Clinical Assistants

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Clinical Assistants

• A Proven HHR Innovation
• Advance Practice Nursing Conference
• September 29th, 2006

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Do you feel like this at the end of the day?
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Why a Clinical Assistant

• Does your waiting room look like this?

If you catch a patients eye do they do this?
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Issue

• Physician / provider shortages in both rural
  urban locations pose a major challenge to the
  Canadian healthcare system. The implementation
  and utilization of Clinical Assistants provides
  a viable cost-effective solution which
  increases accessibility and provides quality
  healthcare.

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Key Drivers

• Physician shortages in both rural urban
  settings
• Reduction in resident coverage from decreased
  availability
• Poor healthcare accessibility
• Long surgical wait times

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Provincial Examples

• Resident coverage was decreasing and a need for a
  new provider model that could provide safe
  efficient patient care in a high volume
  environment.
• Leukemia / BMT Program
• First CAs hired in 2001
• Orthopedics Arthroplasty
• Wait list reduction targets

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Legislation

• THE MEDICAL ACT Dec. 1999 provides the
  licensure through the Register for Clinical
  Assistants in Manitoba.
• Terms and conditions are contained in regulation
  CCSM.c.M90

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What is a CA?

• A health care professional licensed to practice
  medicine under the supervision of a licensed
  physician.
• Physician Extender
• Autonomous Healthcare Provider
• Prescriptive Authority

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Practitioner Models

• Certified Physician Assistants (PAs) trained
  in the U.S. or Canadian Armed Forces.
• More autonomy / less supervision required
• May practice remotely
• Non-Certified
• Foreign Trained Physicians / (IMGs)
• RN, RT, Level III Paramedic
• Direct on-site supervision required

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PA Education/Training

• Training Programs
• Most programs affiliated within the faculty of
  medicine
• Trained in the medical model
• 24-27 months in duration
• Most are Master degree programs
• Previous healthcare experience required
• Trained in Primary Care
• Residency available

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Scope of Practice

• Must follow Physicians scope of practice
• Determined by CAs experience negotiated
  between CA Physician
• Job Description Contract of Supervision must be
  approved by CPSM

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Partners in Medicine
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Remuneration

• Salary
• 5 increment levels
• Identical to Nurse V scale
• 34.61 - 41.85/Hr (Oct. 1st, 2006)
• On-Call
• 1 in 4 call 125/weeknight 200/weekend
• gt 1 in 4 call 150/weeknight 300/weekend

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Liability

• Physician
• CMPA will cover physician liability incurred
  through supervision of a CA
• Clinical Assistant
• CA covered through HIROC if employed by an RHA
• Private carrier liability insurance required for
  private practice

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Key to Implementation

• Identify shortage areas where implementation
  will have the greatest impact
• Education of the healthcare community patients
  to the physician CA model
• Provide appropriate training and orientation to
  new CAs

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CA/NP, whats the difference?

• Practice Specific
• Medical Model vs. Nursing Model
• CAs practice in all areas of medicine surgery
• Flexibility

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Conclusion

• Clinical Assistants
• Proven HHR Innovation
• Safe Cost effective alternative
• Provide quality patient care
• Increase practice volumes efficiency
• Increase access to care
• Decrease wait times

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Questions????

• Contact
• Chris Rhule PA-C/CA (Cert.)
• Discipline Director
• WRHA CA Program
• [phone]
• crhule_at_shaw.ca