First-year Physician Assistant Education students, from left to right, Andrea Pansoy, Susi Schoeley, Rachel Shekhman, and Jordan Pekrul practice assessing a patient's thyroid gland at McMaster University in Hamilton, Ont. on Tuesday, February 2, 2010.Darren Calabrese/The Canadian Press
Making better use of physician assistants could save the health system up to $1-billion a year and free up almost 30 per cent of doctors' time in busy areas like emergency rooms, according to a new Conference Board of Canada report.
"Integrating more physician assistants into health-care teams could help alleviate the increase in demand, decrease wait times and alleviate health workforce shortages," said Louis Thériault, vice-president of public policy at the Conference Board. The financial and efficiency gains are based on the assumption that the number of physician assistants (PAs) would rise steadily, from 500 currently to 900 within five years and then 2,000 in 2030.
PAs, who work under the direct supervision of a doctor, conduct specific tasks like taking patient histories or inserting intravenous lines.
The report stressed that physician assistants would not replace physicians but, rather, routine tasks would be delegated to PAs so doctors' time could be freed up for more productive and specialized interventions.
"This report confirms what PAs have known for years – that we can be an effective and cost-effective part of the health-care team," Chris Rhule, president of the Canadian Association of Physician Assistants, said in an interview.
"We're not saying this is a magic bullet," he added. "PAs are just part of the puzzle, but it's a part of the puzzle that's been forgotten."
Physician assistants have a long history in the military, but have only become integrated into the mainstream health system in recent years.
They tend to work mostly in areas where there are repetitive tasks that can be delegated, such as in primary care, emergency rooms, orthopedic care and surgery.
Almost all of Canada's physician assistants are concentrated in three provinces – Manitoba, Ontario and New Brunswick.
In the U.S., there are more than 130,000 PAs, largely because health-care providers aggressively seek out efficiencies and savings.
In Canada, the hiring of PAs is limited largely by arcane physician billing practices that restrict billing for delegated work. As a result, PAs tend to work in institutions where physicians are salaried rather than paid on a fee-for-service basis.
In Canada, a physician assistant earns between $75,000 and $100,000 – more than registered nurses but about the same as nurse practitioners. A nurse practitioner is a registered nurse with advanced training (a master's degree or a PhD) who operates independently; a physician assistant, which requires a two-year university degree, operates under the direct supervision of a physician, usually as part of an interdisciplinary team.
Generally speaking, nursing groups are unenthusiastic about the use of PAs because they see them as competition for limited health-care dollars.
Mr. Rhule acknowledged that there are some turf issues that need to be addressed at the political level but said that what is important is that "in the real world, the relationship between PAs and nurses is great. Together, we provide excellent team-based care."
The Conference Board of Canada is a not-for-profit think tank that specializes in analyzing economic trends and social-policy issues. In recent years, it has waded deeply into studying the health-care area through its Canadian Alliance for Sustainable Health Care.
André Picard