PA Article

[PAstudent]

http://www.northumberlandnews.com/opinion/columns/article/1610619--physician-assistants-a-solution-to-northumberland-s-health-care-crisis

 

Physician assistants: a solution to Northumberland's health care crisis

View more by Guest Columnist

 

David Clutterbuck.

There is a new health care profession in Canada that could be a major part of the solution to the doctor shortage in Northumberland. Physician assistants, often called PAs, are professionals who practice medicine under the supervision of a physician and have been an important part of the health care system in the U.S. since the 1960s, as well as the Canadian military since the 1980s. They are board certified by national examination in Canada and the Ontario Medical Association supports the PA profession and its growth.

 

Physician assistants are now working throughout Ontario after a pilot project in 2008 proved them a valuable addition to health care teams across the province.

 

Unlike many other advanced care professionals, PAs are true physician-extenders and while working under the oversight of a doctor they can function in all capacities of the physician. It is this model of supervision by which doctors train residents, which means PAs can enter any specialty of medicine and become highly skilled clinicians. There are now two Ontario universities that offer professional degree programs for physician assistants, McMaster University and University of Toronto.

 

Because of the way physician assistants function, emergency room doctors with PAs can see far more patients per shift and spend more of their time on the patients who need it, while the PA continues to assess and treat other patients. This way both can spend more time with each patient to ensure the best care.

 

Physician assistants can take histories, do physical exams, order and interpret tests, diagnose and treat patients in consultation with their supervising physician as needed. By working this way, patients do not have to see a mid-level practitioner and then be referred on to a doctor for more assessment - it all happens in real time, which means shorter wait times and better use of the physician's time.

 

In surgical specialties, PAs would see patients in the hospital, order tests and imaging, interpret results and present the complete assessment to the surgeon to determine if an operation is needed. They can also assist in the surgery, which allows surgeons to focus on the things that require their expertise and reduces wait times for surgery.

 

Northumberland has made great strides with the integration of other advanced health professionals, such as nurse practitioners, into family health teams. Many of these practitioners are oriented toward independent practice, which may streamline primary care services, but does not necessarily extend the capacity of physicians. Because of their training and broad scope of practice, PAs have something new to offer the health care system that will complement the roles of other professionals. Northumberland offers an incentive grant of $81,400 to doctors who come to the region for a four-year term of service. While communities must continue to attract doctors, physician assistants offer a cost-effective way to expand the capacities of Northumberland's existing doctors who are already here serving the community.

David Clutterbuck is a student in the physician assistant professional degree program at the Faculty of Medicine, University of Toronto

[shaka84]

How does assisting in surgery allow the surgeon to focus on things that require their expertise and reduce wait times for surgery?

 

It does not make any sense. The surgeon is responsible for the case and is focused on the entire procedure. Unless the article is suggesting the PA is booking their own cases they cannot reduce wait times for surgery.

 

Do PA's in surgery expect to eventually book their own cases and have their own OR's?

 

S.

[PAstudent]

How does assisting in surgery allow the surgeon to focus on things that require their expertise and reduce wait times for surgery?

 

 

That particular sentence/paragraph in the article is poorly done and confusing. You are right, it does not make sense. This is the part that helps in that respect: "PAs would see patients in the hospital, order tests and imaging, interpret results and present the complete assessment to the surgeon to determine if an operation is needed."

 

 

In places where resources are not the rate-limiting factor (lots ofOR time available) and there is a shortage of medical/surgical staff, PAs reduce wait-times. For instance, in Manitoba Ortho PAs will open, close, do other routine parts of procedures (arthroplasties for instance) and take care of pre-op and post-op issues and run surgical clinics. This way the orthopod can spend more time operating and can run multiple ORs at once (i.e. say three ORS with a PA in each OR doing the routine parts of the procedures and the orthopod going from room to room).

 

Remember, PAs are to be utilized like residents. Just as residents will run clinics and take care of the wards and be in the OR, PAs can do the same. See: http://www.aaspa.com/page.asp?tid=95&name=The-Surgical-PA&navid=18 and http://www.aaspa.com/page.asp?tid=144&

[shaka84]

I take offence to the comparison of PA's to residents. As a surgical resident 1. I work 80-100 hours a week.

2. I am responsibe for medical students and junior residents.

3. I am learning the skills to become a staff surgeon.

4. I went to medical school.

 

The comparison is pretty slim. PA's are mid levels, residents are not.

