CBC health reporter graduates as physician assistant

[PAstudent]

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

 

Hi A-Stark,

 

At first, I read the above post on my Blackberry during a break from class this morning and I thought I would simply answer your question and tell you about my clinical experience previous to being a PA student as well as that which I have had as a PA student. However, I thought about it and, because I joined this forum to inform people about PAs and not to get into a debate I don't see the point. (I am also of the opinion that one need not necessarily have clinical experience in order to address concerns about PAs , but, I digress.) I am normally happy to discuss these things but I can't help but feel that you are asking a question that is not directly relevant to my goal of informing the good people of Premed101 about what PAs do and how we are educated. Indeed, I feel that you are goading me into debate, or, at the least, trying to make this personal somehow.

 

Most everything I have said is factual or research-based and not based on my opinion. Rather, those items inform my opinion just as you are free to look at the facts and inform yourself to create your own opinion.

 

I have no interest whatsoever in debating or arguing on here and simply thought that, as a Canadian PA student, I could offer a perspective and sources of information to help people make-up their own minds. Indeed, I encourage you to seek-out PAs and speak with them, work with them, seek-out physicians who work with PAs and speak to them, and seek out this information yourself. There are good PAs and bad PAs just as there are good physicians and bad physicians. We must all accept that uncertainty is almost always certain

[PAstudent]

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.

 

$75,000 is actually the minimum salary in Ontario (as that is the minimum amount that the Government is offering as a subsidy right now). I have spoken to members of the class that graduated from McMaster recently and to former military PAs working in Ontario and most salaries are a fair bit higher than that with many over $100,000. In Manitoba many PAs make well over $100,000 and I know of several who make about $140,000.

[btco]

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!

 

Just a note that the students in the U of T program are required to have at LEAST one year of full time experience in a health care field involving direct patient care. All the students in that program have at least one previous health care degree.

[PAstudent]

Hey all,

 

I thought that this article might be of some interest: http://www.yorkregion.com/news/local/article/914703--markham-clinic-hires-physician-assistant-grad

[champ]

I am just curious here, what is the competitive average to get into a PA program at mac and u of t? I heard its 3.5 at mac is that true?

[)oooo>]

I am just curious here, what is the competitive average to get into a PA program at mac and u of t? I heard its 3.5 at mac is that true?

 

lol who would do that? with a 3.5 you could easily go into dents in the US and be making 200k a year with your own practice.

[champ]

lol who would do that? with a 3.5 you could easily go into dents in the US and be making 200k a year with your own practice.

 

people must do that...since there are currently people in the PA programs. I would also imagine that the majority of people are not in favor of becoming dentists. Not that theres anything wrong with that. Its just not for everyone.

[cardiomegaly]

Interesting that the physician called her his "physician extender". Most extenders are either senior residents picking up extra call shifts, or full practicing physicians (usually family docs) working on specialty services to fill in on staff shortages.

 

I came across this for Alberta http://www.cpsa.ab.ca/InformationFor/Physician_assistants.aspx

But there are no registered PA's in our province yet.

 

Whether PA's get here or not I'll be using my resident to do my diagnostic work under supervision when I'm staff.

[PAstudent]

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

 

I am fairly certain that I know at least one CFPC EM doc working at Sunnybrook. But perhaps I am mistaken.

[Mamie]

I have to say that as a staff physician I would be exceedingly hesitant to give much autonomy to a PA.

 

I have worked with various other mid-levels and now a few PAs who astound me in their lack of clinical knowledge. They seem capable enough in performing simple technical skills, but are unable to work through a differential diagnosis. When asked how they might like to work up various presenting complaints, they are only able to suggest one or two common diagnoses and are thus able to suggest investigations for these common complaints. Of course, this does mean that they miss the big, bad things that we as physicians have been trained to always rule out. When I compare the PAs performance with the performance of my clinical clerks and junior residents, the PAs come a distant second. I cannot envision giving even a more experienced PA the responsibility I give my other trainees because I do not trust their abilities. Further the idea of an experienced PA thinking him or herself as skilled as a trained physician terrifies me. My experience is that they are not nearly as well trained as physicians and that this sort of over-confidence could easily lead to errors in patient care.

