I received an interesting call yesterday from the CSMLS. I was informed that, in fact, they had not 'dropped the ball' on the PA certification issue (ie. did not fail to retain the mailing list). I was set-straight and informed that this was not what they were mandated to do. The mailing list was actually, I was told, received from the CAP.
This mailing list referred to was (and is) the mailing list for the Pathologists, not for PAs and, yes, it would be improper to retain same.
To not compile (and retain with permission) a mailing list for Canada's PAs however, while carrying-out the questionnaire (at considerable expense) was rather short-sighted. This may not have been the mandate of the CSMLS but, had PAs been involved at the outset, this would have been pointed-out as being, at the very least, rather important. It is unfortunate that the CAP are having to re-do this important step.
Also discussed during the telephone call was the fact that it is more appropriate for the CAP (and the CMA) to be carrying the certification issue forward. This was actually my thinking from the start.
The fact that the credentials and the expectations (learned in the responses to the questionnaire by the CSMLS) put upon PAs is 'all over the map' simply serves to illustrate the crying need for at least SOME regulation. Pick an issue if you will: will it be minimun educational standards? How about expectations of PAs based upon those, or other, standards? What about a nationally-recognised curriculum? Fellowship exams? Continuing medical educational standards? Equivalency criteria for foreign-trained PAs? Grand-mothering/-fathering criteria? Who is going to decide such weighty issues as these? Who knows the answer, if no one is asked in the first place? Clearly, someone lost sight of the real purpose of the process; the real 'mandate' if you will.
I find myself repeating myself (yet again; please forgive me). The Pathologists (at least those at The Ottawa Hospital) have become SO dependent upon the support provided by PAs, that if PA numbers are depleted (through sickleave, vacation, etc.) and the routine work doesn't get done at quite the usual pace, the Pathologists complain. They do this rather than recognizing that the PAs are doing THEIR (MDs') work. The PAs are not regulated, licensed or insured to perform these tasks. The volume (of surgical specimens, for instance) increases; necessitating re-prioritizing some of the traditional, routine tasks performed by PAs, and the Pathologists complain about poor turnaround times; about 'lack of support.' They will even on occasion enlist the support of various clinicians to help argue the need for PA support of their service. Some will even threaten to seek-out greener pastures if the situation doesn't change! Maybe the PAs should be flattered by all of this. Unfortunately, they don't see in all of this that their excellent work is appreciated. The PAs are doing MDs' work! What would happen if suddenly there were NO PAs? Would the Pathologists sit and wait for THEIR work to get done? Is this only obvious to ME?! I'd like to hear an opinion or two from the Pathologists.
I realise that many physicians appreciate the work of their support staff a great deal and that a special relationship is often created over the years that they work together. It is interesting to me to see, in different areas, the different ways in which this relationship 'appreciated' by the physician. Some physicians will passionately argue that their support staff deserve more; higher classification; more money; etc. Other physicians simply demand more. I wish I knew how to lobby the pathologists to argue passionately in favour of the advancement of PAs.
ALL of the jobs that PAs perform do not (since they are MDs' jobs) have workload unit values (through the MIS Guidelines maintained by the CIHI). This way, an employer cannot use units to justify hiring additional PAs. Instead, the few units that they do produce go into justifying the hiring of (usually) Histotechnologists. This isn't necessarily a bad thing but if one thinks about it for a second...if the Histology Lab is busy, who was busy first? Answer: the PAs (and their trusty support staff -- Technicians and Clerical staff).
It is HIGH time PAs were recognized. I am getting impatient. Now that I sit in the manager's seat, I see even more clearly the necessity for progress on this front. I can't believe that it has been 30 years and that virtually nothing has been done. Ontario's Anaesthetists are suggesting that Assistants would help their cause. I'd bet that if they are successful, they will set-up a curriculum, exam, certification process, clearly-defined job description and even suggest appropriate levels of remuneration BEFORE ever allowing an AA (Anaesthetist Assistant) to set foot in an OR. Why the heck wasn't this done for PAs? Do PAs perform tasks any less valuable to patient care than would AAs? I think not. Why the heck can't it be done NOW? Good for U of Manitoba for starting. Thank goodness they didn't listen to all of the nay-sayers who believed that it wouldn't be worth their time or money.