 

S.

[aaronjw]

I take offence to the comparison of PA's to residents. As a surgical resident 1. I work 80-100 hours a week.

2. I am responsibe for medical students and junior residents.

3. I am learning the skills to become a staff surgeon.

4. I went to medical school.

 

The comparison is pretty slim. PA's are mid levels, residents are not.

 

S.

 

 

+1

 

10chars

[PAstudent]

I take offence to the comparison of PA's to residents. As a surgical resident 1. I work 80-100 hours a week.

2. I am responsibe for medical students and junior residents.

3. I am learning the skills to become a staff surgeon.

4. I went to medical school.

 

The comparison is pretty slim. PA's are mid levels, residents are not.

 

S.

 

It is unfortunate that you are offended but this is the reality. PAs are not the same as residents, and PAs, of course, are not being trained to become staff surgeons. But most PAs do get about 75-85 per cent of an M.D. education and start out from school at a level similar to a PGY1 just starting out. That is the whole point of a PA. PAs basically do a fast-track version of med school (you can see my other posts in this forum for a break-down of PA vs MD training at McMaster, specifically this thread http://www.premed101.com/forums/showthread.php?t=47305) and then they learn on the job.

 

PAs are often also responsible for medical students and junior residents as well.

 

A good friend of mine, a PGY3 in gen surg, said one of his greatest mentors is a PA who has been in gen surg for his entire career.

[shaka84]

So...

I went to medical school for 4 years which included 2 years of clerkship and I only recieved 15-25 percent more education than a PA student who completed their program in 2 years. How can you explain that?

Is the MD program that inefficient and/or the PA program that superior in training it's students. Just because a pamphlet says that the PA education is X% of an MD eduction doesn't make it so. There is a lot of politics involved. Making a chart comparing the hours of formal instruction between the two programs is a farce.

Why not make the PA program 3 years long so the PA's will have even more knowledge than the residents.

 

If PA's and residents function the same why do PA's make way more money than residents and work way less? More politics and the government not understanding/respecting the residents role in health care.

 

It's great your friend has a lot respect for a PA at his hospital. Sadly, as an MD the amount of respect we get is sinking fast. We are constantly under attack by the government and mid level practitioners who want to give away our scope of practice to other providers. I can understand why though. If I was told by the government and my professional association that I can do what MD's do I would start to believe it too.

 

A PA functions as a PA. A resident functions as a resident. Trying to blur the lines between the two is inappropriate. I can see a power struggle in the future between residents and PA's if this issue is not resolved.

 

I can definitely see where PA's can help the system but I can also see potential trouble ahead. There was even a previous thread on this site suggesting that PA's should eventually become independent practitioners. It's human nature. You give someone an inch and they will take a mile...

 

S.

[A-Stark]

In places where resources are not the rate-limiting factor (lots ofOR time available) and there is a shortage of medical/surgical staff, PAs reduce wait-times. For instance, in Manitoba Ortho PAs will open, close, do other routine parts of procedures (arthroplasties for instance) and take care of pre-op and post-op issues and run surgical clinics. This way the orthopod can spend more time operating and can run multiple ORs at once (i.e. say three ORS with a PA in each OR doing the routine parts of the procedures and the orthopod going from room to room).

 

Where are resources ever not the rate-limiting factor?

 

And I trust that "arthroplasties" is a typo. (Not that I'd call arthroscopy "routine" either. Portraying certain procedures as routine is something of a false dichotomy. They're only "routine" until they're not.)

[docmm]

It's great your friend has a lot respect for a PA at his hospital. Sadly, as an MD the amount of respect we get is sinking fast. We are constantly under attack by the government and mid level practitioners who want to give away our scope of practice to other providers. I can understand why though. If I was told by the government and my professional association that I can do what MD's do I would start to believe it too.

 

With a MD your scope of practice and level of autonomy will always be greater than any mid-level practitioner. By presenting it as a being "under attack", you make it sound like you went into medicine for the prestige. That's the only real thing I am seeing under attack by expanding the scope of practice of mid-levels. There is a need for more doctors in Ontario and your job prospects are not really being threatened any more so than any other job in health care (competition is increasing). Mid-levels are under supervision and have all of the skills and education needed to perform their in role. Perhaps I am looking at the issue with naive eyes.