Decision for PAs in Ontario to NOT be regulated

[matticus]

To the Ontario/Canadian PAs,

 

I posted this at another forum as well, but I'm hoping some members here could chime in as well.

 

http://www.physicianassistantforum.com/forums/showthread.php/37560-Meanwhile-in-Ontario

 

The decision to not regulate PAs in Ontario seems like a colossal blow to Ontario/Canadian PA prospects. While extremely interested, I have been holding off applying to McMaster's PA program for the last couple years to see how this 'new' profession progressed in Ontario. Frankly, I don't want to spend $25k+ and make the associated life adjustments for something that isn't worthwhile or has no job prospects. I already earn $75k+ in the health care field, however there is no direct patient care, which is what attracts me to PA. I was all set to apply this year until I read this forum and HRPAC's decision.

 

So my questions to you are:

 

1. What tasks do physicians allow you to perform? I am interested in IVs, giving meds, intubation, 12 leads/rhythm interpretation/cardioversion/pacing/defib, casting, etc, you name it. Understandably as you are working under a physician, they would have to be comfortable with you performing these tasks, but how many of you/or your colleagues are allowed to do these things? Is there trust and confidence from the doctor?

 

2. Are doctors generally welcoming of you or adverse to you? How about managers/administrators? Do they feel you are a good investment or only brought you on because of the free government money?

 

3. Now that there are no prospects of regulation and since doctors can't bill for your services, do you feel that after the demonstration project concludes and hospitals/clinics no longer receive funding, your jobs will disappear? Have your schools/the government/CAPA/etc given you any information on job prospects should this situation occur?

 

4. If you had to do it all again, knowing what you know now, would you pursue this career again? If not, what profession would you have pursued instead?

 

Please feel free to include any other advice you feel would benefit someone who is seriously considering pursuing this career. I would welcome WHATEVER comments you have that would help me make a decision.

 

Thanks to all!

Matt

[in2bat0r]

Don't know anything about being a PA, but your explanation of desired scope of practice correlates quite well with that of a paramedic. I'm not sure about Ontario, but in western Canada advanced life support paramedics perform all of those skills without physician supervision, and can make 75-100 grand or more. Also, most of the training programs would cost about the same as the PA program.

[matticus]

Yes, I'm quite familiar with the paramedic career as I'm actually an ambulance dispatcher. I considered the career prior to working as a dispatcher, but after discovering the considerable abuse of the system by 'patients' has turned me off, particularly because of the lifting and wear and tear on the body. The PA career has all the skill aspects of an Advanced Care Paramedic without the wear and tear on the body.

[PAstudent]

The PA scope of practice mirrors the supervising physician scope of practice; my SPs allow me to do everything they do and they teach me if I don't know.

 

Procedurew-wise: in the past week I have done LPs, intubated, managed airways in other ways, diagnosed and managed DKA, pneumonia, CHF, major traumas, minor traumas, narctotics od, benzo od, lacerations/suturing, reduced a shoulder, done conscious sedations, pharyngitis, NSTEMI, STEMI, CVA, various abscesses, and a whole bunch of other stuff.

 

 

Docs are usually happy to have me around (I think! )

 

We don't know what will happen but we suspect we will still be regulated in a few years. The decision now seems political and the CPSO, the body that would regulate us (indeed, kind of does already in an informal way)

 

I highly doubt our jobs will just vanish. I think things will move along, just slowly.

 

Darn straight I'd pursue this again. I love practicing medicine.

 

 

 

 

So my questions to you are:

 

1. What tasks do physicians allow you to perform? I am interested in IVs, giving meds, intubation, 12 leads/rhythm interpretation/cardioversion/pacing/defib, casting, etc, you name it. Understandably as you are working under a physician, they would have to be comfortable with you performing these tasks, but how many of you/or your colleagues are allowed to do these things? Is there trust and confidence from the doctor?

 

2. Are doctors generally welcoming of you or adverse to you? How about managers/administrators? Do they feel you are a good investment or only brought you on because of the free government money?

