This is the third instalment in a series of articles looking at the issue of physician assistants, and the role they could play in British Columbia.
Many countries — and some Canadian provinces — rely heavily on physician assistants to balance a sustainable medical health system.
As of 2022, physician assistants (or physician associates) are accepted professionals in at least 16 countries, including the United States, the United Kingdom, Ireland, and South Africa.
New Zealand, a country with approximately the same population as British Columbia, currently has 30 physician associates spread throughout the nation.
Wayne Lim is the general manager of Te Awamutu Medical Centre, on New Zealand’s North Island. The clinic cares for 14,000 patients, and typically has two physician associates among his staff of 50.
“We first started looking at PAs around 2016, anticipating that the mix of clinicians would have to evolve, given the way the statistical landscape looked… with increasing obesity, increasing diabetes, people getting sicker, with fewer numbers of physicians to look after them, relatively speaking,” he said in an interview with Black Press.
There had been a pilot program run in New Zealand a couple of years prior, testing out PAs in the clinical environment to determine the viability of the profession in the country.
Based on the results of that pilot, the Te Awamutu Medical Centre hired one on a part-time basis. Shortly thereafter, the clinic advertised for a full-time PA. Lim said the PAs have fit in “absolutely brilliantly.”
He said there was a culture adjustment to make, as GPs are ultimately responsible for a PA’s work, thereby requiring an appropriate supervisory structure, but the introduction was relatively seamless.
“It went very, very well, and within weeks, we knew instinctively that it was a great decision,” said Lim. “We found the PAs to be very capable and the GPs got used to the idea of supervising and signing off their work very quickly. We are very happy with the progress we have made.”
Lim said from a business point of view, adding PAs to his team was “a no-brainer. They have a clearly identified set of capabilities… they are paid appropriately, and for a business, it works having people doing what they are best at. They cost less (than a GP) and they do their share of the work, absolutely.”
Lisa DeWolfe, president of the New Zealand Physician Associate Society, says the benefits of the profession are that physician assistants — or associates, as they are identified in New Zealand — can improve job satisfaction, reduce burnout and address shortages in the health system.
Big in the U.S.
The profession is particularly strong in the U.S., where there are approximately 159,000 practitioners engaging in more than 500 million patient interactions each year, according to the American Association of Physician Assistants (AAPA).
The country embraces the profession and gives it an extremely high rating.
The US News and World Report ranked physician assistants as No. 3 in its 100 Best Jobs list for 2022.
Jennifer M. Orozco, 2021-22 president and chair of the AAPA board, and director of advanced practice providers at Rush University Medical Center in Chicago, says physician assistants “help fill in a lot of access gaps across the country.”
“They practise medicine in every health-care setting, from hospitals to emergency rooms to private practice to operating suites,” Orozco said, of the high ranking. “They take care of a patient in every specialty, from primary care to pediatrics all the way through geriatrics and palliative care.”
Profession growing in Canada
In Canada, there are approximately 800 physician assistants, with more than 500 of those working in Ontario.
Manitoba, Alberta, and New Brunswick also accept PAs in their health-care systems, and a PA pilot project was introduced in Nova Scotia in 2019.
According to the Canadian Association of Physician Assistants, PAs in primary care settings can be used for 75 per cent of all visits without referral to physician-level care. Also:
• PAs in emergency departments can reduce wait times by 1.9 times and reduce “left-without-being-seen” rates by half.
• PAs can increase surgical throughput of primary joint replacements by 42 per cent a year and reduce wait times for surgeries by 14 weeks.
• PAs in long-term care settings have been shown to decrease hospital admission rates by 38 per cent for seniors.
And yet, B.C. physician assistants still have to go elsewhere for work.
When asked why the profession is not recognized in this province, the ministry of health in B.C. said the situation is being “monitored.”
“The introduction of a new health profession requires careful consideration, management, and significant resources to properly understand and address the inevitable team function issues that emerge from overlapping scopes of practice,” the ministry said in an email to Black Press.
While the ministry did not go into detail regarding its concerns about overlapping scopes or practice, the Canadian Association of Physician Assistants has stated the hesitation from B.C. surrounds the investment the B.C. government has put toward nurse practitioners, explaining the “limited desire to introduce a new health-care profession.”
Meanwhile, the same US News and World Report that ranked physician assistants as No. 3 in its ‘100 Best Jobs’ list for 2022, had nurse practitioners ranked at No. 2.
“With so many patients having difficulty finding a family doctor or accessing care in a timely manner, it makes sense to introduce PAs into the (B.C.) health-care workforce,” said the CAPA, in a statement to Black Press. “We are always looking for people to help us promote the profession and to advocate for its advancement. We usually encourage our Canadian PAs who want to work in B.C. to write Adrian Dix, the Minister of Health expressing their desire to introduce PAs into the province.”
To express support for physician assistants in British Columbia, email Dix at HLTH.Minister@gov.bc.ca