Career Start Grant for Physician Assistants Graduates (2013)

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1 Career Start Grant for Physician Assistants Graduates (2013) Applicant Information Package Contents 1.0 Background 1.1 Ontario s Physician Assistant Initiative 1.2 Physician Assistant Role and Responsibilities 1.3 Employment Support for 2013 Physician Assistant graduates 2. 0 Employment Supports 2.1 Financial Support 2.2 Recruitment Incentive 2.3 Period of Availability 2.4 Eligibility 2.5 Funding Levels and Eligibility Criteria 2.6 Selection of Approved Employers 2.7 Employers Not Approved for Support 3.0 Employer Responsibilities 3.1 Defining the PA role at your site 3.2 Employment Practices 3.3 Liability Protection 3.4 Authorizing Mechanisms 3.5 Physician Assistant Compensation 3.6 Physician Assistant Vacancies and Termination 3.7 Recruiting Assistance 3.8 Reporting requirements 4.0 The Application Process 4.1 The Application Process 4.2 Timelines 4.3 Application Checklist 4.4 Further Information 1

2 1.0 Background 1.1 Ontario s Physician Assistant Initiative Physician assistants (PAs) were first introduced to the civilian health care system in Ontario in May 2006 with the launch of the HealthForceOntario strategy. The Ontario PA Initiative was a joint endeavor between the Ministry of Health and Long-Term Care and the Ontario Medical Association and included key stakeholders such as the Ontario Hospital Association, the Association of Ontario Health Centres and the College of Physicians and Surgeons of Ontario. The initiative was designed to introduce and evaluate the PA role in a variety of clinical settings in Ontario, and to oversee the development of post-secondary PA education programs. Over the first three years of the initiative demonstration projects were established in a variety of settings (hospital inpatient and emergency departments (EDs), long-term care homes, diabetes education centres, community health centres, and family health teams) and two PA education programs were developed (one at McMaster University and the other at the University of Toronto in collaboration with the Northern Ontario School of Medicine and the Michener Institute for Applied Health Sciences). As of June 2013, over 120 PAs were employed in government funded positions across Ontario. Approximately 45 PAs will graduate from these programs annually. Since the first 21 PAs completed the McMaster program in August 2010, the ministry has provided financial supports to facilitate the employment of PA graduates in areas of high priority for the people of Ontario. Career Start grants have been provided to support PA employment in a variety of settings including EDs, community health centres, family health teams and internal medicine positions in rural and northern geographies. To date, 97 graduates have secured employment within 3 months of graduation. The ministry is providing similar time-limited supports to employers to hire one of approximately 45 (2013) PA graduates; opportunities will be supported in high priority settings where the focus will be on meeting the goals of the Ontario s Action Plan for Health (Action Plan). As the integration of the PA role in Ontario s health care system progresses, the Career Start program aims to encourage sustainability of the position by matching PA graduates with employers who intend to provide long-term integration of the PA position in their organization. In 2014, changes to the Career Start program will be phased in: length of funding time will decrease from two years to one year and rural and the recruitment incentive is to be reviewed to determine its effectiveness in attracting PAs to underserviced areas. 1.2 Physician Assistant Role and Responsibilities The PA is a health care provider who works under the supervision of a registered physician. The PA supports the supervising physician, who maintains primary responsibility for patient care as the principle medical decision-maker. The PA is not an autonomous practitioner, so all tasks must be assigned or delegated to the PA by a supervising physician. The type of work delegated, and the extent of direct supervision provided to the PA, is dependent on the physician s assessment of the PA s individual competencies, skills and experience in 2

