I tried to send a letter to all Canadian PAs for whom I have email addresses. Judging by all of the Undeliverable receipts that I received, it would appear that I have quite a large number of incorrect addresses. Would everyone please be so kind as to contact me with their correct email address? Of course, if you got the letter, don't bother. Thanks.
Sunday, February 12, 2006
Sunday, January 29, 2006
CSMLS?
Anyone who has received an invitation from the CSMLS to attend an ad hoc meeting concerning registration of PAs should think twice before accepting. The CSMLS certifies (‘registers,’ if you prefer) technologists. The loosely-formed committee (of which I am a part) which has been formed within the last few months and has been looking at improving the lot of Canada's PAs, has agreed that eventually, all fully-qualified Canadian PAs will hold an MSc. We do not see the CMSLS being involved in the standardization of credentials or training or certification or regulation of Canadian PAs. If you are invited, my advice to you is that you not attend. Your absence will make the statement for you (and will greatly simplify matters).
Sunday, January 15, 2006
ASSOCIATE (v.)
I must apologise for the long time between posts. The pace of the work in Kelowna was certainly hectic in November and December. I barely had a chance to come up for air. The volume of work in January seems to be somewhat more manageable…so far. I thought you might like to know just how busy it is here. The 3 sites produce about 45,000 cases annually. Three PAs do all of the gross descriptions for those cases. 7 pathologists sign-out those cases. The Ottawa Hospital produces only slightly more cases per year. Twelve PAs and 28 pathologists work at TOH.
To bring you up to date on life in the Interior of BC from my perspective...we will be interviewing candidates for the PA position in Kelowna within the next 1 ½ weeks. This person will assume the position that I have held since May, 2005. I’ll become the PA Quality Coordinator for the three sites within the Interior (Vernon, Kelowna and Penticton). In that role, I will enjoy interacting with the PAs, the Clinical Director (when we get one), the pathologists and the regional manager to introduce a common manual for surgical pathology and gross description templates.
Other news – there will be a 21-week PA locum in Vernon beginning in July (a maternity leave). Also, we will be looking at hiring a casual PA to fill in during vacations and other leaves of the three PAs. It was very nice that Alan Wolff decided to do a 2-week locum in Vernon during Danielle Lee's vacation in January.
Now to the subject of this post: several PAs across Canada and myself have been corresponding recently; trying to firm-up arrangements with the Canadian Association of Pathologists (CAP) so that Canada’s PAs can form an association (The Canadian Association of Pathologist’s Assistants (CAPA)) as a branch of the CAP. It was very nice of the CAP to offer this to us. It means that we will not have to expend huge amounts of time (and money) in drawing-up our own constitution. Cytotechnologists have already associated with the CAP. I envisage the PA arrangement to be similar. The problem (well, one of the problems) is that Canadian PAs are not yet certified. How does one define a PA? Our credentials and our responsibilities are all over the map. We are lucky that our American colleagues have shown the way, partly. The difference is that they already have an accredited training course in place so the definition is significantly less cloudy than in Canada. They have gotten around this problem as well though in that they have allowed for differing levels of membership. You can still belong to the association, but in an ‘associate’ capacity (presumably without voting privileges…but you still get invited to the AGM!) if you, for instance, do not hold a degree. With the CAP’s assistance and direction, we hope to define the criteria for membership in the CAPA.
I think that until the CMA accredits a PA training program, we cannot expect to associate to the same degree as the Cytotechnologists however. The inaugural executive committee can hopefully come up with some criteria for that which defines a Canadian PA and that will go a long way to firming up the definition when drawing up a list of key responsibilities for PAs.
There are a number of contentious issues that we’ll need to grapple with. Among these, perhaps the most difficult will be deciding whether or not to admit non-degree holding PAs into the association. If we agree that we will do this (and I think we should), we then need to decide how many years of bench experience will be required before they are admitted. Certainly those who already hold AAPA memberships or fellowships will be admitted. Foreign-trained medical doctors practising as PAs will likely be admitted but, like all other PAs, will require an assessment from an impartial pathologist (hopefully using a format provided by the CAP); this is in keeping with the wishes of the CAP (see the Position Statement on the CAP website http://www.cap.medical.org/position_statement_assistants.htm). There are already many MLTs who have evolved into PAs. In fact, most Canadian PAs are MLTs. The contribution that they provide to the provision of excellent healthcare should not go unrecognized. They deserve to be allowed to associate along with the [minority] of degree-holders. We can set the bar high for the future (ie. when there are PAs being trained in Canada using an accredited curriculum) but should grandmother/father those who are currently practising.
