B.C. is an outlier among Canadian provinces in not employing physician assistants.
Published Aug 24, 2023 • Last updated 13 hours ago • 6 minute read
Lisa Stewart has worked beside doctors in intensive care at a Winnipeg hospital and treated burn victims while assisting plastic surgeons in Calgary.
Calls to license physician assistants are increasing as staffing troubles continue to plague B.C.’s health-care system, with intermittent closures at several rural emergency departments over the summer.
B.C. is an outlier among Canadian provinces in not employing physician assistants, who are trained in the same medical model as doctors and work under the supervision of a physician.
“(B.C. is) the last of the holdouts,” said Stewart, who graduated from a Manitoba training program in 2012 after learning about physician assistants while in the Canadian military. Physician assistants have worked in the military for decades, with almost every Canadian province apart from B.C. adding them to their health-care systems in recent years.
“I’d love to work as a PA in B.C.,” she said, calling it a “brilliant profession.”
But B.C. has so far refused to license physician assistants, despite a health-care crisis that has led to emergency department closures, treatment delays and crowding.
Earlier this week, North Vancouver internal medicine specialist Kevin MacLeod posted that after returning from a rare vacation, he had 105 new patient referrals added to an already long waiting list.
“Until we have access to teams and physician assistants, that sort of volume isn’t manageable,” he posted on X, the social media platform formerly known as Twitter. “I keep saying it, and I’m sure many are sick of me, but money is not the problem. Every one of those patients is funded if I could see them. It’s a manpower problem.”
In an interview, MacLeod said physician assistants typically have a very defined role that is outlined on an individual basis with a supervising doctor. In the U.S., they often do operating room assists, relieving family doctors of the need to assist, which in turn frees them up to see more patients. MacLeod would like to add a physician assistant to a team that already includes nurse practitioners and other staff.
“So much of the work I do as a specialist is work that I don’t really need to do,” he said, giving the example of calling someone to tell them their ultrasound looks normal. “It makes sense for someone else to be able to do that.”
He emphasized that physician assistants wouldn’t take work away from nurse practitioners or other medical professionals.
“It’s not one or the other. There is work for everyone,” he said. “We’re using nurse practitioners, we’re using pharmacists. If there is anyone on the sidelines, we need to get them working too.”
Stewart said physician assistants do about three-quarters of the schooling doctors do, but no residency, so they are “ready to hit the ground running” upon graduation. Several Canadian universities offer training, with the closest program in Calgary.
Stewart said she knows 10 physician assistants who live in B.C., but travel out-of-province or to the U.S. to work. Some live in rural communities that have been hit with emergency department closures. Hiring them could make an immediate difference to patient care, she said.
A survey several years ago found that about 15 per cent of the 1,000-plus licensed physician assistants in Canada wanted to work in B.C.
Both B.C. United and the B.C. Green Party have been calling on the provincial government to direct the B.C. College of Physicians to set up a licensing regime for physician assistants.
Green Party deputy leader Sanjiv Gandhi, a former pediatric caridiovascular surgeon at B.C. Children’s Hospital, said he worked closely with physician assistants when he lived and worked in the U.S. and would prefer to have them assisting him in surgery over anyone else.
Gandhi said physician assistants also help doctors see more patients. During a clinic with 20 kids to see, physician assistants can meet with patients and get a detailed update, which is then provided to the doctor who makes complex decisions.
“A three-hour clinic can be done in one hour,” he said.
Gandhi said physician assistants would cost the government less money than hiring doctors. They come at a “much cheaper price,” with many choosing the profession because they are interested in medicine but don’t want to be on-call or take on the responsibilities of a primary caregiver.
Doctors of B.C. supports establishing physician assistants. In a statement, the organization representing B.C. doctors said physician assistants could help “address the shortage of health human resources in the province, working as part of a health-care team under the supervision of doctors.”
The statement pointed to U.S. and Canadian data that shows that in areas where physician assistants work alongside doctors, they contribute to improvements in continuity of care, access, patient safety, patient throughput, and length of stay.
In a statement, the College of Physicians and Surgeons of B.C. said, “The decision to introduce PAs into B.C.’s health-care system rests with the provincial government. If the government decides to introduce PAs to B.C., the college would support that decision.”
Patrick Nelson, executive-director of the Canadian Association of Physician Assistants (CAPA), said physician assistants are widely used across the U.S., U.K. and the rest of Canada.
“Why is B.C. the last holdout? That would be a question for the government,” he said.
Stewart, the B.C. director for CAPA, said the ministry has not met with the association despite offers of support.
“The hesitancy lies completely in the Ministry of Health,” she said.
But Paul Adams, executive-director of the B.C. Rural Health Network, said he is optimistic that B.C. could be moving toward licensing physician assistants. A budget committee looked at the issue in the spring, while several B.C. communities have been active in calling for them to help with the rural health-care crisis, including Fort Nelson, Port Hardy, New Denver and Elkford.
“The calls are coming at both the community level and from doctors,” he said.
He said the health ministry’s “business as usual” approach is not working for rural communities where emergency departments run on reduced hours when there is not enough staff.
“Even if we’re talking about 20 to 30 PAs, it makes a difference in our communities,” he said.
A recent investigation by The Tyee counted 147 service interruptions of six or more hours in the Island Health region so far this year, and 147 in Northern Health.