3 that practice setting. Further, only work within the physician s own scope of practice can be assigned or delegated to a PA. PAs graduate as generalists, and may develop skills in specialty areas with further training and work experience. Physician Assistants work in a variety of clinical settings. The type of work typically completed by a PA may include: Conducting patient interviews and taking medical histories Performing physical examinations and procedures Providing counseling on preventive health care Performing controlled acts as delegated by a physician Performing other tasks within the supervising physician s scope of practice that the physician deems the PA qualified to complete. The PA profession is not regulated in Ontario. As such, all medical care provided by the PA must be supervised by a registered physician, and must follow a recognized process of delegation. The College of Physicians and Surgeons establishes the process for delegation of controlled acts that physicians should follow with when working with a PA. Although the PA role is relatively new to the Ontario health care system, it has been very successfully integrated in other jurisdictions. For a number of years, PAs have been (and continue to be) key members of Canadian Forces health care teams. In Manitoba, PAs have been part of the health care system for some time and are a regulated health profession. Furthermore, PAs have worked in the United States health care system for decades. Research from these jurisdictions has demonstrated that adding PAs to the health care team in primary, secondary, or tertiary care settings can be a safe and cost effective way to improve patient access to care and to improve patient satisfaction. A Physician Assistant toolkit has been developed by the province of Ontario. This toolkit includes information about PA competence, PA supervision requirements, liability considerations and delegation concepts. This information is available on the HealthForceOntario website at 1.3 Employment Supports for 2013 Physician Assistant Graduates Short-term financial support is being offered to facilitate the employment of new PA graduates as their profession is being introduced and integrated into Ontario s health care system. Assistance with the application for support and recruitment of 2013 Ontario PA program graduates will be centralized through the HealthForceOntario Marketing and Recruitment Agency (HFO MRA). Support for costs associated with employing a PA will be available to approved employers that are able to recruit and hire a PA graduating from either McMaster University in August 2013 or the Consortium Program in December Employment Supports 2.1 Financial Support Financial support will be provided to selected employers to assist with the costs of employing a 2013 Ontario PA graduate. The support is to be used to help cover the costs associated with full-time employment, including recruitment, salary/benefits, overhead, start up, orientation and integration supports. 3

4 The amount of support that employers will qualify for is $46,000 at a 50:50 cost split with employer (employers are expected to match the grant funding). Employment support will be provided for a period of two years to support the full-time employment of a 2013 Ontario PA graduate only. Support will be flowed monthly to eligible employers. Prospective PA employers will be expected to agree to the terms of support prior to participating in the recruitment process. It is important to note that successful applications do not guarantee successful recruitment of a PA. Therefore, support will only be available to approved employers that are successful in recruiting a 2013 Ontario PA program graduate within the period of availability. There will be a limited number of approved sites, and it is expected that that the recruitment process will be competitive. 2.2 Period of Availability To receive a grant, employers are required to confirm acceptance of full-time employment from one of Ontario s approximately 45 PA graduates by October 31, Graduates from McMaster University must start work no later than November 18, 2013 and graduates of the Consortium Program must start no later than January 31, The grant will continue for a period of two years to support the full-time employment of the same PA. Support is intended for employment of the recruited 2013 Ontario PA program graduate. 2.3 Recruitment Incentive A one-time incentive of $10,000 is available for PA graduates who accept employment in northern and/or rural geographical areas PA graduates that are employed at a site with a Rurality Index for Ontario (RIO) Score of 40 or higher, or at a Northern Urban Referral Centre (Timmins, North Bay, Sudbury, Thunder Bay, Sault Ste Marie), will receive this support. This incentive is intended to help increase success in recruiting PAs to work in northern and/or rural geographies and must be provided directly to the PA. The incentive grant will be reviewed to determine its effectiveness in supporting PA positions in underserviced communities; recommendations for change will be implemented for the graduating class of Eligibility PA graduates will be supported in high priority settings where the focus will be on meeting the goals of Ontario s Action Plan for Health Care (Action Plan). Consideration will be given to employers who are able to demonstrate how the integration of a PA in their setting will support the priorities of the Action Plan (e.g. chronic disease management and prevention, seniors care, increased access to health services, etc). Separate application forms are available for: Emergency Medicine, Primary Care (Community Health Centres, Aboriginal Health Access Centres) and General Internal Medicine (inpatient). 4

