New education programs and provincial regulations mean more PAs across Canada

After four years of working as a registered nurse, Calgary-based Hailee Rochon decided to pivot to a new career.“I wanted to something that allowed me to be part of higher-level decision making, but also work in a more autonomous role,” she says. “As a nurse, I got to see the gaps in healthcare, and decided that I was going to seek a career that addresses the gaps that I was seeing firsthand.” Last spring, communications from her alma mater, the University of Calgary, alerted her to a brand-new program: the Master in Physician Assistant Studies. (She also found out that the nurse practitioner master’s program was on pause, so she’d have to study elsewhere to follow that path.)Completing the two-year program—a year of course work and a year of clinical rotations—plus passing an exam would qualify her as a physician assistant (PA). The name is somewhat misleading, which is why they’re called physician associates in some jurisdictions. PAs work on their own but are supervised by a licensed physician, and follow a scope of practice related to that doctor’s specialty.Rochon says she has heard it described as “the fourth- or fifth-year resident that isn't going to leave the position.” PAs might appear in primary care, offering routine consultations and treatments while family physicians tackle complex patients, or often on surgical teams, where they do rounds, paperwork, assist in surgery and assess and discharge patients.“You don't often see a space in healthcare where it is so new and innovative, so much of healthcare is entrenched in tradition,” says Rochon. She’s part of the first, 20-student University of Calgary cohort, landing a coveted spot in a pool of 200 applicants.National growthKirsten Luomala, a PA and president of the Canadian Association of Physician Assistants (CAPA), says the pandemic has triggered interest. “The system has been strained. Health ministers and the various agencies have been looking for solutions and asking if every medical position has to be filled by a physician. When you’re in a shortage, you turn to advanced practice providers.”PAs date back to the 1960s in the U.S., where there are 200,000 PAs working today (they’re also recognized in 16 countries worldwide). In the 1980s, the Canadian Armed Forces began training them and deploying them, often to remote areas. Manitoba began regulating PAs in the 1990s and the Canadian Medical Association first recognized and regulated them nationally in 2003.Up until recently, just four provinces acknowledged PAs, with 1,000 of these professionals working across the country. Now, almost every province either regulates them or is in the process of doing so. Calgary’s new program joins established degrees at University of Manitoba, the University of Toronto and McMaster University. Dalhousie University launched a Master in Physician Assistant Studies in January 2024 and the University of Saskatchewan will become the sixth university offering training as of next fall. Of late, as well, the existing programs have expanded.“We’ve gone from about 50 seats to 200 seats now,” says Luomala. As the provinces have funded more education spots, they’ve added more jobs as well. Efficient practiceResearch shows that PAs fill important gaps. A 2016 study out of the University of Toronto shows surgical teams with a PA have a mere 0.5% late discharge rate and a 16% early discharge rate. As well, residents reported a lighter workload with improved rotations and better patient care.Luomala works as part of a 16-physician surgery team at the University of Alberta Hospital, where she and a nurse practitioner help the wing run smoothly. She likes the videos of U.S. neurosurgeon Dr. Betsy Grunch, who works closely with PAs. “She looks like the happiest physician I've ever seen in a busy specialty, because her team helps make her life easier.”Dr. Trustin Domes, academic director of the Master of Physician Assistant Studies Program at University of Saskatchewan says, “It's becoming clear that PAs are an integral member of healthcare teams and are changing the healthcare landscape.” He says that profession could lead to a “transformative shift . . . towards a team-based model with the goal of improving the care of patients.”To qualify for training programs, prospective students usually need a basic science background and experience in healthcare, but it’s wide open beyond that. Rochon says her classmates are nurses, paramedics, physiotherapists, health administrators and researchers with PhDs. (Luomala works closely with the new University of Calgary program and says one student is an engineer.) Graduates are generalists, and they train on the job in their specialities. Rochon, who’s worked in fertility health as a nurse, expects she may want to go that path again, but is excited to do her second-year rotations to get exposed to different scopes of practice.Luomala herself worked for many years with the Canadian Armed Forces. A friend of hers who’s a PA has worked in orthopedics, ENT and now is in occupational health. “It’s very much a portable profession in which you can change your course and try something new.” Importantly, PAs work closely with patients and are a vital part of collaborative teams, but Luomala says they’re free of having to run a business as many physicians do, and her hours are set and reasonable.As the profession builds across the country, more kinks will be worked out, especially around pay. Currently, most are on government-paid salaries, while PAs who work on for family physicians get paid directly by that doctor. As a result, range is dramatic from $75K to $150K. Only Manitoba has a union representing PAs. Luomala says the Conference Board of Canada proposed a fee for service model in a 2023 report that might offer a better approach. Governments seem interested in investing in this cost-efficient advanced practice profession. “I think we should open our eyes to all of the professions out there and what they bring to the table,” says Luomala. “We should all be supporting each other and lifting each other's professions up, because ultimately, we're all here to provide care for patients.”

New education programs and provincial regulations mean more PAs across Canada

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