 

3. Now that there are no prospects of regulation and since doctors can't bill for your services, do you feel that after the demonstration project concludes and hospitals/clinics no longer receive funding, your jobs will disappear? Have your schools/the government/CAPA/etc given you any information on job prospects should this situation occur?

 

4. If you had to do it all again, knowing what you know now, would you pursue this career again? If not, what profession would you have pursued instead?

 

Please feel free to include any other advice you feel would benefit someone who is seriously considering pursuing this career. I would welcome WHATEVER comments you have that would help me make a decision.

 

Thanks to all!

Matt

[whiteteeth]

Ouch.

 

If the government decides to take away the funding, ... then who are they going to work for? Are they going to be a medical assistant/secretary for a clinic?

 

I will be staying far away from the PA program. My mind is now set on becoming NP if I can't get into dent.

[PAstudent]

Ouch.

 

If the government decides to take away the funding, ... then who are they going to work for? Are they going to be a medical assistant/secretary for a clinic?

 

I will be staying far away from the PA program. My mind is now set on becoming NP if I can't get into dent.

 

Several hospitals and private practices are currently paying PAs with no government funding. This will likely continue as PAs usually generate income and improve metrics

 

In my position as an emergency medicine PA at a Toronto hospital only a small part of my salary is funded by the Government.

 

Also, the OMA, CAPA, and the MOHLTC have been working on new riding

Models that are not dependent on regulation

 

 

The real downside of not being regulated is the necessity of medical directives for everything which can be a but of a nuisance at times.

 

 

The CPSO will create a registry of qualified PAs and this will lead to regulation once the numbers grow. This is from the email capa sent today:

While disappointed that the PA profession will not be regulated, the report overall is actually very positive. HPRAC commented on the fact that we don't meet the risk of harm threshold due to the SAFETY of our practice. The report states that “public safety and quality of care are sufficiently upheld at this time through the delegation model.” We already knew that the PA practice was safe and that we were highly skilled competent professionals, however, this has now been validated by HPRAC and this report. The report recommends that a compulsory registry be established. This registry will build on the existing certification process and will increase certainty about practitioners’ qualifications. A registry of this nature will strengthen the existing process and is a way to provide additional oversight to the PA profession and well as provide assurance that all PAs in Ontario have met common entry-to-practice requirements and that they participate in continuing education. It is suggested that this mandatory registry be created under the direction of the College of Physicians and Surgeons of Ontario (CPSO). CAPA will be working closely with the CPSO to help establish and to develop clear, comprehensive policy and guidelines for supervisory doctors that addresses both clinical and non-clinical issues identified in a PA’s practice. While this is not regulation, it is an optimistic step which will offer title protection and provide assurances to the public and other health care providers about our education and qualifications. Inter-professional Collaboration is also mentioned as a challenge that we face daily and will be addressed via the registry. This proposed model will support the ongoing practice of PAs as part of inter-professional teams.

 

Page 18 of the report talks about the cost of regulation to professionals, employers and taxpayers. A comparative example is provided using the College of Dental Technologists of Ontario. In 2011, operational costs of the College of Dental Technologists of Ontario who had 488 members were $676,000. This is a significant cost and is prohibitive in the best of economic climates let alone what we are all facing in the latest era of fiscal cutbacks.

 

I understand and share your disappointment regarding the outcome of the report, but please understand the document does offer a positive alternative and in fact stresses the fact that PAs are SAFE and competent practitioners. We are being supported by many, including the OMA, CPSO and the MOHLTC. These organizations have all offered their support and have stated that they believe the profession will continue to grow and flourish in Ontario.

 

During the weekend I did receive some questions from members wanting more information. I have summarized some of the answers to those questions in generalities below. I will also respond personally to those emails that I received.

 

· Funding is a separate issue and this decision does NOT directly affect the OMA's announcement.

 

· The PA profession is NOT abandoned or going away.

 

· We are not YET regulated, however as the profession grows and if further evidence becomes available over time to support our claims regulation is a possibility.

 

· This report should in no way affect you in your current practice. If it does then I would advise you to please contact myself and the National Office so that we can work with you to help get any issues resolved."

