What is a PA?

Physician Assistants (PA) are academically prepared and highly skilled health care professionals who provide a broad range of medical services. PAs are physician extenders and not independent practitioners; they work with a degree of autonomy, negotiated and agreed on by the supervising physician(s) and the PA. PAs can work in any clinical setting to extend physician services. PAs complement existing services and aid in improving patient access to health care. A relationship with a supervising physician is essential to the role of the PA.

The PA’s scope of practice is determined on an individual basis and formally outlined in a practice contract or agreement between the supervising physician(s), the PA and often the facility or service where the PA will work. Activities may include conducting patient interviews, histories and physical examinations; performing selected diagnostic and therapeutic interventions or procedures; and counseling patients on preventive health care.

In Canada, 250 PAs currently work in health care settings, primarily in Manitoba and Ontario. There are approximately 150 students currently enrolled in PA programs in Canada and it is expected that there will be 188 students in January of 2011. PAs are gradually being introduced in other provinces, and evaluation of their impact on access, wait times, quality of care and both patient and provider satisfaction is ongoing.

As the profession’s national organization, CAPA advocates PAs practising in all parts of Canada in both military and civilian sectors. On behalf of the profession, CAPA’s mission is to advocate endorsement of the physician–PA model of care as well as to ensure a national standard of education and certification of PAs that justify the trust of health care colleagues and the patients we serve.

The History of the Physician Assistant

The Physician Assistant (PA) profession evolved in the United States during the mid-1960s, in response to a shortage and uneven geographical distribution of doctors working in primary care. The first trainees were highly skilled military medics who, following Vietnam War service, had no equivalent medical role in civilian life. These days, PAs continue to be a safe and effective part of the U.S. health system with over 79,000 practicing PAs and 156 accredited programs.

Mid-level clinicians have been employed by the Canadian Forces (CF) for over 50 years and in 1984 the first class of “Physician Assistants” graduated from the Canadian Forces Medical Services School at Borden, Ontario. They are generally acknowledged as the first formally trained PAs in Canada.

In 1997 Warrant Officer Thomas Ashman, stationed at Canadian Forces Station Alert as a PA, conceived the idea of a National Academy of Canadian PAs. In October 1999 the Canadian Academy of Physician Assistants (now the Canadian Association of Physician Assistants- CAPA) was formed; Thomas Ashman was elected founding president. CAPA’s goal was to be a national professional organization that advocated for Physician Assistants and represented its membership across Canada (By PAs for PAs).

In 1999, the Canadian Forces funded the development of CAPA with the intent that it would become self-sufficient and expand to include a civilian component. In September 2001 CAPA, with assistance from the Canadian Forces Medical Services School, developed the Occupational Competency Profile for the Civilian PA in Canada; this OCP was adopted by the Canadian Forces. The first Physician Assistant Entry to Practice Certification Examination (PA Cert Exam) was conducted in 2005, confirming a national standard of quality and professionalism for PAs trained and certified in Canada. September 2009 sees the release of an updated National Competency Profile and Scope of Practice for Canadian physician assistants.

In September 2002, the Canadian Forces inaugurated a redesigned PA program to align with requirements for accreditation by the Canadian Medical Association (CMA). In 2008 the first two civilian PA education programs are launched at the University of Manitoba and McMaster University. The PA Consortium (University of Toronto, Northern Ontario School of Medicine, and the Michener Institute of Applied Sciences) launches a third civilian program in January 2010.

In June 2003, the CMA recognized the PA as a health professional. This paved the way for an accreditation process to begin; in June 2004 the CMA Conjoint Accreditation Services surveyed and accredited the Canadian Forces Health Services School PA education program. Since then, two other programs have been accredited: the University of Manitoba Physician Assistant Education Program and the McMaster University Physician Assistant Education Program. In addition, the University of Toronto, in collaboration with the Northern Ontario School of Medicine and the Michener Institute for Applied Health Sciences, has registered its application for accreditation.

In 1999, Manitoba enacted legislation allowing PAs to function as Clinical Assistants (Canadian Certified). It should be noted however that in 2009 there was an amendment made to allow practice under the title of Physician Assistant. The province currently has numerous PAs practicing in medical and surgical specialties. In May 2006, the Ministry of Health and Long-Term Care for Ontario (MOHLTC) announced the inclusion of PAs in Ontario’s provincial health care system. The first PAs began work the following January as part of the first phase of a demonstration project evaluating the impact of PAs in the Ontario health care system. The province of New Brunswick followed suit in 2009 when the College of Physicians and Surgeons of New Brunswick announced that licensing for PAs would now be provided under the Medical Act. In January 2010, Regulation 14 was created in order to dictate the terms of practice for PAs in the province. Most recently, on December 3, 2010, the Council of the College of Physicians and Surgeons of Alberta passed a bylaw allowing PAs to register as non-members. However, PAs are not regulated by the College.

For information about the history of the PA profession, visit the PA History Center Web page. For a list of historical events related to the Canadian PA profession, read this document.

Code of Ethics of the Physician Assistant profession

The Canadian Association of Physician Assistants recognizes the responsibility of its members to practice and maintain the highest standard of ethics in the delivery and provision of quality health care services to all patients.

