'We can bring a lot to the team,' says physician assistant eyeing job in N.S.

A physician assistant who wants to be one of the first to do the job in Nova Scotia says it won't take long for new hires to make a difference.

Laurel MacInnis, who worked as a physician assistant in Ontario before returning to her hometown of Halifax, has her eye on one of three jobs the Nova Scotia Health Authority is rolling out as part of a three-year pilot program.

Physician assistants, who must be accredited under the Canadian Association of Physician Assistants, are used elsewhere in the country to help carry the load for physicians, and to free them up to focus on the most complex of cases.

The inaugural positions, posted on Thursday, will be assigned to work in the hip and knee orthopedic program. 

But NDP Leader Gary Burrill has said that this is no time for pilot projects. His party tabled a bill on Wednesday urging the health authority to expand the positions right across the province. 

MacInnis spoke with Maritime Noon's Bob Murphy about the role physician assistants play, and why she believes they're needed in Nova Scotia. Their conversation has been edited for clarity and length. 

What's the best way to describe what physician assistants do?

We're health-care professionals who are trained to extend the services of our supervising physicians. We work under the supervision of a licensed doctor who delegates our work to us. We perform physical exams and procedures. We can order and interpret tests like diagnostic tests, prescribe medications and assist in surgery and many different procedures. And one of the biggest advantages of adding PAs to a health team is freeing up a doctor's time, so they can spend more time with complex patients who need the direct and specialized expertise of a physician.

The physician assistants under the pilot program in Nova Scotia will work in orthopedics, so what would you foresee them being able to do in that particular setting?

A physician assistant on an orthopedic service might help with pre-and-post-op clinic.... We would help in preparing a patient for surgery, so that's surgical prep. We would help perioperatively throughout the surgery. We would work as an assist and then we would also help manage the patient on the ward post-operatively … so essentially all of the different areas within the orthopedic setting we would assist with.

So are you able to work independently then, or do you have to always rely on the supervision of a physician?

I always work as an extension of my supervising physician. They can be present or they can be a phone call away. 

Can you diagnose?

I do diagnose. As a physician assistant, we order and interpret tests, so we can order diagnostic tests, such as imaging, bloodwork and we then interpret and diagnose along with our clinical exam. 

What we're told is that this helps make the system more efficient. Was that your experience in Ontario?

Absolutely. Coming onto the team at Markham Stouffville Emergency Department, I was helping with the patient flow and access to care. I was able to help decrease the physician burden and improve the access to care for the patients by seeing patients on my own and then debriefing with my supervising physician.

As a result, would you say that the hospital was able to see more patients in a period of time?

The feedback from my chief, and from the group of supervising physicians in the department, was certainly we were seeing patients much more quickly. In Markham there's a population of over 400,000 — similar to Halifax — and our wait times were less than two hours.

So down to around two hours from what initially?

Six to eight hours. So say a patient, for example, came in with a complex laceration — which is a cut, like a bad wound — I would be able to see that patient within one to two hours instead of them waiting in the department for six to eight hours.

In Nova Scotia, the government here has approved a three-year pilot project, as you're aware. The government says that approach is necessary because anytime there are changes made to the system it affects other aspects of healthcare and it wants to make sure everything becomes integrated before making broader changes. How challenging can that integration be?

I think that generally a team like an orthopedic team or a primary care team has been extremely accepting of physician assistants because we do enhance the team dynamics. I think we can bring a lot to the team.... I had a great reception from the nurses, allied health, the physicians. I have to say that as physician assistants, we are thrilled that the government is opening up this window of opportunity, and I think we have a lot to add to the current situation in the province. So regardless of primary care or specialty service, I don't think it will take very long for us to integrate.