Transcript The New Brunswick Physician Assistant Experience - CAPA

THE NEW BRUNSWICK PHYSICIAN
A S S I S TA N T E X P E R I E N C E
2009-PRESENT
Dr. Graeme Young MD, FCFP(EM), Dip Sport Med.
Chief, Department of Emergency Medicine
Medical Director of Emergency Program Fredericton Area
Manager, Physician Assistant Program
Horizon Health Network Fredericton Area
[email protected]
NB PA PROGRAM
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Thank You for your attention !!
???????QUESTIONS??????
DISCLOSURES
Nil/none
OVERVIEW
 Where did Physician Assistants come from??
 The P.A. Profession
 The Canadian P.A.
 New Brunswick’s P.A. interest
 DECH Emergency Department Fredericton- P.A. interest
 DECH P.A. Program
 Where I think we are headed in NB.
WHERE DID THE PHYSICIAN ASSISTANT COME
FROM??
 1961- Charles Hudson recommends to the AMA ‘the creation of two new
groups of assistants to doctors from medical and non-medical personnel’
 1965- Dr Eugene Stead at Duke University Medical Center,
North Carolina put together the first ever class of P.A’s, made up
North
of US
Navy Corpsmen. The program was based on the ‘Medical
Education Fast Track’ training for doctors during World War 2.
1968- American Academy of Physician Assistants formed
1971- First Civilian PA Training program – Montefiore Medical Center, New York.
1979- PA’s Employed in all 50 US States
WHERE DID THE PA
COME FROM??
1984- first formal Canadian
trained P.A’s are trained at
Canadian Forces Medical
Services at CFMS Borden
W H E R E D I D T H E PA C O M E F RO M ?
 2008 – First Canadian civilian programs open at University of
Manitoba and McMaster University. Manitoba offering Masters level
degree, and McMaster offering an Undergraduate level Degree. Both
leading to eligibility for Certification.
W H E R E D I D T H E PA C O M E F RO M ?
 Currently there are 400+ PA’s practicing in Canada, where as there
are 83,600+ in practice in the U.S.
 2010 – CNN Money rated the PA career as the #2 best job in US.
Description of Job : ‘What they do: Act as Robin to a doctor’s
Batman’
 2012 Forbes Magazine rates PA Studies Masters Degree as #1
Masters Degree for Jobs with an average salary of $102,000 US$.
I N T E R E S T I N T H E PA P R O F E S S I O N
 My interest in PA’s began in 1993. NDMC Ottawa Surgical resident.
 PA’s high ranking NCO’s, in charge of Clinics, Emerg Dept., and OR’s.
Formal military setting, regimented and ultra organized. (Me?)-nope!
 Quickly found these specialized PA’s would make my ‘medical life’
much more enjoyable if you kept on their good side!!
 So I befriended every PA I met and soon I came to appreciate the
huge part they played in the Medical community at NDMC and the DND.
 Even then I was thinking about where the PA fit in civilian medicine.
I N T E R E S T I N T H E PA P RO F E S S I O N
 1996 – I’m out of DND, little PA contact until 2009.
 2009 – Chief of Emergency Medicine and Program Director in
Fredericton Area. Two busy ED’s and 40 doctors at two sites.
 2009- Dr Wayne MacDonald (NB Dept. of Health) – ‘Feasibility
Study for the use of Physician Assistants in New Brunswick’.
 Dr MacDonald had DND experiences with PA’s which lead him to
strongly support the use of PA’s in NB. Suggested employment in
ED. Parallels what they have done in DND for decades.
MY CHALLENGES
 Create a job description, and training program for ED PA’s,
encourage interest in local ED Doctors and Medical community.
 Secure funding for two full time PA’s (hopefully for more to come)
 Hire two good candidates .
 Roll out integration program, and evaluate our PA’s progress.
DECH PA PROGRAM
 Regional Emergency Dept. in 2009 – 46,000 visits per year.
 36,000 visits at Oromocto site as well (15km away)
 40 Emerg Doctors at two sites.
 My Job as chief: staff the centers, and do QA and development.
D E C H PA P RO G R A M
 2009 – LWBS rates 12-13% (six times national expected rates), long wait
times, frustrated and overcrowded work conditions, and safety issues.
 Proposal to Medicare director for funds to help us address these issues
with new PA model was accepted!! Two new PA’s could be hired!
 2010 – PA Program Committee (two ER docs, Dr MacDonald, HR rep,
and Nurse Manager) formed draught of Job Description from National scope
of Practice Documents (and from Manitoba’s documents).
 Secured salary range, integration program guidelines, then applicants
reviewed.
D E C H PA P RO G R A M
 Hiring process took some time. 17 good applicants and 20+ FMG’s.
 Two PA’s selected – (one US Grad, one DND Grad)
DECH PA PROGRAM
 Two experienced PA’s Joined Drs Hebb and Young as supervising MD’s.
 2 month block rotations, Evals at 2,4, and 6 Months ; then yearly.
 Our Goal is: Comfort with every level of triaged patient. From
trauma care to sore toes!
 Both PA’s exceeded our expectations.
At Six months the PA’s were assigned other supervising staff having to “win –
over” each one. There were some challenges but this went very well.
Our PA’s select patients off our tracker just the same as our MD’s do.
D E C H PA P RO G R A M
 PA’s select patients from our electronic ‘tracker’. They do history , physical,
investigate (labs, Xrays, ECG’s), review the tests and findings, then execute
the plans for care. Reviewing the plan with the MD’s, for follow-up care
and use of community resources. (at times BETER than MD’s do!!).
 Consultants : ‘I need to speak to the doctor’ changed slowly to ‘thanks for
the consult and your good work’. At times still some snags, but less often.
 Barriers between our nurses and PA’s : non-existant right from the start!!
D E C H PA P RO G R A M
 2013 – resignation of one PA leads to Hiring of Canadian PA
 Civilian Graduate from University of Toronto program.
 During process again hosts of great PA applicants
 No FMG’s applied– the word is out about Certified PA’s.
 2014 Legislation in NB to allow PA’s to prescribe medications. Small hold up still
on ‘controlled drugs’, but change has helped our patient flow considerably!!
DECH PA PROGRAM
 System review since PA introduction: 2014 on track for 50,000 visits
 LWBS Rates : Unchanged at 12%; ERLOS – Unchanged at approx
200min. Though neither stat is great, the only change is the PA Program and
the volume rose 8%......That is success by any measure!!!
 Patient satisfaction higher with PA’s than with MD visits.
 Very few conflicts, few complaints, overall……FANTASTIC!
 Plans for new staffing program for ‘PA Stream’ in Ambulatory Care in ED
WHERE ARE WE HEADED IN
EMPLOYMENT IN
PA
NB?
 Fredericton DECH-ED, request to DOH for two additional PA’s.
 If Approved funding , then we will hire ASAP! We would like daily PA
coverage from 8am-Midnight – 7days per week. Maybe night coverage??
 Other Departments – St John, Moncton ED’s some interest voiced.
 Orthopedics inpatient care proposed in 2012, but no funding as yet.
 New Liberal Government in NB, so we will keep ‘proposing new programs
for PA employment’ as cost effective health care provision for New
Brunswickers.