PA FACT SHEET 2015

PAs IN CANADA

 The introduction of PAs into Canada began in the Canadian Armed Forces approximately 40 years ago.

 PAs were introduced into the Canadian public healthcare system 14 years ago in Manitoba, in Ontario 8 years ago, in New Brunswick 4 years ago and in Alberta in 2013.

 The PA profession is regulated in Manitoba and New Brunswick by the college of and surgeons in these provinces.

 In Alberta and Ontario, PAs are not currently regulated but are permitted to practice by way of delegation under the Medical Act. The College of Physicians and Surgeons of Alberta has a voluntary registry for PAs and the College of and Surgeons of Ontario will be developing a compulsory registry for PAs practicing in the province.

 There are approximately 500 PAs practicing in Canada, roughly 300 of which are practicing in Ontario.

PAs IN THE US

 PAs have been practicing in the US for roughly 50 years and is one of the fastest growing segments of the healthcare workforce with over 100,000 PAs practicing in primary care and virtually every medical specialty1.

 It is projected that in 2020, there will be between 137,000 and 173,000 certified PAs.2

 More than 7000 PAs graduate each year from 191 accredited programs.3

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1 AAPAFact Sheet. (2015) pg. 1. Retrieved from: https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2147483705 2 The Americian Academy of Physician Assistants. (2013). PAs past, present and future. Paragraph 3. Retrieved from: http://www.aapa.org/the_pa_profession/quick_facts/resources/item.aspx?id=3840

3 AAPAFact Sheet. (2015) pg. 1. Retrieved from: https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2147483705

STATUS OF CANADIAN HEALTHCARE SYSTEM

 International surveys of primary care physicians in seven countries show the current inadequate status of Canada's primary care system in comparison to other nations. Evidence suggests a lean and perhaps inadequate supply of primary care providers.4

 Approximately 4.5 million Canadians do not have access to a primary care provider.5

 Family report seeing an average of 107 patients per week excluding those seen while on call. Almost 40% see more than 100 patients per week; 5% see more than 200.6

 Nearly half of Canadians (47%) reported that they recently went to an emergency department for a health problem that their regular doctor could have treated if he or she had been available -- the highest among the countries surveyed.7

 The current median wait time for referral to specialist is 18.2 weeks, three days longer than in 2012. Twenty years ago, the average wait time for treatment in Canada was 9.3 weeks.8

 Canadians across the 10 provinces are waiting for about 928,120 procedures, up by 57,658 procedures from 2012.9

 By 2036, it is expected that a quarter of Canada’s population will be over age 65, almost double the proportion today.

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4 Moores, Wilson, Cave, Woodhead, and Donoff; Improving the Quality and Capacity of Canada's Health Services: Perspectives. Healthcare Policy, 3(2) 2007: 0-0

5 Statistics Canada. (2012). Canadian Community Health Survey. Retrieved from: http://www.statcan.gc.ca/dailyquotidien/110621/dq110621b-eng.htm

6 Canadian Medical Association. (2010). National Physician Survey Summary. Retrieved from: http://www.ocfp.on.ca/docs/publications/national-physician-survey-2010---backgrounder.pdf?sfvrsn=2

7 CTV News. (2013). Canada ranked last among OECD countries in health care wait times. Retrieved from: http://www.ctvnews.ca/health/canada-ranked-last-among-oecd-countries-in-health-care-wait-times- 1.1647061#ixzz2yPmVShoK 8 The Fraser Institute (2013). Waiting Your Turn: Wait Times for Health Care in Canada. Retrieved from: https://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research- news/research/publications/waiting-your-turn-2013.pdf 9 The Fraser Institute (2013). Waiting Your Turn: Wait Times for Health Care in Canada. Retrieved from: https://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research- news/research/publications/waiting-your-turn-2013.pdf

ROLE OF PAs IN THE HEALTH SYSTEM

 PAs in primary care settings can be used for 75% of all visits without referral to physician level care.10

 PAs can manage up to 62% of all patients in emergency care environments.11

 In the emergency department setting, PAs appear to be equally capable of performing procedures as a physician if adequately trained and supervised. The quality of care provided by PAs is comparable with that of emergency specialists (attending) physicians and senior residents. This results in shorter wait times for patients.12

 The average PA has over 1000 – 1350 patient encounters per year. This is slightly less than a supervising physician who in the same practice might see on average 1500 in any given year. This number of course is subjective given the different variables including authorship of encounters that have been overtaken by the supervising physician when they countersign13

BENEFITS TO THE HEALTH SYSTEM

 PAs have been shown to enhance the delivery of care and improve access for patients.

