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 

Dr.Graeme.Young@HorizonNB.ca

NB PA PROGRAM

Thank You for your attention

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D I S C L O S U R E S

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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.