5 Employers in other settings who are able to demonstrate how the PA role will support the goals of the Action Plan, and how the PA will be integrated into their practices on a longer-term basis will also be given consideration. Priority will be given to opportunities in rural and/or northern areas. Eligible employers must demonstrate a plan for sustaining the PA role (supports in place including financial and organizational) and how they plan to integrate (organizational capacity/strategic planning) the PA into their practices on a longer-term basis upon completion of the two year grant funding. Organizations that meet the eligibility criteria are encouraged to apply, however, it is anticipated that only a select number of employers (approximately 60-70) will be approved to participate in recruiting a 2013 Ontario PA program graduate. Independent of setting, all sites will be required to demonstrate that they are able to support full-time employment of the PA for 2 years, that their clinical team and administration is supportive of employing a PA, that they have adequate space and infrastructure to accommodate a PA, that they have a plan to ensure that the PA has adequate physician supervision at all times, that they have secured necessary finances to supplement the grant funding and that they have a plan to ensure that necessary enablers to PA practice (such as orientation, medical directive, etc) are in place. 2.5 Selection of Approved Employers While there is a desire to ensure a variety of employment opportunities exist for Ontario s PA graduates, the MOHLTC is supporting opportunities in areas of highest need, both clinically and geographically. As such, a limited number of sites will be approved to receive employment supports. The degree of interest in this type of initiative has been significant in the past, and it is anticipated that the selection of approved sites will be a competitive process. Sites that are approved to post their opportunity will be selected based on the strength of their application. Employers will be ranked and approved based on demonstrated need for the assistance of a PA graduate, as well as on their proposed role and demonstrated readiness to employ a PA. It is anticipated that approximately opportunities will be approved and posted. Only approved sites that successfully recruit a 2013 PA graduate will receive financial support. 2.6 Employers not approved for support Employers that are not approved to receive a grant through this initiative, but that are still interested and able to employ a PA, may still recruit an Ontario PA Grad through their own recruitment efforts. Many employers in Ontario have been successful in supporting the costs of employing a PA without targeting funding from the government. For example, some employers have found that employing a PA creates efficiencies for the physician, enabling them to see more patients and therefore increase OHIP billings, roster sizes and ED AFA volumes to offset employment costs. Sites receiving incentive funding, such as ED wait times incentives, have used this funding to support PA employment costs. Some employers that see high value in the PA role have funded employment through their global budget. 5

6 HFO MRA will facilitate the posting of all available PA jobs in Ontario, regardless of whether they are eligible for financial support through this initiative or not. The PA graduates are encouraged to pursue a job with any employer that they prefer. Employers who are not approved for a grant, but who still wish to recruit a PA may contact HFO MRA. 3.0 Employer Responsibilities 3.1 Defining the PA Role at your Site Experience has shown that employers who invest some up-front time in planning how the PA role will be most effectively utilized in their clinical setting gain the greatest number of advantages from employing a PA. Sites that are able to clearly articulate how the PA role will be used in their setting and how supervision will occur are typically able to integrate the PA role into the existing clinical team most efficiently. Defining the clinical role for the PA requires that a team has an understanding of the PA role and competencies, and is able to define how a PA will assist in the delivery of care in that clinical setting. The PA role should be implemented in a way that will improve access to care, or have other anticipated benefits that directly impact the quality of patient care being provided. Employers should contemplate the types of duties the PA will participate in, how those duties will be assigned and supervised, and how care will be coordinated among team members. Providing adequate supervision requires that a physician registered with the College of Physicians and Surgeons of Ontario is available to provide direction and supervision (either direct or indirect, as per the physician s judgment) to the PA at all times. There must always be a physician available to consult with the PA either in person or by phone, and every PA should have a primary supervising physician who has responsibility (administrative and/or clinical) for the PA. That said, supervision will often be shared by more than one physician and sites should identify an alternate physician who can provide supervision when the primary physician is unavailable. Consideration should be given to how the period of assessment of PA skills will occur at the start of PA employment, as well as to how work, and specifically controlled acts to be performed by the PA, will be assigned and/or delegated. There are a number of links to resources that will help employers understand PA practice and supervision requirements posted on the HFO website along with this information package. Applicants are strongly encouraged to familiarize themselves with these resources when considering PA employment. Planning and Integration requires that employers provide a plan for sustaining the PA position once the two year career start funding ends. Employers must demonstrate that organization and financial supports are in place or are being developed to integrate the PA position into their practices/services on a longerterm basis. 6

