Physician assistants want to help Albertans without a family doctor but say barriers remain

Some health-care providers say physician assistants could help ease Alberta's family doctor shortage and they're calling for more support from the provincial government.

Physician assistants, or PAs, are trained to examine, diagnose and treat patients under the supervision of a doctor.

Despite being recognized as regulated health professionals nearly two years ago, there are just 46 PAs registered by the College of Physicians and Surgeons of Alberta and few of them work in primary care.

"We hear the stories about people who can't get in to see a doctor. ...They're struggling," said Kirsten Luomala, an Edmonton-based PA and incoming president of the Canadian Association of Physician Assistants.

"Now's the time to start moving this forward."

According to Luomala,  PAs worked exclusively in the Canadian Armed Forces until 2013 when Alberta Health Services started a pilot project, using PAs in areas such as surgery and emergency departments.

And while the use of PAs is expanding within AHS (in hospitals, for example), Luomala said they're underutilized in the strained primary care system.

"We could do 75 per cent of what the physicians do. We could see the less complex cases," she said.

"We'd free up the family doctor's time. We can do some of the paperwork that they get stuck with. ...They can actually expand their practice. They can take on more patients."

But the path to growing Alberta's pool of physician assistants — and integrating them into primary care — has been a rocky one.

"Outside of Alberta Health Services ... we are not being utilized to our fullest extent.  And part of that is a lack of funding," Luomala said.

In primary care, she said, a PA's salary must be paid either by a family physician or a primary care network.

"The biggest barrier ... is an effective funding model," Luomala said.

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Training program 'gathering dust'

Another key roadblock according to Dr. Jon Meddings, professor and past dean of the University of Calgary's Cumming School of Medicine, is that Alberta has no training program for physician assistants.  

"We need a solution now," he said. "We need to expand the type of people who provide primary care."

There are just are just three accredited programs in Canada.

What isn't widely known, said Meddings, is that the University of Calgary developed a physician assistant training program in 2015. 

"It's been sitting gathering dust for seven years," he said.

"We've got perfectly good training program sitting there ... but government has never actually said 'Yes, we will employ them. These are the conditions under which they will be employed.'  And then 'Please start training them,' which we could do at almost any time," he said.

Dr. Doug Myhre said he was contracted by Alberta Health to create the Bachelor of Physician Assistant program when he was an associate dean at the University of Calgary.

While he was focused on rural practice, Myhre said it was designed to get PAs working in both rural and urban settings.

"For the price tag of $2 million a year we had a program that could create 20 PAs a year," he said.

According to Myhre, the plan dropped off the radar after it went to the department of Advanced Education for review. At the time, PAs were not regulated in the province.

"I had support from Alberta Health and Alberta Health Services," he said. "We had support from across the faculty as well. ... So it was really disappointing."

Given Alberta's health care crisis, Myhre believes now is the time to revive it.

"They're a piece that could be really responsive and ramped up quickly," he said, noting international medical graduates or medical personnel, such as paramedics, would make ideal students.

"I would definitely like to see it on the provincial government's radar again."

In a statement provided to CBC News, the university said it is working with the provincial government on "a number of innovative educational solutions for health workforce shortages," and a physician assistants program is one under consideration.

The Alberta government didn't respond to questions about the funding framework or whether it supports a local training program prior to publication time.

But a spokesperson for Health Minister Jason Copping acknowledged the benefit of health professionals such as physician assistants.

"Alternative providers support physicians by providing hands on care to patients under the direction and/or supervision of the physician. These models of care can extend physician capacity," Scott Johnston said in an email.

"Care models that integrate Alternative Care Providers contribute to the recruitment and retention of physicians because of a more manageable patient load and improved work/life balance."

According to Johnston, AHS is planning to add 100 new alternative providers, including physician assistants, to help out in hospitals with critical staffing shortages.

On Tuesday, the UCP government promised $243 million in new funding for primary care over three years, if next week's budget passes.

The plan also hinges on the results of the provincial election in May.