ABSTRACT
The first Canadian physician assistant (PA) survey was done in 2010 and used to establish baseline information on Canadian PAs' educational background, practices, role, responsibility, and satisfaction with their careers.
Methods and results A master file of PAs in Canada was obtained and information was received from 106 PAs (68% response rate). Of those, 51% classified themselves as civilian PAs (n = 54) and 49% as Canadian Forces (CF) PAs (n = 52). The mean age was 46 years (range, 27-65 years), and 47% of respondents were between 35 and 44 years of age. Males made up 72% of respondents (
Figure 1). Although the gender divide was more pronounced in the military group, 17% of CF PAs are female; by comparison, 39% in the civilian group and 65% of US PAs are female.
1 Females were slightly overrepresented among the respondents to the survey compared with the proportion of female Canadian Academy of Physician Assistant (CAPA) members in general. One-quarter (24%) of practicing CAPA members are female.
All active PAs still in the Canadian Forces are graduates of the CF program, which has educated nearly half (48%) of the PAs in Canadian civilian practice (Figure 2). Of the remaining civilian PAs, 28% graduated from Ontario's International Medical Graduate (IMG) PA program stream, and the rest graduated from training programs in the United States. Thirty eight percent of the respondents graduated from their PA programs before 2005, and 85% indicated they held either US or Canadian PA certification. The average time spent as a PA in Canadian practice was 6 years.
Figure 3 presents areas of specialization or focus. Family medicine and emergency medicine are the top two areas of focus for civilian and CF PAs. General internal medicine was the next most often indicated specialty focus for civilian PAs.
At least 28% had departed the CF to become civilian PAs in the past 2 years. One-quarter of those had changed from primary care to a surgical or medical subspecialty. Change was anticipated for 20% who planned to increase their research activities, and 11% intended to increase their work hours.
As many as 40% of the surveyed CF PAs indicated the intention to become civilians within the next 2 years; though 62% were 45 years or older, a common
retirement age for members of the Canadian Force. Reducing administrative duties was the next most popular response, at 27%, and roughly 1 in 5 (21%) said they expected to increase their work hours.
Statistically significant predictors of satisfaction included age, civilian versus CF status, and more than 4 years working as a PA (Table 1). Predictors of satisfaction in relationship with other health professionals and patients were also examined, but none of the variables turned out statistically different.2 PAs with more than 4 years of service were also likely to be satisfied with current professional life and to have a satisfactory balance between personal and professional commitment.
PAs working for employers who pay for professional development activities were more likely to be satisfied with their opportunity to use their skills to their full extent and opportunity for career advancement. They were also 3.1 times more likely to be satisfied with availability of continuing professional development to meet their needs. Additionally, PAs who worked in emergency medicine compared to primary care settings were more likely to be satisfied with opportunities to use their skills.
Discussion The PA profession in Canadian health care is new and appears to be expanding rapidly across the different provincial systems. The greater than 80% career satisfaction is important to attract and increase the cadre of PAs in Canada (and correlates with an American survey that noted similar findings of PAs3). There also appears to be a higher number of patients seen in civilian than in military practice, and more seen in general practice than is reported in American PA studies.1
Conclusions Canada is poised for a period of dramatic growth for the PA profession. This is occurring at a time when Canada has one of the leanest ratios of physicians to population in the world. PAs are just one way to increase access to health care, but they are a profession with a proven track record in Canada—and one that suggests small investments will produce a high rate of return. The concentration of PAs in primary care roles, which have been identified as a Canadian health priority, is a supporting factor for this profession. JAAPA
Richard W. Dehn, MPA, PA-C, department editor
Ian Jones is program director, University of Manitoba PA program, and president of the Canadian Association of Physician Assistants. Bosu Seo is from the Division of Continuing Professional Development, University of Manitoba. Tara Chauhan works in health policy and research for the Canadian Medical Association. Lynda Buske is mathematics director, Workforce Research, Canadian Medical Association. The authors have indicated no relationships to disclose relating to the content of this article.
REFERENCES
1. American Academy of Physician Assistants. AAPA Annual Census, 2009. http://www.aapa.org/about-pas/data-and-statistics/aapa-census/2009-data. Accessed September 23, 2011.
2. Canadian Association of Physician Assistants. Scope of Practice and National Competency Profile. Ottawa: Canadian Association of Physician Assistants; 2009.
3. Bourgeault IL, Mulvale G. Collaborative health care teams in Canada and the US: confronting the structural embeddedness of medical dominance. Health Sociology Review. 2006;15(5):481-495.