"

[whiteteeth]

I have no doubt that PAs are competent providers. But they're not regulated. HUGE concern.

 

How is funding not a separate issue?

Aside from the donations, don't hospitals bill the government?

I'm a RN, and I get paid from the hospital. Hospital logs how much work I do and justifies the funding spent on us - funding requested to government.

 

Physicians bill the government for their work.

 

You and I don't know for sure that PA profession is not being abandoned or going away.

 

Just because US still has PA, doesn't mean Canada will. PA program in Canada started recently. US PA program started long long time ago.

 

Too much politics involved and hard to gain power.

Just like Primary Care NP have hard time changing from salary position to fee-for-service.

Just like NP anesthesia in Canada has extremely difficult time becoming established.

 

Physicians in my downtown hospital and my friend's hospital value NPs, but don't think much for PAs and don't feel they are needed.

 

A lot of oppositions. Only going to be an uphill battle from here...

[futureGP]

it sure doesn't prevent the PAs from being hired by the hospitals

 

 

 

but looking at the long-term prospects of PAs it's not good news. Hospitals can only hire so many, and in order for this profession to grow there has to be an incentive for private clinics outside of hospitals to hire PAs. Without regulation, idk how each clinic will think about hiring a PA (sure they may increase metrics and generate income at a hospital setting, but the same economics doesn't apply to smaller clinics -- it's like comparing apples with oranges)

 

even if it does, you need to have something to convince the private clinics to start hiring PAs and to actually adopt changes. it's not an easy task and that's why regulation of PAs is so important for the proliferation of this profession

[PAstudent]

Lots of PAs, myself included, work-in private clinics and generate income and improve metrics. Many of us do this with no special government support. As long as my supervising physician sees and is involved with the patient he can bill and we split the billing.

 

 

 

 

it sure doesn't prevent the PAs from being hired by the hospitals

 

 

 

but looking at the long-term prospects of PAs it's not good news. Hospitals can only hire so many, and in order for this profession to grow there has to be an incentive for private clinics outside of hospitals to hire PAs. Without regulation, idk how each clinic will think about hiring a PA (sure they may increase metrics and generate income at a hospital setting, but the same economics doesn't apply to smaller clinics -- it's like comparing apples with oranges)

 

even if it does, you need to have something to convince the private clinics to start hiring PAs and to actually adopt changes. it's not an easy task and that's why regulation of PAs is so important for the proliferation of this profession

[kpm]

Hey PAStudent,

Are you PAStudentCanada on the PA forum? If so, just wondering why on the PA forum, it seems like you are having some issues with the doctors at your job, but on here, it seems like you are saying a lot of positive things about the same job. Could you clarify?

[futureGP]

Lots of PAs, myself included, work-in private clinics and generate income and improve metrics. Many of us do this with no special government support. As long as my supervising physician sees and is involved with the patient he can bill and we split the billing.

 

so how does it typically work?

 

you do hx/pex for every patient, come up with Dx, plan, and ask the physician to order tests/prescribe?

 

or is there some sort of an agreement where you are able to prescribe/order requisitions on behalf of the supervising physician?

 

with PAs not being regulated i'm guessing the big part is 'unable to prescribe/order labs/imaging' + the billing part

[PAstudent]

so how does it typically work?

 

you do hx/pex for every patient, come up with Dx, plan, and ask the physician to order tests/prescribe?

 

or is there some sort of an agreement where you are able to prescribe/order requisitions on behalf of the supervising physician?

 

with PAs not being regulated i'm guessing the big part is 'unable to prescribe/order labs/imaging' + the billing part

 

 

 

I have medical directives so I order/prescribe under medical directive.

[PAstudent]

Hey PAStudent,

Are you PAStudentCanada on the PA forum? If so, just wondering why on the PA forum, it seems like you are having some issues with the doctors at your job, but on here, it seems like you are saying a lot of positive things about the same job. Could you clarify?

