Meet the PAs Podcast

Pre-PA students and current PA students will enjoy this episode as Rachael and Becky discuss the details of student life in the PA program at McMaster University through a round table discussion with 4 current first year students. Life as a student at McMaster is discussed and even the super impressive Lana applying for Jeopardy! GO Lana! We are thankful all 4 were willing to take the time to engage our podcast community. The discussion took place during the 2017 CAPA conference so there is some audible background noise in this episode.

Chris was the first civilian physician assistant in Canada, helped get the PA program in Manitoba started and just finished 3 years as president of CAPA and transitioned to the role of past president in October 2017. This interview takes place just days before he transitioned to past president at the CAPA 2017 Conference in Ottawa just after he returned from the UK PA conference. Chris has led an interesting life, even spending the previous few years traveling the world for enjoyment. He has a LOT of good information for practicing PAs in Canada. You do not want to miss this enlightening and informative interview. 

Patrick Nelson is the executive director of CAPA and is responsible for the operations of the national office, raising awareness and advocating for the PA profession with government and stakeholders, and achieving financial stability within CAPA. Prior to joining CAPA, he was the Executive Director of Public and Corporate Affairs at the Ontario Medical Association (OMA) and also served as an aide to Ontario’s Minister of Health. Join us as Patrick takes us through an update of the PA profession across the provinces of Canada.

Natalie St. Pierre is the Director, Communications and Stake Holder Relations for CAPA. This interview takes place during the CAPA 2017 conference in Ottawa. Natalie reviews the critical role of advocacy and the progress CAPA is making in Ontario, Quebec and BC with PA days and PA advocacy among politicians and the general public.  Natalie and CAPA have prepared and advocacy toolkit for practicing PAs to help support individuals in contacting their local politicians and newspapers and contribute to the advocacy campaign.  She also provides a brief overview of the recently released evidence by the Conference Board of Canada showing the benefit and impact of PAs in the healthcare system.  Natalie discusses the buzz around the newly released PA video in both English and French.

Anne graduated from Mcmaster University's PA program in Ontario in 2011 and has been working in Orthopedics since that time. She is a true trailblazer with many talents providing irreplaceable assistance to CAPA, a detailed blog delivering vital information for PA students, practicing PAs and to those employing PAs. She has recently been voted CAPA national vice president. (Of note, this interview was recorded just before the voting results were released.) Please join us and listen to Anne's riveting success in the physician assistant industry. 

MTP Podcast Episode 2:Anne Dang, CCPA

Released: September 26, 2017

Length: 36 minutes

Legend: Rebecca Mueller (Becky)=B, Rachael Thompson=R, Anne Dang=A

~MUSIC~

R: Okay so this week, we sit down with Anne Dang, newly elected vice president of CAPA

B: Welcome to Meet the PAs podcast. Here the experiences of seasoned PAs, up and coming development of policy from industry leaders, and the exploration of those new to the career. Interviews done with a Canadian twist and maple syrup

MUSIC

B: Okay, so do you mind first telling us just a little bit about yourself and your background, how you became a PA, and brought you to today

A: Okay, so I was originally born and raised in Toronto, and I attended McMaster University for my undergraduate studies. I studied Health Sciences at McMaster and I decided to do a minor in Psychology. I've been involved with a lot of different executive committees during udnergerad, youth donors of canada. I started a mental heatlh initiative there, so I do like volunteering and being involved in that regard. I got into the PA program as part of the class of 2011 so I believe just a year after you and once I graduated in 2011, I obtained a position through the career start program in orthopedic surgery outpatient practice in burlington. So, I have the contract 2 years, and that was extended for another year, and then another year after that, befire they cut funding. Apart from that, I'm an avid baker, I love to take dance classes, and I’ve had an interest in building websites social media and tech from a very young age so that's always been my interest growing up. And, yeah so that's a little bit about myself

B: So, how did you even hear about the PA profession and the PA program back when you entered?

A: It's really interesting bc I heard about it back in my 3rd year. What had happened was, all of my classmates were writing the MCAT, looking into pharmacy and dentistry. I was attending all these different sessions and booths about different careers, like naturopath, chiro, physio, and I knew that i wanted to do medicine and be in a helping position, but i just didn't know if going to medical school and becoming a physician was the right fit for me. So, I got to the point of almost registering for MCAT prep courses and then I went to my guidance counsellor and she had mentioned that there is a new program that McMaster is offering, the PA program, and again this is back in like 2007/2008, so quite a while back and she had mentioned that one of my former classmates O’Hood Alfeback was actually a student so we were both in the same year, but she finished her undergraduate after 3 years before getting into the PA program. So she was in her first year, and I had this opportunity to sit down and have lunch with her. And, so we talked, she told me about the program, I attended the information session that Dr. John cunnington back in MDCL the 3rd floor and at the time, like, I had heard about the PA program but I didn't want to apply until there was at least one class, just so that they could sort of work out the kinks and perhaps like, because at the time, there were no working civilian Canadian PAs right? So everything that we were looking at were - that I was looking up - were American. So it was definitely, it felt like I was taking sort of a leap of faith in my fourth year. It was the only program I applied to, luckily I got in.

All: [LAUGHTER]

R: That’s awesome

A: Yeah, and the thing is when I entered my first year, and you know how the McMaster PA program the first year is based on the medical school curriculum, they literally take cases from the med school curriculum and use it in the PA program. And I thought to myself you know, if I have the aptitude to get into the PA program, like you know maybe perhaps, like, did I really kind of miss out by not going to medical school? Like, or not even trying to apply? I had to sort of reiterate the reasons why I wanted to choose the PA profession in the first palace and then after doing clerkship and seeing the lifestyle and the schedules of residents and med students, and the differences in lifestyles and opportunities, I knew the PA program was a really really good fit.

R: Probably why we chose it too, the lifestyle it makes a huge difference

A: Absolutely

B: Okay, so could you take us back a little bit if you mentioned that you had funding obviously the first two years at the orthopedic practice you were at, but then a couple years later, they actually discontinued the funding. And, so, how long were you unemployed for a period of time and how did you do that transition.

