Health Force Ontario demonstration project addresses resource shortage

Date Published | Jun. 1, 2008

BY NORM TOLLINSKY

During his first few months of employment in the Emergency Department of Timmins District Hospital, Shawn Best figures he spent at least a half hour every day fielding questions from hospital staff about who he was and what he did.

One of approximately 60 physician assistants (PAs) working in hospitals, clinics and long term care facilities as part of a Health Force Ontario demonstration project, he spent just under 21 years in the Canadian Armed Forces as a primary care medic and physician assistant.

Just 40 years old and eligible for retirement, Best didn’t think twice when the Ontario government came calling with an opportunity to trade in his uniform for a civilian gig.

The first phase of the physician assistant initiative began in January 2007 and was a one-year emergency department pilot project that placed PAs in six hospitals. The next phase consisted of three, two-year demonstration projects, the largest of which saw an additional 50 PAs join interprofessional teams in hospitals throughout Ontario. Some PAs are also working in community health centres and others are employed directly by physicians or groups of physicians.

“What we are trying to learn is how we can effectively introduce PAs in Ontario,” said Jeff Goodyear, director of the Ministry of Health and Long-Term Care’s Human Resources Policy Branch. “We’ll learn what kind of roles are suitable and what supports we need so we can move forward and proliferate the role around the province.”

Canadian Forces

The Canadian Forces have had physician assistants for years and the U.S. has 60,000 of them, but with the exception of a handful employed at Winnipeg Health Sciences Centre and a few who work for federal government correctional facilities, there were no roles for PAs in the Canadian health care system prior to Ontario’s demonstration project.

Neither were there any civilian training programs, but that, too, is about to change following a decision by McMaster University to launch a 24-month physician assistant training program in September. Another program with a Northern Ontario delivery component is also rumoured to be in the works.

As a physician assistant, Best assesses patients admitted to the emergency department, takes down their history and orders treatment through his supervising physician.

He will also suture wounds or do casting, freeing up physicians to see other patients.
Unlike nurses, explained Best, physician assistants are trained on the medical model.

“It’s difficult to compare a PA and an RN because the roles are completely different. RNs are trained on the nursing model. They’re outstanding at what they do, but they’re carrying our orders and doing the patient care.”

According to Goodyear, there is no scope of practice for PAs because they are not independent practitioners.

“Their scope of practice is set by their supervising physician. It’s whatever the physician feels comfortable delegating to them. As the relationship grows, the physician is more comfortable with what the physician assistant can do, so it evolves over time.”

A warrant officer in the military, Best served in Croatia and Afghanistan. While based in Kandahar, he participated in medical outreach missions tending to the health care needs of the locals, often encountering diseases and medical conditions never seen in Canada, including one case of post-polio syndrome in a 10-year-old boy.

He was a little apprehensive when he first started his job at Timmins District Hospital.
“It was terrifying to say the least. It was the first time I was out of the military in 21 years and it was a different culture, but I love it. It’s a really good group here and I’ve had 100 per cent support from the start.”

Best is one of nine physician assistants currently working in Northern Ontario.

Kirkland Lake

Another former Canadian Forces PA, Kelly Helmink, from Terrace Bay, joined the emergency department at Kirkland and District Hospital in September 2007.
Helmink, 49, retired from active service with the military in 1996, but continued to serve as a physician assistant with the Reserves. He was able to land a few civilian gigs as a medic in the Arctic and in Sudan, interspersed with assignments in Senegal, Darfur and the Middle East, but the opportunity to live a more settled life back home in Northern Ontario had its appeal.

Nurses in the emergency department were a little puzzled at first “because they didn’t know who I was, what I was and how it was going to affect them, but everything went smoothly when they found I was part of the team.

“When I’m seeing a patient, the physician can see someone else, so it has reduced wait times and increased patient satisfaction.”

Also serving as PAs in the Ontario demonstration project are 39 international medical graduates who completed a rigourous, four-month integration program. Some PAs with U.S. training and qualifications have also been recruited by Health Force Ontario.
Following the current two-year pilot, the Ministry will sit down with its partners, conduct an evaluation and make some decisions about how to proceed, said Goodyear.

www.healthforceontario.ca
www.caopa.net