Exploring Emergent Roles for Physician Assistants in Rural and Northern Ontario (March 2012)

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Title: Exploring Emergent Roles for Physician Assistants in Rural and Northern Ontario
Principal ApplicantTitle(s)Institutional AffiliationFunding AmountAnticipated CIHR Submission Date
Dr. Bruce Minore Professor and Research Director Centre for Rural and Northern Health Research at Lakehead University $14,750 March 2012
Co-Applicant(s)Titles(s)Institutional Affiliation(s)
Dr. Roger Strasser Dean and CEO Northern Ontario School of Medicine
Dr. Elizabeth Wenghofer Associate Professor and Director School of Rural and Northern Health at Laurentian University
Dr. Mary Ellen Hill Senior Researcher Centre for Rural and Northern Health Research at Lakehead University

 

Description of Proposed Project for Submission to CIHR

Since announcing the introduction of physician assistants (PAs) as a new group of care providers in 2006, Ontario has moved carefully, but steadily toward their incorporation as members of interdisciplinary health care teams (Appendix A - Background). Initial MOHLTC demonstration projects placed PAs in a range of clinical settings including some in underserved areas and the ministry's most recent initiative (2011) actively encourages hiring of PA graduates in rural and northern locations; nonetheless, there are no plans to analyze the resulting evaluation data from a rural perspective.1 Evidence from the United

States (Henry, Hooker & Yates 2010; Jolly 2007; Hooker 2006) and Scotland (Buchan, O'May & Ball 2007; Farmer, Currie, Hyman, West & Arnott 2011), however, suggests that PAs' practices are significantly different in rural locations. As well, rural demands and gaps in services can create expectations of a more autonomous than assistive PA role (Wakefield, Spilsbury, Atkin, McKenna, Borglin & Stuttard 2008).

The intent of the proposed CIHR study is to examine PAs' emergent roles in the health care system of rural and northern Ontario. This will be achieved through four objectives: (i) to determine the organizational factors that facilitate or impede incorporation of PAs as members of interdisciplinary health care teams; (ii) to determine whether the interpretation/ application of the vertical substitution model (supervision/delegation) adopted in Ontario facilitates or impedes optimal utilization of PAs; (iii) to determine whether the participation of PAs as members of the health care team improves access to care; and (iv) to determine the effects of each of the foregoing on the PA scope of practice and role in rural settings. A steering committee will guide the study's implementation (Appendix B – Composition).

The proposed study will focus on issues that are highly germane to understanding the introduction of a new provider group into the health workforce of Ontario. It will apply a mixed methods approach, involving four data collection activities: (a) an environmental scan, via telephone interviews with key informants in other Canadian (Manitoba, New Brunswick, Alberta) and international (United States, Scotland, Australia) jurisdictions to provide a basis of comparison for assessing the factors which facilitate or impede PAs' integration into rural practice settings and identify "lessons learned" that are potentially applicable to Ontario's situation; (b) Ontario key informant interviews, assessing issues

around the roles and scope of practice of PAs in rural and northern communities, with separate samples of PAs in practice, physician supervisors, nurse practitioners and other interdisciplinary team members, administrators and program managers, from hospitals, physician practices, community health centres and Aboriginal health access centres; (c) PA work activity analysis (Farmer et al. 2011) of data collected for two, 2-week periods from a minimum of 10 PAs located in ten sites, using a community sentinel design that captures differences in population size and services (Anderson 1996); and (d) a rural-lens secondary analysis of MOHLTC data from the demonstration projects (if access can be negotiated). Should this proposal to OHHRRN be successful, the MOHLTC has nominated Ms. Jane Seltzer, Manager, Allied Health Human Resources Policy and Planning Unit, as its contact person.

A multi-step approach to knowledge translation will use: summaries of findings for all participants; oral presentations to MOHLTC/HealthForce Ontario decision-makers; oral presentations to faculty, staff and students in the Ontario PA training programs; OHHRRN "fireside chats," podcasts and the working paper series; presentation of findings at conferences; and peer-reviewed publications. As the topic has received comparatively little attention from researchers, the proposed study could make a significant contribution to an under-examined aspect of rural health human resources.