We should also stipulate that the degree holders hold an appropriate degree (eg. BSc in Biology; MSc; MD).
What do we do about those who never perform autopsies? What about those who perform only autopsies?
I would be interested to hear any input that you might have to this subject. I am sure that many of you have lots of things to add and have many questions; I’d be glad to hear from you. We had hoped to have a 2006 meeting of Canadian PAs but it’s looking like this might have been a little optimistic.
An update re PA workload units: the CIHI will be looking at this in the fall and the following spring (2007). The wheels of bureaucracy certainly do turn slowly. The good news is that they are turning.
Also, I was pleased to sit with the British Columbia laboratory accreditors (DAP) in November. It amazes me that PAs have flown under the radar of the accreditors in all other provinces. It took the BC pathologists to give the accreditors the heads-up about the existence of PAs and the significant change in practice that had occurred recently. Their written report will be available soon and it will contain recommendations (in keeping with the CAP’s stated wishes concerning CME activities, for example) which apply specifically to PAs. I think that all of Canada’s PAs should make their provincial lab accrediting bodies aware of their existence and should also insist that there be specific wording in the accrediting agreement stipulating that there be proper, safe working conditions for PAs, adequate space, CME activities, safety awareness training, etc. I’ll bring you all up to speed on what I learn from the written statement from the DAP once I get the chance to read it.
Other news – there will be a 21-week PA locum in Vernon beginning in July (a maternity leave). Also, we will be looking at hiring a casual PA to fill in during vacations and other leaves of the three PAs. It was very nice that Alan Wolff decided to do a 2-week locum in Vernon during Danielle Lee's vacation in January.
Now to the subject of this post: several PAs across Canada and myself have been corresponding recently; trying to firm-up arrangements with the Canadian Association of Pathologists (CAP) so that Canada’s PAs can form an association (The Canadian Association of Pathologist’s Assistants (CAPA)) as a branch of the CAP. It was very nice of the CAP to offer this to us. It means that we will not have to expend huge amounts of time (and money) in drawing-up our own constitution. Cytotechnologists have already associated with the CAP. I envisage the PA arrangement to be similar. The problem (well, one of the problems) is that Canadian PAs are not yet certified. How does one define a PA? Our credentials and our responsibilities are all over the map. We are lucky that our American colleagues have shown the way, partly. The difference is that they already have an accredited training course in place so the definition is significantly less cloudy than in Canada. They have gotten around this problem as well though in that they have allowed for differing levels of membership. You can still belong to the association, but in an ‘associate’ capacity (presumably without voting privileges…but you still get invited to the AGM!) if you, for instance, do not hold a degree. With the CAP’s assistance and direction, we hope to define the criteria for membership in the CAPA.
I think that until the CMA accredits a PA training program, we cannot expect to associate to the same degree as the Cytotechnologists however. The inaugural executive committee can hopefully come up with some criteria for that which defines a Canadian PA and that will go a long way to firming up the definition when drawing up a list of key responsibilities for PAs.
There are a number of contentious issues that we’ll need to grapple with. Among these, perhaps the most difficult will be deciding whether or not to admit non-degree holding PAs into the association. If we agree that we will do this (and I think we should), we then need to decide how many years of bench experience will be required before they are admitted. Certainly those who already hold AAPA memberships or fellowships will be admitted. Foreign-trained medical doctors practising as PAs will likely be admitted but, like all other PAs, will require an assessment from an impartial pathologist (hopefully using a format provided by the CAP); this is in keeping with the wishes of the CAP (see the Position Statement on the CAP website http://www.cap.medical.org/position_statement_assistants.htm). There are already many MLTs who have evolved into PAs. In fact, most Canadian PAs are MLTs. The contribution that they provide to the provision of excellent healthcare should not go unrecognized. They deserve to be allowed to associate along with the [minority] of degree-holders. We can set the bar high for the future (ie. when there are PAs being trained in Canada using an accredited curriculum) but should grandmother/father those who are currently practising.