As I said to the representative of the CSMLS, going as far as they did and not continuing is like climbing 3/4 of the mountain and giving up. It is lamentable that direction was not (or so it appears) sought when it was clearly needed. I can only pray that the CAP / CMA does not get bogged down but rather forges ahead with a clear view to the reason behind furthering PA regulation: that is, the protection of the public, the patient, the institution, themselves, and yes, the Pathologists.
Tuesday, February 22, 2005
Saturday, February 12, 2005
CAP's Address?
It would appear that the CAP neglected to include a return address on the letter mailed out to all of the pathology departments in the country. The Ottawa Hospital PAs are going to put all of theirs together and will mail their names, addresses, signatures, etc. to the CAP office (774 Echo Drive, Ottawa, ON.).
Tuesday, February 08, 2005
Workload
Alright! I've had it!
On behalf of myself and the dedicated PAs with whom I work, I submitted an application for workload units to the Canadian Institute of Health Information (CIHI) in 2003 and I have yet to hear from them (despite diplomatic reminders, by yours truly, and inquiries since that time). I see my colleagues suffering under the weight of many, many complex, important surgical specimens while having to deal with insufficient space, insufficient technical assistance, insufficient staff, insufficient time and insufficient patience to get the work done in good time.
I see The City of Ottawa free-up the substantial money to hire 28 new Paramedics. Good idea; let's get more patients into the institution so that their presence can have a ripple effect upon every other department within the hospital. But don't bother to ask us! I see tons of Registered Nurses being romanced into seeking employment at The Ottawa Hospital. At the same time, I see the Anaesthetists taking a job action on Feb 11th as a result of the increased OR volume being inflicted upon them by the provincial government -- primarily as a result of not being consulted. Right on! Good for you! I don't see anyone asking if there should be more Lab Technologists or PAs to handle the additional volume of surgical specimens. What the heck is the point of doing the surgery if there's no diagnosis (FYI - for the uninitiated - the 'diagnosis' comes from Pathology ... nowhere else)? If all the government is doing is rushing a bunch of sick patients in one door; having the surgery performed; then shoving them [prematurely] out the other door, they're not helping health care one bit. They are, in fact, hindering good health care by 1. overwhelming the PAs, the Lab Med Technical staff and the Pathologists and 2. shortening post-op length of stay and thus risking a certain percentage of post-op deaths (which they are evidently willing to accept on your behalf -- nice of them eh?). To what end? I'll tell you why: to dupe the voting public into thinking that shorter waiting lists for surgery = better health care. Neither the politians nor the public know. Healthcare workers know. Too bad they don't ask.
I submit that if the CIHI would get off there duffs and process the application for workload units for PAs, the amazing volume of work that PAs perform could be easily tracked such that additional resources, including staff, could be easily justified in the next budget. As it is, the PAs are forced to console themselves in the knowledge that they are doing the best they can, for their patients, in spite of what seems to be the entire system ignoring them, if not taking advantage of them. I don't blame them at all for being 'irritable' from time to time. I'm talking about people who, more than anyone I know, have their hearts in the right place. Collectively, they have the highest work ethic of any group I know.
PAs, unlike Nurses of the 21st century, have the very lucky advantage, when it comes to patient care, of being separated from what is becoming a truly ugly situation. If you have had the misfortune to partake of the services of an ER, or heaven forbid, an in-patient ward, recently you know all too well that Canadian healthcare has taken on a completely different colour than when we were kids. I would not want to be a Nurse working in an ER. Pain aside, unless you are dying, you get 'stabilized' and then flushed out the door (and sometimes even if your ARE dying). This must be a real eye-opener for Nurses who started out with a more traditional idea of what nursing was all about. I'm glad I don't have to succumb in such a way to the immediate constraints of funding; I'd rather just supply the very best care that I can. I'm glad I'm a PA.