A: So, what's interesting is that even thought the ministry had cut funding, I suppose within the two years that I had been working there, I had proven my value so what I had done was I took information from an EMR, learned how to do medical coding and billing and determined how much he was making and how much he was seeing prior to PA implementation. And then what it was like after a PA had been implemented. So just doing that quick comparison, I was able to demonstrate he was able to double or triple the number of patients he was seeing. In a day, he was shortening the number of clinics. I was tracking also the hours I was spending on forms, like for every hour that Im spending talking to Patients over the phone, doing patient education, reviewing investigations, doing medical legals, that amount of time is time that the physician is not spending so even though that's not a monetary value I was just trying to demonstrate from you know a quality of life point of view ways I was contributing, because at the very least I wanted to prove that I was at least cost neutral and that there were other benefits. And having brought that information, I think the physician was very, he was very happy with my work, he said this wasn't really necessary for you to do because his wife was extremely happy that he wasn't spending hours after Clinic dictating, or working on forms or anything like that so he was very happy with implementing a PA into the practice. So we found different creative ways to make it work so luckily I haven't, I’m still with the same employer that I started with after I graduated, luckily, but we’ve, in terms of how I've been working with the physician, has somewhat evolved. So, it was primarily in an outpatient setting clinic and then on the day he was in the hospital operating or at the Fracture Clinic at the hospital I would be working on medical legals, forms, triaging, just taking that workload off of his shoulders. What we started to add was I became a research coordinator from some of the clinical studies that he was working on so rather than hiring someone to do that for him he could utilize me in that way. Also taking on students for teaching, I was able to help with that regard. And, lastly, because I'm a full-time employee of this particular physician, the physicians across the hall from us are physiatrists and are like you know ‘we really like the way that your clinics are working perhaps can I work one day a week with your PA’ so he it almost like he sort of rents us out to other physicians and the hourly rate that we charge those other physicians come back and helps pay for our overhead because I'm not yeah I'm not in with him every day of the week. That's sort of different creative ways that we've been able to help pay for overhead. Recently, we were able to get into the fracture clinic so that's been great so I've been able to help him out there and he's been finding it really tremendous in terms of just efficiency and flow.

R: Yeah for sure, fracture clinics are… - patients always complain ‘I was there for like 5 hours and they only saw me for 5 minutes’. To be able to speed that up or get people in closer to their appointment time must be so satisfying

A: Exactly

B: So, to recap, you spend typically about two days a week in the clinic, you spend a couple days a week on doing paperwork and research coordinating, and then the remainder of the time is split between Fracture Clinic and kind of rent-a-PA day?

A: Yeah, essentially. Two to three clinics per week, an admin day, and then one day with fracture clinic, and then sometimes one day is dedicated to teaching so I do occasionally go down to UofT and will do a session here and there

R: Awesome

B: Nice, nice. Could you explain a little bit about your level of autonomy and how that maybe has changed from day 1 or year 1 to now, here we are like year 6 and also talk a little bit about how your medical directives are working especially considering that you are under a couple of physicians one day a week.

A: Sure. So I just want to preface this with… - because of the OHIP billing rules with regards to specialists, my physician has taken the schedule of benefits and taken that General Preamble and we interpret it literally. So in order for a MD to bill for the work a PA has done in a speciality practice, they have to be - there has to be meaningful involvement within that setting. And I’ve seen this model within the ER as well as other orthopedic surgery practices. So how that works is direct supervision, and what that means was within the first year, the first two weeks I just shadowed the physician. Maybe the first one or two clinics, I would shadow him, get a better understanding of what his style was in terms of his history taking, what special tests he likes to use on exams, what he looks for on investigations, and what kind of criteria the patient has to meet in order to be an operative patient versus non operative as well as his spiel he likes to do for his pre-ops to post-ops. I essentially kind of learned how to be an extension of him and that shadowing period was really important cause then I could sort of understand what his workflow was and where a PA could really make a difference in terms of improving the workflow. So, then in the next few weeks, we started with...I was operating very similar to a clinical clerk where I would go in and do a history and physical examination. Come out of the room, case present to the physician and then we would go in together and he would finish off the patient encounter and of course he can bill for that interaction because he was meaningfully involved. So then as that evolved and I got more comfortable with my scope of practice, my abilities and what I was able to do, we started that I was doing the history, physical, I was helping to interpret the investigations, come out case present, and i would do a proposal for a plan so management and plan in terms of physiotherapy, prescriptions whether we're gonna be going for operative management and then the physician would either agree or disagree, now most of the time he just agrees like ‘Yup, I think that’s great’.

He would finish up the patient encounter so he can bill for that and then I start on the next patient, doing their history and physical. So usually what that involves is preparing all of the investigations ahead of time and printing out all of the prescriptions. I’ve developed a lot of patient education handouts because most patients are usually, they kind of draw a blank once they leave the room, they don't really remember what the physician may have talked about so they’re able to take that home, we've been able to develop that as well. So were having two clinicians seeing patients at the same time and I've essentially done 75-80% of the work and the physician just agrees or disagrees and goes in and finishes off the encounter which is great bc it runs very very smoothly. So that's the model that we work under right now. We did try to experiment with the idea of a PA running just a clinic on their own autonomously but right now the physician wouldn't be able to bill for it and I believe he’s…

B: It's the funding is the problem, the funding of that is the problem

A: Exactly

R: The billing in Ontario is the issue, yeah, for sure. Have you noticed like a huge change in wait times for patients to get in and be assessed now that there are two clinicians in the clinic?

A: Absolutely. I would say that it has changed, i would have to ask the administrative assistant the wait times. So, the wait times to see the orthopedic surgeon has gone down substantially. It used to be like 8 months to a year or more at least in our practice in Burlington, I know wait times differ from city to city but we're getting closer to 3 4 months. I mean, if we can add a PA only clinic where we do non-complex, perhaps soft tissue consultations, that'd be even...we could even widdle that down quite a bit more, but...

R: That's awesome

A: Yeah, but the thing is that there's usually two wait times with regards to the orthopedic surgeon, there's the wait time to see the surgeon and then the wait time to surgery. So he still gets only one OR day a week and so that...

B: And thus far, you are not in the OR with him?

A: No, that is something that we are working on and it's been a little bit difficult but, because there's just these hurdles we have to overcome but if PAs were regulated in Ontario, it would be a substantially easier hurdle to overcome

B: We agree

B: Yup, for sure On that note, basically exactly on that note, sort of, what do...other than regulation or speaking to regulation, what do you think are the biggest hurdles that PAs in Ontario and PAs in Canada are facing right now

A: With regards to the biggest hurdles, I would say let me see here, so apart from regulation, I think the next step would be expansion to all provinces. I know that for instance, new brunswick has had a PA pilot project which is great theres like two PAs working in the ER but they haven't really gone beyond that

R: And they've been there for a long time

A: And they have been there for a long time and the evidence is there in terms of the studies that prove that PAs have been integrated. They’ve been integrated successfully into other provinces, into the Canadian healthcare system, and they've been proven to be doing well in the States. So being able to expand it into other provinces is, I think, is something I would like to see happen. As well, as the funding models and billing abilities because I think if there’s a way to pay and integrate PAs, it would make it substantially easier. I think they're almost one in the same actually

R: Yeah

B: We agree. One without the other doesn’t make sense, they need to go together. Do you see the thoughts about PAs and knowledge about PAs are changing over time in ONtario and Canada.DO you feel like things are improving in that direction and what things specifically do you expect to see change around the corner, in the profession? Aside from...like the funding model and regulation is a bit longer term and a little bit more complex within the province, but on a shorter term scale like within the next 1 to 2 years, what specifically do you think we’re going to see change in a positive fashion?

