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THE NEW BRUNSWICK PHYSICIAN ASSISTANT EXPERIENCE
2009-PRESENT
Dr. Graeme Young MD, FCFP(EM), Dip Sport Med.
Chief, Department of Emergency Medicine
Medical Director of Emergency Program Fredericton Area
Manager, Physician Assistant Program
Horizon Health Network Fredericton Area
NB PA PROGRAM
Thank You for your attention
!!
???????QUESTIONS??????
D I S C L O S U R E S
Nil/none
OVERVIEW
Where did Physician Assistants come from??
The P.A. Profession
The Canadian P.A.
New Brunswick’s P.A. interest
DECH Emergency Department Fredericton- P.A. interest
DECH P.A. Program
Where I think we are headed in NB.
W H E R E D I D T H E P H Y S I C I A N A S S I S T A N T C O M E F R O M ? ?
1961- Charles Hudson recommends to the AMA ‘the creation of two new
groups of assistants to doctors from medical and non-medical personnel’
1965- Dr Eugene Stead at Duke University Medical Center, North
North Carolina put together the first ever class of P.A’s, made up
of US Navy Corpsmen. The program was based on the ‘Medical
Education Fast Track’ training for doctors during World War 2.
1968- American Academy of Physician Assistants formed
1971- First Civilian PA Training program – Montefiore Medical Center, New
York.
1979- PA’s Employed in all 50 US States
WHERE DID THE PA COME FROM??
1984- first formal
Canadian trained P.A’s
are trained at
Canadian Forces
Medical Services at
CFMS Borden
WHERE DID THE PA COME FROM?
2008 – First Canadian civilian programs open at
University of Manitoba and McMaster University.
Manitoba offering Masters level degree, and
McMaster offering an Undergraduate level Degree.
Both leading to eligibility for Certification.
WHERE DID THE PA COME FROM?
Currently there are 400+ PA’s practicing in Canada,
where as there are 83,600+ in practice in the U.S.
2010 – CNN Money rated the PA career as the #2 best job
in US. Description of Job : ‘What they do: Act as Robin to a
doctor’s Batman’
2012 Forbes Magazine rates PA Studies Masters Degree
as #1 Masters Degree for Jobs with an average salary of
$102,000 US$.
I N T E R E S T I N T H E PA P R O F E S S I O N
My interest in PA’s began in 1993. NDMC Ottawa Surgical
resident.
PA’s high ranking NCO’s, in charge of Clinics, Emerg Dept., and
OR’s. Formal military setting, regimented and ultra organized.
(Me?)-nope!
Quickly found these specialized PA’s would make my ‘medical life’
much more enjoyable if you kept on their good side!!
So I befriended every PA I met and soon I came to appreciate the
huge part they played in the Medical community at NDMC and the
DND.
Even then I was thinking about where the PA fit in civilian
medicine.
INTEREST IN THE PA PROFESSION
1996 – I’m out of DND, little PA contact until 2009.
2009 – Chief of Emergency Medicine and Program Director in
Fredericton Area. Two busy ED’s and 40 doctors at two sites.
2009- Dr Wayne MacDonald (NB Dept. of Health) – ‘Feasibility
Study for the use of Physician Assistants in New Brunswick’.
Dr MacDonald had DND experiences with PA’s which lead him
to strongly support the use of PA’s in NB. Suggested
employment in ED. Parallels what they have done in DND for
decades.
MY CHALLENGES
Create a job description, and training program for
ED PA’s, encourage interest in local ED Doctors and
Medical community.
Secure funding for two full time PA’s (hopefully for
more to come)
Hire two good candidates .
Roll out integration program, and evaluate our PA’s
progress.
DECH PA PROGRAM
Regional Emergency Dept. in 2009 – 46,000 visits per year.
36,000 visits at Oromocto site as well (15km away)
40 Emerg Doctors at two sites.
My Job as chief: staff the centers, and do QA and
development.
DECH PA PROGRAM
2009 – LWBS rates 12-13% (six times national expected rates), long wait
times, frustrated and overcrowded work conditions, and safety issues.
Proposal to Medicare director for funds to help us address these issues
with new PA model was accepted!! Two new PA’s could be hired!
2010 – PA Program Committee (two ER docs, Dr MacDonald, HR rep, and
Nurse Manager) formed draught of Job Description from National scope of
Practice Documents (and from Manitoba’s documents).
Secured salary range, integration program guidelines, then applicants
reviewed.
DECH PA PROGRAM
Hiring process took some time. 17 good applicants and
20+ FMG’s.
Two PA’s selected – (one US Grad, one DND Grad)
DECH PA PROGRAM
Two experienced PA’s Joined Drs Hebb and Young as supervising
MD’s.
2 month block rotations, Evals at 2,4, and 6 Months ; then yearly.
Our Goal is: Comfort with every level of triaged patient. From
trauma care to sore toes!
Both PA’s exceeded our expectations.
At Six months the PA’s were assigned other supervising staff having
to “win –over” each one. There were some challenges but this went
very well.
Our PA’s select patients off our tracker just the same as our MD’s do.
DECH PA PROGRAM
PA’s select patients from our electronic ‘tracker’. They do history ,
physical, investigate (labs, Xrays, ECG’s), review the tests and
findings, then execute the plans for care. Reviewing the plan with the
MD’s, for follow-up care and use of community resources. (at times
BETER than MD’s do!!).
Consultants : ‘I need to speak to the doctor’ changed slowly to
‘thanks for the consult and your good work’. At times still some snags,
but less often.
Barriers between our nurses and PA’s : non-existant right from the
start!!
DECH PA PROGRAM
2013 – resignation of one PA leads to Hiring of Canadian PA
Civilian Graduate from University of Toronto program.
During process again hosts of great PA applicants
No FMG’s applied– the word is out about Certified PA’s.
2014 Legislation in NB to allow PA’s to prescribe medications. Small
hold up still on ‘controlled drugs’, but change has helped our patient
flow considerably!!
DECH PA PROGRAM
System review since PA introduction: 2014 on track for 50,000
visits
LWBS Rates : Unchanged at 12%; ERLOS – Unchanged at
approx 200min. Though neither stat is great, the only change is
the PA Program and the volume rose 8%......That is success by any
measure!!!
Patient satisfaction higher with PA’s than with MD visits.
Very few conflicts, few complaints, overall……FANTASTIC!
Plans for new staffing program for ‘PA Stream’ in Ambulatory
Care in ED
WHERE ARE WE HEADED IN
PA EMPLOYMENT IN NB?
Fredericton DECH-ED, request to DOH for two additional PA’s.
If Approved funding , then we will hire ASAP! We would like daily PA
coverage from 8am-Midnight – 7days per week. Maybe night
coverage??
Other Departments – St John, Moncton ED’s some interest voiced.
Orthopedics inpatient care proposed in 2012, but no funding as yet.
New Liberal Government in NB, so we will keep ‘proposing new
programs for PA employment’ as cost effective health care provision
for New Brunswickers.