Nurses cautious about expanding role of physician assistants

Several provinces are looking at physician assistants as a way to shorten patient wait times, but a nursing group says there is no place for them in the Canadian health care system.

Physician assistants have been used in the military for decades, and they work in many hospitals and clinics in the U.S. They work under a doctor's supervision, doing everything from filling out paperwork to prescribing medication to surgical procedures.

Manitoba came up with a plan to fast track surgeries using physician assistants in 2003. One surgeon works on overlapping operations in two rooms, with two teams of anesthetists, nurses and physician assistants.

Jose Araneta is one of 55 clinical assistants, as they are known in Manitoba. Araneta said when he started working, they were doing three knee replacement surgeries a day about twice a week, and the waiting list was about 28 months.

Now, "we usually get seven, eight cases done by 3:45," Araneta said.
Pilot project in Ontario

Officials at Ontario's health ministry saw what was happening in Manitoba and started a pilot project to see how physician assistants could fit into its system.

"This is another way that they can get highly qualified care when they need it, where they need it, as part of receiving care from a team," said Dr. Joshua Tepper, an assistant deputy health minister in Ontario.

The idea is meeting with resistance, however, from the Registered Nurses Association of Ontario. The group said Ontario should be training more nurse practitioners instead, because they are better educated and have more autonomy than physician assistants.

Physician assistants will have to turn to nurses or call physicians to act on medical directives when a patient's situation changes, said Doris Grinspun, executive director of the RNAO.

Grinspun said she is especially worried that some physician assistants are doing surgical procedures, which she says puts patients at risk.

I would say to my family, friends, colleagues, to the public: don't let them touch you," said Grinspun. "Make sure to ask who is taking care of you."

In Winnipeg, Ian Jones, vice-president of the Canadian Association of Physician Assistants, bristled at Grinspun's view. Jones works in neurosurgery.

"If I was drilling into somebody's skull by myself, I would be nervous too, but I don't," said Jones. "I work with a physician. I'll have the drill on my arm, he'll be standing right there .… When you need an extra set of hands, my hands are there. So I can make the neurosurgeon a lot more effective and efficient. And that's my job."

Alberta is also looking at allowing physician assistants to take some of the workload normally done by doctors.

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