R: What would you like to see change?

All: [LAUGHTER]

All of the above I guess, apart from regular funding, billing, PA integration, I think what I'd really really like to see, is just more excitement about the PA profession, especially when it comes to employers. So, you know, we’re preaching to the choir when we're talking about, you know, how great PAs are. Like, I know PAs know that PAs are impactful

R: Are great! [LAUGHTER]

A: But a huge misconception that I usually talk to physicians and when I speak to other physicians and residents and med students, like they've heard of a PA, they maybe know someone that is a PA but it's just like there’s knowledge of the profession but they're really not in the decision making process of ‘Do I actually need to hire a PA for my practice?’. I would love to get to a point where people feel like it's a huge investment to have a PA come on, where there's going to be an improvement in their workload, quality of life, like everybody needs an assistant, and physicians are already used to delegating to residents, medical learners, PA students. I think that I would love to see more employer awareness and give physicians some kind of working model to show that you know, one reaction I get sometimes is that I can't afford you guys, you guys are too expensive, but actually I believe that is a false misconception. I believe that if you're creative, if you do your research, and if you breakdown the numbers and have certain goals that you're trying to set, that a PA could be cost-neutral, in terms of money, I guess at the end of the day, or even generate money for your practice, depending on how you utilize the PA. So, I guess it's just a selling point for physicians to show that in addition to, there isn't just the monetary value of a PA, like every hour they spend with the patient ding forms, medical legals, is an extra hour you have to focus on other things, whether it's more complex patients, academia, doing research, spending more time with your family, like I think it's definitely a worthy investment, especially if you hire the right PA for your practice.

R+B: Mhm, Yup

A: And I know that a lot of our fellow colleagues are just working examples of that. So, that's what I would like to see more of. I think more physician awareness because at the end of the day, they are our supervisors, in terms of the model that we work with within Ontario

B: Assuming, that you are successful and elected to be CAPA board, what would be your approach to help get employers and get PAs involved with future employers and build that excitement?

A: So, I find that I've been looking to my supervising physicians for examples of sort of this model. I had this idea that basically, we get a couple of inquiries about ‘how can I work with a PA?’ from physicians. When our supervising physicians tell their physician friends about you know I just recently hired this PA, this is great, it makes such a huge difference in my practice, and you know we can sort of preach to physicians, but I feel like it's different when it's coming from fellow colleges. I used to work with a physician Dr. Wong, before he moved to Nova Scotia. And he worked with O’Hood actually, prior to him moving and what they did was they had a presentation so it was an orthopedic surgeon presenting to other orthopedic surgeons and orthopedic surgery residents of how a PA was being used in his practice.

R+B: That’s awesome

A: And they demonstrated the model and there were a lot of good questions afterwards. It would have been neat to see what physicians from that session ended up following up or making communication with that but I think having conversations with physicians, not just like, you know, ‘PAs are great, they save the healthcare system money’, but actually going in and giving them practical tips and examples and models of how PAs have been used used in different practices, whether that's presenting at family med conferences, doing a quick presentation in rounds for instance at different hospitals, or even like if we were to have family health teams meetings or CHC meetings, I don't know, perhaps we can lure them in with coffee or lunch and be like this is a lunch and learn so that way it's not taking up too much of their time and just quickly show them a colleague of theirs that has implemented a PA successfully and these are the tools and these are steps that you follow. I think we're just trying to enable physicians to do that. That’s an idea that I had.

R: That’s be awesome

So I think being able.. Yes I agree. I think having that conversation would be, would actually, I feel like it would be very impactful in terms of PA employment and integration.

R: Cause yeah, when you have your supervising physician, and they're like ‘Oh, this is fantastic, I can't believe this, I didn't know what I did without you before’ bluh, bluh, bluh. It would be nice if they took that out and said that to other physicians and made other physicians think ‘Hey, maybe I should look into this’, like getting them to actually do that instead of just saying it to you or their immediate colleagues, but actually convincing them to make that part of their... something they want to do, would be awesome

A: Exactly

B: Okay, so we know that you do a lot for the PA profession online, could you give...list a short short snippet and introduction as to what you do in the online world and the tech world?

R: And your website

A: Okay, it’s a very loaded question

All: [LAUGHTER]

A: SO I guess, how I just, I love journaling and scrapbooking and I’ve been building websites since I was 12 so I’ve had this thing about documenting my life like it's just something I really enjoy doing so when I got into PA school, it just kind of felt natural to document what I was doing as a PA. But my earlier blog entries about like my rotations were pretty rough, so I’ve kind of put...those are no longer published, but anyway

R+B: [LAUGHTER]

A: So how it started was like many of my fellow PA colleagues, I would get a lot of questions from friends, and family, and former classmates about the PA profession and I found that a lot of the questions were the same. So, what I’d do would save these email drafts of these questions, and it's kind of tedious to have to go in and copy and paste, copy and paste, and answer these same questions over and over. So why don't I just put these on an online platform and answer the questions there. So when I started doing that, it started to get more views and more followings and then the PA community came aware of it. So, through that I was able to reach out to CAPA and volunteer my design services with them. That includes putting together posters, infographics, things like that. I love working with photoshop and design, final cut, like I just love being able to create. I love working with my hands and creating things, I just suppose that I really enjoy doing. So it was just sort of a way to combine my love of social media with the PA profession. And so in addition to that, I started on Twitter, first posting as sort of a general canadian PA account and then as myself and then that started to grow as I started to share more information. And I think a lot of my inspiration comes from American PAs. There are so many of them down there, they have a PA week

B: Yes they do!

A: They’re featured on the news, they're all over social media, they have great advocacy groups. Each state has their own association and there's tons of PA-led businesses, like PA coaching, PA mentoring, PA ...

B: PA owned clinics

A: PA owned clinics, PA recruiting, consulting, publications, like some PAs run their own scrub clothing business. For instance, I recently added myself on instagram and there’s a huge community of PAs on Instagram, primarily students, because I think it's a younger generation thing as well. But, I think that it’d be nice for Canadians to have that as well, I think that we’re starting…

R: Definitely

A: We’re starting to see that. If we’re not on these different platforms, engaging in conversations, then were not part of the conversation, right? So it's good, I’ve been seeing a lot of PA students, and PAs getting on twitter, even engaging in like...Facebook groups are a big thing now, whether you're in the private or public sector in terms of networking because I think we're getting away from working in silos. For instance, Dr. Smith actually works with two physician assistants and I also work alongside Denise O’Leary, who's the Ontario chapter President. And at the beginning of the year when she first...she's taking over maternity, so when she started, she would always tell me about there's more than one oncology PA working in Ontario, but they often think that they're the only one and they don't know where to get resources or collaborate. So we started this idea of these facebook speciality networking groups and often adding people to these groups they're like ‘I had no idea there were 15 of us in Ontario.’ So it's a way of...

