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Physician Assistants in Canadian Emergency Departments: Not only Time but Long Overdue

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A recent news story highlighted the hiring of two Physician Assistants in the Brantford, Ontario emergency department.

Though a welcome announcement, in my view, it shouldn’t be news. This should be an every day, routine occurrence recognizing the very important role that PAs have to play in the average Canadian emergency department.

Human resources shortages are well documented and chronic. Dr. Andrew Affleck has estimated that Canada currently requires a further two thousand emergency physicians to staff the approximate eight hundred EDs in the country and with the aging work force, this number will undoubtedly grow. Anyone who has worked in the ER recognizes that the emergency nurse is the lifeblood of the department and yet far too many have only part-time jobs and with the demands of the job, often have one eye open for the next better opportunity.

When facing the question of human resources shortage my bias is to expose and train more physicians in emergency medicine and to develop a cadre of full-time dedicated emergency nurses to provide the necessary care.

That being said, the emergency department is a big tent and many providers may have arole to play in care delivery.

Fourteen million Canadians visit the Emergency Department on annual basis and a large percentage present with comparatively minor illness or injury. Of those patients who present to Canadian emergency departments, CTAS levels IV and V populations are often measured in the 50-60% range. The concept of a physician extender to help manage these types of patients has great appeal.

When I served in the Canadian Army Medical Services, I worked along side Medical Assistants ( the precursor to the PAs of today) and I found many of them to be excellent.

The training for Physician Assistants in Canada has improved since the days of the military Med-A and the graduates now leave with a Baccalaureate or Master’s degree from a university level program affiliated with a medical school. Military physician assistants are also now exposed to severe trauma while in the theatre of war.

PAs are now recognized in Manitoba, Ontario and New Brunswick. There are currently in excess of three hundred PAs working in clinical settings in these three provinces.

The experience of most Canadian emergency departments that have been involved with pilot programs with respect to the use of PAs has been universally positive.

Their time to play a meaningful role in the delivery of emergency care in Canada has come. This is a program that Canadian emergency physicians should enthusiastically embrace and promote.

2 Responses »

  1. In rural states like Maine, Vermont and Minnesota, including the Mayo Clinic system, where it has been all but impossible to get board-certified EM docs hospitals have turned to the PA model to provide ED services.
    Suggest that those interested take a look at “Best Practices: Utilizing Physician Assistants in Rural (Critical Access) Emergency Departments”

    http://urgentmatters.org/e-newsletter/current_issue/BP.9.4

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