Physician assistants support physicians in a range of health care settings and work under the direction of a licensed physician to provide patient/client care. In Canada, PAs have been employed by the Canadian Forces for many years to deliver health care services to members of the military and their families. PAs have been working in Manitoba since 2002, where they are known as clinical assistants. PAs have also practiced in the United States since the 1960s. The PA role is currently being integrated into the health care systems of many other countries around the world.

The specific duties of the PA vary, depending on the individual competencies of the PA, the supervising physician’s area of practice, and the types of duties that the supervising physician chooses to assign. Examples include:

• Conduct patient interviews and take medical histories
• Perform physical examinations
• Perform certain controlled acts delegated to them by a physician
• Provide counseling on preventive health care

Evidence shows that PAs help to improve access to health services and overall quality of care. The introduction of PAs is designed to help reduce wait times and help ensure that the right care is provided by the right provider at the right time. Expanded interprofessional health care teams will be better able to serve patients in a timely manner.

Ontario’s Physician Assistant initiative is introducing PAs to a number of different health care settings through a series of demonstration projects across the province. The initiative also includes the establishment of Ontario-based post-secondary PA education programs.

In the initial phase of the demonstration project 60 PAs were hired (approximately 10 US trained PAs, 10 retired Canadian Military PAs and 40 international medical graduates given PA training) on two-year contracts to work in:

• More than 20 hospitals as part of interprofessional teams in areas that include general internal medicine, emergency, orthopedics/orthopedic surgery, general surgery, complex continuing care and rehabilitation. This part of the project is led by the Ontario Hospital Association.
• Five primary care Community Health Centres where PAs work as part of interprofessional teams in areas that include chronic disease management programs, addictions and mental health, and pediatric and women’s health care. This part of the project is led by the Association of Ontario Health Centres.
• Diabetes care and long-term care patient management settings where PAs are employed directly by a physician or group of physicians. This part of the project is led by the Ontario Medical Association.

More recently, the Ministry has announced an extension of some of the first wave of PA projects and the expansion of the PA Demonstration Project to include a further 20 PAs in Emergency Departments and 20 in Family Health Teams.

Both the Canadian and the Ontario Medical Associations have endorsed and support the development of the PA profession.

Physicians who have liability coverage with the Canadian Medical Protective Association are covered while working with Physician Assistants or supervising PA students.

Currently there is no legislation in place in Ontario regulating the PA Profession. As a result, all activities conducted by PAs are carried out as delegated acts under the authority of the Regulated Health Professions Act 1991 (RHPA). In practice this means that clinical activities performed by PAs are carried out either through the direct delegation of a physician, or through a medical directive previously approved by physicians and with the ongoing supervision of a responsible physician. At the present time it is not known whether PAs will ultimately have a self-regulating College or whether they might become regulated or (credentialed) by the College of Physicians and Surgeons of Ontario.

In Ontario, Registered Nurses in the Extended Class, also known as Nurse Practitioners (NPs), are registered nurses with post-baccalaureate education and clinical experience. Nurse practitioners have the legal authority to independently perform a number of authorized acts beyond those that registered nurses are permitted to perform, for example, ordering and interpreting diagnostic tests, communicating diagnoses, prescribing pharmaceuticals and performing specific procedures. NPs are required to practice within their legislated scope of practice. NPs work collaboratively with many other health professionals and they consult with physicians as required by the needs of their patients.

Thus NPs are independent practitioners working within their legislated scope of practice. In some cases NPs and PAs may undertake similar types of clinical activity, but the PA is always working in a delegatory and supervised role.

In 2008, McMaster University launched Ontario’s first civilian physician assistant education program. The minimum entry requirement is two years of university education, which is followed by a 24 month, continuous education program (6 semesters; equivalent to three years of university education), leading to a Bachelor of Health Sciences Physician Assistant degree. After graduation, PAs will qualify to take the certification examination with the Canadian Physician Assistants Certification Council of Canada (PACCC), an independent Council of the Canadian Association of Physician Assistants (CAPA).  This includes an entry to practice examination which ensures that the PA meets the standard set out in the Occupational Competency Profile (OCP) for the Physician Assistant profession.

In addition, the University of Toronto, in collaboration with the Michener Institute for Applied Health Sciences and the Northern Ontario School of Medicine has opened a PA Education Program in 2010.

Ultimately health care jobs come from the government using new money to create new jobs, or from individuals or groups finding opportunities within the current funding envelope.

Is the Ministry going to offer new money? At the present time, this is unknown. The Ministry is certainly studying this, but has not announced any opportunities outside of the demonstration projects.  While it seems likely and is consistent with what the government has been saying and doing, the health care community is awaiting Government announcement about specific initiatives.

Are there job opportunities within the health care system as it currently stands? To a large extent this depends upon the imagination and initiative of individuals and leaders of health care institutions. Jobs will come from those who have work and a budget, and foresee savings or new revenue opportunities from employing PAs. In hospitals, such jobs could include hospitalist, ICU, surgical or ER assistants. The further you get away from the GTA, the greater is the likelihood that there will be job opportunities. In physician offices jobs could include PAs in rostered family practices, surgical or diabetes clinics, or other chronic disease clinics, such as heart failure, HIV, lipid, stroke prevention and geriatrics