Physician Assistants (PAs) were introduced in Ontario as a new health care professional (outside military use) in May 2006, as part of a new health human resources strategy of the Ontario Ministry of Health and Long-Term Care. PAs were introduced as part of a multi-faceted strategy with the explicit goals of: decreasing wait times; increasing access to care; achieving team and patient satisfaction; and improving team recruitment and retention. Ontario PAs are not autonomous health professionals, but work under the direct supervision of a physician who delegates particular tasks to the PA, including controlled acts governed by the Ontario Regulated Health Professions Act. The supervising physician retains liability for the PA's work.
While PAs have worked for several decades in the Canadian Forces and in the US, their use in a civilian capacity is new to Canada. PAs have a unique scope of practice that varies depending on the individual physician-PA relationship, although this relationship is guided by a National Competency Profile that defines how and under what circumstances the PA may work. PAs may take patient histories, conduct physical examinations, order and interpret tests, diagnose and treat illnesses, counsel on preventative health care, and develop additional specialized skills while working with a supervising physician.
In 2012, approximately 125 PAs were working in Ontario, although it is difficult to establish exact numbers and demographic information because Ontario PAs are unregulated with no mandatory government licensing records kept. Ontario PAs applied for status as self-regulated health professionals, but the Health Professions Regulatory Advisory Committee recommended that PAs not become licensed at this time, instead suggesting a compulsory registry to be designed and administered by the College of Physicians and Surgeons of Ontario. This has not yet been implemented.
The Ontario Ministry introduced PAs by initiating a demonstration project that included salary support for new PAs, the establishment of two PA education programs at McMaster University and the University of Toronto, and an evaluation component. This demonstration project was scheduled to end in 2009, but the Ministry has continued to renew salary support funding, with current contracts scheduled to end in 2015.
The fate of PAs in Ontario is uncertain once Ministry salary support is discontinued. There is no data available on the number of PAs who are employed without Ministry funding and it is unknown whether current employers will find ways to continue to employ PAs should the government funding end. Contributing to this uncertain future is a lack of Ontario-specific evidence about the effectiveness, cost, and safety of PAs as well as vocal opposition from other health professional groups (e.g. Registered Nurses Association of Ontario). Supportive factors include the alignment of the PA role with Ontario health system priorities (e.g. reducing wait times, ameliorating physician shortages), the support of physician groups, good enrolment in the PA education, and the apparent success of the role in the United States.
For more information: https://escarpmentpress.org/hro-ors/article/view/1187