Are we in this together?

There is no question that Canada’s healthcare system is struggling to provide adequate care to Canadians. The system was failing prior to COVID-19, and the recent pandemic further aggravated the already strained system, causing further fractures felt by both patients and providers alike. Long ER wait times, limited or no access to a family care provider, and waitlists for specialists, make it clear that something needs to change. The status quo hasn’t worked in a long time, and the time to act is now. A problem as complex as healthcare in a nation as large and diverse as ours, will not be solved by a single remedy. Many changes must be implemented at various levels, and one of those changes is the integration of physician assistants (PAs) into our healthcare system. PAs are advanced practice clinicians who undergo a truncated medical education and practice medicine under a supervising physician. PAs are common in many western countries and the profession is quickly growing in Canada. PAs are one of the solutions to our healthcare woes, particularly in family medicine, where more than 2.2 million Ontarians do not have a family practitioner. To successfully integrate, we need support from existing healthcare professionals, beginning with those directly on the frontline, our nurses. Read: Saskatchewan to spend $1.3 million to hire new physician assistants Prior to my acceptance into the PA program at the University of Toronto in 2022, I obtained my BSc nursing though the University of Ottawa. I chose to study nursing because of my passion for healthcare, and I felt it was a step forward from my previous career as a military medic. While my intention was always to apply to the PA program, I embraced my nursing education, knowing that it would help shape the clinician I longed to be. I did not anticipate however, the animosity directed toward my chosen profession from those who were supposed to be colleagues. Throughout my nursing education, I encountered numerous nursing professors who spoke of clinicians in negative terms, particularly when it came to PAs. I realized I was naïve in my beliefs that “we were all in this together,” because while I was open to nursing, nursing felt closed to PAs. I found it disturbing and ironic that these professionals would denigrate other healthcare partners, while simultaneously lamenting about their own treatment and calling for more respect and inclusion. I was first introduced to interprofessional collaboration while in fourth year nursing, which is a framework to guide healthcare team members in providing collaborative care, rather than interdisciplinary care. During my clinical shifts however, I saw that not all nurses were applying it to PAs. Experiencing this hostility caused me to guard my PA aspirations, concerned about being shunned. During my consolidation, I spoke with a nurse about the PA profession, feeling he was “safe” to confide in because he had also served in the military, which has employed PAs since the 1980s. I will admit that I was disappointed and insulted when he replied that he would not work with or accept orders from a PA and, when prodded, I learned that his reasoning was based on faulty information about the profession. In hindsight, I am not surprised with the animosity the nursing profession has toward PAs, considering that the CEO of the Registered Nurses Association of Ontario (RNAO) Doris Grinspun once stated, in 2009: “I would say to my family, friends, colleagues, to the public: don’t let them (PAs) touch you. Make sure to ask who is taking care of you.” I recognize that time has passed since Grinspun’s remarks so I called her up but she essentially stood by her words and rather offered justifications for her position while bringing up government failures multiple times. It was RNAO that actively voiced concern over PAs being unregulated and therefore a danger to patients, only to later fight against PA regulation by the College of Physicians and Surgeons (CPSO). I am pleased to note that the profession is regulated in other provinces and will be in Ontario starting in 2024. I hope that in the future, the PA profession will receive words of support rather than ignorance from RNAO and its members. It was not so long ago that nurse practitioners were fighting a similar battle, and I ask that they remember how they felt. Until that time comes, I will continue to advocate for PAs, because the profession has proven itself to be valuable in our fragile healthcare system. I implore my fellow PA students and those in practice to join me in continued demonstration of why we are needed more than ever. Lastly, I extend my hand to the nursing profession and ask that it use its powerful voice and influence to support us, and I pledge to be worthy of that support. For now, I think we can all agree upon one thing: There are patients who need us. Meghan Gagnon is a PA student who also has a nursing degree in Toronto.

Are we in this together?

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