 

Having had experience with PAs, I can only see a role for them in very well supervised clinical spheres, performing very simple tasks- nothing near the level of autonomy I allow my medical trainees.

[PAstudent]

Hi Mamie,

 

Thank you for sharing your experiences here because I am hoping that you will take me up on an offer to have some positive experiences or, at the least, hear about them and learn more about PAs and PA education as it is developing in Ontario. I think it indeed unfortunate, actually, appalling, that you have had negative experiences with the few PAs you have worked with. What you describe is nothing less than incompetence! and, just as it would be unacceptable from a physician, it is unacceptable from a PA. I urge you to consider strongly that the PAs you have met are not representative of PAs in general and certainly not of the PAs currently being graduated out of McMaster and other similar programs.

 

I have, of course, heard of PAs with the limited knowledge and skills of which you speak and I assure you this is neither the norm nor is it what is expected of a PA. Unfortunately, physician experiences with PAs with poor knowledge/clinical acumen have the potential to cast a dark shadow over all PAs and, because I don't want that to happen, I am responding so boldly to your post.

 

 

I can only speak directly about the McMaster PA program in which I am a student. Not only does our Dean, Dr. John Cunnington, point out to us frequently that we are expected to perform at the same level as a graduating MD student when we graduate, but that, since the PA students take the same exams as the MD students: PPI exams, the CREs (AKA CAEs), and the OSCES, hard data on PA performance exists and, it is my understanding that the PA classes prior to us have performed at the same level (sometimes higher) than the MD students.

 

Furthermore, the PA clerkship at McMaster is integrated with the MD clerkship and the responsibilities and expectations of the PA clerks are the same as the MD clerks, no distinction is made in this regard.

 

Finally, as mentioned above, I would like to offer you the opportunity to meet some competent PAs and the physicians with whom they work, or at the very least, have a chat with the physicians. In particular, I think you should speak with the medical director (a physician) and the PAs at a major Toronto emergency department and trauma center, one of them very experienced (she worked in the USA) and the other 3, graduates of my program. The PAs there function much like residents and have been given the same privileges as residents from what I understand. The medical director is very fond of PAs and most of the physicians there have come to trust them a fair bit as well. The other possibility is if you would like to speak with the physicians who run the program at McMaster. I have sent you a private message giving you some more details. Please take me up on my offer. At the very least, have a chat with these colleagues of yours that have worked with PAs and think they are great.

 

I just think is a true shame that you have had these negatives experiences and I want you to see how wonderful a PA can be and how much physicians and patients can benefit from their implementation. If a PA cannot function in much the same way as a resident then, as I have already said in this thread, something is wrong!

 

 

 

 

 

 

 

I have to say that as a staff physician I would be exceedingly hesitant to give much autonomy to a PA.

 

I have worked with various other mid-levels and now a few PAs who astound me in their lack of clinical knowledge. They seem capable enough in performing simple technical skills, but are unable to work through a differential diagnosis. When asked how they might like to work up various presenting complaints, they are only able to suggest one or two common diagnoses and are thus able to suggest investigations for these common complaints. Of course, this does mean that they miss the big, bad things that we as physicians have been trained to always rule out. When I compare the PAs performance with the performance of my clinical clerks and junior residents, the PAs come a distant second. I cannot envision giving even a more experienced PA the responsibility I give my other trainees because I do not trust their abilities. Further the idea of an experienced PA thinking him or herself as skilled as a trained physician terrifies me. My experience is that they are not nearly as well trained as physicians and that this sort of over-confidence could easily lead to errors in patient care.

 

Having had experience with PAs, I can only see a role for them in very well supervised clinical spheres, performing very simple tasks- nothing near the level of autonomy I allow my medical trainees.

[gsxronax]

I think there's a bit too much political correctness. This is just another way for the government to save money at the expense of patient care. I have a hard time understanding what differentiates these "PA" from NPs, other than these PAs have infinitely less training compared to even nurses nevermind NPs.