I see a number of PAs are less than glad however; and I don't blame them at all. We're having to really scramble to continue to provide even a reduced level of care to that which we have been accustomed. The ever-present, and growing, mountain of specimens is truly daunting. I don't blame the PAs for looking like they're caught in the headlights. I don't blame them for looking for a temporary change of venue. It's difficult to maintain your dedication to the patient under circumstances like these.
Rest assured however that your profession is a truly honorable one. You are set apart by what you do; by what you know; by how you do it. This is not BS. You are perceived by your fellow Technologists with respect, awe and envy. You deserve more and WILL receive it; it is just a matter of time. Be patient (this too sets you apart). It will come. In the meantime, I know you will continue to do the best you can for your patients; because that's part of what sets you apart from the rest.
Hang in there. You're the best.
On behalf of myself and the dedicated PAs with whom I work, I submitted an application for workload units to the Canadian Institute of Health Information (CIHI) in 2003 and I have yet to hear from them (despite diplomatic reminders, by yours truly, and inquiries since that time). I see my colleagues suffering under the weight of many, many complex, important surgical specimens while having to deal with insufficient space, insufficient technical assistance, insufficient staff, insufficient time and insufficient patience to get the work done in good time.
I see The City of Ottawa free-up the substantial money to hire 28 new Paramedics. Good idea; let's get more patients into the institution so that their presence can have a ripple effect upon every other department within the hospital. But don't bother to ask us! I see tons of Registered Nurses being romanced into seeking employment at The Ottawa Hospital. At the same time, I see the Anaesthetists taking a job action on Feb 11th as a result of the increased OR volume being inflicted upon them by the provincial government -- primarily as a result of not being consulted. Right on! Good for you! I don't see anyone asking if there should be more Lab Technologists or PAs to handle the additional volume of surgical specimens. What the heck is the point of doing the surgery if there's no diagnosis (FYI - for the uninitiated - the 'diagnosis' comes from Pathology ... nowhere else)? If all the government is doing is rushing a bunch of sick patients in one door; having the surgery performed; then shoving them [prematurely] out the other door, they're not helping health care one bit. They are, in fact, hindering good health care by 1. overwhelming the PAs, the Lab Med Technical staff and the Pathologists and 2. shortening post-op length of stay and thus risking a certain percentage of post-op deaths (which they are evidently willing to accept on your behalf -- nice of them eh?). To what end? I'll tell you why: to dupe the voting public into thinking that shorter waiting lists for surgery = better health care. Neither the politians nor the public know. Healthcare workers know. Too bad they don't ask.
I submit that if the CIHI would get off there duffs and process the application for workload units for PAs, the amazing volume of work that PAs perform could be easily tracked such that additional resources, including staff, could be easily justified in the next budget. As it is, the PAs are forced to console themselves in the knowledge that they are doing the best they can, for their patients, in spite of what seems to be the entire system ignoring them, if not taking advantage of them. I don't blame them at all for being 'irritable' from time to time. I'm talking about people who, more than anyone I know, have their hearts in the right place. Collectively, they have the highest work ethic of any group I know.
PAs, unlike Nurses of the 21st century, have the very lucky advantage, when it comes to patient care, of being separated from what is becoming a truly ugly situation. If you have had the misfortune to partake of the services of an ER, or heaven forbid, an in-patient ward, recently you know all too well that Canadian healthcare has taken on a completely different colour than when we were kids. I would not want to be a Nurse working in an ER. Pain aside, unless you are dying, you get 'stabilized' and then flushed out the door (and sometimes even if your ARE dying). This must be a real eye-opener for Nurses who started out with a more traditional idea of what nursing was all about. I'm glad I don't have to succumb in such a way to the immediate constraints of funding; I'd rather just supply the very best care that I can. I'm glad I'm a PA.
