N.S. Health expands efforts to get physician assistants into primary care

An effort to place physician assistants with primary care practices around the province takes more work than assigning them to emergency departments, but Nova Scotia health officials believe the move could have far-reaching benefits.

Since a call for interest last year, Nova Scotia Health has placed physician assistants with two primary care practices, hired three more who will start later this year, and has openings with 16 other practices.

"Primary care is the foundation [of the health-care system] and if this can allow access or attachment and get more people timely access to a primary care home, then it will be worth it," Dr. Todd Howlett, an emergency medicine doctor and the health authority's medical director of innovation, said in a recent interview.

A physician assistant, or PA, trains in the medical school model and practises medicine under the supervision of a licensed doctor. They can take on straightforward cases, order and review tests, prescribe some medications and assist in surgery.

After years of little interest in bringing the role to Nova Scotia, despite it being well established in other parts of the country, Canadian military and the U.S., the province is embracing it in a big way.

Expanding use in Nova Scotia

A pilot project in 2019 placed three physician assistants in the orthopedics division at the QEII Health Sciences Centre. PAs subsequently started working in emergency departments and Dalhousie University launched its own training program this year.

Howlett said matching PAs with primary care practices can mean addressing workload concerns some doctors are experiencing. That can mean shorter waits for patients to see a health-care provider, or extend the working life of doctors who might be considering retirement.

The challenges the province's primary-care system faces are well documented. As of last month, more than 156,000 people were in need of a family practice, according to the provincial registry.

At a recent meeting of the legislature's standing committee on health, Dr. Leisha Hawker, past-president of Doctors Nova Scotia, said physician stress and burnout are "at an all-time high, while physician wellness is at an all-time low."

Challenges facing doctors

Aging populations of both patients and doctors contribute to the strain on the system, Hawker told MLAs.

"Almost a quarter of our physicians are 60 years and older and looking at retirement in the next few years," she said.

While health-care recruitment teams are working hard to bring more doctors to Nova Scotia, Hawker noted that as of the beginning of March there were 213 physician vacancies, 129 of them in family medicine.

Howlett said the key to success when it comes to integrating PAs with family medicine practices is a good match between them and the doctor they will work under.

"The magic of the PA is the relationship they develop with the physician," he said.

"So we're spending a lot of time making sure that the fit is right."

Plans to recruit in the U.S.

Meanwhile, efforts to get more PAs into emergency departments also continues.

When the province took that first step last year, the plan was to have four PAs working in the emergency department at Dartmouth General Hospital and four at Shore Shore Regional Hospital in Bridgewater.

Only two are working in Dartmouth so far, and one is scheduled to start this spring in Bridgewater. There are also two PAs working in the emergency department at Cumberland Regional Hospital in Amherst and one at Cape Breton Regional Hospital.

Howlett said the aim remains to expand the use of PAs in emergency departments around Nova Scotia, but the role faces the same human resource challenges as the rest of the jobs in the health-care system.

The health authority is seeing strong interest from PAs working in the United States and Howlett and other officials are headed south of the border later this year for a recruitment trip.

"We had some ambitious targets and, like anything else, when you do that and you don't get the numbers, then you re-evaluate."