Pilot project aims to relieve overworked doctors with physician assistants

Newfoundland and Labrador is hiring a handful of physician assistants for a three-year pilot project that's expected to lighten doctors' workloads and improve access to health care.

Kathleen Abreo, a physician assistant in Manitoba who was looking at moving to the province before COVID-19 struck, says the project may open up opportunities for her and her husband, Dr. Travis Barron, a hospitalist originally from Torbay.

"We were looking at it very seriously prior to the pandemic but it didn't work out for us because I couldn't work as a PA in Newfoundland and Labrador but it's on the table now," said Abreo, who offered to volunteer as director of a Newfoundland and Labrador chapter of the Canadian Association of Physician Assistants.

"Couples who work in health care … it's a thing," she said. "I think that with PAs being able to work there, you will see a lot of medical talent being attracted to the province."

Abreo says physician assistants can be part of the solution to the province's health-care crisis. Tens of thousands of residents don't have family doctors and wait-lists for surgeries have grown long.

Physician assistants are clinicians who work with doctors but don't have an independent licence, she explained, extended services doctors can offer and increasing access to health care.

In other parts of Canada, said Abreo, PAs work in many areas of medicine, from family doctor offices to emergency rooms.

"Our scope is a sort of negotiated autonomy, whatever our supervising physician is comfortable letting us do," she said. That includes taking medical histories and doing physical exams and minor procedures. "Physician assistants can be a first assistant in surgery. They can work in specialist care and provide whatever services the specialist is comfortable with," she said.

PAs can lighten a physician's workload and free them up to focus on patient care at the more highly skilled end of their scope of practice because "many hands make light work," she said.

N.L. starting slow

The provincial government is starting with a small number of physician assistants but a statement sent to CBC News suggests it expects PAs will have a lot to offer.

"The department regards physician assistants as highly skilled health-care providers who could help to strengthen the province's health-care system," says the statement from the Department of Health and Community Services.

"The goal of the pilot program is to see physician assistants practise medicine in collaboration with physicians working autonomously under the supervision of a licensed doctor to extend physician services and improve patient access to care across Newfoundland and Labrador."

Under the pilot project physician assistants will be working at the following five sites (one per health zone):

• Charles S. Curtis Memorial Hospital in St. Anthony.
• Western Memorial Regional Hospital in Corner Brook.
• James Paton Memorial Regional Health Centre in Gander.
• Burin Peninsula Health Care Centre in Burin.
• Janeway Children's Health and Rehabilitation Centre in St. John's.

The Health Department says physician assistants in Newfoundland and Labrador will be involved in inpatient care, surgical/trauma assists, hospitalist coverage, orphaned patient report followup, cancer clinic support, emergency assessments and patient assessments in primary-care clinics. 

Physician assistants already work in Alberta, Manitoba, Ontario and every Atlantic province except Newfoundland and Labrador. Abreo says physician assistants could play an important role in increasing access to health care in rural areas of the province..

"In underserved rural communities, people sometimes don't have access to inpatient in person services a lot. So they get intermittent virtual care, which is not so great," she said. Adding a PA to a team can increase access to in-person care, and help prevent worse health problems through services like cancer screening, she said. 

Potential to recruit from the U.S.

Abreo says many PAs interested in working in Newfoundland and Labrador have already contacted her through her role with the association, including expat Newfoundlanders who want to come home.

As the province hasn't worked out a system to regulate PAs in Newfoundland and Labrador, the pilot program will only be accepting Canadian-trained PAs initially.

The provincial Health Department says N.L. Health Services is actively recruiting under the pilot program, and the department will fund and evaluate the program's impact.

The former president of the Canadian Association of Physician Assistants doesn't believe a pilot project is necessary.

"It won't take long for [Newfoundland and Labrador] to recognize how valuable a PA can be," said Kevin Dickson, a physician assistant in New Brunswick.

He's warning Newfoundland and Labrador to act fast.

"As the demand for PAs soars … so too will the shortage be a problem," said Dickson.

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