CHR.ps, page 1-16 @ Normalize - Calgary & Area Physician's ...

Columns:
June 2007
From the president: When the playing gets ugly in the
healthcare sandbox ------------------------------------------------------ 4
Medical advisory board report -------------------------------------- 13
Home care physician update --------------------------------------- 12
Features:
Pediatric neurologist Bev Prieur --------------------------------------- 7
News:
Contents
Vital Signs reader survey ---------------------------------------------- 6
GRIDLOCC -------------------------------------------------------------- 10
Foothills annual spring dinner -------------------------------------- 11
e-Partners project coming ------------------------------------------- 12
Executive summary from the head of the department of
pathology & laboratory medicine ---------------------------------- 14
Breaking records and nearing goals: regional computerized
physician order entry ------------------------------------------------- 15
Bulletins & notices ----------------------------------------------------- 16
On the cover: Pediatric neurologist Bev Prieur with
patient Elizabeth Matwe.
Photo by Dave Lowery.
Editorial
Where are the PAs ?
Nobody knows how exactly much it costs to educate a physician
to the point of MD graduation, nor even what to include in the
calculation. It probably requires at least $300,000 of investment by
the individual and by society. Then, after residency training physicians
exercise their discretion and judgment in ordering investigations,
hospital care, drugs, and so on, and in a professional career the
resulting health system expenditures will amount to millions or tens
of millions of dollars.
When a business executive, or a movie director, or a politician
wants to get the job done they will appoint a personal assistant – a
PA. It seems to be the same idea in healthcare administration. But
what is the corresponding role to support highly trained physicians
in effective management of all those health care dollars?
Although there are elements of American health care that are not
required in Canada, there are obviously good ideas that we should
examine and emulate. One such is the health profession of physician
assistant. These are people with undergraduate degrees who proceed
to two or more years of additional training 1 , pass a national
examination, and then obtain a state PA license. Their education
usually takes place alongside medical students in medical schools,
clinics and teaching hospitals, sometimes in the most prestigious of
academic medical centres in the United States. They are not physician
extenders, medical assistants, bedside physicians, nor nurses, nurse
practitioners, or prescriber pharmacists. Their role is to work under
the supervision of physicians and to augment medical practice, rather
than to become alternative or competing providers.
The PA concept is almost non-existent in Canada with the notable
exception of the Armed Forces. Yet in the US there are 132 accredited
PA education programs, with 65,000 practitioners working in almost
every type of medical environment 1 .
The suggestion to have PAs in Canada is not new 2 , but nothing
seems to happen. Forty years ago, when the Calgary medical school
was established, it was to be innovative and have a focus in primary
care 3 . It would be timely to revisit the original social objective and
consider an innovative physician assistant degree program in Calgary.
Program funding and payment processes would have to be worked
out - if they train in medical schools the AMA might possibly support
them as colleagues.
Ray Lewkonia
1. Physician assistants. US Department of Labor
http://www.bls.gov/oco/ocos081.htm
2. B. Goldman 1993. Why aren’t we using physician assistants? CMAJ 149; 1170.
3. WA Cochrane 1968. Philosophy and program for medical education at the
University of Calgary. CMAJ 98; 500-505.