And I don't buy the "we are training PAs and encouraging them to serve the north" spiel. If they really were, then they should have ROS or license limitations that allow them only to function in certain geographic locations/city sizes.Bottom line: the politicization of 'scopes of practice' is alive and well, with PAs, RNs, NPs, and even naturopaths (!!) trying to carve out a big a slice as possible.

[PAstudent]

these PAs have infinitely less training compared to even nurses nevermind NPs.

And I don't buy the "we are training PAs and encouraging them to serve the north" spiel.

 

Unfortunately, it seems you have been misinformed on both counts. I suggest reading the thread and the many posts I have made explaining PA training at McMaster. Nurses have training as nurses whereas PAs have training as PAs. The McMaster PA program is based on the MD program. PAs study medicine, nurses study nursing. Making the statement that PAs have less training than nurses misses the type of training being done. As for the NP vs PA thing, I have posted on that as well. If, after reading my posts and the links to the CAPA NP vs PA document you still have difficulty understanding the difference, I invite you to send me a private message to discuss things further and help your understanding. I would even be willing to converse by phone if necessary.

 

As for serving the north, I have no clue where you are getting that idea. Nobody is encouraging me to serve any particular region. Nor is the PA program aimed specifically at the North. In fact, one of the places PAs can be most useful is in a busy city where large practices can benefit from the improved efficiency provided by a PA.

[0593202]

I agree that there is a distinction between an RN and a PA but in terms of expertise, a PA is closer to a RN then a physician. In terms of decision making, problem solving and responsibility, there's a reason they are under a doctors supervision for their entire career. I still think it's a great idea to free up a doctor from some of the more monotonous and low risk tasks and procedures that can take place in family medicine, I just fear that the public will end up merging family doctor and PA into the same category when referring to medicine, and error in judgment that could have bad consequences.

[PAstudent]

I agree that there is a distinction between an RN and a PA but in terms of expertise, a PA is closer to a RN then a physician. In terms of decision making, problem solving and responsibility, there's a reason they are under a doctors supervision for their entire career. I still think it's a great idea to free up a doctor from some of the more monotonous and low risk tasks and procedures that can take place in family medicine, I just fear that the public will end up merging family doctor and PA into the same category when referring to medicine, and error in judgment that could have bad consequences.

 

Hi Graeme,

 

I am not sure what you mean by "closer" but the knowledge and skill set of a PA and the physicians they work with are similar (not the same) and the tasks and functions of a PA are the same as of a physician, not of an RN. I have RNs in my class and they can attest to this.

 

I am not really sure why there is a perception that somehow PAs will be encroaching on nursing territory or that we somehow know the things nurses know. We don't. There is a reason one has to study nursing to be a nurse, it is not an easy job and it requires a great amount of training and dedication with different skill-sets than those that medical practitioners need. I have lots of friends in nursing and have been exposed to nursing courses and practice and there is very little overlap. I also have lots of physician friends and friends in MD programs and the overlap with them is almost (notice I said ALMOST) all encompassing.

 

I have said this before several times in this thread and I will say it again, even if doing so makes me sound like a broken record: nurses practice nursing; PAs practice medicine. I wouldn't have a clue how to do the job of a nurse because I am not in nursing school. PAs are part of the medical team. A PA works the same as a physician, seeing patients, ordering investigations, interpreting results, making diagnoses, and ordering treatment. PAs provide nurses with orders just as physicians do. At McMaster, as PA clerks, we have the same role as the MD clerks and the same expectations thrust upon us. PAs take call and all the other things the MD students do.

 

I don't think everybody understands that while PAs are under supervision, they are also autonomous in decision making. PAs don't assist physicians by doing what physicians tell them to do, PAs assist by taking part of the workload and, if needed, getting advice and feedback from the physicians. If a PA is not working this way they are either a)not being used properly or b)not functioning properly as a PA.

 

The amount of training that PAs get at McMaster is not that much less than the MDs get either in quantity or quality. The major difference, of course, beyond the extra undergraduate time, is that the MDs will go onto residency (post-graduate training) where they will learn to become independent practitioners of medicine. The PA students do not go onto residency (though in the USA they can) and will always practice medicine without independence. That is the PA-MD model, autonomy with supervision.

