Physician assistants solve doctor and dollar shortages
After three nights of throbbing pain, and ready to gnaw my own leg off, I walked into a Florida hospital one day last week, defeated, ready to sell my soul for relief.
And out I came with an ankle brace, a pack of pills and a possible solution to chronic Canadian health-care clogging.
Two words: physician assistants. During a three-hour stay in emergency at Lee Memorial in Fort Myers, I never met a single doctor. Yet the care was, if not excellent, certainly satisfactory, spiced up by the wails of homeless Tyler, the one-footed Vietnam vet who was, allegedly, dropped by ambulance attendants on the way in, and the tubby rich guy complaining about Obamacare and $900 a month in private health premiums, with a $5,000 deductible.
But, back to the plot of My Left Foot: An X-ray was done within 15 minutes, quick history taken by a nurse within the first hour, and treatment offered within three, then off limping into the Sunday sun, ready to narc up.
As a profession, physician assistants are growing by leaps in the United States, so much they number in the hundreds of thousands. I was surprised to discover we have them here — about 80 in Eastern Ontario, including six at The Ottawa Hospital.
By some estimates, physician assistants can treat up to 75 per cent of emergency walk-ins. They can help with surgeries and bone-setting, and prescribe some medications. Salaries? In the $75,000 to $120,000 range, according to their national association.
Second-tier service seems to be where the broad public sector is headed anyway. Consider that contract professors, at a fraction of the tenured rate, are teaching most of the undergrad courses at universities, and special constables are being eyed to replace full-pop coppers wherever possible.
It is the same argument: Just as you don’t need a licensed mechanic to handle an oil change, you don’t need a fully-endowed physician, with four years at Harvard or McGill, to treat a bo-bo. Announced layoffs at The Ottawa Hospital and The Royal are only different fuel on the same fire: Health care is burning a hole in the public purse. So on to cheaper. Who, how?
Robert Brunet, 54, is a staff physician assistant in Hawkesbury and a board member of the Canadian Association of Physician Assistants. Before completing six semesters of training at the University of Toronto in 2010, he was a paramedic for 18 years.
He has worked extensively in hospital emergency departments but recognizes the profession has a long way to grow in Ontario. “We’re so much in our infancy, it’s incredible.”
Anyone accepted into physician assistant programs comes with plenty of clinical experience. Nurses often apply, or those with master’s degrees in health fields, or credentialed health-care workers from other countries.
Brunet calls it a “restricted practice” — because there are treatment limits — comparing it to the capabilities of a resident doctor.
The association says on its website that about 60 per cent of emergency walk-ins can be treated by a physician assistant. Brunet says, in his experience, it’s even higher.
“We’re upwards of 75 to 80 per cent, depending.” And on more complicated cases, like chest pain, the assistant can start the investigative process, he said, before a physician or specialist arrives.
“For the smaller, less urgent cases, quite clearly I can manage things.”
He now works with a pair of physicians and a couple of clinics. With his help, the doctors are able to see twice as many patients, he said. “We’ve had great responses as far as satisfaction rates are concerned.”
He also assists with surgery, doing things like sutures and cauterization.
There are two Ontario universities turning out more than 50 physician assistants every year. Strange how they’ve worked so far below the radar.
Nothing in health care is simple, Lord knows. There has been concern expressed about the regulation of physician assistants, the level of hands-on supervision from an accredited doctor, and suspicion cast by nurse practitioners.
“Structure and funding models,” is how Brunet politely describes the barriers. Many are the turrets to be guarded.
There is much about the American health system we wouldn’t tolerate here. But with PAs, they might be on to something: the concept that skills training should suit the job, not wildly exceed it. The old way is harder and harder to afford, no leg to really stand on.