Bachelors vs. Masters

[asinh90]

Hi all,

 

I have a few questions about the PA program in general. I'm considering applying to McMaster this year (about to graduate from uOttawa with a Bsc Honours in Biomedical Sciences) and was wondering what the major differences are between having a bachelors (McMaster) or applying to Manitoba and acquiring a masters?

 

I've also heard that if you want to practice in Ontario, you must be an Ontario PA graduate. i.e. If I were to go to Manitoba I could not come back and work in Ontario. Is this true?

 

Are there any big advantages to going to the States to study? Since it's a much more defined position there, I was wondering if this would be reflected in job opportunities or salary, etc?

 

Thanks in advance for any help!

 

asinh90

[PAstudent]

Hi all,

 

I have a few questions about the PA program in general. I'm considering applying to McMaster this year (about to graduate from uOttawa with a Bsc Honours in Biomedical Sciences) and was wondering what the major differences are between having a bachelors (McMaster) or applying to Manitoba and acquiring a masters?

 

I've also heard that if you want to practice in Ontario, you must be an Ontario PA graduate. i.e. If I were to go to Manitoba I could not come back and work in Ontario. Is this true?

 

Are there any big advantages to going to the States to study? Since it's a much more defined position there, I was wondering if this would be reflected in job opportunities or salary, etc?

 

Thanks in advance for any help!

 

asinh90

 

The programs are different. I wouldn't do one or the other simply because of masters v bachelors. I would have rather had a masters than another bachelors (especially since the first one I have is also a BHSc. from Mac). However, I felt the program at Mac was better for me. You should look into the programs themselves.

 

Most of the PAs in Ontario did not go to school here. Manitoba is fine. What you are talking about are the newly funded spots, those are reserved for the new grads.

 

No real advantage to the USA unless you want to work in the USA (Candian civlian PA programs are not recognized in the USA yet).

[whiteteeth]

PAStudent, how does PA system work in Canada?

I mean unlike states, PA and NP are unable to use fee-for-service model.

They are both salaried.

 

For example, let's say that I hypothetically go for the PA program and want to work in a family practice afterwards.

 

Unless it's a government funded family health center or community health center, there is no way that I can work under another physician in private physician practice because I wouldn't have any way to bill for my service provided right?

 

Right now, I think NP program is lobbying to use fee-for-service model and is in the midst of piloting one in BC, but what about PA?

[PAstudent]

PAStudent, how does PA system work in Canada?

I mean unlike states, PA and NP are unable to use fee-for-service model.

They are both salaried.

 

For example, let's say that I hypothetically go for the PA program and want to work in a family practice afterwards.

 

Unless it's a government funded family health center or community health center, there is no way that I can work under another physician in private physician practice because I wouldn't have any way to bill for my service provided right?

 

Right now, I think NP program is lobbying to use fee-for-service model and is in the midst of piloting one in BC, but what about PA?

 

 

There is nothing stopping a family practice from hiring you. Government funding directly for your position is not necessary and there are several instances of physicians/practice groups paying for a PA. The work you do as a PA is indeed billable to OHIP by your supervising physician. This has been discussed in other threads.

[whiteteeth]

Hmm interesting

What does this mean though:

a) Physician bills OHIP on behalf of you

PA has their own OHIP billing #

 

Either way, I still find it a good thing that OHIP still can be billed on your behalf.

 

NP still lacks that. They're salaried in NP led-clinics.

 

But if the pilot testing passes for fee-for-service model for NP, then hopefully, they are able to directly bill OHIP and be able to open their own private clinic.

[PAstudent]

Hmm interesting

What does this mean though:

a) Physician bills OHIP on behalf of you

PA has their own OHIP billing #

 

Either way, I still find it a good thing that OHIP still can be billed on your behalf.

 

NP still lacks that. They're salaried in NP led-clinics.

 

But if the pilot testing passes for fee-for-service model for NP, then hopefully, they are able to directly bill OHIP and be able to open their own private clinic.

 

As things exist right now there is no such thing as a PA in Ontario legislation. Therefore, PAs cannot bill directly to OHIP. I.E. no billing number. But just as physicians bill OHIP for work done by their residents, physicians also bill ohip for work done by their PA.