I see a number of PAs are less than glad however; and I don't blame them at all. We're having to really scramble to continue to provide even a reduced level of care to that which we have been accustomed. The ever-present, and growing, mountain of specimens is truly daunting. I don't blame the PAs for looking like they're caught in the headlights. I don't blame them for looking for a temporary change of venue. It's difficult to maintain your dedication to the patient under circumstances like these.
Rest assured however that your profession is a truly honorable one. You are set apart by what you do; by what you know; by how you do it. This is not BS. You are perceived by your fellow Technologists with respect, awe and envy. You deserve more and WILL receive it; it is just a matter of time. Be patient (this too sets you apart). It will come. In the meantime, I know you will continue to do the best you can for your patients; because that's part of what sets you apart from the rest.
Hang in there. You're the best.
Sunday, February 06, 2005
CAP's PA mailing list
It has been a couple of weeks since the CAP sent out it's first correspondance asking that Canada's PAs respond with their mailing address (and written permission). Please take a moment to think of a PA who you know who may not have received this letter. Include even those who work at large centres. There are a number of reasons why the letter, addressed to "The Director" may not find its way to the PAs. If these people are examining surgical pathology specimens, rendering Gross Descriptions and/or performing autopsies (at a level above Morgue Attendant or deiner), they are performing duties which are those generally considered within the job description of Pathologists' Assistant.
Give her/him a call to enquire. If they got one, that's great, if they didn't, please make sure that they do. This is a very important first step. The CAP must have everyone's permission to proceed to the next step.
More on the issue of what constitutes a PA: let there be no misconception; a Morgue Attendant is NOT a PA. For the Morgue Attendants out there, please understand that I am in no way denigrating you, your occupation or the much-valued assistance that you provide. Generally speaking, the prerequisite for employment as a Morgue Attendant include a Grade 12 (in Ontario) high school diploma. Currently, the minimum prerequisite for employment as a PA is a Medical Laboratory Technologist diploma and registration with the appropriate provincial college. It is very important that at this juncture PAs force themselves to take the hard line and, at the risk of alienating the MAs with whom they work day in and day out, clearly define to themselves and to their colleagues, Pathologists included, the criteria which define "Pathologists' Assistant."
Another problem which will need to be addressed is that concerning PAs who are not involved in all aspects of Pathology. Consider PAs working at a forensic science centre, assisting at autopsy; performing the dissection on behalf of the Forensic Pathologist. They never see or handle surgical pathology specimens yet they are, as much as the Forensic Pathologists are Pathologists, PAs. To clarify, these are not Morgue Attendants. They are performing the dissection of the organs, examining tissues, interpreting their findings and communicationg these to the Pathologist. On the other hand, there are PAs who never do autopsies, but who handle surgical pathology specimens. Same story; just like the Pathologists who they assist, they too are PAs.
Give her/him a call to enquire. If they got one, that's great, if they didn't, please make sure that they do. This is a very important first step. The CAP must have everyone's permission to proceed to the next step.
More on the issue of what constitutes a PA: let there be no misconception; a Morgue Attendant is NOT a PA. For the Morgue Attendants out there, please understand that I am in no way denigrating you, your occupation or the much-valued assistance that you provide. Generally speaking, the prerequisite for employment as a Morgue Attendant include a Grade 12 (in Ontario) high school diploma. Currently, the minimum prerequisite for employment as a PA is a Medical Laboratory Technologist diploma and registration with the appropriate provincial college. It is very important that at this juncture PAs force themselves to take the hard line and, at the risk of alienating the MAs with whom they work day in and day out, clearly define to themselves and to their colleagues, Pathologists included, the criteria which define "Pathologists' Assistant."
