Physician assistant program up and running

The Northern Ontario School of Medicine (NOSM) has teamed up with the University of Toronto and the Michener Institute of Applied Health Sciences to introduce the province's second physician assistant (PA) degree program.

The first class of 22 students, six of whom are from Northern Ontario, hit the books in January.

The physician assistant role was introduced to Ontario in May 2006, but is well established in the Canadian Armed Forces and in the United States. More than 60 physician assistants, primarily ex-Armed Forces personnel, U.S.-trained PAs and International Medical Graduates, are already working in emergency departments, clinics and family health teams across the province in a series of demonstration projects funded by HealthForceOntario.

NOSM representatives worked with their colleagues at the University of Toronto and the Michener Institute to develop the curriculum for the program and will co-ordinate clinical learning placements for the PA students in their second year of the two-year program.  Students will earn a Bachelor of Science Physician Assistant degree from the University of Toronto and will be able to practice anywhere in Ontario under the supervision of a licensed physician.


Applicants

The University of Toronto approved the program at the end of June and began accepting applications August 1. By September 15, more than 100 applications were received.

Students are required to have at least two years of university and one year of health-care experience with direct patient contact. Eligible candidates would, for example, include nurses, X-ray technologists, kineseologists, physical therapists and chiropractors.

While HealthForceOntario and the Ontario Medical Association are trumpeting the introduction of the PA role as a way to reduce wait times in emergency departments and compensate for physician shortages, not everyone is happy.

In a press release issued in January, the Registered Nurses Association of Ontario (RNAO) warned that patients "will not be well served if the provincial government pursues a plan to allow physician assistants to work in hospitals, family health teams, community health centres and family physician offices."

Wendy Fucile, president of the RNAO, warned that nurses are "alarmed" about the inadequate educational requirements to become a PA, claiming "candidates could have studied history or engineering to be accepted" into the program.

"I don't think the Ontario plan for civilian physician assistants will result in graduates who are properly prepared to see and treat patients," she complained. Instead, "the province should be educating and hiring more registered nurses and nurse practitioners," said Doris Grinspun, the RNAO's executive director.

The University of Toronto's admission requirements preclude history or engineering grads from qualifying for its program, but the RNAO accusation is accurate with respect to the province's only other PA program at McMaster University, Elizabeth Whitmell, the U of T's PA program manager told the Northern Ontario Medical Journal.

In a battle of press releases, the Ontario Medical Association (OMA) took issue with the RNAO complaint as being "unfounded" and "completely untrue."

"Ontario's doctors support the work of PAs because we firmly believe that when all health-care providers work together, patients benefit from an enhanced level of comprehensive and timely health care," said OMA president Dr. Suzanne Strasberg.

"At a time when Ontario's doctors are advocating for increased collaboration between health-care professionals, especially with nurses and nurse practitioners, it's unfortunate that the RNAO is not following our lead."

Adding fuel to the fire, the RNAO also questioned the PA "experiment" from a financial perspective, complaining that in addition to the base salary that physician assistants receive, physicians assigned to oversee the work of PAs are also paid compensation.

"At a time when health-care budgets are already strained and when people are concerned about financial accountability, this seems irresponsible," said Fucile.

Physician assistants are not regulated health professionals and are only allowed to work under the supervision of their assigned physician. They conduct patient interviews and physical examinations, perform diagnostic and therapeutic interventions, order and interpret laboratory and radiological results and counsel patients on preventative health care.


Curriculum

The curriculum in year one of the program is a blend of home-based online learning and several month-long periods of classroom instruction at the University of Toronto. Students take courses in a broad range of subjects, including anatomy, physiology, pharmacology and pathology, said Whitmell.

The second year of the program is dedicated to clinical learning in a variety of health-care settings.

"The students will do six months of training in Northern Ontario and get a comfort level with practicing in small, Northern communities," said Sue Berry, director of health sciences and interprofessional education at NOSM. "The next six months, they'll be assigned to larger, tertiary care hospitals in southern Ontario to gain experience in an urban environment."

The class of 22 will be split up, so only half of the students will be based in Northern Ontario communities at any one time.

According to Berry, every effort will be made to ensure that clinical learning placements for the PA students don't overwhelm Northern Ontario physicians who are already engaged as clinical teachers for undergraduate medical students and residents.

The first group of 11 PA students is scheduled to commence clinical learning in Northern Ontario in January 2011.

The partnership with the U of T and the Michener Institute, and NOSM's involvement in the development of the curriculum will be an advantage "should we feel prepared to have our own standalone PA program three, four or five years down the road," said Berry.