[whiteteeth]

Thank you for the info PAstudent

[PAstudent]

Thank you for the info PAstudent

 

No worries!

[xngn8r]

According to Physician Toolkit from HealthForce Ontario

 

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

•

Currently in Ontario, physicians are paid a stipend for supervising PAs within the PA–physician relationship.

•

 

Unless they have changed something, I do not think a physician can bill for PA services unless he/she also sees the patient.

 

At this point I would choose US school. At least you can work in US as well as Canada. I am attending PA program at D'Youville in Buffalo. If anyone has questions about this program, I can provide some info.

[PAstudent]

No, this is not correct. The rule that the toolkit refers to is the same one that physicians are supposed to be following when working with a resident. And, as most med students/residents can attest on this board, depending on the specialty/setting the staff physician sometimes does not personally attend to the patient but still bills for the work of the resident. Also, the definition of seeing the patient is, apparently, vauge enough that, as one physician who supervises 4 PAs told me "I can literally pop by the door way and say "howdee" and walk away."

 

All that said, I am certainly no expert in the law/rules of OHIP billing. I am only telling you what is actually done in practice. Heck, even as a clinical clerk, depending on the case, I have seen patients many times in emerg, in IM consults, and in Sx consults (both out pt and in pt) where my supervising physician never saw the patient at all but still billed for it. And I see this happening all the time with other clinical clerks, both MD and PA.

 

 

 

 

 

According to Physician Toolkit from HealthForce Ontario

 

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

•

Currently in Ontario, physicians are paid a stipend for supervising PAs within the PA–physician relationship.

•

 

Unless they have changed something, I do not think a physician can bill for PA services unless he/she also sees the patient.

 

At this point I would choose US school. At least you can work in US as well as Canada. I am attending PA program at D'Youville in Buffalo. If anyone has questions about this program, I can provide some info.

[whiteteeth]

No, this is not correct. The rule that the toolkit refers to is the same one that physicians are supposed to be following when working with a resident. And, as most med students/residents can attest on this board, depending on the specialty/setting the staff physician sometimes does not personally attend to the patient but still bills for the work of the resident. Also, the definition of seeing the patient is, apparently, vauge enough that, as one physician who supervises 4 PAs told me "I can literally pop by the door way and say "howdee" and walk away."

 

All that said, I am certainly no expert in the law/rules of OHIP billing. I am only telling you what is actually done in practice. Heck, even as a clinical clerk, depending on the case, I have seen patients many times in emerg, in IM consults, and in Sx consults (both out pt and in pt) where my supervising physician never saw the patient at all but still billed for it. And I see this happening all the time with other clinical clerks, both MD and PA.

 

In terms of addressing OHIP billing: Fact is, PA is not a resident. Neither is NP.

http://www.oha.com/Services/PhysicianandProfessionalIssues/Documents/Roles%20and%20Responsibilities%20of%20Physicians%20Supervising%20PAs_.pdf

 

5.0 OHIP Billing Rules for PA Practice

The general rule is that physicians cannot bill for the work of Physician Assistants unless the circumstances requires the active participation of the physician in the clinical activity of the PA. Thus,

if a supervising physician renders a service to the patient in addition to the

service rendered by the PA, then the physician may bill for the service they

personally render.

if the clinical activity is provided without participation service being rendered

by the supervising physician, then the supervising physician would not be

able to bill for the service rendered by the PA.

In defining participation service, the rules state that "it would be inappropriate for the physician to submit a claim to OHIP for simply greeting the patient aka HOWDEE" -- a

reasonable contribution to the clinical encounter is required. The rules specify

that the physician must engage in the history, performance of any "necessary" (further) physical examination and communication of a diagnosis and/or treatment plan.

This does not mean that the physician must duplicate the service to bill for their role in review and oversight. In a circumstance where the PA has rendered a service, but the physician meets with the patient, the physician may bill a partial or complete assessment or consultation if they perform the required elements of the service personally. This may be a fairly brief encounter depending on the nature of the service provided and the skills and experience of the PA. The fee code claimed must be consistent with the service performed by the physician.

 

 

Secondly, I'm a bit disturbed to hear that physicians are providing superficial supervision of newly graduated PAs.