Another problem which will need to be addressed is that concerning PAs who are not involved in all aspects of Pathology. Consider PAs working at a forensic science centre, assisting at autopsy; performing the dissection on behalf of the Forensic Pathologist. They never see or handle surgical pathology specimens yet they are, as much as the Forensic Pathologists are Pathologists, PAs. To clarify, these are not Morgue Attendants. They are performing the dissection of the organs, examining tissues, interpreting their findings and communicationg these to the Pathologist. On the other hand, there are PAs who never do autopsies, but who handle surgical pathology specimens. Same story; just like the Pathologists who they assist, they too are PAs.
Thursday, February 03, 2005
Some Pertinent Philosophy
I keep having to remind myself that there may be some poor souls reading this who haven't a clue what a PA is; what they do; and what they mean in the 'grand scheme' of the monstrous machine that is our healthcare system. So here goes with some more ramblings, some of which may help the uninitiated to understand where PAs fit in.
I was talking to a fellow PA today concerning a seemingly small but oh so important fact about PAs. Once you're a PA and you get some training, your new-found knowledge allows you to do things which only MDs are allowed, or are mandated, or are paid, or are licensed, or are insured, to do; namely, identify (this is going to sound stupid to those not acquainted with the field) normal tissues. Please allow me to explain; I'll try to not insult the PAs out there and I'll try to not be overly simplistic. If you think of it for a second, how is one to know what normal looks like if you don't know what abnormal is? I've seen this tons of times through the years with wet-behind-the-ears Pathology Residents who unknowingly embarass themselves when, at rounds, they proudly point out a particular 'lesion' in an organ which is, in fact, completely normal. Conversely, something which is grossly abnormal can be glossed over as being unremarkable if that's the only thing that this newby has ever seen. I'm probably not getting this across with as much accuracy as I'd like but suffice it to say that the simple act of confidently identifying even normal, let alone lesional, tissue is a feat reserved for an elite group of individuals and although PAs take this ability for granted, it is something that only they, and medical doctors can, with confidence, do. You'll not be very surprised that my next thought is that PAs don't get paid anywhere near what they're worth. You'll likely say, yah sure, everyone says that and I admit that I am biased (how'd you guess?) but I assure you that it definitely applies in this case. Don't take my assurance though, take the word of various surgeons and oncologists who know that their patients are best served when their specimens are handled by PAs and no one else (I think I'm beginning to repeat myself! Sorry).
I was spouting to a colleague earlier today (a different individual than the fellow PA mentioned above) that PAs, somewhat like Cytotechs should have a feature built-in to their registration or license (when that occurs) which prescribes a limit to the number of complex surgical specimens which can be examined in a day (In Ontario, Cytotechnologists have a 60 slide/day limit). If one realizes that the profession of PA is akin to an art rather than a pigeon-holed assembly line type of occupation doing the same thing hour after hour and day after day, the idea of placing a limit on the number of examined specimens, in order to ensure that the last one is examined with the same level of expertise, application of knowledge and use of judgement as the first, is indeed a very good idea in my opinion -- for the patient's sake. I was also saying to this colleague that PAs will do well to continue to diversify their interests in the service of the Pathologists, if not insist upon it. That is to say that they should include things like brain-cutting, sectioning and reporting (incl. opportunities for learning with the Neuropathologist) as well as heart sectioning and reporting (incl. similar teaching opportunities with the Cardiovascular Pathologist). Just like Pathologists who have a portion of their work week allocated for CME activities or other academic pursuits, so should PAs. It is in the interests of not just the patients or the institutions to have well-trained PAs. It is in the interests of the Pathologists to have interested, well-informed, well-rounded, alert PAs acting on their behalf. It is the Pathologist's signature that goes at the bottom of the report but they had better be confident that the PAs who are working for (or with, if you prefer) them are doing the job at least as well as they could do themselves. That level of trust MUST be present in the relationship between PA and Pathologist. If not, the PA need not exist. I'd hate to be a Pathologist who couldn't trust the PA. I would like to think (and I'm not kidding myself) that there isn't one of the twenty-seven Pathologists at The Ottawa Hospital who wouldn't honestly admit that the 9 PAs are doing at least as good a job as they could do themselves. I know that they would say, if asked, that the PAs are the greatest. Regrettably, words don't buy that Mercedes I've had my eye on!
