Physician assistants (PAs) are beginning to work in eight Alberta communities. Pharmacists need to keep two things in mind when working with them:
1. Pharmacists should not accept prescriptions written by PAs unless they are signed by the supervising physician.
2. Pharmacists must exercise extra diligence in assessing the appropriateness of prescriptions from PAs, as they are currently unregulated and therefore invite additional responsibility to the pharmacist.
What is a physician assistant?
The Canadian Association of Physician Assistants website (http://capa-acam.ca) explains that, “Physician Assistants are physician extenders and not independent practitioners; they work with a degree of autonomy, negotiated and agreed on by the supervising physician(s) and the PA. PAs can work in any clinical setting to extend physician services. PAs complement existing services and aid in improving patient access to health care. A relationship with a supervising physician is essential to the role of the PA.
“The PA’s scope of practice is determined on an individual basis and formally outlined in a practice contract or agreement between the supervising physician(s), the PA and often the facility or service where the PA will work. Activities may include conducting patient interviews, histories and physical examinations; performing selected diagnostic and therapeutic interventions or procedures; and counseling patients on preventive health care.”
In Canada, most physician assistants are trained through the Canadian Armed Forces. There are a small number of university programs located in Ontario that train PAs. As the programs are relatively new, they are not accredited, aside from being recognized by the Canadian Association of Physician Assistants. Manitoba is the only Canadian jurisdiction in which PAs are regulated.
PAs recently introduced in Alberta
Demonstration projects are proposed for 8 locations; 4 community-based, and 4 institution-based. The first project began on the obstetrics ward at the Peter Lougheed Hospital in Calgary, and the second, a community-based project started in Milk River on August 29. Other locations scheduled to receive PAs include Bassano, Calgary, Red Deer, Beaverlodge, and Edmonton.
The College of Physician & Surgeons of Alberta (CPSA) has been asked to maintain a list of candidates who submit recognized credentials as having received training as a PA. CPSA has been clear that it does not validate these credentials, that it does not maintain a register, and that it has no authority to regulate PAs. It is willing to accept such responsibility if requested and granted the jurisdiction to do so by the Minister.
ACP concerned about PA prescribing
Both ACP and CARNA have expressed concern about the projects, particularly with respect to the project methodology that would have PAs providing “orders or prescriptions” to nurses or pharmacists because physician assistants are not yet regulated in Alberta.
It is proposed that PAs will work under the direct supervision of a physician for a period, and upon assessment and demonstrated competency, that the degree of supervision will increasingly become less direct.
ACP has sought legal advice about the ability to delegate prescribing privileges to PAs. We have brought our concern to the attention of AHS project leaders, and it has been agreed that all PA prescriptions must be co-signed by a physician before dispensing.
Please monitor ACP communications for updates as the PA projects evolve.
*Important note – since becoming regulated health professionals, physician assistants have the authorization to prescribe most medications. PAs cannot prescribe controlled substances or narcotics. For more information, refer to the Link article Physician assistants able to prescribe published May 3, 2023.