R: Yeah, speciality groups are awesome, because you can really ask questions that are relevant to your practice and just generally being a PA in Canada is tricky at the moment so it's nice to have a group to get feedback on and see how other people feel the way if you do.

B: Oh yeah, and Anne that’s exactly how I felt. I thought I was the only oncology and palliative care PA in Canada, let alone in Ontario [LAUGHTER]

A: Yeah, there's quite a few of you actually [LAUGHTER]

B: Surprisingly enough

A: Yeah, it's nice to know you're not alone and that there are other PAs that are having similar challenges in terms of integration or longevity of employment. So, it's good to be able to tackle that and letting each other know of job opportunities

R: And funding models and what's worked in your practice

R: Mhm

B: Just the sharing of ideas, exactly

A: And resources

B: Okay, so you have your blog, could you share the website

A: So it's canadianpa.ca. Essentially, it's a resource for patients, pre-PAS that are interested in getting into the PA program, currently practicing PAs, and I'm hoping to create a section eventually for employers. The idea I had specifically was just downloadable PDFs where they can check things off a list in terms of a needs assessment for their clinic. I think there are a couple of characteristics of the supervising physician that are sort of necessary if you're going to work successfully with a PA

R: Oh, for sure

A: Including the ability to delegate. If you struggle to even hand off work to fellows or residents, and if you're really particular or protective of your practice, it might be a little bit more challenging to integrate versus someone who is happy to hand that off

R: Definitely

B: Okay so right now, it's focused on students, PA students, some current practicing PAs, and you hope to continue to expand that. And that's canadianpa.ca

A: Yes

B: And then you're also all over facebook and part of the facebook groups [LAUGHTER]

A: Yes, you should be able to find me there

R: To all of our benefits

R: You are also on LinkedIn?

A: Yes, I am

R: How do you manage your LinkedIn account in terms of PA awareness and networking?

A: So, if I see that someones a Canadian PA, I will add them on LinkedIn. Regardless of whether or not I've met them, because I feel like sooner down the line, I probably will meet them, whether it's at a conference or if they have any questions. And then from time to time, because I do have some physicians on there just because of my supervising physician, I’ll post updates about PA funding, specifically career start. Like ‘Oh, the funding is out, the deadline is in 30 days, make sure you read over this’ and I’ll link to it, I kind of make it easy to share.

R: That’s awesome

A: Yeah

B: And then you also have an instagram account that people can follow in the PA profession

A: Yup that's @canadianpablog because canadianpa was taken

R: Ahh

A: That's the handle

B: Oh funny, canadianpa was taken. So we should follow whoever canadianpa is

All: [LAUGHTER]

B: Do you plan to attend the CAPA conference in Ottawa in 2017?

A: Yes, absolutely. And I hope everyone attends {LAUGHTER} especially since it's in Ontario. It's not as far as Nova Scotia, or Winnipeg, which is where it's been nin the past

R: Yeah I hope so too

R: Oh, what do you think are the biggest misconceptions of PAs right now in Canada

A: Biggest misconception...I touched on one previously was “i can't afford a PA’ I think the term physician assistant meaning medical assistant or administrative assistant, sometimes I do see job postings on indeed.ca advertising for physician assistant but when you look at the job description it's actually a medical secretary.

B: Yes we see that too

R: Yup, we've noticed that too

A: Yup, so i know that some of us do make an effort to contact those employers and be like ‘ look you should probably take down the posting or modify it’. And, another one is the misconception, I'm not sure if you ladies bump into this a lot but, from a lot of patients I get asked how long are you in school for, what's your next steps, when are you going to be an orthopedic surgeon. And I'm like ‘Actually this is it, this is my job, I have been working for my supervising physician for a long time’. And another thing too, I was speaking with a colleague, a few weeks ago, about speaking with physicians about being just an assistant. I'm sure that there are a lot of PA students who go through rotations, and I've experienced this as well, where the physician will say ‘Well you're basically doing everything that the clinical clerk is doing, why don't you just go all the way, why don't you just become a physician and not just be just an assistant’. But what I think they don't realise is that we’ve chosen the profession…

R: For a reason

A: For a reason. We’re an extension of a physician. There's a lot of ways that we can grow within the profession whether it’s research, teaching, academia, advocacy, entrepreneurship, for instance, joining hospital boards. Like there is a reason. And I know that they’re very well meaning, they're only trying to let you know that you're excellent, you're intelligent, they see you as one of their own, like their colleagues. But at the same time, there's a ways to go in terms of building respect and knowledge about the profession in terms of what were able to do

R: I get that question ‘ When are you done school, because I've seen you here for years?’ all the time. And I’m like ‘No, I’m done, I’ve been done since I've been working here’. Yeah, it's enduring because they're like ‘When are you going to be my doctor’ and I’m like ‘I’m not’ [LAUGHTER]

A: Yup [LAUGHTER]

R: Like, I don't want to be. I can't be, and I don't want to be but I'm happy to help you sort of thing. I mean it's used to really bother me, and now I try to see it as an opportunity to sort of better explain the physician assistant role and what we do and sort of why I chose this because ,yeah, it often leads into that question ‘Oh, so you're not going to be a doctor? Well, why not? You're already doing a lot of the things that the physician would do’ And so, the two questions tend to be fairly linked, at least in my experience. And it used to brother me because I'd have to explain it over and over again and now I take it as an opportunity to really explain it to patients and be like ‘This is why I didn’t do it, this is what we do’.

A: Mhm

R: And be like ‘You should talk to other people about seeing a PA and how awesome they are’.

B: [LAUGHTER]

A: Yup, exactly

B: Promote us, that's good, good. Well, that covers a lot of things. Anything else, Anne, that you feel like we missed and that would be good for the topic of conversation?

A: No, I think we, more or less, covered it. Yeah, this was great

B: Okay, good, so, if people have further questions for you or would like to contact you, you're okay with that, right?

A: Yeah, absolutely

B: And you would like them to contact you through...what's your preferred method of contact?

A: I actually find linkedin really good. So, if people would prefer to message me that way, but I would respond to whatever social media platform you end up choosing.

B: [LAUGHTER] Okay, we will link, when we post this interview, we will link all of your platforms so people can easily contact you and we will preface to go to linkedin

A: Okay, fantastic!