I was talking to a fellow PA today concerning a seemingly small but oh so important fact about PAs. Once you're a PA and you get some training, your new-found knowledge allows you to do things which only MDs are allowed, or are mandated, or are paid, or are licensed, or are insured, to do; namely, identify (this is going to sound stupid to those not acquainted with the field) normal tissues. Please allow me to explain; I'll try to not insult the PAs out there and I'll try to not be overly simplistic. If you think of it for a second, how is one to know what normal looks like if you don't know what abnormal is? I've seen this tons of times through the years with wet-behind-the-ears Pathology Residents who unknowingly embarass themselves when, at rounds, they proudly point out a particular 'lesion' in an organ which is, in fact, completely normal. Conversely, something which is grossly abnormal can be glossed over as being unremarkable if that's the only thing that this newby has ever seen. I'm probably not getting this across with as much accuracy as I'd like but suffice it to say that the simple act of confidently identifying even normal, let alone lesional, tissue is a feat reserved for an elite group of individuals and although PAs take this ability for granted, it is something that only they, and medical doctors can, with confidence, do. You'll not be very surprised that my next thought is that PAs don't get paid anywhere near what they're worth. You'll likely say, yah sure, everyone says that and I admit that I am biased (how'd you guess?) but I assure you that it definitely applies in this case. Don't take my assurance though, take the word of various surgeons and oncologists who know that their patients are best served when their specimens are handled by PAs and no one else (I think I'm beginning to repeat myself! Sorry).
I was spouting to a colleague earlier today (a different individual than the fellow PA mentioned above) that PAs, somewhat like Cytotechs should have a feature built-in to their registration or license (when that occurs) which prescribes a limit to the number of complex surgical specimens which can be examined in a day (In Ontario, Cytotechnologists have a 60 slide/day limit). If one realizes that the profession of PA is akin to an art rather than a pigeon-holed assembly line type of occupation doing the same thing hour after hour and day after day, the idea of placing a limit on the number of examined specimens, in order to ensure that the last one is examined with the same level of expertise, application of knowledge and use of judgement as the first, is indeed a very good idea in my opinion -- for the patient's sake. I was also saying to this colleague that PAs will do well to continue to diversify their interests in the service of the Pathologists, if not insist upon it. That is to say that they should include things like brain-cutting, sectioning and reporting (incl. opportunities for learning with the Neuropathologist) as well as heart sectioning and reporting (incl. similar teaching opportunities with the Cardiovascular Pathologist). Just like Pathologists who have a portion of their work week allocated for CME activities or other academic pursuits, so should PAs. It is in the interests of not just the patients or the institutions to have well-trained PAs. It is in the interests of the Pathologists to have interested, well-informed, well-rounded, alert PAs acting on their behalf. It is the Pathologist's signature that goes at the bottom of the report but they had better be confident that the PAs who are working for (or with, if you prefer) them are doing the job at least as well as they could do themselves. That level of trust MUST be present in the relationship between PA and Pathologist. If not, the PA need not exist. I'd hate to be a Pathologist who couldn't trust the PA. I would like to think (and I'm not kidding myself) that there isn't one of the twenty-seven Pathologists at The Ottawa Hospital who wouldn't honestly admit that the 9 PAs are doing at least as good a job as they could do themselves. I know that they would say, if asked, that the PAs are the greatest. Regrettably, words don't buy that Mercedes I've had my eye on!
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