We should also stipulate that the degree holders hold an appropriate degree (eg. BSc in Biology; MSc; MD).
What do we do about those who never perform autopsies? What about those who perform only autopsies?
I would be interested to hear any input that you might have to this subject. I am sure that many of you have lots of things to add and have many questions; I’d be glad to hear from you. We had hoped to have a 2006 meeting of Canadian PAs but it’s looking like this might have been a little optimistic.
An update re PA workload units: the CIHI will be looking at this in the fall and the following spring (2007). The wheels of bureaucracy certainly do turn slowly. The good news is that they are turning.
Also, I was pleased to sit with the British Columbia laboratory accreditors (DAP) in November. It amazes me that PAs have flown under the radar of the accreditors in all other provinces. It took the BC pathologists to give the accreditors the heads-up about the existence of PAs and the significant change in practice that had occurred recently. Their written report will be available soon and it will contain recommendations (in keeping with the CAP’s stated wishes concerning CME activities, for example) which apply specifically to PAs. I think that all of Canada’s PAs should make their provincial lab accrediting bodies aware of their existence and should also insist that there be specific wording in the accrediting agreement stipulating that there be proper, safe working conditions for PAs, adequate space, CME activities, safety awareness training, etc. I’ll bring you all up to speed on what I learn from the written statement from the DAP once I get the chance to read it.
Monday, November 21, 2005
The True Value of PAs
I have been a Pathologist’s Assistant for over 30 years and although this issue had occurred to me before, never have I been so certain of its validity.
Not long after I departed oh-so-comfortable Ottawa, my home, and The Ottawa Hospital (TOH) and came to BC to help the Interior Health Authority (IHA), along with two other well-trained PAs, deal with a crisis which was generated out of a contractual disagreement involving the Ministry, IHA and the Pathologists, I realized the true value of PAs.
Insofar as I had been around at the very beginning, I obviously knew what PAs contributed to a patient’s care. But the gradual evolution which I participated in had created such a comfortable relationship between PAs (of whom there are now a dozen at TOH) and the Pathologists that our contribution had become something of a ‘given’. I took it for granted and did not truly understand its value. Here, in BC, I have had the chance to put it all into perspective. I now recognize that the contribution which PAs provide to the functioning of Anatomical Pathology has far greater value than I had ever known. I find it fascinating to recount the day when the Interim Medical Director (who had not been involved in the actual negotiations in sourcing PAs for IHA; but who had been convinced of the value of PAs) stated that he and I were among the highest paid staff in pathology. I had to stifle a laugh. I hazard to guess that on an annual basis, the Medical Director will be paid in excess of $300K. Boy, was he wrong!
It is worth listening to pathologists who all believe, rightly, in the importance of the Gross Description in the provision of a high quality surgical pathology report. This is understandably a facet of a pathologist’s job which s/he takes very seriously; it is the first step towards arriving at an accurate diagnosis. It is completely understandable that a pathologist should feel that only a pathologist ought to be the prosector of surgical specimens. If the prosector fails to examine a specimen appropriately or completely; fails to describe an important lesion or even an important negative finding; fails to take sections of a lesion or fails to take sections in an appropriate fashion, the pathologist performing the Microscopic Description may not ever see a slide of the lesion. This would have a permanent (but invisible to the latter pathologist) effect on the diagnosis, and ultimately the treatment and prognosis of that patient. If different individuals will be performing the Gross and Microscopic Descriptions (regardless of their credentials), a level of trust must exist between them. I would not feel comfortable if I were the pathologist if I did not trust the prosector (I sympathize deeply with the pathologists who feel that they have been forced to accept PAs into the IHA). An experienced, knowledgeable PA (or other individual) is essential (if the pathologist her/himself isn’t doing the Gross Description).
