standard of care to effect putative cost savings. We'll see.

 

Just for the record, I am 27 and many of my classmates are younger than me. We do have students older than me and I don't see anything wrong with that. Even if you do have someone in their 50s, that person can still practice medicine for 10,20,30 years even. I know several physicians in their 80s still going strong.

 

They are the distinct minority and it's doubtful they're working especially intensive hours much less taking call. That's hard enough at 50 let alone 85. Are PAs practising medicine then?

 

I am a bit taken back by your opposition to PAs without, so far as you have shared, having had the opportunity of working with them or of seeing how they are implemented in different settings.

 

Once again, you seem to be under the impression that the presumed PA role is hard to grasp. I don't have to find an intrinsic flaw in the individual competencies of PAs to criticize the enterprise in general.

[PAstudent]

This is one of the nagging problems I have: PA programs are open to all, even if you have minimal science/prior healthcare experience. The program is two years of "medicine", then you're thrown into the wards/clinics, and suddenly you become as competent as the physician who is watching over you?

 

Either that's a load of ****, or I'm just an absolute moron for going to medical school (and not only that, being so dumb that my 4 yrs of undergrad + 4 yrs of MD and 5 yrs of residency training) will be equivalent to a high schooler doing a two year PA program.

 

 

Hmm.. I think that you are a bit misinformed about what it takes to get into a PA program (many have requirements and processes similar to MD programs). Also, nobody is claiming that a newly graduated PA is going to be as competent as a seasoned physician, that would be ridiculous. However, after a PA has practiced emergency medicine for many years they should be functioning at the same level as an emergency physician, if not, then something is wrong. The PAs that work with my cousin have years of experience behind them. I posted about admissions requirements earlier in the thread but here are links to the admissions pages for the three Canadian PA programs:

 

http://www.facmed.utoronto.ca/programs/healthscience/PAEducation/Admission_Requirements.htm

 

http://umanitoba.ca/faculties/medicine/education/paep/pros_students/3829.html

 

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

[Dongzhuo]

First I think that there is a shortage of health care providers and developing PA's in Canada may help alleviate that. However, physicians and us future physicians, need to be very very careful about the future of PA's. (Not to disparage anyone here)

 

The thing is, politicians don't really care who gives patients care as long as they can save money. As the PA student said, their program is modeled after the MD program. They are also said to be about as competent as graduating Y4 med students, which may even likely be true. So eventually, someone might say, hey, if PA's and MD's graduate at about the same level, why don't we open up family medicine residency positions and let PA graduates serve our underserved communities? If this flood gate opens, PA's will soon be able to do all sorts of residencies, and will soon demand the SAME PAY AS PHYSICIANS. I mean, if their knowledge base is the same, and the work they do is the same, why don't they get paid the same?

[PAstudent]

First I think that there is a shortage of health care providers and developing PA's in Canada may help alleviate that. However, physicians and us future physicians, need to be very very careful about the future of PA's. (Not to disparage anyone here)

 

The thing is, politicians don't really care who gives patients care as long as they can save money. As the PA student said, their program is modeled after the MD program. They are also said to be about as competent as graduating Y4 med students, which may even likely be true. So eventually, someone might say, hey, if PA's and MD's graduate at about the same level, why don't we open up family medicine residency positions and let PA graduates serve our underserved communities? If this flood gate opens, PA's will soon be able to do all sorts of residencies, and will soon demand the SAME PAY AS PHYSICIANS. I mean, if their knowledge base is the same, and the work they do is the same, why don't they get paid the same?

 

Hi Dongzhuo,

 

I am glad you brought that up. PAs are not autonomous nor do PAs want to be! PAs, by definition, work under the supervision of physicians. There are PA residencies in the USA but graduates of the residency programs are not independent and continue to work under physician supervision. PAs are physician extenders. The mission statement of the Canadian Association of Physician Assistants is "Foster development of the Physician / PA Model to assure quality care for Canadians" The PA-MD relationship is key! We must work as a team. Check-out http://caopa.net/index.php?option=com_content&view=article&id=4%3Amission-and-vision&catid=2%3Aabout-capa&Itemid=34〈=en and http://caopa.net/index.php?view=category&cid=2%3Apa-faqs&option=com_quickfaq&Itemid=53〈=en

[future_doc]

First I think that there is a shortage of health care providers and developing PA's in Canada may help alleviate that.

 

The thing is, politicians don't really care who gives patients care as long as they can save money......I mean, if their knowledge base is the same, and the work they do is the same, why don't they get paid the same?

 

I think you answered your own question, i.e., the politicians are attracted to the tremendous cost savingss of a P.A. in terms of education and in salary. Therefore, PAs will never receive the same pay as physicians and will always be subordinate to physicians. If they are placed in remote areas where there are no doctors, they will practice tele-medicine/internet-medicine under the supervision of a physisican in another locality, presumably with whom they have worked before.

