A prescription for speedy care?
Physician assistants: So-called deputy doctors provide a surprising range of services
By asking how long my daughter and I had been waiting for our doctor, an elderly lady recently started a chat about innovation in our health system among patients in the waiting room of our local medical clinic.
Given there are only so many doctors and a rising number of patients, she raised the question of how the system could work better so that she and most other patients could get in faster for fairly routine conditions.
Due to wait times, patients had enough time to discuss how our health system should step up to be more innovative and active to give B.C. patients access to the type of health professionals who are already caring for patients to the north, south and east of B.C.’s borders.
Patients in Alberta, Alaska, Washington state and in northern territories can access physician assistants (PAs). Further east, so can Ontarians, Manitobans and New Brunswickers.
Much like the findings of a national survey, the waiting room chat showed that most B.C. patients are initially unaware about physician assistants but value PAs after learning how their work elsewhere in Canada benefits patients.
After hearing what physician assistants can do, patients largely feel that PAs could effectively speed up patients’ access to good quality care.
Being under direct supervision of a doctor, PAs can provide you with quite a range of services such as stitches, prescriptions, physical exams, laboratory and diagnostic tests, therapeutic procedures, and education and counselling.
Physician assistants, which personally I sometimes describe as “deputy doctors,” are qualified to see up to 75 per cent of patients in primary care clinics. They are also qualified to do much more than just primary care with your family doctor. In other provinces, they care for patients in emergency rooms, psychiatry, orthopedic, and neurosurgery.
Shortly after our waitingroom chat, I saw the release of a national report card listing as a priority for B.C. the permitting of PAs to work in our province. The grading was by the Canadian Association for Physician Assistants (CAPA). They noted how PAs reduced wait times for orthopedic surgeries by 38 per cent by helping surgeons take on more patients.
And for emergency departments, PAs can:
• Care for 62 per cent of ER patients,
• Reduce ER wait times by nearly 20 per cent
• Reduce by half the number of patients who leave ERs before getting to see a doctor.
My fellow patients in our clinic’s waiting room were surprised when I revealed that some PAs are actually working here in B.C., but not for the general public. The Canadian Armed Forces have used PAs for 50 years. Soldiers or sailors can see PAs at some bases here in B.C., such as at Esquimalt naval base on Vancouver Island.
Patients curious about the safety of seeing a PA were relieved about hearing the military involvement. If PAs are trusted to care for Canadian soldiers even in risky war zones like Afghanistan, my fellow patients said the soldiers’ families and the rest of the B.C. public should also be able to access PAs across the province’s health system. There are also physician assistants living in B.C. who don’t work for the army or in our province. So they are flown out regularly by employers in other provinces, states or the northern territories. One such commuter is Sean Kurtz, a PA who lives in his hometown of Revelstoke and is flown out biweekly to the Northwest Territories for a clinic caring for 1,500 diamond mine workers.
After working as an addictions counsellor and a nurse in B.C., Kurtz graduated as a PA at the University of Manitoba, then worked at one of Manitoba’s busiest emergency departments. At the start of his shift, he would care for 15-18 patients who had been waiting all night or day in the emergency department to see a doctor. Patients would be more quickly diagnosed, treated (sometimes with prescriptions) or transferred by having him work as a PA there.
B.C. has added about 300 nurse practitioners in the past decade, so some ask if another type of mid-level clinician is needed.
As a former nurse in B. C., Kurtz himself makes a good case for how PAs are different but can collaborate closely with nurses to be more efficient and effective for patient care. A 2013 research study by the UBC School of Nursing, funded by the Michael Smith Foundation for Health Research, also made the case that teamwork is very important. Doctors and physician assistants must be quite collaborative with nurses and nurse practitioners.
Last year, career website Glassdoor ranked physician assistant as No. 1 of the top 25 best job opportunities in the U.S. with more than 45,000 job openings with an average salary of $111,376 US.
Like other jurisdictions, PAs might be a notable job opportunity in the future for B.C. As baby boomers age, they will significantly raise the number of seniors needing the highest volume of health services. The number of health workers will also be dropping because many are baby boomers who will be retiring.
Several parts of the health sector are continuing their years of advocacy to add PAs to B.C.
The BC Care Providers Association (BCCPA) included PAs as a wish in its September 2015 white paper on Strengthening Seniors Care Delivery in B.C. to achieve quality, innovation and collaboration. Seniors in retirement homes will avoid going to hospital — up to 38 per cent less often — by using PAs, says a U.S. study cited by BCCPA. Adding and integrating PAs into seniors’ care is on the BCCPA’s agenda for their popular Care to Chat forum in a couple months.
Doctors of BC, the former B.C. Medical Association, issued its latest policy statement in 2013 on adding PAs to B.C. Dr. Charles Webb, president of Doctors of BC, also shared this statement to me: “Doctors of BC supports the establishment and deployment of physician assistants in B.C. We are aware of pilot programs in other provinces that have met with great success, and we see the integration of physician assistants as one tool to addressing the shortage of health human resources in our province — particularly to improve access to under-served areas and populations in rural and remote communities.”
The B.C. College of Physicians & Surgeons has told the national association of PAs that they are willing to regulate PAs to permit them to begin treating patients in B.C. once the provincial government is willing to amend legislation.
The Ministry of Health is waiting for more evidence from other provinces’ usage of physician assistants before acting to permit B.C. patients to test use of these deputy doctors in B.C.’s health system.
Doctors of BC supports the establishment and deployment of physician assistants in B.C.
DR. CHARLES WEBB
PRESIDENT, DOCTORS OF BC