 

Nopers. Every situation is different and PA practices in Ontario vary widely. There are PAs with a great deal of autonomy and PAs with very limited autonomy.

 

I like most of the docs in our practice and I think they like having me around (at least I hope they do).

 

I just finished a shift where I:

 

Intubated two patients, managed ETOH intoxication and withdrawal, sutured up a few lacs, diagnosed/ managed:

few ear infections, URTIs, two appendicitis, a cholycistitis, an NSTEMI, a hypertrophic cardiomyopaty, three suicidal patients (formed them), a cellulitis, a knee gout (did an artherocentesis), did an LP, put an ankle slab on a young girl for a salter harris #, and a bunch of other stuff i can't remember because I am so tired now.

 

I love my job.

[kpm]

Ok, thanks for the reply. This makes a lot more sense now. I feel bad for the other PAStudent then...

[what]

i call BS on you seeing all those fairly high acuity patients in the span of 1 shift. an intubation and everything surrounding it takes a minimum of half an hour. a laceration and everything surrounding it can take anywhere from 5 minutes to an hour or more depending on complexity. LPs can take some time to set up and prepare. to have done those procedures AND see all these seemingly higher acuity things such as appys, choles, NSTEMIs while effectively acting as a resident because you would have to review things with a doc is VERY unlikely unless your shift was particularly long.

[PAstudent]

i call BS on you seeing all those fairly high acuity patients in the span of 1 shift. an intubation and everything surrounding it takes a minimum of half an hour. a laceration and everything surrounding it can take anywhere from 5 minutes to an hour or more depending on complexity. LPs can take some time to set up and prepare. to have done those procedures AND see all these seemingly higher acuity things such as appys, choles, NSTEMIs while effectively acting as a resident because you would have to review things with a doc is VERY unlikely unless your shift was particularly long.

 

 

Wow; that is rude, coming on here and accusing me of lying. It was a long shift (over 12 hours). That said, I have had shorter shifts with just as much acuity and variety.

[jerkoutnow2]

Wow; that is rude, coming on here and accusing me of lying. It was a long shift (over 12 hours). That said, I have had shorter shifts with just as much acuity and variety.

 

right on PAstudent,

 

fight for your independence! fight for separation of PAs as an independent profession!

 

You deserve it!

[PAstudent]

right on PAstudent,

 

fight for your independence! fight for separation of PAs as an independent profession!

 

You deserve it!

 

What in the world are you talking about? I don't want PA independence and never said anything of the sort.

[preppy038]

What in the world are you talking about? I don't want PA independence and never said anything of the sort.

 

i think he is trolling you

[PAstudent]

i think he is trolling you

 

What does "trolling" me mean?

[preppy038]

What does "trolling" me mean?

 

it's hard to explain :s people do it a lot on the net

 

http://en.wikipedia.org/wiki/Troll_(Internet)

[PAstudent]

it's hard to explain :s people do it a lot on the net

 

http://en.wikipedia.org/wiki/Troll_(Internet)

 

Ohh, haha. Okay, thanks.

[Pink Tulip]

Welcome to the Internet....

 

Going back on topic here, it does seem a bit unnerving that they're willing to put all the money to start the PA programs and yet they won't regulate them. It seems kind of contradicting for me.... I know Manitoba already has their PA's regulated and it seems to be working very well there. I don't think it will affect too many of the jobs though as far as private billing goes (since as someone already said on here, you can bill through your supervising physician) HOWEVER if they want to keep PA's where they need them (in hospitals and other government facilities for example), they will need to regulate them eventually or they're wasting their millions of dollars already put into starting this initiative.

[sampson]

PAs played a very important role in healthcare services.Physician Assistant Education Program is very honored program which for doing in healthcare and services.We are pleased to be honoring PAs for contributions to health care services.The main work is diagnose patients under the direction of their supervising physician.

[jerkoutnow2]

PAs played a very important role in healthcare services.Physician Assistant Education Program is very honored program which for doing in healthcare and services.We are pleased to be honoring PAs for contributions to health care services.The main work is diagnose patients under the direction of their supervising physician.

 

what? ur so random