PHARMACY CONNECTION ARTICLE

Ontario’s Physician Assistants: An Update

Published on: November 1, 2014

In 2006, the Ministry of Health and Long-Term Care announced a demonstration project to evaluate the role of Physician Assistants (PAs) in the provincial healthcare system. Since the launch of the PA demonstration project, PAs have been successfully integrated into interprofessional teams within specialized hospital services (internal medicine, orthopedics, surgery, etc.), community health centres, ambulatory, diabetes and long-term care settings, and more recently family health teams (FHTs) and emergency departments. There are currently approximately 250 PAs working within these practice settings across Ontario.¹

History and Education

PAs have practiced in the United States since the 1960s and with almost 90,000 practicing members, they have established their role as a safe and effective part of the U.S. healthcare system.² Similar to the U.S., the Canadian PA is rooted in the Canadian Forces as a class of clinicians introduced to provide medical care to the men and women of the Canadian Forces both at home and abroad. However, it wasn’t until the 1990s that the concept of the PA within Canada’s civilian healthcare system began to take shape.

Today, in addition to training under the Canadian Forces Health Services Program, three Canadian Universities offer degree programs in Physician Assistant Studies; McMaster University (Hamilton), University of Manitoba and the University of Toronto.

Regulation and Scope of Practice

Despite PA practice advances in Ontario, an application (January 2012) by the Canadian Association of Physician Assistants (CAPA) to the Health Professions Regulatory Advisory Council (HPRAC) for regulation of the Physician Assistant profession in Ontario was not approved. This decision was centred on HPRAC’s assessment that public safety and quality of care are sufficiently upheld through the delegation model under the supervision of a licensed physician. Therefore, PAs remain unregulated under the Regulated Health Professions Act (RHPA), and, as such, do not have the independent authority to preform controlled acts.

Without the independent authority to perform controlled acts, the care a PA provides under the supervision and delegated authority of a registered physician; which must take place within the physician-patient relationship. The specific duties of a PA will vary according to individual PA competencies, the physician’s area of practice, and the work the physician chooses to assign, but may include:

• Conducting patient interviews and taking medical histories
• Performing physical examinations
• Counseling on preventative healthcare
• Performing certain controlled acts delegated by the physician (including prescribing)

Delegation

Any controlled act assigned to the PA must be delegated by the physician either through a direct order (verbal or written) or through the use of a medical directive. When a physician delegates to a PA, they must do so in accordance with the College of Physicians and Surgeons of Ontario (CPSO) policy on Delegation of Controlled Acts: http://www.cpso.on.ca/policies-publications/policy/delegation-of-controlled-acts.

Although PAs are not authorized to independently prescribe medication, a PA acting under the authority of a physician may evaluate patients and prescribe medication as established by his or her delegated authority. Ultimately, the supervising physician remains responsible for the quality of care that the PA provides to patients.

FAQs

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1. http://capa-acam.ca/about-pas/pa-fact-sheet/
2. http://capa-acam.ca/about-pas/history/