HTTP://JCANPA.ca https://ojs.lib.umanitoba.ca/index.php/jcpa/sitemap
Professional, Practical and Political Opportunities: Optimizing the Role of Ontario Physician Assistants in Family Medicine
PDF

Keywords

physician assistant
family practice
qualitative
case study
health services research

How to Cite

Burrows PHD, MSC, BHSC(PA) BSC CCPA, K., Abelson PHD, MSC, J., Miller PHD, MSC, PT, P., Levine, MD MSC FRCPC FACP FISPE, M., & Vanstone, PHD, M. (2020). Professional, Practical and Political Opportunities: Optimizing the Role of Ontario Physician Assistants in Family Medicine . Journal of Canada’s Physician Assistants, 1(4), 17-33. Retrieved from https://ojs.lib.umanitoba.ca/index.php/jcpa/article/view/855

Abstract

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.

PDF

References

1. Vanstone M, Boesveld S, Burrows K. Introducing Physician Assistants to Ontario. Health Reform Observer. 2014;2(1).
2. HealthForceOntario. Physician Assistants: Government of Ontario; [Available from: http://www.healthforceontario.ca/en/Home/Health_Providers/Physician_Assistants.
3. Bowen S, Botting I, Huebner L-A, Wright B, Beaupre B, Permack S, et al. Potential of physician assistants to support primary care. Evaluating their introduction at 6 primary care and family medicine sites. 2016;62(5):e268-e77.
4. Hooker RS, Everett CM. The contributions of physician assistants in primary care systems. Health Soc Care Community. 2012;20(1):20-31.
5. Grzybicki DM, Sullivan PJ, Oppy JM, Bethke AM, Raab SS. The economic benefit for family/general medicine practices employing physician assistants. Am J Manag Care. 2002;8(7):613-20.
6. Bagley B. Health outcomes among patients treated by nurse practitioners or physicians. JAMA. 2000;283(19):2521; author reply 4.
7. Jones IW, Hooker RS. Physician assistants in Canada: update on health policy initiatives. Can Fam Physician. 2011;57(3):e83-8.
8. College of Family Physicians of Canada. Position Statement: Physician Assistants 2011 [Available from: https://www.cfpc.ca/uploadedFiles/Resources/Resource_Items/Health_Professionals/CFPC%20Position%20Statement_Physician%20Assistants_FINAL%20ENGLISH.pdf.
9. Taylor MT, Wayne Taylor D, Burrows K, Cunnington J, Lombardi A, Liou M. Qualitative study of employment of physician assistants by physicians: benefits and barriers in the Ontario health care system. Can Fam Physician. 2013;59(11):e507-13.
10. Yin RK. Case Study Research Design and Methods. 5th ed. Thousand Oaks, CA: Sage; 2014. 282 p.
11. Baxter PJ, S. . Qualitative case study methodology: study design and implementation for novice researchers. The Qualitative Report. 2008;13(4):544-59.
12. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88.
13. Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis:Striving to Meet the Trustworthiness Criteria. International Journal of Qualitative Methods. 2017;16(1):1609406917733847.
14. Aronson J. A pragmatic view of thematic analysis. The Qualitative Report. 1994;2(Spring):1-3.
15. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice. 2018;24(1):120-4.
16. Lincoln Y, Guba E. Naturalistic Inquiry. Newbury Park: Sage Publications; 1985.
17. Noble H, Smith J. Issues of validity and reliability in qualitative research. Evidence Based Nursing. 2015;18(2):34-5.
18. Anney V. Ensuring the quality of the findings of qualitative research: looking at trustworthiness criteria. Journal of Emerging Trends in Educational Research and Policy Studies. 2015;5(2):272-81.
19. Canadian Medical Protection Association. Working with physician assistants: collaborating while managing risks 2016 [Available from: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2016/working-with-physician-assistants-collaborating-while-managing-risks.
20. Canadian Association of Physician Assistants. Professional liability insurance 2019 [Available from: https://capa-acam.ca/practicing-physician-assistants/liability-insurance/.
21. The College of Family Physicians of Canada. Position statement Physician Assistants. 2011.
22. Sangster-Gormley E. How case-study research can help to explain implementation of the nurse practitioner role. Nurse researcher. 2013;20(4):6-11.
23. Sangster-Gormley E, Martin-Misener R, Downe-Wamboldt B, Dicenso A. Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review. J Adv Nurs. 2011;67(6):1178-90.
24. Drennan V, Levenson R, Halter M, Tye C. Physician assistants in English general practice: A qualitative study of employers’ viewpoints. 2011;16(2):75-80.
25. van Soeren MH, Micevski V. Success indicators and barriers to acute nurse practitioner role implementation in four Ontario hospitals. AACN Clin Issues. 2001;12(3):424-37.
26. van der Biezen M, Derckx E, Wensing M, Laurant M. Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study. BMC Fam Pract. 2017;18(1):16.
27. San Martin-Rodriguez L, Beaulieu MD, D'Amour D, Ferrada-Videla M. The determinants of successful collaboration: a review of theoretical and empirical studies. J Interprof Care. 2005;19 Suppl 1:132-47.
28. Nelson S, Turnbull J, Bainbridge L, Caulfield T, Hudon G, Kendal D, et al. Optimizing scopes of practice: new models for a new health care system. Ottawa, ON; 2014.
29. The College of Physicians and Surgeons of Ontario. Tackling the doctor shortage: a discussion paper. Toronto, ON; 2004.
30. Ardal S, Abraham C, Olsen D, Lalani H, Kamal A. Health human resource toolkit. HealthForceOntario; 2007.
31. Ministry of Health and Long Term Care. Patients first: action plan for health care. Toronto, ON2015. p. 1-16.
32. Royal College of Physicians and Surgeons of Canada. MAINPORT ePortfolio [Available from: http://www.royalcollege.ca/rcsite/cpd/moc-program/about-mainport-eportfolio-e.
33. Physician Assistant Certification Council of Canada. PACCC CPD policy: Canadian Association of Physician Assistants; [Available from: https://capa-acam.ca/paccc/continuing-professional-development-cpd/paccc-cpd-committee-cpd-policy/.
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.