 

As for family medicine; PAs work in all specialties and in the USA where the profession is already well-established, the majority of PAs do not work in FM. In fact, from what I know about the PA workforce in Canada, while there are of course FM PAs, most Canadian PAs are not in FM either (it seems to be mostly emerg, orthopedics, and then some internal, psych, and other IM and surgical sub-specialties). Though I don't have any actual statistics on this so I could be wrong.

 

It is unfortunate that some people might feel threatened by the introduction of PAs; whether it be because they think PAs will encroach on their jobs or because they don't feel PAs are fit to practice medicine. Fortunately, most people I have met who felt this way quickly changed there minds after actually working with a PA.

 

By definition, a PA may not provide a standard of care lower than that of the physicians with whom she/he works. Being treated by a PA is similar to being treated by a resident and most physicians who work with PAs treat them as residents because, essentially, that is how the relationship is supposed to work.

 

 

Since I have basically just repeated things I have already said in previous posts in this thread, I'll end this post by giving you a way to look at PA vs MD training as a compare and contrast because I think that might make things a bit clearer as to how well-prepared the McMaster PA students are. The McMaster MD program trys to teache you everything they possibly can about medicine in the amount of time allotted (http://registrar.mcmaster.ca/calendar/current/pg1274.html ). The PA program also tries to teach everything possible in the amount of time allotted. Of course, less time is allotted for the PA program so less medicine is learned. But the quality is the same.

 

This is my understanding of the differences and similarities. I get most of my knowledge of the MD program from friends in the program so I might be incorrect so anyone with more knowledge, please feel free to correct me!

 

For the MD program: There are the Medical Foundations that last, in total, about 13 months followed by clerkship which lasts about 17 months. (the figure can vary a bit, I suppose, taking into account vacations, extra placements, electives, etc.).

 

For the PA program: There are the Medical Foundations that last, in total, about 11 months followed by clerkship which lasts about 12 months. (again, figures can vary a bit).

 

Why are the PA MFs shorter by a few months? Partially because some of the more complex cases have been changed for us (for instance, the MDs study a case with polycystic ovary disease and Diabetes Melittus type II whereas we have the same case without the polycistic ovary disease, though it may be put back next year). The second reason is that some of the MD cases have simply not been included because of time constraints. That does not mean that a PA would not be able to understand and deal with a patient with polycistic ovary disease. Nobody can study every disease in med school, PA or MD. The important thing is to know how to understand the underlying mechanisms and to have enough knowledge and skills to continue learning and to become more proficient at medicine. The MDs certainly get a more thorough education, but not a better one.

 

Why is the PA clerkship shorter by about 5 months than the MD clerkship? Simply because we don't rotate through all the same specialties as the MDs do. The core PA rotations are: family medicine, internal medicine, emergency medicine, surgery, psychiatry, and pediatrics (though there is talk of adding ob/gyn as a core rotation for the next class). Integrated into the core rotations are selectives (e.g. one could finish general surgery with 2 weeks of neurosurg, ortho surg, etc., etc.) We are given only 10 weeks for electives. The MD core rotations have everything the PA rotations have PLUS ob/gyn, anesthesia, ortho, and others. I also understand that the MDs have more elective opportunities than we do.

 

 

That gives you a cursory overview of the differences in curriculum. As I have stated before, both the MDs and PAs take the PPI exams, the OSCEs, and the CREs/CAEs (the name has changed a few times).

 

I hope this post has been helpful. I've had a long day and am not sure how cohesive this has been.

[A-Stark]

I have said this before several times in this thread and I will say it again, even if doing so makes me sound like a broken record: nurses practice nursing; PAs practice medicine. I wouldn't have a clue how to do the job of a nurse because I am not in nursing school. PAs are part of the medical team. A PA works the same as a physician, seeing patients, ordering investigations, interpreting results, making diagnoses, and ordering treatment. PAs provide nurses with orders just as physicians do. At McMaster, as PA clerks, we have the same role as the MD clerks and the same expectations thrust upon us. PAs take call and all the other things the MD students do.

 

So you really have no idea what nurses do then? I don't follow your distinction. Nurses tend to do a lot of tasks that the medical team doesn't have "time" for - exams, vitals, procedures like lines and tubes. And meticulous charting that exceeds, say, the typical cursory surgery "note".

