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Preamble:
WHEREAS the Minister of Health’s mandate includes “continuing to improve emergency medical services response times, decrease surgical backlogs, and cut emergency room wait times,” “supporting primary care as the foundation of our health care system by assessing alternative models of care,” and “working to address rural health challenges such as access to health care professions”; and
WHEREAS the Alberta Health Charter includes the expectation to “have access to team-based primary care services”; and
WHEREAS one of the guiding principles in the Alberta Health Act is “that Albertans have reasonable access to timely and appropriate care, including primary care”; and
WHEREAS additional Physician Assistant positions would increase resources to primary care teams within the across Alberta in a timely and cost-effective manner;
Operative Clause:
THEREFORE, BE IT RESOLVED THAT the Rural Municipalities of Alberta (RMA) advocate that the Government of Alberta assist physicians to standardize the scope of practice for Physician Assistants employed in rural Alberta care settings to ensure they can be co-located with supervising physicians and have comprehensive medical directives; and
FURTHER BE IT RESOLVED THAT RMA advocate that the Government of Alberta allocate funding to post-secondary institutions for the development of Physician Assistant educational programs; and
FURTHER BE IT RESOLVED THAT RMA advocate that the Government of Alberta increase funding for rural Physician Assistant positions.
Member Background:
A Physician Assistant (PA) is a health professional trained in basic medical sciences who provides care under the supervision of a physician. The Canadian Armed Forces (CAF) established the PA title in 1984 and the position has been introduced into civilian healthcare in an increasing number of provinces since then. Alberta started its pilot program in 2013, including a PA position in the Town of Milk River within the County of Warner that worked effectively to serve the population in the clinic and emergency room.
PAs do not replace the work of physicians, but instead work as part of a healthcare team to decrease the routine workload of physicians. The scope of work for a PA may include taking complete histories on a patient, performing advanced physical examinations, doing work ups, interpreting labs, diagnosing, and prescribing medication. The treatment and methodology are reviewed by and at the discretion of the supervising physician. This supervision can be direct or indirect and the physician does not need to be co-located to the PA. This is especially important in remote areas where PAs can increase rural access to healthcare and take part in improving care for seniors in long-term care closer to home.
The current healthcare system is not serving Albertans as it should, as is evidenced by the fact that the Milk River Hospital emergency room was closed 30 times in 2023, with closures lasting from a few hours to a few days. Within Alberta there are slightly more family physicians per capita than there were a decade ago (based on fee-for-service payments under the Alberta Health Care Insurance Plan), but there have been changes in practice and culture that are not being addressed by this slight increase. Routine medical visits for prescriptions, straightforward ailments, preventative healthcare, and overseeing chronic ailment treatment plans are all tasks primary care physicians currently undertake but could be delegated to PAs. Medical directives for PAs are often institution-specific, but should be more standardized and larger in scope for rural PAs so patient care can be comprehensive and efficient.
Filling additional positions for PAs within the system will require increased education opportunities. PA training can be a bachelor’s degree or a master’s program, followed by a national level competency profile, and a national certification exam. They can be trained at schools throughout the country and will have the same level of competency and training. Education is shorter compared to the training of physicians, so issues in primary care will be addressed more quickly. There are currently only four PA training programs across Canada which offer a combined annual total of 93 seats. More programs are in development, including at the University of Calgary, but should have the full support of the Government of Alberta to move development and accreditation forward quickly.
RMA Background:
RMA has no active resolutions directly related to this issue.
Alberta Advanced Education
Thank you for your letter regarding RMA Resolution ER1-24S: Government Support for Physician Assistants. I am pleased to respond.
I agree with RMA members that Albertans deserve access to healthcare when and where they need it. Through Budget 2024, Alberta’s government continues to invest in the Alberta at Work initiative to develop a highly skilled workforce, attract talent to the province, and encourage all Albertans to participate in the labour market.
I am pleased to let you know that Advanced Education recently funded an increase of over 3,900 seats in post-secondary programs in health care across the province through the Targeted Enrolment Expansion initiative. This funding is intended to encourage students to enter critical health care professions, including nurses, medical laboratory professionals, paramedics, and physician assistants. Many of these seats were funded at institutions located in rural communities and are likely to result in more rural health care professionals.
Regarding physician assistant programming, I am excited to share that Advanced Education recently approved the University of Calgary’s new Master of Physician Assistant Studies (MPAS) program, which will welcome its first students in August 2024. Advanced Education is investing $6.8 million over the next three years to add 20 new seats per year to the program. The University of Calgary will manage the program’s delivery, including designating where students will complete their clinical placements.
Alberta Health
RMA has not received a response from Alberta Health.
Development:
It is important for Albertans to have access to healthcare close to home. A variety of healthcare providers, including Physician Assistants, have the scope of practice and training to contribute to the provision of comprehensive primary care.
Physician Assistants became a regulated profession in Alberta and have been able to practice in the province since 2021. They are regulated by the College of Physicians and Surgeons of Alberta (CPSA), who also regulate physicians. Joint regulation may be ideal to standardize Physician Assistant and Physician scopes of practice, promote information sharing and resources, and the ability for Physician Assistants to work collaboratively as part of a care team with a Physician, medical direction and appropriate supervision. According to the CPSA, Physician Assistants do not bill Alberta Health, but are paid by their group or Primary Care Network. As a result, Physician Assistants and Physicians have standardized scopes of practice. However, the CPSA and Alberta Health Services are responsible for privileging, or granting Physician Assistants and Physicians permission to perform certain skills and procedures in a facility.
In March 2024 the Government of Alberta announced the creation of the first training program for Physician Assistants in Alberta at the University of Calgary. This two-year training program will welcome its first class of 20 students in August 2024. Program enrollment will grow by 20 students per year over the next three years.
Prior to this announcement, 53 Physician Assistants worked in the province. The profession was regulated by the College of Physicians and Surgeons of Alberta in 2013. The RMA expects this announcement to have a positive and significant impact on the number of Physician Assistants who practice in the province. Program entry requirements dictate that “prior client-facing health experiences,” which may suggest any physician assistants will not be new healthcare workers, but healthcare workers with a new skill set and capacity.
While this is an extremely positive step taken by the Government of Alberta, it does not address the full scope of resolution ER1-24S. For example, Physician Assistants must work in an interdisciplinary team as they are required to be supervised by a Physician. RMA is not aware of a program requirement that the University of Calgary Physician Assistant program reserve any of the training seats for rural applicants.
Given the partial fulfillment of this resolutions asks, the RMA assigns this resolution a status of Accepted in Part. RMA will continue to advocate for the increased presence of Physician Assistants in rural comprehensive practice and will monitor the new program.
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