Almost any employee in the hospital can arrive at a valid explanation why their occupation or profession, if not performed, would be detrimental to the quality of the healthcare that the institution was able to provide to its patients. If the Housekeeping department does not maintain a high standard of cleanliness in the entire hospital, patient’s will suffer. If the dieticians do not maintain healthy menus and properly prepared foods, patient’s will suffer. If the plumbers…well, you get my point, I hope. The difference between all of these individuals and PAs, is that physicians have never scrubbed the floors, made beds, prepared meals or repaired toilets. A number of para-medical professions have been introduced over the last three decades the members of which are performing tasks which have heretofore been the sole responsibility of physicians. PAs are among them. What they do (like Nurse Practitioners, Physician Assistants, Midwives, etc.) has an even greater level of importance to the provision of high quality healthcare than that of those who perform the myriad necessary tasks elsewhere in the hospital. Just ask a doctor who used to do these things how important they are. Ask her/him what the impact of error is.
A significant amount of pathologists’ time used to be dedicated to performing Gross Descriptions. It is a part of the job, regardless of who performs it, which ought not be rushed. A high quality Gross Description results in superior patient care. I don’t know of any pathologist or PA who would knowingly compromise the examination of a specimen by allowing exterior influences to rush or distract her/him from examining the specimen as fully as it deserves.
Published papers have shown that PAs are better at examining gross specimens than pathologists because it is their primary responsibility; their raison d’etre. PAs don’t have to rush through a ½ dozen specimens so that they can get to their office to sign-out yesterday’s surgicals. PAs can dedicate more time to finding every last lymph node in that peri-colic fat. Surgeons and oncologists want the specimens from their patients examined by a PA because they know that a PA will probably find more lymph nodes and will abide by a protocol which has been set for the examination of that type of specimen, every time. There will not be variation from one PA to the next.
Pathologists are very well paid for their time. They are paid roughly five times what a PA is paid (when you factor-in benefits). I think that there is a sound argument, when viewing the value of what PAs do and comparing the salaries of PAs and pathologists, for paying PAs a significant amount more than what they are now receiving. I have always contended that a PA is worth roughly ½ of a pathologist.
Yes, there are more-experienced, and there are less-experienced PAs. Yes, there are more dedicated, or more knowledgeable PAs, as there are those who are less so. Yes, there is no formal training, no certification and no regulation of PAs (and yes, it’s high time that this happened). The importance of what PAs do NOW however cannot be ignored. Putting it off until later simply ignores the reality and, from a PA’s perspective, makes the situation only more of an insult. PAs are grossly underpaid and I sincerely hope that the process begun by the CAP results in a situation where PAs can finally be remunerated in a manner more commensurate with their responsibilities (at the glacial rate that things are ‘progressing’ however, I doubt that I will ever benefit personally by any of the issues currently being considered).
Slotting PAs into a unionized pay grid is, I believe a mistake; it was a mistake when first forced upon yours truly in Ottawa many years ago and it is still a mistake. ‘You get what you pay for.’ There will always be exceptional individuals, regardless of the profession, just as there will always be those who are less exceptional. They all get paid the same amount when slotted into a pay scale. The training of Medical Laboratory Technologists does not prepare an individual to be a PA. There are insights into disease processes, physiology, inflammation and repair, neoplasia, etc. that are simply not taught to Technologists. They don’t need that type of training and they’re not paid to have that knowledge. It ought come as no big surprise that the best PA in many ways is a physician. Foreign-trained MDs who are not yet licensed to practise in Canada are well worth considering for PA positions. A potential drawback might be, however, that these individuals might be somewhat less compliant, or accepting, of the status quo; they might not be enough like MLTs to fit in. Wouldn’t it be nice if there was a position roughly mid-way between MD and MLT?!
PAs cannot exist in their role (performing a task which was heretofore the sole responsible of a medical doctor) without a foundation in medicine. If a PA could not be trusted to competently examine a specimen, even the simplest of specimens, s/he would require hands-on supervision by the pathologist. This would obviously take the pathologist away from her/his even more important duty of performing Microscopic Descriptions and rendering diagnoses and would make the PA redundant.