 In an Ontario study on the utilization of PAs, 71% of physicians working with PAs reported that the PA had a positive impact on patient throughput, with higher results in the non- settings than in the hospital settings. .14

 In the same study; 95% of physicians working with PAs said that the PA had increased their own efficiency in providing care.15

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10 Schweitzer, S.O. & Record, J.C. (1981). Staffing primary care in 1990: physician replacement and cost saving. Springer Publication Co., New York.

11 The Australasian College of Emergency and Australasian Society for Emergency Medicine. (2011). Roles and Task Assignments. para 3, p.p. 9.

12 The Australasian College of Emergency Medicine and Australasian Society for Emergency Medicine. (2011). Roles and Task Assignments. Quality of Care. para 3, p.p. 13.

13 Somerset CHC, Angela Cassell. 2015, June 17, via email

14 Ministry of Health and Long-Term Care.(2012). Ontario Physician Assistant Implementation - Report of the Evaluation Subcommittee. p.p. 25 15 Ministry of Health and Long-Term Care.(2012). Ontario Physician Assistant Implementation - Report of the Evaluation Subcommittee. p.p. 27

 PAs in emergency departments can reduce wait times by 1.9 times and reduce left without being seen rates by half.16

 In emergency settings PAs have been proven to perform initial assessments 15 minutes faster than residents and almost 20 minutes faster than MDs. In this particular setting PAs saw more patients than residents and a higher proportion were sent home.17

 PAs can increase the attending physician’s coverage by releasing physicians from follow-up activities to provide clinical coverage to incoming ED patients.

 PAs working in general surgery have been shown to improve the resident experience by decreasing residents’ workload.

 In general surgery the utilization of PAs can reduce late discharges (from 20% to 0.5%), increase early discharge rate (16%) and allow residents to spend less time on EMR (21 hr/week vs 31 hr/week).18

 PAs in orthopeadics can free up their supervising orthopeadic surgeon; the equivalent of four 50 hour work weeks per year.

 PAs can increase surgical throughput of primary joint replacements by 42% a year and reduce wait times for surgeries by 14 weeks.

 In orthopeadics, PAs used as first assistants in the operating room instead of general practitioners can free up the equivalent of 1.5 general practitioners working 40 hours per week for 44 weeks per year based on a surgical volume of 1400 joint replacements per year.19

 It has been proven in long-term care centres with the addition of a PA the emergency room admission rate was as low as 0% in 2014 compared to the provincial average published by CIHI of 13.0%.20

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16 Ducharme, Adler, Pelletier, Murray and Tepper. (2009). Impact on patient flow after the integration of nurse practitioners and physician assistants in Ontario emergency departments. The Canadian Journal of Emergency Medicine, Vol. 5, p.p. 458. Retrieved from: http://www.cjem-online.ca/v11/n5/p455

17 Sunnybrook ED data. March 2015 18 Mount Sinai Hospital, Toronto, ON, General Surgery. March 2015

19 Bohm, Dunbar, Pitman, Rhule and Araneta. (2009). Experience with physician assistants in a Canadian arthroplasty program. Can J Surg, Vol. 53, No. 2, p.p. 106 - 107. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845948/

20 Trillium Health. March 2015

 Teams that include PAs can improve the speed of treatment by taking a first responder role in emergencies and always being available on the ward.21 In addition, evidence suggests that patient safety can be enhanced by the presence of PAs.

 Surgical PAs in rural practice settings can result in significant time savings for general surgeons who could be freed up to concentrate on more acute and complex care needs.22

 PAs enable family physicians to better meet targets for vaccinations, pap smears, blood pressure checks and other preventive measures.23

 Employment of PAs in infectious diseases can lead to a decrease in time to consultation from 21.4 hours to 14.3 hours and shorten the length of stay by a differential 3.6 days.24

 In a community health centre setting PAs have been proven to perform approximately 600 new patient intakes over a 2 year period, have over 2000 encounters with patients with various complexities and have shown expedited treatment for patients with acute symptoms, avoiding further medical costs of treating severe conditions.25

 PAs working in remote settings have been shown to decrease the number of cancelled appointments, increase the total of clinic appointments and increase the total of patients booked with the PA.26

 PAs in remote settings can also increase in clinic walk-ins, improve access to a provider, improve continuity of care, increase patient satisfaction and increase other health provider job satisfaction.27

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21 Siggins Miller “prepared for Health Work Force New Zealand”. (2012). Evaluation of the Physician Assistant Trial, Final Report. p.p. v.

