Master Corp. Eric Demers, a medic with the Canadian Provincial Reconstruction Team, jokingly grimaces as he asks a young boy to squeeze his fingers as part of an examination in Kandahar in September 2005. Now retired from the military, Demers says physician assistants could be a way to increase care for B.C. patients. (Photo by Sgt. Jerry Kean, Canadian Armed Forces)

Physician assistants say they can help B.C. health care woes

Reducing wait times, improving doctor efficiency is the goal

For years, Eric Demers provided medical care on Canada’s army bases and submarines. Now as part of the Canadian Association of Physicians Assistants, he said physicians assistants (PAs) are one way to address B.C.’s shortage of health care providers.

Demers described PAs as “doctor extenders” who always work under the supervision of a doctor but can handle many routine tasks, allowing doctors to treat more patients. In studies done in Ontario, 95 per cent of physicians working with PAs said that the PA had increased their own efficiency in providing care, and that PAs in emergency departments can reduce wait times by 1.9 times and reduce “left without being seen” rates by half.

The practice began in the United States in the 1960s, after a pioneering program at Duke University was designed as a way for military medics to continue to apply their knowledge. PAs are currently recognized in four provinces: Alberta, Manitoba, Ontario, and New Brunswick, and the idea has been endorsed by Doctors of BC and the Canadian Medical Association. Demers said it could also address the shortage of medical care in B.C.

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For years, the B.C. Ministry of Health has been trying to shift the province from family physicians as a first point of contact, instead transitioning to a team-based model of care where different allied health professionals collaborate under one roof. In May, the province announced funding for 200 more nurse practitioners (NP) over three years, and Demers said he would like to see PAs added as well. Unlike PAs, NPs can work independently (but often work collaboratively with other health care providers). Demers said each had their advantages, and wanted both to be included in B.C.

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The Canadian Association of Physician Assistants has met with Minister of Health Adrian Dix as well as the previous BC Liberal caucus. They will meet this weekend (Oct. 18 to 21) for their annual conference at the Victoria Conference Centre.

“There’s some interest, but there does not appear to be a lot of motivation to recognize PAs in B.C.,” said Demers.

“I think it’s a bit of fear of the unknown, and not knowing all the advantages of physicians, the value we can bring to the health care system.”

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The Ministry of Health has not yet replied to requests for comment.

On the Saanich Peninsula, a team-based model of care is already underway but looking to grow. Shawna Walker, executive director of Peninsula Medical, said their main barrier in hiring alternative health care providers like nurse practitioners and physicians assistants is how B.C. pays doctors. Only a general practitioner can bill B.C.’s Medical Service Plan (MSP) on a fee-for-service basis. With that in mind, Peninsula Medical is seeking Ministry funding to pay a fixed salary for an allied health care provider, such as a NP or PA.

Walker said Peninsula Medical’s mandate is to increase access to care and attachment of patients to a family doctor, and including other health care providers like registered nurses, social workers, dietitians have been proven to increase access for patients. Since a PA would enable the family doctor to care for more patients, she said they would consider adding that discipline to their team-based practice.


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