B: And of course should check out canadianpa.ca. It's really quite a fabulous blog, you obviously put in a lot of effort

R: It’s excellent

B: You obviously put in a lot of effort.

A: Thank you, I appreciate that

B: Great thank you so much for talking with us!

R: Thank you

A: Yeah, absolutely. All right, take care

~MUSIC~

END

It did not take long for us to make mistakes in our podcasting adventures lol. We are not technically inclined and, thus, are prone to errors. This is a quick discussion correcting our mistakes from our first episode. 

1. our correct website is www.mtppodcast.ca

2. the Launch episode was recorded ahead of time and then the application for itunes and stitcher was submitted. We though it would take a few weeks for the application to be accepted and assumed that would be around the time of the 2017 CAPA conference. The podcast was approved much faster so everyone can listen earlier. In the podcast we state that the CAPA conference is starting the next morning. This obviously wrong now given the quick turnaround of itunes. 

YAY! We are launching our first episode at the CAPA conference 2017. In this episode we, Rachael and Rebecca, describe our experiences as physician assistants in Ontario since its inception in 2010. 

MTP Podcast Episode 1: LAUNCH

Released: September 26, 2017

Length: 36 minutes

Legend: Rebecca Mueller (Becky)=B, Rachael Thompson=R

~MUSIC INTRO~

B: Welcome to Meet the PAs podcast. Here the experiences of seasoned PAs, up and coming development of policy from industry leaders, and the exploration of those new to the career. Interviews done with a Canadian twist and maple syrup

~MUSIC INTRO CONTINUES~

B: Welcome to Meet the PAs podcast. Here the experiences of seasoned PAs, up and coming development of policy from industry leaders, and the exploration of those new to the career. Interviews done with a Canadian twist and maple syrup

R: Welcome to the first Meet the PAs podcast!

B: Yay, we’re really excited to have you guys here and we’re so glad you’ve tuned in to listen to us. This first podcast is just going to be an introduction to who Rachael and I are, and our history as PAs and what brought us here today to the podcast so far, so that's how were going to run this one.

R: Yeah so, I’m Rachael, I’m a Canadian-trained PA, I was in the inaugural class of McMaster’s 2010 program, 2008 started, graduated in 2010 and I work in a semi rural small 10-bed hospital in MidWestern Ontario.

R: So how did I get to be a PA? Well I did my undergrad in science, and I knew I wanted to do something in healthcare and I knew about the PA program in the states and it sounded perfect, but, there wasn't really an option here for that. So after my undergrad, I actually took a year off and worked as a pastry chef. I took a year off and backpacked around Europe with my best friend and then I was a pastry chef for a year, and I was just trying to decide what I wanted to do.

B: So that is completely different, pastry chef to medicine!

R: I always knew I wanted to be in medicine but i loved to cook, and it was a place that I knew people and was friends with some of the people who worked there and it actually was an amazing experience and some of the people I worked with have turned into my best friends in the entire world.

R: I’m so glad I did it for two reasons: one because I made really good friends and learnt how to cook all fancy things and got to just really have fun for the year and the second reason being it was that year that the PA program came to Canada, so I was extraordinarily lucky.

R: One of my relatives works at one of the Universities in Ontario and said ‘Hey this PA program is opening up in Canada, you should apply’, and so I did and I was super nervous, because I knew they were only taking 20 some odd students, and I was taking an additional physiology course that summer just to make sure that I had the background in case I got in or if I was applying to med school or nursing school or whatever I was doing; I wanted an extra physiology course. I was working my butt off, taking this physiology course and applying to the program and interviewing for the program, and I was really lucky to be selected and enter the program at McMaster. That's sort of how I became a PA.

R: How did you become a PA Becky?

B: I’m from the States, so it's a completely different dynamic. I knew from a very young age that I wanted to work in medicine. So, I didn't know exactly if I wanted PA or Nurse Practitioner or Physician, what that might look like, but I knew I wanted to be in the medical field. When I was in High School, there was a program for students who were doing well in the school, that the State of Minnesota would pay for you to go to take college courses and they would also count at the same time for your high school classes so I actually went to college in High School and I got my 2-year nursing degree. So, I started working at a nursing home and subsequently at an internal medicine clinic at the age of 16.

B: So, I’ve been in medicine for a really long time and it was great because I had a way to pay, a little bit anyway, sort of helped me pay my way through University and PA school, as well. So, I then went to University already starting with a medical background and I started exploring my options and I knew pretty early on that I didn’t want the physician route; it seemed like constant work and you never had someone to go to if you didn't know something. I liked the idea of having somebody around when I didn't know the answer, it felt a little more secure for me, plus the job outlook for PAs, in the States anyway, was huge, and we're working on it here, it's improving.

B: I chose not to go the Nurse Practitioner route, and you might have thought I would because I started in the Nursing side, but I really liked the science background side of it, of the PA degree, so I wanted to go that route for that reason; just a little more in depth on the science side and also because I didn't have to dedicate to one speciality. Nurse Practitioners, from the little bit that I know anyways, they're definitely more solidified in the area that they studied in, but PAs can move around. So I liked the broad spectrum PAs can go at.

B: So, I got my University degree in biology and chemistry and I minored in medical ethics. It really saturated my medical background and then, I moved on to PA school in Chicago and completed my degree there. I moved to Canada for love, you’ll go anywhere for love, so that's what brought me here and I came to Canada in 2010 right after I got married.

B: I knew at the time that the program here was brand new, and the first graduates were in 2010. I had no clue about the differences between Canada and the US. I didn't know I was coming to Canada to be a trailblazer. I had no idea the animosity that happened between the nurses and PAs and the long road that would come ahead in terms of being allowed to practice and not working under your own license, and all those little details, I had no idea.

B: Currently though, I did come and I did get a job working in Oncology in Owen Sound. So, I did Oncology for 4 years, and then I moved to strictly palliative care. So, that's my long story background.

B: So Rach, tell us your experience, thus far, in Emergency Medicine. What do you like about it, what do you hope to see change in the future, all those kinds of things.

R: Well, rural Emergency Medicine is a little bit different than big city Emergency Medicine and that's part of the reason I love it. I actually fell in love with rural Emergency Medicine on my first clinical rotation. I was doing Family Medicine in MidWestern Ontario and the family docs did one or two days a week of call, so when I was doing family med rotation I got to see the rural emerg and I just thought it was sort of the perfect fit. Volumes are lower, the acuity is extremely varied; you do everything from coughs and colds, and stubbed toes, to major farm accidents, so the variety was there, which was something I liked and it sort of struck me as something I wanted to do.