22 Sigurdson, L. (2006). Meeting Challenges in the Delivery of Surgical Care: A Financial Analysis of the Role of Physician Assistants. Saint Mary’s University. UTMJ, Vol 88, No.2, p.p. 20.

23 Taylor, M.T.,Taylor D. W. (unpublished) (2012). Benefits and Barriers to the Employment of Physician Assistants by Physicians in the Ontario Health Care System: A Qualitative Study.

24 Toronto East General Hospital. Infectious Diseases. March 2015 25 TAIBU Community Health Center. March 2015

26 Alberta Health Services. Demonstration Project Evaluation Report. February 2015

27 Alberta Health Services. Demonstration Project Evaluation Report. February 2015

 PAs are allowing physicians to increase the number of patients they are able to treat in a day and to serve in their practices overall. Having a PA on staff has permitted many physicians to provide same-day access for patients with acute problems.28

COST EFFICENCIES

 Surgical PAs in rural practice settings can result in significant time savings for general surgeons who can be freed up to concentrate on more acute and complex care needs. An American literature review examined the cost-benefit projection and estimated that the employment cost of a PA was 53 percent less than hiring a supplementary physician.29 Given that the average salary for a PA in Canada is similar to that of the US, this comparison could apply to Canadian provincial health systems.

PAs AND SENIORS CARE

 PAs can increase access to medical care for seniors. Having a full-time PA on staff at a nursing home or long-term care facility can translate into patients being evaluated sooner and can prevent transfers to the hospital in many cases.30

 PAs in long-term care settings have been shown to decrease the hospital admission rates by 38% for seniors.31

 PAs can have an important preventive role in the care of geriatric patients.32

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28 Taylor, M.T.,Taylor D. W. (unpublished) (2012). Benefits and Barriers to the Employment of Physician Assistants by Physicians in the Ontario Health Care System: A Qualitative Study.

29 Hooker, R. (2000). The Economic Basis of Physician Assistants Practice. Physician Assistant. Vol 24 (4), p.p. 51-71.

30 Hooker, Cawley and Asprey. (2010). Physician Assistant Specialization: Nonprimary care. PA Specialty Care. Ch. 7. p.p. 235.

31 Hooker, Cawley and Asprey. (2010). Physician Assistant Specialization: Nonprimary care. PA Specialty Care. Ch. 7. p.p. 235.

32 Hooker, Cawley and Asprey. (2010). Physician Assistant Specialization: Nonprimary care. PA Specialty Care. Ch. 7. p.p. 235.

 The 30-day readmission rate was reduced by 25% in patients receiving visits from PAs as part of a home care program.33

 In Ontario there are 129 active physicians holding subspecialty training in geriatric medicine serving a population of 2.0 million seniors. This yields a ratio of 0.65 geriatricians per 10,000 older Ontarians. By contrast there are 1641 pediatricians serving a population of 2.2 million children, yielding a ratio of 7.5 pediatricians per 10,000 Ontario children. This discrepancy is more alarming considering that by 2016 Ontario seniors will outnumber Ontario children.34

PUBLIC SUPPORT FOR PAs

 Among Canadians that have received care, more than nine in ten were satisfied (75%) or somewhat satisfied (18%) with the experience.35

 More than eight in ten Canadians support (56%) or somewhat support (26%) a greater role for PAs.36

 More than eight in ten Canadians are comfortable (53%) or somewhat comfortable (28%) receiving primary care from a PA under a physician’s supervision.37

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33 Nabagiez JP, Shariff MA, Khan MA, Molloy WJ, McGinn JT Jr. J Thorac Cardiovasc Surg. 2013 Jan;145(1):225- 31, 233; discussion 232-3. doi: 10.1016/j.jtcvs.2012.09.047. (2013). Physician assistant home visit program to reduce hospital readmissions. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/23244257 34 Stall, Bear and Sullivan (2013). Who will care for Canada’s seniors? Health Debate. Retrieved from: http://healthydebate.ca/2013/08/topic/community-long-term-care/who-will-care-for-canadas-seniors 35 Nanos Research. (2014). Awareness and Impressions of Physician Assistants. Executive Summary. p.p. 2. Retrieved from: http://www.nanosresearch.com/library/polls/POLNAT-S14-T623.pdf 36 Nanos Research. (2014). Awareness and Impressions of Physician Assistants. Executive Summary. p.p. 2. Retrieved from: http://www.nanosresearch.com/library/polls/POLNAT-S14-T623.pdf 37 Nanos Research. (2014). Awareness and Impressions of Physician Assistants. Executive Summary. p.p. 2. Retrieved from: http://www.nanosresearch.com/library/polls/POLNAT-S14-T623.pdf