Not exactly as illustrated (in Nova Scotia).

A September announcement that the province’s health department plans to launch a new pilot project to road-test the use of physician assistants had somehow passed over — or under — my Spidey-sense news radar until it popped up again, almost incidentally, near the end of a news report Friday.

The Friday story focused on new data released to the legislature’s Health Committee that showed a spike in the number of hours provincial collaborative emergency centres (CECs) have been shuttered this year. Confirming what most of us could already intuit from the depressing daily drumbeat of news about this or that closure, the health department’s data — complete with a comparative chart — demonstrated closures had “increased significantly.”

What caught my attention, however, was an almost aside reference deep in the story.

The CBC’s legislative reporter, Michael Gorman, had dutifully rounded up all the usual shocked-and-appalled responses from all the usual opposition party suspects.

For his part, Conservative leader Tim Houston mused it might be time for the province to review even the existence of the collaborative emergency centres. “The goal of providing care closer to a community is admirable,” he allowed. “We should be making sure that people can access care in a way that’s convenient, quick and that really improves health outcomes. But when you start to fade away from that goal, which it seems like we’re doing now, it’s definitely time to look at it.”

Tammy Martin, the NDP’s health critic, wasn’t buying that. No surprise there. During its one term in government, the NDP successfully pioneered the use of CECs to provide emergency services to citizens in underserved rural areas.

Now back in opposition, the NDP has been pressing and pestering the McNeil government to open even more CECs. Without success. Martin told Gorman the problem wasn’t with the concept of collaborative emergency centres but with its execution. “I think the model would work if it was staffed properly.”

One way to do that, she suggested, would be to consider using alternative staffing models, including physician assistants.

And then Gorman’s report continued:

“Right now, the health authority is doing a three-year pilot project using three physician assistants to work with orthopedic teams.”

We’ll come back to that.

First of all, what’s a physician assistant anyway?

According to Brittany Belair, a Halifax woman who graduated from the University of Toronto’s physician assistant program and currently works as a PA at Toronto Western Hospital — but would prefer to come home to work in Nova Scotia if we had a PA program — physician assistants are “physician extenders.”

They don’t replace doctors or nurses. Like medical residents, they work with doctors under their supervision, doing routine jobs like assessments, meeting with patients before and after surgery, helping out in the operating or emergency room, and writing prescriptions.

Essentially, they’re professionally trained, cost less and make the healthcare system work more efficiently and effectively.

“Everyone has their niche,” she says. “Everybody is important in taking care of patients. What we really need to focus on is patient care and providing more access to care quicker and in a more cost-effective way so we can take care of Nova Scotians better.”

Are physician assistants some new, never-tried idea?

No. In fact, Fred Wu, the California-based president of the Society of Emergency Medicine Physicians, told a Halifax conference in May that 70% of American emergency departments employ physician assistants. So does the Canadian military. Ditto for New Brunswick, Manitoba, Ontario. There are currently 650 licensed, trained, and ready-to-work physician assistants in Canada. They even have their own professional association.

So let’s revisit:

“Right now, the health authority is doing a three-year pilot project using three physician assistants to work with orthopedic teams.”

Uh… We have a five-alarm healthcare emergency in Nova Scotia. We have a shortage of doctors and nurses. Emergency rooms keep closing. It’s a mess. It’s a crisis…

And yet, the best we can muster in response is a pitiful three-year pilot project with just three physician assistants in just one medical discipline.

The holdup? Apparently, we can thank the College of Physicians and Surgeons of Nova Scotia, which had to give its blessing to a process for licensing and regulating PAs before the province could even begin the pilot project. Just getting the proposal to the piloting phase has taken “a number of meetings over the last year” between the College and the Nova Scotia Health Authority.


We aren’t talking about experimental brain surgery here. Surely, if the College was really concerned about licensing and regulation — and not, perhaps, just professional turf protection — someone could have picked up the phone and called their counterpart in one of the other jurisdictions where PAs already operate to ask how they managed to do it without endangering patients or the future of health care.

It shouldn’t be that hard. Really.

Stephen Kimber is an award-winning writer, editor, broadcaster, and educator. A journalist for more than 50 years whose work has appeared in most Canadian newspapers and magazines, he is the author of...

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  1. Seems to be that’s the way everything happens in Nova Scotia. We have to re-invent the wheel every single time. Transit tickets? The TTC in Toronto has had machines in the subway stations since the 1950’s that spit out tickets, but here you have to go to a convenience store to buy them. Why are we still paying a physical cash toll on the bridges? License plate scanning technology has been operating in Ontario since the 1990’s. We could get rid of the toll booths entirely. Nova Scotia really is stuck in the past.

    1. I love the 407 scanners, I haven’t had t pay for years. They don’t seem to like Nova Scotia plates.

  2. My great aunt rode her bicycle to mining villages in County Durham delivering babies in her role as a midwife well after the introduction of the National Health Service in July 1948. Close to 70 before she retired in the late 50’s.