R: When the job came up in rural emerg, I sort of jumped on it, and I have actually been there my entire career, going on 7 years now, being a practicing PA, which seems like a ridiculously long time.

Both: [LAUGHTER]

B: And you started there on the new grant program?

R: Yeah, initially the new grad funding had full funding for the first two years I was there, and then I had partial funding for another 2 years, and now, I have a rather unique funding model where my salary is paid by the doctors that I work with, and my benefits and what not are paid by the hospital, so we have a rather interesting funding mode going on.

B: You are technically a hospital employee?

R: Yes, I am still employed by the hospital, and so the physicians pay the hospital my salary

B: And then they subsequently give it to you?

R : Yeah

B: And how many physicians are splitting that salary?

R: 4, well 5 technically, I have 4 regular supervising physicians, and then I have one locum who comes on a regular basis, and then actually we have two locums that come on a semi regular basis, so i guess 6 total

B: So the locums actually contribute?

R: Yeah, so whoever I am working with on that day contributes whatever amount is due, which I actually don't even know what it is

B: Oh, so it's not like an even split, so they base it off who you're working with that day as who owes?

R: Yeah, so the docs that I work with more often, pay a little bit more, at least I think that's the way it works. I actually have no idea how it works in the background, but that was my understanding that if whoever i was working with that day, a certain percentage or certain dollar amount from that day went toward my salary

B: Does that create any kind of awkward dynamic on the day to day basis that you're working with them?

R: I don't think so, most of the docs are actually really happy that I’m there and some of them have actually asked me to work on my days off and that they would be willing to pay for me to come in. So I don't think that they mind doing it that way, it works for us, it's not ideal. I mean ideally, there would be funding models in place that were more systemic obviously, but it works for us

B: So, obviously you're well appreciated then since they’re asking you to come more often, and they're willing to pay you individually to do that. So obviously you've had really good results working there. How is it with your medical directives, and getting board approval, and that process? Is it fairly slow, do you have an easy time getting that through, or how does that go through?

R: Initially, it was a bit tricky. We took medical directives from somewhere else and modified them as we usually do, but my rural hospital is one in a group of 4 hospitals so the board for all 4 hospitals has to approve my medical directives, but i'm the only PA within the organization. So although the initial directives applied to all four sites, despite not having PAs, getting them approved by the board who didn't really understand PAs and why only the one site got a PA was a bit difficult.

R: Having my medical directives, I recently edited them and got them updated to reflect my skill level that I am now at, or at least somewhat reflect the skill level i am now at, was a lot easier, because I’ve talked to the board, I've been there a long time, my docs are really on board with giving me a little bit more autonomy and certain things that I had already been doing but now I don't have to get cosigned everytime i do them. And ordering more tests because they realized I am more than capable of recognizing when those tests are important, not important, relevant, not relevant, that kind of thing. It's still not ideal, I can't prescribe by myself, which is a bit of hinderance

B: So everything for prescription needs to be cosigned?

R: So I don't have to have meds I order within the ER cosigned; I don't order narcotics, and that's perfectly fine by me

B: Right, you don't really want that?

R: Yeah, I don't really want that, but if I need a narcotic acutely, the docs will give me an order for that very quickly, it's not been a major issue, but it would be nice to just write a prescription and not have to get it cosigned

B: For all the home meds?

R: For all the antibiotics, and rash creams, you know, silly minor things like that. But hopefully that will come along as the, particularly in Ontario, as the regulation and stuff gets more clarified, that’ll be a lot easier, I think.

B: Right, right

R: So yeah, I really do love my job, I mean everybody has good days and bad days, but I really enjoy my work, I think I'm really lucky

B: Do you see yourself staying at this place?

R: I hope so, I mean it's a bit of a commute for me, and I now have a young family, so it would be nice to be home a little bit earlier, I think. But, I really, really enjoy my work, so I'm not actively looking for anything else but any means. So, if something came up and I couldn't keep my job, obviously I would be looking or we get new doctors and dynamics can change and whatnot

B: And right now you're on a permanent full time status with the hospital anyway so there's no contracts that are ending...

R: Oh no, I'm on a contract, I’ve got a 3 year contract so [Laughs] i'm still on contract

Both: [LAUGHTER]

R: The frustrating aspect of keeping a job

Both: [LAUGHTER]

R: I mean it's a lot better now, it's a 3 year contract versus previously it was going every six months, which was super anxiety inducing, it makes you not...

B: You don't have any job security

R: You don't have any job security, so it makes you feel like you're unappreciated even if the people you're working with really do appreciate the work you do. And just not having job security makes you feel like you're not as valued as some of the other employees, which isn't really the case but that's sort of how I felt. But, a 3 year contract is sufficient for me to feel secure in my job

B: Right, and those 6 months contracts are happening in between when the initiative funding was ending and they didn't have a model to fund you?

R: Yeah and it was sort of ‘what would the hospital pay for, what would the government pay for, what would the docs pay for’, nobody really wanted to commit. So it's just the 6 month contracts at a time and every time it would expire, the government would extend it a little bit further, so the hospital and the docs are not obviously going to pay more if they weren't going to have to, obviously, that doesn't make any sense. So that was probably the most frustrating part of being a PA so far, is the insecurity around having a job

B: Right and obviously, you're not the only one to have that problem, that's what we're all here working towards, right? And CAPA is behind us, and hopefully we’re seeing some progress of that so hopefully, hopefully, that decreases the frequency that PAs are experiencing that in their jobs. And, so you mentioned that your scope of practice in the ER is actually pretty good aside from writing prescriptions on discharge. Does that include procedures, codes, like what kind of activity are you having within the ER itself?

R: Well, it varies obviously, depending on what comes in, but I usually see pretty much every patient that comes through the door, regardless of status, unless it's super busy, then sometimes the doctor and I will tag team and get people through the door as fast as we can. We are a very small hospital so if it's a code, everybody is there, the docs there, I'm there, all the nurses in the building, which is usually only 2. If it's during the day, we have an RPN, as well as the 2 nurses that are in the building, and if we’re really lucky then we have a nursing supervisor in the building, so if you happen to come in and your coding and it's 2 pm on a tuesday, there might be a total of 6 people in the room

B: I mean you are a primary example of how PAs can be used appropriately to increase access to care. I mean obviously you're in a small area and it is an area of high need, and with only an average two nurses in the building, and not just in the ER, but in the hospital, two nurses and one doc, you are there providing a significant change in the access to the number of patients that can be seen and moved through that ER

R: Yeah absolutely, and the community has realized that for sure and there was a lot, when I first started, there was a lot of hesitancy from the nurses around having a PA because they didn't, not so much that they were anti-PA, but they just didn't really understand the PA role. And so, you know, with the nurses union, whatnot, there was a lot of ‘oh they're going to take nursing jobs and if you have this you won't get more staff for nursing’ but the roles between an RN and PA are completely different, and now the nurses that I work with are really appreciative of having a PA and they love, and I am good friends with them, so I assume they like me personally

Both: [LAUGHTER]

R: But, they really do like having a PA, it makes the nurses life and job easier

B: Excellent, excellent, well you're on the front lines working for us that's for sure

Both: [LAUGHTER]

R: So, that's a lot about me and my, sort of, perspective on things, what about you, Becky, tell us about your time in oncology

B: I really love oncology, I love the science behind oncology, and the intricacies that develop in the interaction between chemotherapy and the different target therapies available, and we are attacking cancer cells. I really enjoy that, I also really enjoy the aspect of working with cancer patients, I feel very appreciated by them and their families and I feel like I'm actually doing something of value so I really enjoy it.

