Objective: To identify that facilitators and barriers that influence Physician Assistant (PA) role optimization and success in family practice settings. Setting: Rural and urban family practice settings in Ontario that had employed a PA for a minimum of two consecutive years. Participants: Six family medicine clinics in Ontario represented by seven family medicine Physician Assistants, eight Family Physicians (seven supervising physicians, one physician/administrator), and one clinic manager. Method: To identify the factors that influence role success and barriers which prevent PA role optimization, we conducted an exploratory single case study with embedded subunits of analysis. Data consisted of semi-structured interviews with 15 participants and analysis of documents (medical directives, job announcements, and communications).
Main findings: Barriers and facilitators to PA integration and role success can be categorized into professional, practice-based, and political factors. Professional factors that facilitate role optimization include the professional relationship between the PA and physician, level of comfort with autonomy, trust, rapport and PA competencies. Practice factors that optimize the role include appropriate administrative support/organization, investment in PA training and patient satisfaction. Barriers include employer knowledge of medical-legal risks, communication around the PA role and accessibility of funding. Political factors that limit role optimization and success include billing practices, absence of consistent funding models and lack of regulatory oversight.
Conclusion: Most of the barriers identified relate to enduring policy legacies, which continue to limit the sustainability and stability of PAs in Ontario. Successful Family Physician-PA teams have created individualized solutions to these barriers, and describe their partnership as increasing patient access to care, improving work-life balance, expanding comprehensiveness of services, and advancing team-based collaborative care.
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