Physician Assistants

At least the health care article written for the Calgary Herald, Mar/25, by James Ferrabee, was informative. He describes how much of the primary care in the U.S. is being slowly taken over be Physician Assistants, a program that I supported back in the early 70’s as the U.S. was coming in with theirs.
It was about that time that the Calgary medical school had, as their Dean of Medicine’ a young, bright acquaintance of mine, Dr. L. McLeod. Another young family physician and I met with him and proposed a two to three year program at the Calgary medical school for physician assistants. I had a nurse working for me at the time (Pat W), that I had taught to put on and remove casts, do minor suturing, do prenatal visits, well baby check-ups and assist my office nurse in arranging consultations, investigations, etc. Pat had a group of people in certain chronic disease areas (obesity, diabetes, etc) that she worked with regularly and councelled, and made house calls on palliative care patients. This expanded the number of patients that I was able to accommodate in my practice by approximately thirty percent and I feel, improved the care that I was able to give overall in my practice. Unfortunately, our universal healthcare system provided no means for charging for her services (I could only charge the system if I, as the attending physician, gave the service personally), so when our great leader, Mr. P. E. Trudeau, brought in wage and price controls and “extra billing” was outlawed, I had to discontinue the program because it represented an overhead that I was unable to recapture.
With this practical experience, I felt strongly that we should move in the direction of physician assistants provincially, with a billing system specifically for their services. Unfortunately, Dr. McLeod felt there would be too much conflict with the department of nursing and other jurisdictional headaches, and did not pursue establishing a school for Physician Assistants.
I found it interesting that Mr. Ferrabee quotes an annual median income of $70,000 for Physician Assistance in the States. This certainly doesn’t correlate with charges that are reported by Canadians when seen in the U.S. by physician assistants. They rarely report being charged under one hundred dollars for their visit. The median income for a Canadian family physician doing ongoing continuing care (excluding walk-in clinic docs), probably runs in the range of $100,000 to $130,000 per annum after expenses, and our office visit charge in Alberta is app. $30 a visit. Either the Physician Assistants in the U.S. are being ripped off by a huge overhead beauracracy, or our Canadian physicians are outworking the U.S. assistants by a mile.
Interesting also was the statement that in the U.S there are 62,000 jobs for PAs and only 55,000 P.A.s, pointing out again the universal shortage of healthcare providers. Insulting was the idea put forward, that the resistance to such a program would come from physician groups. If we are allowed to incorporate these care givers into our practices, walk-in clinics, and emergency departments as I did 35 years ago, and not assume the cost directly from out pockets (as I had to thirty five years ago), I see no problems. If this group is to replace the traditional family doctor, then the public should be opposed. As for the hospitals themselves (other than the emergency triage area), care in today’s hospitals is too acute to have anyone but the most highly trained giving primary care.
Naively, Mr. Ferrabee thinks governments in Canada would and should embrace this idea. He should keep in mind that increased access means increased cost, and the primary goal of our politicians in to control cost. Our waiting lists (risk lists) are our implements of sustainability.