B: I happened upon oncology just by chance, like it wasn't something that I set out for. But, when I moved to Canada, I suddenly realized I didn't have a lot of job options in 2010. In fact, I didn't have the option of the new grad funding because that only applied to people who were new graduates in Ontario, so I couldn't utilize that. In fact, I don't remember at the time any job postings for people who were not new grads, and I wasn't part of the initiative of bringing the career to Ontario either; I didn't even know how to become a part of that.

B: So I just started putting out my application by hand, just cold calling, and I ended up getting the job in Owen Sound. It was originally posted for a nurse practitioner, but I got kinda lucky because the oncologists who were there all did their fellowships in the States, so they knew exactly what a PA was, and how to use them, and it went quite well.

B: So, I was the first PA in Owen Sound, and there's always like the new, rusty pieces of starting a new job and being the first of a career in amongst people who, that the oncologist might know who I am, but the administration at the hospital or the nursing staff and other doctors at the hospital didn't know what a PA was and who I was. So it took a little bit of time but once everyone got to know me, it worked very well.

B: I was quite happy with my scope of practice there; I was able to order all sorts of bloodwork, as well as imaging exams, including ultrasounds, CT, MRI, and I was, you know, I could talk to the pathologist and really understand what was happening, and really order any multitude of things. Even getting patients transferred to a more acute center, like Princess Margaret hospital, I had no issue talking to the oncologist there as well, it really went quite well.

B: I saw an average of about 10 patients a day, which in a family practice setting seems kind of low, but in an oncology setting, I think it's right on target. I don't think I could've seen more than 10 on a typical day. And, I also managed all of the inpatients, all of the admitting, and all of the discharging as well as seeing those 10 outpatient people in the clinic.

B: And that slowly evolved to, of course, doing some kind of palliative care, you can't do oncology without doing a bit of palliative care at the same time, it's just inevitable. I really also appreciated that aspect, I find it kind of a privilege to be a part of people's life during that period of their life.

B: So, that went really well for about 4 years, I really enjoyed it and then I started a family so that took me away from Owen Sound for a short period of time, and I moved to doing palliative care in the community in Brampton. It just worked a little bit better with my family, it's not quite as long of hours and it was only palliative care. Most of the patients were palliative due to an oncologic reason, but it was the only palliative care in the community which gave me a completely different perspective; not only a community versus hospital care, but also of the resources that are available in different clinics because they vary drastically and dramatically, which was something that I was not aware of until faced with that. But, I also very much enjoyed that.

B: I also kind of cover for some people in family practice settings, when somebodys on vacation etcetera. I do that because I like to help the people I know, it's not something I enjoy quite as much, family practice setting is not really my cup of tea. I like the acute severely ill patients for some reason,

Both: [LAUGHTER]

B: But, I admit it's a completely different dynamic that I really enjoy. So, right now I'm actually currently not employed. I’m spending time with my family, I’m enjoying putting out this new podcast, and I'm also enjoying spending time with you Rachael working on our PA Helpers thing too, which we'll talk about in a little bit, and so I’m doing that and enjoying that. And I am also dabbling in a bit of medical writing now as well so I guess I have my hands in a lot of buckets and that's okay for right now, that's just what works

R: Yup, and what is it about palliative care that you love so much?

B: I have no idea, it's just really awesome. It's kind of like this window into a world that everybody else ignores. It's part of life, everybody is born and everybody dies, and it's something that we need to put more focus on. If anybody deserves really good quality care at any point of their life, it is definitely at the end of life. And so many people are ignored when it happens or given not that ideal of care, I mean you shouldnt’ be dying in a hospital. Hospitals are busy, they’re loud, they’re for people who are sick and who are going to get better and leave. It's not for people who are at a time of life that we can't change the circumstance.

B: We can hopefully make it comfortable for them, but we can't change the circumstance and you ideally should be in a quiet, serene setting where there is room for your loved ones to be around you, and not full of these busy loud, beeping things coming over the speakers, and code red, and code blue, code all these things being yelled and nurses coming in and rushed and having to share rooms with maybe somebody else who is in a completely different setting of life.

B: That is not the way to go, nobody wants that. Ideally you should be calm, quiet, serene, and I hesitate to say this word, but even almost pleasant at times and if we can get our culture to kind of come to a different understanding of what it means to die, maybe we wouldn't have a fear of it and it could be something that, whether or not we want it to happen, we can be ready for it to happen. And deal with the grief, not only from the patient’s perspective, but also of the people they love at the time. Everybody goes through that grief and a good palliative care team should be able to handle the grief of the patient as well as the grief of the family members. It is so ideal for that to happen and I feel so blessed to have been allowed in the rooms with people who are in that situation.

R: And to offer them comfort…

B: And to offer them some comfort. People ask me all the time if it's really sad, and I don't find it very sad. The only times that I find it sad, disturbing and that I have had many tears over are the times where I can't get people comfortable. And that hasn't happened very often, I can count on one hand the number of times that has happened, but when it does happen, I really feel like I've failed and the whole team usually feels like we’ve failed.

B: It's definitely not a one person effort, it is a multidisciplinary effort, that when done successfully, is really a beautiful thing that you walk away feeling really good about and that you feel like the family and the patient probably feel good about too. I mean, it's sad still, like nobody wants to lose somebody they love, but when it goes well, it goes so well. And the times that it's sad, that I actually shed tears about and get angry over are when, for whatever reason, either medications don't work to control symptoms, or we run, which is the more common side is it's not medication, the more common side is that there are administrative issues that you run into that end up blocking your ability to successfully achieve a calm passing. And those make me angry to the point of tears.

R: Understandably, that's totally understandable.

R: So, Becky has a very unique perspective being trained in the US, so what are some of the big differences you see from Canada and the US as far as PAs at this point?

