RNAO: Inadequate education of PAs could jeopardize patients

Members of the public will not be well served if the provincial government pursues a plan to allow physician assistants (PAs) to work in hospitals, family health teams, community health centres, and family physician offices.

The board of directors of the Registered Nurses' Association of Ontario (RNAO) has unanimously endorsed a position statement, which raises serious questions about the level of education and regulatory oversight physician assistants have and how these could jeopardize patients.

The role was adopted by the Ministry of Health and Long-Term Care in 2006. A number of pilot projects are currently underway in selected Ontario communities. Physician assistants are not regulated health professionals and can only work under the direct supervision of their assigned physician. They can conduct physical examinations, interpret test results, diagnose and treat illnesses, write prescriptions and assist during surgery.

Wendy Fucile, President of RNAO, says the association is alarmed about the inadequate educational requirements to become a physician assistant. "They only need two years in an undergraduate program to be admitted into a PA education program and their course of study doesn't have to be in a scientific or health-care related field. The candidate could have studied history or engineering to be accepted." Fucile also takes issue with the program itself saying the requirement to spend one year in the classroom and one year in a general clinical setting is insufficient. "This is in marked contrast to the approach in Canada's Armed Forces where PAs have extensive prior experience as medical assistants before training as physician assistants. I don't think the Ontario plan for civilian physician assistants will result in graduates who are properly prepared to see and treat patients," adds Fucile.

The association also questions the physician assistant experiment from a financial perspective. In addition to the base salary that physician assistants receive, physicians assigned to oversee the work of PAs are also paid compensation. Fucile questions the cost effectiveness of paying double for a health-care worker. "At a time when health-care budgets are already strained and when people are concerned about financial accountability, this seems irresponsible," says Fucile.

RNAO's Executive Director Doris Grinspun says if the Ministry of Health and Long-Term Care is interested in improving access to care and improving clinical outcomes in a cost-effective way, it should be educating and hiring more registered nurses and nurse practitioners instead of creating a new type of health-care worker that is unregulated. "Patients in Ontario can rely on the fact that RNs and NPs are highly educated, skilled professionals. That's why nurses enjoy the highest level of trust among members of the public."