7 3.2 Employment Practices Employers are expected to exercise good employment practices with the PA, as they would with any employee, in accordance with employment standards in Ontario. Usual Human Resource practices for your organization (orientation, performance management, contracting, probationary periods, compensation and benefits, etc) should be followed. 3.3 Liability Protection Sites employing a PA are advised to understand the liability associated with employing and supervising a PA. More information pertaining to liability can be found on the HFO MRA website. Supervising physicians must carry protection through the Canadian Medical Protective Association or equivalent. In most cases, PAs will be included as part of the employer s existing comprehensive liability plan. Employers should confirm this with their insurance carrier. In some cases, PAs may need or want to provide their own professional liability coverage. Individual professional liability protection for PAs can be obtained from the insurer coordinated by their national professional association, the Canadian Association of Physician Assistants. 3.4 Authorizing Mechanisms PAs are not regulated and as such are not independently authorized to perform acts that are controlled under the Regulated Health Professions Act. All clinical work completed by a PA must be assigned by the supervising physician. Clinical work involving controlled acts must be delegated in accordance with the policy for delegation established by the College of Physicians and Surgeons of Ontario. It is important that the clinical team understands how the assignment and/or delegation of clinical work to the PA will occur. Sites should be prepared to invest some time defining this, as well as developing appropriate mechanisms for delegation to facilitate PA practice, such as medical directives. Sample medical directives for PAs, as well as other resources to assist sites in understanding delegation and to develop authorizing mechanisms are available along with this application package on the HFO website. You may contact one of the associations listed at the end of this information package for additional information. 3.5 Physician Assistant Compensation The suggested salary level for a newly graduated PA is $75,000. Benefits should be consistent with the sites existing employment practices. 3.6 Physician Assistant Vacancies and Termination In certain circumstances, if the PA leaves the Career Start position before the contract end date, the position may be backfilled. Employers must contact HFO MRA for further details on eligibility. 7

8 Employers must commit to funding an additional six-week, full time position for the PA if the PA is not bridged into permanent full time employment at the end of the two year funding period. 3.7 Recruiting Assistance HFO MRA will coordinate the recruitment process for PA graduates. Employers approved for PA employment supports will be required to recruit through HFO MRA. Available PA jobs will be posted on a secured site available only to eligible graduates. Employers are required to submit a job posting with their application form. All available jobs will be posted by mid September. Employers will be required to manage the recruitment and hiring process at their site, completing applicant screening, interviews, reference checks, etc. as they feel is appropriate. All hiring decisions are made by the employer, and approved employers have no obligation to hire a PA if they do not find one that they feel is the right fit. Similarly, although the PA graduates have varied interests, there is no guarantee that an approved employer will be successful in finding a PA who wants to work for them. 3.8 Reporting Requirements Employers that have been successful in hiring a 2013 PA graduate must confirm the PA start date with HFO MRA by October 31, At this time, they will be required to agree to the funding schedule and reporting responsibilities. Financial supports for employment costs are expected to flow monthly. Sites that cease to employ the PA during the 2 year funding window will be required to notify the funder, and return any overpayment of the employment grant that might have been made. As a condition of funding, PA employers will be expected to provide the following reports: Report Interim progress reports on the PA role outcomes of employing a PA and the sustainability plan Final Report on the outcomes of employing a PA and how PA role has been integrated into the organization Financial reports (annual budget and quarterly reports) Expected Deadline At 6 months and 18 months At end of program As directed Further reporting requirements will be specified with the funding agreement provided to each employer. 4.0 The Application Process 4.1 The Application Process Applications are available by clinical setting. Please be careful to select the correct application form. All applicants will be notified of their eligibility. 8

9 4.2 Estimated Timelines August 21 (Week of) Sept 16 October 31 November 18 January 31 Deadline to submit applications PAs can begin to apply for posted positions Deadline for offer of employment to be accepted by PA McMaster University graduates must begin work by this date The Consortium of PA Education graduates must begin work by this date 4.3 Application Checklist Review applicant information package Review Physician Assistant resources available online at Internal discussions (senior and administrative staff) re: PA role Complete Application Form Include Job posting (with estimated start date) Submit Completed Application to: Carla Gomez Project Lead, Physician Assistant HealthForceOntario Marketing and Recruitment Agency Tel: (416) Fax: (416) Further Information Please contact: HealthForceOntario Marketing and Recruitment Agency Carla Gomez at or (416)

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