Dr. Alex Nataros and Lisa Stewart, CCPA, MPAS Director, BC, Canadian Association of Physician Assistants, met with Port Hardy council last Tuesday evening to discuss how the hiring of physician assistants (PA’s) would benefit the North Island.
Nataros was running slightly behind schedule due to the Port Hardy Hospital emergency department being very busy, but he still managed to make it to the meeting where he and Stewart were warmly welcomed by council.
Stewart started off the committee of the whole meeting by explaining that she and Nataros have been working together since last August, and he’s informed her of all the issues Island Health has been dealing with while trying to keep the Port Hardy Hospital emergency department open 24/7.
“He’s [Nataros] worked with physician assistants previously when he worked in Manitoba, and I’ve been advocating to bring PA’s to British Columbia, so we put our heads together and thought Port Hardy would be a great place to bring in PA’s,” Stewart said, noting PA’s are classified as mid-level care providers, basically an extra set of hands for a physician.
“We work mostly … in partnership with physicians, our license and our practice is a direct extension of our physician,” confirmed Stewart. “We have three PA’s who are interested in working in the northern Island communities, with one PA who says she’s available June 1 to come work here, and it would effectively enable Port Hardy to keep your emergency open. It would allow Alex to do some work in the clinic and allow the PA to work in emerg, or the PA could pick up emerg shifts overnight and Alex could sleep and be ready when he’s needed by the PA.”
PA’s are very highly skilled medical providers that can independently see and treat patients, and also prescribe medications. Their role can be considered similar to a training resident, or similar to a nurse practitioner.
“We’re not independent providers, we’re an extension of a physician,” added Stewart. “Alex and I have been working very hard to bring a PA to Port Hardy.”
Stewart and Nataros are putting forth a proposal to allow Nataros to hire a PA to work with him in his practice, and they need the Minister of Health Adrian Dix to approve it to make it happen.
Once Dix gives the green light, PA’s can be living and working in Port Hardy in the very near future.
Nataros quickly introduced himself to council, stating he’s worked in rural remote communities across Canada, and then noted that recently one of Port Hardy’s physicians has decided he will not be working in the emergency department beyond March unless Island Health significantly steps up and commits for locum position funding and nursing funding.
“That’s a really big deal,” he said, explaining Port Hardy needs to start looking at innovative new models of health delivery. “I’m very clear in terms of my capacity and what I’m able to do, and what I’m able to do with physician assistant support.”
Nataros added he’s interviewed numerous PA’s who are eager to relocate specifically to the North Island, and they would all be committed community members outside of the hospital.
“[PA’s] are a political issue,” he said, stating that he feels that council’s voice could help make PA’s in British Columbia become a reality.
“I presume that the hold back is funding?” asked Coun. Janet Dorward. “Or is there something else?”
“I am very clear this will more than pay for itself in my fee for service bill,” answered Nataros. “I could readily hire two or three physician assistants and pay for them.”
He explained with a team of PA’s backing him up, he could have a roster of 5,000-6,000 patients under his name.
“This is a new care delivery model that’s proven across Canada, our Canadian military, and around the world.”
Dorward asked again what is the hold back from the Ministry of Health approving PA’s.
“Unfortunately it is a lack of understanding what a physician assistant is,” Nataros clarified. “In B.C. it is a new trade, and again, the perception of the current government has been a commitment to a nurse practitioner approach - we have two in our community, they are fantastic - but it’s different, a nurse practitioner is like an independent practitioner, physician assistants are by definition dependent on the physician.”
Nataros again clarified it’s not a funding issue, just a lack of understanding by the Ministry of Health.
Coun. Brian Texmo asked how new of a practice are physician assistants.
“PA’s have been working in the military for 60 years,” Stewart answered. “Civilian PA’s have been practicing in Manitoba for probably at least 20 years, maybe closer to 25 years.”
She then noted PA’s have been advocating for 12 years now to be allowed to work in the B.C. health-care system.
“There’s literally no reason the Ministry of Health should be waffling on this anymore,” Stewart added.
Texmo asked what the training for PA’s involves.
“Our training is modelled after a physician’s training,” Stewart answered. “Our program, we pretty much have the same entry prerequisites that med students need to get into medical school.”
The program itself is 24 months, it is affiliated with medical schools, and they’re taught by doctors and other PA’s.
“Our practice model emulates that of a physician’s practice,” she added. “When we graduate we are not doctors, but we are taught to work alongside seamlessly with physicians.”
Coun. Fred Robertson asked who certifies PA’s.
“In all the other provinces in Canada, physician assistants are regulated underneath the College of Physicians and Surgeons,” said Stewart.
Robertson asked if the college of nurses has commented on PA’s.
“Not formally, but we are meeting with them,” said Stewart. “They’ve been providing education to nurses about what PA’s are and have extended a hand of interest.”
Coun. Dennis Dugas said he thinks it will be a great opportunity for the District of Port Hardy, so long as the people down in Victoria get onboard, and then asked where PA’s are trained.
Manitoba, Ontario, there’s a program in development in Calgary, and there’s another program in talks for Saskatchewan, confirmed Stewart.
“This is a tremendous opportunity for Port Hardy,” said Nataros. “Port Hardy’s been front and center in the news for far too long in terms of lack of medical capacity, so this is an opportunity for leadership from council.”
Council agreed to write a letter of support for the hiring of PA’s in Port Hardy for Nataros and Stewart’s proposal.