 

I don't think everybody understands that while PAs are under supervision, they are also autonomous in decision making. PAs don't assist physicians by doing what physicians tell them to do, PAs assist by taking part of the workload and, if needed, getting advice and feedback from the physicians. If a PA is not working this way they are either a)not being used properly or b)not functioning properly as a PA.

 

Since PAs function at most as junior residents, they are essentially not "autonomous" at all. Unless you're a senior resident, you always review a patient with your senior and/or staff before you proceed. And if your resident pages you and asks you to see a patient in emerg, you must do that unless you have one compelling reason not to.

 

By definition, a PA may not provide a standard of care lower than that of the physicians with whom she/he works. Being treated by a PA is similar to being treated by a resident and most physicians who work with PAs treat them as residents because, essentially, that is how the relationship is supposed to work.

 

Eh? This isn't about definitions or assumptions about how PAs would operate, but about how things work in practice. You have been presented with accounts that aren't consistent with your ideal scenarios, to which you've responded only that they obviously were "bad PAs" or that that's not how it's "supposed to work".

 

I'd say that ORs should not have turnaround times of over an hour sometimes and that tests should always be carried out on schedule as ordered, but desiring an ideal does not make it so.

 

Why are the PA MFs shorter by a few months? Partially because some of the more complex cases have been changed for us (for instance, the MDs study a case with polycystic ovary disease and Diabetes Melittus type II whereas we have the same case without the polycistic ovary disease, though it may be put back next year). The second reason is that some of the MD cases have simply not been included because of time constraints. That does not mean that a PA would not be able to understand and deal with a patient with polycistic ovary disease. Nobody can study every disease in med school, PA or MD. The important thing is to know how to understand the underlying mechanisms and to have enough knowledge and skills to continue learning and to become more proficient at medicine. The MDs certainly get a more thorough education, but not a better one.

 

So you don't do any obs/gyn rotation yet you'd feel comfortable with presentations of PCOS? I suppose the same would go for fibroids, endometriosis, ectopic pregnancies, presentations and stages of labour, and, well, another else obs/gyn related. How can you do emerg without direct experience with common gyne presentations, particularly since most will not actually require a consult? And I'll go right out and say it - a more thorough education is more or less by definition a "better" one.

[PAstudent]

Since PAs function at most as junior residents, they are essentially not "autonomous" at all. Unless you're a senior resident, you always review a patient with your senior and/or staff before you proceed. And if your resident pages you and asks you to see a patient in emerg, you must do that unless you have one compelling reason not to.

 

So you don't do any obs/gyn rotation yet you'd feel comfortable with presentations of PCOS? I suppose the same would go for fibroids, endometriosis, ectopic pregnancies, presentations and stages of labour, and, well, another else obs/gyn related. How can you do emerg without direct experience with common gyne presentations, particularly since most will not actually require a consult? And I'll go right out and say it - a more thorough education is more or less by definition a "better" one.

 

 

Hi A-Stark,

 

I am responding with some hesitation because I felt that some of your earlier posts were hostile without merit. But, I consider you my colleague and I think I have a professional obligation to engage in discussion with you. I don't wish to argue or debate but I have elaborated on my earlier postings by responding directly to some things you have said.

 

PAs do not always review a patient with a physician before proceeding. A first-year (or first several of years) PA is more likely to review more, and the physician should require this. PAs and MDs need to work together to create agreements about how they will work. Every PA-MD team is different. A PA with 10 years of experience within his/her specialty is not likely to need to review before proceeding all that often. You are neglecting to understand the unique MD-PA team that develops differently in every situation. There is autonomy in the work of a PA, but the amount of that autonomy is dependent on the PA, the physician, and the type of relationship they have. At one end of the spectrum you have PAs with years of experience who run departments and have physicians available by phone. At the other hand you have an active PA-MD presence seeing patients together and sharing the work of each patient. There is plenty in-between.

