I Stand Corrected

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.