It's like asking newly graduated medical students (but in terms of PA, it's only 2 years) to diagnose and treat patients on their own...

and then the supervising physician is not double checking on the work done by the newly graduates/medical students and saying "HOWDEE" only to the patients and signing off on whatever PA has done.

[PAstudent]

I never made the claim that a PA is a resident. I pointed out that the rule is seen as the same by many of the physicians actually working with PAs. PAs function in much the same was as residents, practicing medicine under the legal arrangement of supervision. You may be initially disturbed, but this is the way things have been done for years and it seems to work quite well. Indeed, I have seen many newly graduated med students, PGY1s/R1s that is, be the only clinician to actually interact with the patient. This, in fact, has been the norm in several places I have worked. They do discuss the care with their supervising physician as is appropriate. If the supervising physician feels there is a need for them to actually interact directly with the patient then they do, otherwise they discuss things with the resident and bill for it appropriately.

 

Again, I am not an expert in the law/rule/policies here. I am merely letting you know what I have learned to be the actual practice in most places with PAs that I have worked at. It has also been explained to me by several physicians who supervise PAs that they are indeed complying with the rules and that it seems many people misunderstand them. Take that for what you will.

 

 

 

 

 

In terms of addressing OHIP billing: Fact is, PA is not a resident. Neither is NP.

http://www.oha.com/Services/PhysicianandProfessionalIssues/Documents/Roles%20and%20Responsibilities%20of%20Physicians%20Supervising%20PAs_.pdf

 

5.0 OHIP Billing Rules for PA Practice

The general rule is that physicians cannot bill for the work of Physician Assistants unless the circumstances requires the active participation of the physician in the clinical activity of the PA. Thus,

if a supervising physician renders a service to the patient in addition to the

service rendered by the PA, then the physician may bill for the service they

personally render.

if the clinical activity is provided without participation service being rendered

by the supervising physician, then the supervising physician would not be

able to bill for the service rendered by the PA.

In defining participation service, the rules state that "it would be inappropriate for the physician to submit a claim to OHIP for simply greeting the patient aka HOWDEE" -- a

reasonable contribution to the clinical encounter is required. The rules specify

that the physician must engage in the history, performance of any "necessary" (further) physical examination and communication of a diagnosis and/or treatment plan.

This does not mean that the physician must duplicate the service to bill for their role in review and oversight. In a circumstance where the PA has rendered a service, but the physician meets with the patient, the physician may bill a partial or complete assessment or consultation if they perform the required elements of the service personally. This may be a fairly brief encounter depending on the nature of the service provided and the skills and experience of the PA. The fee code claimed must be consistent with the service performed by the physician.

 

 

Secondly, I'm a bit disturbed to hear that physicians are providing superficial supervision of newly graduated PAs.

It's like asking newly graduated medical students (but in terms of PA, it's only 2 years) to diagnose and treat patients on their own...

and then the supervising physician is not double checking on the work done by the newly graduates/medical students and saying "HOWDEE" only to the patients and signing off on whatever PA has done.

[A-Stark]

I never made the claim that a PA is a resident. I pointed out that the rule is seen as the same by many of the physicians actually working with PAs. PAs function in much the same was as residents, practicing medicine under the legal arrangement of supervision. You may be initially disturbed, but this is the way things have been done for years and it seems to work quite well. Indeed, I have seen many newly graduated med students, PGY1s/R1s that is, be the only clinician to actually interact with the patient. This, in fact, has been the norm in several places I have worked. They do discuss the care with their supervising physician as is appropriate. If the supervising physician feels there is a need for them to actually interact directly with the patient then they do, otherwise they discuss things with the resident and bill for it appropriately.

 

Apart from routine matters that come up while covering the floor overnight, I cannot think of any times where an R1 should not review with either the senior resident or staff.

[PAstudent]

Apart from routine matters that come up while covering the floor overnight, I cannot think of any times where an R1 should not review with either the senior resident or staff.

 

I agree. And that is indeed what they do, they review/discuss with their senior or the staff. But the senior or the staff do not always see the patient themselves. Same with PAs. The PA, especially a new PA, usually reviews/discusses things with the staff physician but the staff physician does not always see the patient themselves. However, from what I have been told and seen, they are still billing for it. It has been explained to me by MOHLTC officials and physicians who supervise PAs that this is appropriate.