• Physician Assistants shall be committed to providing competent medical care, assuming as their primary responsibility the health, safety, welfare, and dignity of all.
• Physician Assistants shall extend to each patient the full measure of their ability as dedicated, empathetic health care providers and shall assume responsibility for the skillful and proficient performance of their professional duties.
• Physician Assistants shall deliver needed health care services to health consumers without regard to gender, age, race, handicap, creed, colour, religion, national origin, sexual orientation, socio-economic and/or political status.
• Physician Assistants shall seek consultation with their supervising physician, other healthcare providers, or qualified professionals having special skills, knowledge, or experience whenever the welfare of the patient will be safeguarded or advanced by such consultation.
• Physician Assistants shall provide only those services for which they are qualified by way of education and/or experience and in accordance with pertinent legal and regulatory authorities.
• Physician Assistants shall not misrepresent in any manner, either directly or indirectly, their skills, training, professional credentials, identity, or services.
• Physician Assistants shall strive to maintain and increase the quality of individual health care service through individual study and continuing medical education.
• Physician Assistants shall have the duty to respect the law, to uphold the dignity of the Physician Assistant profession, and to accept its ethical principles. The Physician Assistant shall not participate in or conceal any activity that will bring discredit or dishonour to the Physician Assistant profession and shall expose. Without fear or favour, any illegal or unethical conduct in the delivery of medical services.
• Physician Assistants ever cognizant of the needs of the community shall use the knowledge and experience acquired as professionals to contribute to an improved community.
• Physician Assistants shall place service before material gain and must carefully guard against professional conflicts of interest.
• Physician Assistants shall strive to maintain a spirit of cooperation and collegiality with their professional organizations and respect for the general public.

CAPA Scope of Practice and National Competency Profile

Preface

The Canadian Association of Physician Assistants (CAPA) is a national professional organization that advocates for physician assistants (PAs) and represents its membership across Canada and globally. It is committed to fostering development of the physician/ physician assistant model to assure quality care for Canadians. The Scope of Practice and National Competency Profile are created with the support of The Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC) as a resource for PA’s, Supervising Physicians, Educators, Legislators and other health professionals.

CAPA has established and maintains the national standard of practice for PAs and provides the National Certification Process through the Physician Assistant Certification Council (PACC). The Canadian Medical Association (CMA) offers conjoint accreditation of PA training programs with CAPA. By guiding educational programs and assisting legislators, CAPAs goal is to provide efficacious health professionals to the Canadian public, and foster the development of the profession nationally.

Historically the PA’s role was developed within the Canadian Forces Health Services to provide a full spectrum of medical care. Civilian PAs are practicing in Manitoba, Ontario, New Brunswick, and in Alberta. This model is being increasingly used to help meet the pressing demand for quality medical care around the world. In the U.S. Physician Assistants have been assisting in meeting this need since the 1970’s. In addition, health care planners and administrators in many countries worldwide have utilized similar models or are starting to explore this health care profession.

Introduction

CAPA’s objective in the development of this document is to communicate to the public and to the PA profession a set of standards that all physician assistants are expected to acquire for entry to practice. It is intended to help employers, PAs, physicians, educators and others to understand the breadth and depth of practice for PAs in Canada.

This document provides the Scope of Practice Statement and the National Competency Profile, developed for entry-level Generalist PAs in Canada. The Scope of Practice Statement defines how and under what circumstances the PA may exercise their competencies within the health care system. The PA scope of practice is relevant to practice in any health care setting or role.

PA Education Programs

The following are the minimal entrance standards published on the Program sites or utilized in Program materials as at January 21, 2011. Please understand that the Canadian Association of Physician Assistants is not an educational agency and the information provided is our attempt to provide the most current information possible. For further information and to verify the information provided here please visit the programs sites or contact them directly.

McMaster University Physician Assistant Education Program

Bachelor of Health Sciences Degree (Physician Assistant) requirements: Academic: A minimum of 10 full-courses or 20 half courses (two years) are required. Courses that employ small group, self-directed or inquiry learning are excellent preparation for the McMaster's PA program. Applicants are expected to have achieved an overall simple average of at least 3.0 on the OMSAS 4.0 scale for consideration. Higher grades may be required. McMaster has always been an innovator in the field of medical education and invited applicants will participate in The Multiple Mini-Interview, or MMI. The MMI increases the overall reliability of the interview in judging an applicant's merits.

The Consortium of Physician Assistant Education

Bachelor of Science Physician Assistant Degree (BScPA) requirements: Academic: Minimum 10 full-courses or equivalent academic credits at a recognized university with cumulative average GPA of at least 3.0 on the OMSAS (Ontario Medical Schools Application Service) 4.0 scale is recommended. All applicants are required to have completed one FULL course (post-secondary level) or equivalentin each of Human Anatomy, Chemistry, and Physiology. Non-academic : Experience as a Health Care Professional in good standing with minimum 1680 hours (1 year full-time)of direct patient contact in a professional setting (i.e. direct involvement in treatment and/or care planning and delivery for patients in hospitals,medical office/clinic, nursing home, care home or other care facilities).

Canadian Forces Health Services Training Centre Program

Physician Assistant Program Physician Assistant Baccalaureate in an allied health program requirements: Must be a member of the Canadian Forces Graded entry based on prior learning will be available for candidates with advanced standing or experience such as other allied health professionals, or paramedics. Qualification Level 6 Medical Technician qualification; rank of Sergeant; and successful completion of the Junior Leadership Course or Professional Level Qualifications (12-15 years of service). In addition, candidate must be merit listed for promotion to Warrant Officer.

University of Manitoba's Physician Assistant Education Program

Master of Physician Assistant Studies requirements: This Program is open to graduates of a four year Bachelor's degree, preferably in a health sciences field, from a college or university recognized by the University of Manitoba, with a minimum GPA of 3.0 in the last two full years (60 credit hours) of study. Undergraduate courses in Human Anatomy, Physiology and Biochemistry are required if they were not taken in the Bachelor's degree. Microbiology and Psychology are asset courses. It is strongly recommended that applicants have 2000 hours (1 year full time) of directpatient contact, i.e. direct involvement in treatment and/or care planning and delivery for patients in hospital, medical office/clinic, nursing home, care home or other care facility. The PAEP admission requirements are described on the Faculty of Graduate Studies minimum requirements web page