ONTARIO MEDICAL ASSOCIATION STATEMENT ON PHYSICIANS WORKING WITH PHYSICIAN ASSISTANTS

Transcription

1 ONTARIO MEDICAL ASSOCIATION STATEMENT ON PHYSICIANS WORKING WITH PHYSICIAN ASSISTANTS Ontario Medical Association February 2009

2 The contents of this publication may be reproduced in whole or in part provided the intended use is for non-commercial purposes and full acknowledgment is given to the Ontario Medical Association. Ontario Medical Association 525 University Avenue Suite 300 Toronto, ON M5G 2K7 Tel: Fax: Inwats Ontario Medical Association Statement on Physicians Working with Physician Assistants ISBN X 2009 Ontario Medical Association ACKNOWLEDGEMENTS This paper was prepared by Carol Jacobson. The OMA wishes to express gratitude to many individuals and representatives of sections for their contributions and valued comments during the development of this position paper, notably: - Dr. Deborah Hellyer - OMA Section on Orthopedic Surgery

3 Contents Introduction... 2 OMA Principles on Physicians Working with Physician Assistants... 2 Appendix - Background on Physician Assistants... 3 Ontario s Physician Assistant Initiative, Brief History and Role of Physician Assistants... 3 Education and Accreditation... 3 Liability Protection... 4 Delegation... 4 Number of PAs per Supervising Physician... 4 Billing... 5 Regulation... 5 Table of Contents i

4 Introduction In May 2006, physician assistants (PAs) were introduced in Ontario as part of HealthForceOntario s initiative to increase patient access to health care in areas of high need. Physician assistants are highly skilled health professionals who can play a significant role in extending the ability of supervising physicians to deliver medical services. The OMA welcomes the introduction of PAs in Ontario. Ontario physicians have clearly demonstrated their interest in working with PAs by participating in the PA Demonstration Projects that are currently taking place across the province, and in their desire to be included in future projects. The OMA supports physicians who choose to work in an interprofessional relationship with physician assistants, and to support the successful integration of physician assistants into Ontario s healthcare delivery system has developed the following principles: OMA Principles on Physicians Working with Physician Assistants 1. The physician assistant may be the employee of the physician or employed by a facility and supervised by a physician. 2. Supervising physicians should not be adversely impacted financially. Physicians should be compensated for supervising PAs and, where necessary, reimbursed for administrative costs, e.g., physician employed PAs. The OHIP fee schedule must allow supervising physicians to be compensated for all PA work that is carried out under delegation. 3. Physician assistants from other jurisdictions must meet established Ontario criteria. PAs should be required to write the Canadian Association of Physician Assistants certification exam. 4. Physician assistants will mirror the supervising physician s practice in terms of practice venue, which may include office, hospital, long term care homes, community health centres, rehabilitation centres, etc. Mechanisms must be in place to credential physician assistants to work across practice venues. 5. The physician assistant should be permitted to prescribe medications and write orders as delegated by the supervising physician. 6. Physician assistants may take call as part of their duties. 7. The resources (staff, equipment and supplies) must be available to enable physicians and physician assistants to carry out their work. 8. Team building activities/exercises are critical to the successful physician/pa working relationship and the integration of physician assistants into the health care system. 9. Professional liability protection should be mandatory for PAs who practice in Ontario. 10. Physicians must not be forced to supervise or delegate work to PAs it must be voluntary. 2 Ontario Medical Association Statement on Physicians Working with Physician Assistants

