Provinces testing physician assistants to stretch dwindling doctor numbers

EDMONTON — After they spend about 10 minutes with him in the emergency room, Jack Buchanan’s patients often end up calling him doctor.

He wears a big name tag with his title – physician assistant – and always explains that he’s there to help the doctor, not take over. But some people don’t immediately understand the difference.

“After about five hours of waiting, they just want to be seen.”

Physician assistants are one way that governments across Canada could stretch the dwindling number of family doctors and specialists to tend to a growing population.

Provinces have tried a variety of other solutions. Nurse practitioners have been licensed in every province since 2006. Pharmacists have some prescribing powers in Alberta, and telephone health advice lines, generally staffed by nurses, are open around the clock in most parts of Canada.

Alberta’s health minister recently went so far as to say that he won’t be convinced a “so-called doctor shortage” even exists until other health-care workers are a full part of the medical system.

“So much of this is about changing the mindset of what used to be. In the ’60s, when you felt sick, you went to see the doc,” Ron Liepert said last month as he outlined the province’s blueprint for health care. “We’ve got so much more to offer today in health care.”

The concept of shifting some primary care focus off doctors and onto other health-care workers isn’t new, says John Church, associate professor at the University of Alberta’s Centre for Health Promotion Studies.

But a number of factors – including a drop in the number of doctors being trained in the 1990s, new physicians who aren’t willing to sacrifice a life outside work and a shortage of doctors choosing family medicine – have made it a necessity.

“I think that the doctor shortage has forced the issue in a way it’s never been forced before,” Church says.

The idea of using physician assistants seems to be catching on, especially with doctors themselves. Often called physician extenders or multipliers, they’ve been helping doctors in the United States for decades. More than 70,000 work south of the border, but until now the only ones in this country have been trained by the military.

Ontario has been running pilots projects – Jack Buchanan is working at one in Brockville. And Manitoba has used ex-military or American-trained assistants since 2002.

This fall, the University of Manitoba and Hamilton’s McMaster University will accept students into Canada’s first non-military physician assistant programs. Edmonton’s Northern Alberta Institute of Technology hopes to follow within a few years if the Alberta government regulates the assistants.

Physician assistants can handle a wide variety of tasks in general medicine and some specialties, says Buchanan, who is also vice-president of the Canadian Association of Physician Assistants.

They take histories, fill out charts, run tests, suture and put on casts. They’re trained roughly to the level of a senior resident, in many cases. While full-fledged doctors generally might have only passing contact with some patients, they must sign off on all decisions the assistant makes.

At his hospital, Buchanan plays a role in every level of patient care.

“The doctor can be seeing a chest pain, and so can I,” he says. “That way, the sicker people actually get seen faster and it reduces overall wait times.”

In his hospital, he says, wait times have been cut by one-third since physician assistants began working.

Ontario’s health minister, George Smitherman, has said it’s too early to say exactly what role physician assistants will play, but they seem to help improve timely and effective access to care.

Liepert foresees the day when physician assistants will be part of revamped health care in Alberta, although the exact details have yet to be released.

“I think the other provinces are all waiting to see how Ontario is going,” says Buchanan.

The Canadian Medical Association is firmly in favour of physician assistants. President Dr. Brian Day points out, though, that they’re often recruited from among the ranks of nurses, which then exacerbates the nursing shortage.

The drastic shortfall in both family physicians and specialists can’t be ignored, and no amount of spin from politicians such as Liepert can change that reality, Day says.

“When a patient is sick, they generally want to see a doctor.”

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