B: Well it's interesting. It was a huge shock factor moving here for me, because PAs have been established for 50 years in the US. I moved from a place where I was going to have no trouble finding a job, my pick of jobs, a really good salary, stability if i wanted it, and everybody pretty much understanding what a PA is, to a place where jobs seemed very scarce and nobody knew what a PA was, and the pay is substantially less. It was a bit of a shock.

B: Also, I was not prepared for the animosity that seemed to come along amongst other professions and we've mentioned in this podcast already particularly the nursing profession. Although, I want to be really careful to say it has not been individual nurses that I’ve come across, I’ve had VERY good experiences working with individual nursing staff, and become really good friends with them, that has never seemed to be the issue. The issue has really seemed to be on a more admin side, that unions and administrative groupings as a whole seem to be against the introduction of the PA profession.

B: I would say that in the US, there is a mild animosity, but it isn't anywhere on the same scale that it is here. Most of the time, I don't know if it's most of the time. Frequently, jobs in the US are posted for, it'll say looking for PA or NP in pediatrics or PA or NP in hematology/oncology, or whatever it is, they're often posted for both, because they’re both Master level degrees in the States, they both have the capacity to prescribe narcotics and on a similar level, like they prescribing authority is similar across the board. I mean there are certainly differences, but they are miniscule, if we’re quite honest, the differences tend to be more on the political side and you may have a reason to prefer one profession over the other. But, ultimately what it really comes down to is that most jobs, PAs and NPs are capable of doing, and that you want to find the right person for the job; the personality, the skill, the knowledge base for that job.

B: So, many jobs in the US are posted for either or. There are some that are still selected postings for NP or PA but those are becoming fewer as time goes on. And of course the scope of practice for PAs in the US is huge, HUGE, in comparison. I mean you would never, unless you're brand new to the practice, or a brand new grad, even just if you've been practicing for a while, you should start a new job not expecting a physician to follow you with every patient, and that just doesn't happen.

B: So here for many reasons, for billing reasons, for safety of practice reasons, for reasons that PAs haven't just been around a lot, and for the reason that we practice under the license of a physician here, a lot of physicians follow up after every patient. At the very least, a lot of physicians say ‘hey what did you do with this’, even if they didn't actually see that patient, but there’s a lot of repetitive work happening here, that doesn't need to be happening, that doesn't happen in the states. Certainly, if the PA comes across a patient they don't know what to do with, you go to the physician, of course you do, of course

R: Sort of the whole point

B: Yes, that's the whole point, but also part of the point is to see more people and reduce workload on individuals. So, a PA might see a patient every 15-20 minutes, but the doctor’s also seeing a patient every 10-15 minutes in the US, so you're seeing double the number of patients or more with each PA that you have on your load. They also do many procedures, they're doing joint injections, they can do the nerve blocks, and if you're in the OR, PAs do all the pre-op physicals, the post-op care, and they're closing all the patients in the OR.

B: So, that's a lot of work, which is not happening here. Most surgical PAs are not actually in the OR yet here, and they're not doing the pre-op physicals. They're still sending the pre-op physicals to the family physicians, which is another time-consuming effort because the patient on their own has to find the way to get in whereas if you've got a PA who can do the pre-op right there, it's time saving and cost saving on both sides. So, the scope of practice is almost incomparable. However, I will say that I see an improvement in the time, in the 7 years, that I’ve been here. I see an improvement in the scope of practice that most PAs seem to be having from when I started to now

R: Oh for sure, I’ve even noticed that, that's changed

B: Yeah, it actually seems pretty dramatic and I feel like the change that we’re seeing with the PA profession here is happening on a faster curve than it did in the States. In the States, when it started, was a huge struggle, year after year after year, not only to get the scope of practice and the independence, but to get the acceptance and approval to practice and get the numbers. And when you look at the numbers, starting in the US and starting in Canada, we’re having a faster increase of both the number of PAs practicing and the number of schools teaching PAs and the scope of practice changes. It's all happening on a faster curve than it started in the States

R: Well, that's exciting and good news

Both: [LAUGHTER]

B: Yes, exactly, and we have other counter ports that are also struggling but seeing improvements. We look at the UK and we’re in the UK and there's absolutely people who feel that the profession is slow to move but really when you look at it, the curve is happening quite quickly there. They have a greater number of PAs in the UK than we have here, but their scope of practice is comparable and so they’re seeing some improvements on a similar scale as we are. Same in Australia, the Netherlands, and even in Germany. So, we are spreading and we are here to stay

R: Yayyy

Both: [LAUGHTER]

B: And, of course, you can talk about the difference in pay as well, but it's tough to compare when the States has such a different system of healthcare and we won't get into all that here, but we can…

R: We can make it a topic in another podcast

B: And truth be told, PAs in Canada make enough to live comfortably off of, and it may not be the 6 figure income that most PAs are making in the States, but we are making enough to be comfortable

R: Yeah and I mean by comparison the doctor in the same job in the States would make significantly more than a doc here. So... they also have a LOT more liability

B: True, so it's not an even comparison

Both: [LAUGHTER]

R: No

B: Okay well, I think, is there anything else you have to add, Rachael, about your experience or?

R: No, I'm sure we’ll do more of these podcasts, where it’s just you and I. We’ll probably end up taking listener questions and talking about things that are up in the news. If you guys have any questions for either one of us or just in general you can always email us at, you can just send us an email from our website which is mt...

B: mtppodcast.com

R: Thanks!

B: You can contact us on there. We also have facebook, you can contact us on all the social media places, also you can contact us on LinkedIn. My name is Rebecca Mueller and Rachael Thompson, we’re both on LinkedIn. You can feel free to contact us anyway. Also if you'd like us to interview you, I mean this is what this podcast is about, getting to know our comrades and fellow PAS across Canada, and building some community for ourselves. So, if you’d like us to interview you, and you want to showcase something on the podcast, please let us know!

R: Yeah, we would be happy to have you on!

B: So, thanks for joining us for our very first podcast and our launch and I hope that most of you have been able to make it out to the CAPA conference, which is starting tomorrow and if you're not here, hopefully you can join us next year at the conference in support of our really wonderful and growing profession

R: Oh so, if you're a student, check out our sponsor PAhelpers.ca we have all of your study guide needs there to help you pass the Canadian PA exam

B: The first and only study guide made for Canadian PAs

R: With Canadian units and Canadian gold standards

B: [LAUGHTER] They also happen to be the sponsor of this podcast. Alright, thanks and take care everybody

~MUSIC OUTRO~

R: Meet the PAs podcast is sponsored by PAhelpers.ca where you can find all your Canadian exam prep needs. If you enjoyed this podcast, please visit us at MTPpodcast.com. Please remember to rate, review, and subscribe and we would love your feedback.

~MUSIC OUTRO CONTINUES

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