 

As for obs/gyn. I will be doing a rotation in it as have many of my upperclassmen/women because we feel it is important. The school is trying to make it a core rotation for the next class. Of course I wouldn't feel comfortable treating obs/gyn stuff without having an education in it. There are plenty of things that MDs don't get to do or learn in core rotations and they also seek out that training either in electives or as residents.

 

As for your last comment, that a more thorough education is better, I don't disagree. There is a reason a PA is a PA and a physician is a physician. The physician has a more thorough formal education. And that is why a PA must have a supervising physician.

 

The point you are neglecting is that the quantity and quality of that supervision is not uniform among all PA-MD teams.

[Mourning Cloak]

PAs do not always review a patient with a physician before proceeding.

 

Out of curiosity, who provides the PAs with their malpractice insurance?

 

MDs have CMPA

RN/NPs have CNPS

PAs ?

[PAstudent]

Out of curiosity, who provides the PAs with their malpractice insurance?

 

MDs have CMPA

RN/NPs have CNPS

PAs ?

 

Hi Mourning Cloak,

 

Excellent question! :-) The short answer is that things depend on where a PA is: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Advocacy/Physician_Assistants/PA-Toolkit_en.pdf#page=18

[Mourning Cloak]

The short answer is that things depend on where a PA is: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Advocacy/Physician_Assistants/PA-Toolkit_en.pdf#page=18

 

Eeek. Although the "supervising physician" is assuming the responsibility, s/he can't bill for the work his/her PAs do?

[PAstudent]

Eeek. Although the "supervising physician" is assuming the responsibility, s/he can't bill for the work his/her PAs do?

 

I'm not sure where you got that idea. Yes, physicians can and do certainly bill for what PAs they are supervising do.

[Mourning Cloak]

I'm not sure where you got that idea. Yes, physicians can and do certainly bill for what PAs they are supervising do.

 

It's in the CMA document you posted (page 15)

 

Currently, provincial funding models do not permit physicians to bill for care provided by a PA.

[PAstudent]

It's in the CMA document you posted (page 15)

 

Currently, provincial funding models do not permit physicians to bill for care provided by a PA.

 

Good catch! I'm not sure what to make of that as I know several physicians who do bill for work done by PAs and I know several PAs who tell me their supervising physicians do bill for their work. So I just went and spoke briefly with some people in-the-know.

 

Here is the scoop as I understand it: the way OHIP is set-up it would indeed be illegal for physicians to bill for patients seen by a PA. At the same time, there is no structure yet for PAs to bill OHIP. The legal loophole around this that is apparently being used by many, which accounts for the situations I know of, is that the physician still has to actually see the patient and discuss the care with them directly.

 

To be clear, I am confused by this as well. The people I have spoken with have said this is a muddy gray area so to speak. Obviously, the funding structure is being developed and nothing even semi-permanent is in place yet.

 

Remember, this is still an experimental pilot project being funded by the Government of Ontario. I can't see how this is going to work-out in the long-term unless OHIP billing for PAs is enabled. That is part of the appeal for a physician.

 

I wish I had a better answer for you, but I don't. Us PA students and PAs are wondering many of these same things ourselves. We are pioneering something new in Ontario and we don't know exactly how things will turn-out.

[Mourning Cloak]

"The Ontario OHIP fee schedule was written before the introduction of PAs in Ontario and does not accommodate delegated PA billings . . . . Physicians will not be paid for the delegated services provided by the PA unless physicians see the patient and are actively involved in the episode of care.

 

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

 

I'm not a family doc (and not going to be one, either ), but I'd guess this PA thing isn't going to fly well in other provinces until the billing agreements are altered to permit the physician to bill for services provided by his/her PAs.

[PAstudent]

The Ontario OHIP fee schedule was written before the introduction of PAs in Ontario and does not accommodate delegated PA billings.

 

Physicians will not be paid for the delegated services provided by the PA unless physicians see the patient and are actively involved in the episode of care.

 

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

 

Nice find! Yah, that seems to jive with the PA-MD teams that I know about. Physicians still technically needing to see the patient. The question is one of how things will develop over the next few years.

 

A lot is changing rapidly at the Ministry of Health and Long Term Care and Dr. Joshua Tepper, who had spearheaded the PA project has left.