5 Appendix - Background on Physician Assistants Ontario s Physician Assistant Initiative, Between 2008 and 2010, a number of two-year PA demonstration projects are taking place in hospitals, community health centres, long-term care facilities and physician offices. There are a number of different employment models being used, including a physician-employed model, which is being led by the Ontario Medical Association. Upon completion in March 2010, the projects will be evaluated to determine how to best integrate PAs into Ontario s healthcare delivery system. Preliminary evaluation results of hospital projects indicate overall satisfaction of both PAs and their supervising physicians. Brief History and Role of Physician Assistants PAs have been part of the Canadian Forces Health system for over 50 years, and have been practicing in Manitoba as certified clinical assistants since Physician assistants entered practice in the United States in the 1960s as a means to address physician shortages, and in 1971 the American Medical Association supported physicians working with PAs. (Hooker 2003) PAs work across the spectrum of medical care, including surgical, medical and primary care. Their activities may include: conducting patient interviews; taking histories; conducting physical examinations; performing selected diagnostic and therapeutic interventions; ordering and interpreting patient laboratory and radiological results; and counselling patients on preventive health care. PAs are trained as generalists, and develop their specialty depending on the supervising physician. The role of the PA is unique among health care providers in that PAs are not autonomous practitioners; the supervising physician determines what services/procedures the PA is permitted to carry out as delegated acts. Although there are common competencies/scope of practice for PAs in Ontario, their role is determined by the supervising physician s scope of practice and the physician/pa relationship. Roles and responsibilities must be clearly defined, and they may change over time as the relationship evolves. The Ontario role for PAs is based on the Canadian Association of Physician Assistants National Occupational Competency Profiles and Scope of Practice statement. (HealthForceOntario: Defining the Physician Assistant Role in Ontario, April 2007) Education and Accreditation PAs competency-based education is modelled after medical training, but is of a shorter duration, usually months, and includes both medical studies and clinical practice. PA programs, most of which require prior health care experience, lead to a bachelor s and/or a master s degree. Until recently, the military program at the Canadian Forces Medical Services School, located at CFB Borden in Ontario, was the only PA training program in Canada. In September 2008, McMaster University and the University of Manitoba each enrolled their first civilian classes of students training to become PAs. Ontario Medical Association Statement on Physicians Working with Physician Assistants 3

6 Since 2005, the PA Certification Council (PACC), which is independent of CAPA, has been responsible for the development of PA national standards and the administration of PA certification exams in Canada. In May 2003, PAs were included in the Canadian Medical Association s (CMA) conjoint accreditation process. In conjunction with the CMA, the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Canadian Family Practice College (CFPC), CAPA is developing a national competency standard based on the CanMEDS Framework, as well as a process to integrate PAs into the RCPSC and CFPC continuing professional development programs. The OMA as member of the PACC is also involved in this work. Liability Protection OMA policy on interprofessional care (IPC) states that physicians should confirm that all health care providers have adequate liability protection as a condition of entering into an interprofessional team. As stated in the above OMA Principles on Physicians Working with PAs, professional liability protection should be mandatory for PAs who practice in Ontario. 1. Like all health professionals, both regulated and unregulated, PAs must have adequate liability coverage. 2. Unlike most health professionals, PAs are not independent practitioners, so the physician may be liable for acts of the PA. Healthcare Insurance Reciprocal of Canada (HIROC) provides liability protection for PAs working in the Ontario PA Demonstration Projects. The coverage offers claims-based coverage that incorporates many features that would normally be found in occurrence-based coverage. (Farber, OMR, March 2008) Delegation Delegation is carried out by direct orders or by medical directives. The development of medical directives, a critical component to facilitate the full functioning of PAs, should involve all members of the IPC team. Templates should be developed to facilitate the preparation and use of medical directives. Number of PAs per Supervising Physician Although the Ontario PA Demonstration Projects are structured with one supervising physician for each PA, in reality, more than one physician is involved in the PA s supervision due to the PA work schedule, which is a 35 hour work week. The number of PAs a physician could or should supervise requires examination. In the U S, physicians may supervise more than one PA. 4 Ontario Medical Association Statement on Physicians Working with Physician Assistants

7 Billing The Ontario OHIP fee schedule was written before the introduction of PAs in Ontario and does not accommodate delegated PA billings. The Ministry of Health and Long Term Care pays physicians for personally providing insured services to patients. Physicians will not be paid for the delegated services provided by the PA unless physicians see the patient and are actively involved in the episode of care. In the US, physicians bill Medicare for PAs work. If the physician is not onsite, the physician is paid a prorated amount of the physician fee for services rendered by the PA. If the physician is on site, 100% of the physician fee for the services rendered is paid, and this payment covers the PA s salary. The OHIP fee schedule must be amended to permit supervising physicians to be compensated for the PAs work that is carried out under delegation, with or without the presence of the supervising physician. Regulation In Ontario, the Regulated Health Professions Act provides the legal framework for the delivery of care by regulated health practitioners; PAs are not currently a regulated profession under the Act. In Manitoba, they are regulated by the College of Physicians and Surgeons of Manitoba. As more PAs are integrated into health care delivery in Ontario, the regulatory status of the profession should be addressed. Ontario Medical Association Statement on Physicians Working with Physician Assistants 5