 

P.A.s are the evolving newbie in our health care system and their full role is yet to be determined. Personally, I think it is a good thing, win/win, for physicians, patients, government, health care system.

[leviathan]

However, after a PA has practiced emergency medicine for many years they should be functioning at the same level as an emergency physician, if not, then something is wrong.

I have to disagree with you there PAstudent. I know a few PAs who have worked for years in the ED and they are far from equal to an emergency physician, even in their own opinions. When having group discussions and in-class discussions on certain medical topics, sometimes they would try to answer questions from our profs and I noticed some scary deficiencies in these guys where I wondered "you are supposed to be equivalent to a doc in the ER and you didnt know X?". I'm not trying to bash PAs, because the reality is they AREN'T supposed to be equivalent to an ER doc like you just claimed.

 

Most (all?) of them work in the fast track area, treating pharyngitis or stitching up minor wounds. They are not dealing with the sick patients who have multiple comorbidities and complex presentations in the acute care section of the ED.

[PAstudent]

I have to disagree with you there PAstudent. I know a few PAs who have worked for years in the ED and they are far from equal to an emergency physician, even in their own opinions. When having group discussions and in-class discussions on certain medical topics, sometimes they would try to answer questions from our profs and I noticed some scary deficiencies in these guys where I wondered "you are supposed to be equivalent to a doc in the ER and you didnt know X?". I'm not trying to bash PAs, because the reality is they AREN'T supposed to be equivalent to an ER doc like you just claimed.

 

Most (all?) of them work in the fast track area, treating pharyngitis or stitching up minor wounds. They are not dealing with the sick patients who have multiple comorbidities and complex presentations in the acute care section of the ED.

 

I would say that speaks to those PAs as individuals and not to PAs as a profession. Frankly, that is rather frightening! As I said, if that is the case, then something is wrong. I know several PAs that do deal with the sick patients in the acute care section of the ED. I have also heard of situations like the one you describe, where a PA works mostly in fast track. In those cases, there has usually been some reason for this. We also have to accept that, as in any profession, there are going to be people who are more competent than other people. It is indeed the job of the PA-MD team to determine where a PA's comfort zone is. There are thousands of emerg PAs in the States and quite a few here. Sunnybrook is one of the hospitals with a few emerg PAs, here is an article from the spring:

 

http://www.hospitalnews.com/modules/magazines/mag.asp?ID=3&IID=144&AID=1758

 

Quote from the article:

"Zlata sees Canadian Triage Acuity Scale (CTAS) 1-5 patients regularly, which can range from emergent to non-emergent cases that could involve acute abdominal pain or chest pain, shortness of breath, stroke symptoms, back pain, broken bones, and simple lacerations. She is also part of the resuscitation team, capable of central line placement and chest tube placement. She estimates that her being on the team results in an up to 60 per cent increase in the number of patients seen in a given zone per shift."

[cardiomegaly]

So Sunnybrook will hire PA's but not CCFP(EM) docs?

[cheech10]

So Sunnybrook will hire PA's but not CCFP(EM) docs?

 

Different budgets. Docs bill OHIP directly (whether FFS or AFP), and don't cost the hospital anything, but hiring an additional doc dilutes the MD billings accordingly. Hence the reluctance to hire new docs in many departments, or require specific qualifications. PAs, RNs, NPs get a salary from the hospital, and therefore don't cost the MDs in lost billings (in fact, can generate more billings for the MDs through efficiencies and billing for delegated tasks, similar to when staff physicians bill for the work their residents do). The hiring processes are completely separate, as are the organizational hierarchies.

[A-Stark]

I would say that speaks to those PAs as individuals and not to PAs as a profession. Frankly, that is rather frightening! As I said, if that is the case, then something is wrong. I know several PAs that do deal with the sick patients in the acute care section of the ED. I have also heard of situations like the one you describe, where a PA works mostly in fast track. In those cases, there has usually been some reason for this. We also have to accept that, as in any profession, there are going to be people who are more competent than other people. It is indeed the job of the PA-MD team to determine where a PA's comfort zone is. There are thousands of emerg PAs in the States and quite a few here. Sunnybrook is one of the hospitals with a few emerg PAs, here is an article from the spring:

 

So... how much clinical experience do you have so far? Because you seem rather quick to dismiss any skeptical comments about PAs.

[degoo_]

75000 salary according to that article...

[hastin11]

75000 salary according to that article...

 

Yeah, a 75,000 average salary is not really that high though. Consider that, if 75 is average, most will make considerably less than starting off. Consider that medical residents make almost that much in PGY-5, and they are still in training lol. It doesnt seem like an outrageous salary to me, although considering PA's seem to feel that their training is in many ways similar to MDs, I would wonder how they would not become resentful to accept such a lower comparitive salary.