PAs are a part of the majority of pathology departments on the continent. They need to be trained to a minimum level of competency using an accredited curriculum so that the public, the employers and they themselves can be protected against errors. They need certification and regulation and the recognition that they deserve. It would appear that the movement currently is to mirror the model in the USA when training PAs; namely post-graduate training. I am inclined to agree.
I believe that it is well past the time that the employers of Canadian PAs ought to take a look at what they have and what they are paying for it. They need to examine the impact of error of each of their employees and pay an appropriate salary for each of those individuals. The task of performing Gross Descriptions is no less important to the provision of quality healthcare now than it was when pathologists were performing them.
Not long after I departed oh-so-comfortable Ottawa, my home, and The Ottawa Hospital (TOH) and came to BC to help the Interior Health Authority (IHA), along with two other well-trained PAs, deal with a crisis which was generated out of a contractual disagreement involving the Ministry, IHA and the Pathologists, I realized the true value of PAs.
Insofar as I had been around at the very beginning, I obviously knew what PAs contributed to a patient’s care. But the gradual evolution which I participated in had created such a comfortable relationship between PAs (of whom there are now a dozen at TOH) and the Pathologists that our contribution had become something of a ‘given’. I took it for granted and did not truly understand its value. Here, in BC, I have had the chance to put it all into perspective. I now recognize that the contribution which PAs provide to the functioning of Anatomical Pathology has far greater value than I had ever known. I find it fascinating to recount the day when the Interim Medical Director (who had not been involved in the actual negotiations in sourcing PAs for IHA; but who had been convinced of the value of PAs) stated that he and I were among the highest paid staff in pathology. I had to stifle a laugh. I hazard to guess that on an annual basis, the Medical Director will be paid in excess of $300K. Boy, was he wrong!
It is worth listening to pathologists who all believe, rightly, in the importance of the Gross Description in the provision of a high quality surgical pathology report. This is understandably a facet of a pathologist’s job which s/he takes very seriously; it is the first step towards arriving at an accurate diagnosis. It is completely understandable that a pathologist should feel that only a pathologist ought to be the prosector of surgical specimens. If the prosector fails to examine a specimen appropriately or completely; fails to describe an important lesion or even an important negative finding; fails to take sections of a lesion or fails to take sections in an appropriate fashion, the pathologist performing the Microscopic Description may not ever see a slide of the lesion. This would have a permanent (but invisible to the latter pathologist) effect on the diagnosis, and ultimately the treatment and prognosis of that patient. If different individuals will be performing the Gross and Microscopic Descriptions (regardless of their credentials), a level of trust must exist between them. I would not feel comfortable if I were the pathologist if I did not trust the prosector (I sympathize deeply with the pathologists who feel that they have been forced to accept PAs into the IHA). An experienced, knowledgeable PA (or other individual) is essential (if the pathologist her/himself isn’t doing the Gross Description).
Almost any employee in the hospital can arrive at a valid explanation why their occupation or profession, if not performed, would be detrimental to the quality of the healthcare that the institution was able to provide to its patients. If the Housekeeping department does not maintain a high standard of cleanliness in the entire hospital, patient’s will suffer. If the dieticians do not maintain healthy menus and properly prepared foods, patient’s will suffer. If the plumbers…well, you get my point, I hope. The difference between all of these individuals and PAs, is that physicians have never scrubbed the floors, made beds, prepared meals or repaired toilets. A number of para-medical professions have been introduced over the last three decades the members of which are performing tasks which have heretofore been the sole responsibility of physicians. PAs are among them. What they do (like Nurse Practitioners, Physician Assistants, Midwives, etc.) has an even greater level of importance to the provision of high quality healthcare than that of those who perform the myriad necessary tasks elsewhere in the hospital. Just ask a doctor who used to do these things how important they are. Ask her/him what the impact of error is.
A significant amount of pathologists’ time used to be dedicated to performing Gross Descriptions. It is a part of the job, regardless of who performs it, which ought not be rushed. A high quality Gross Description results in superior patient care. I don’t know of any pathologist or PA who would knowingly compromise the examination of a specimen by allowing exterior influences to rush or distract her/him from examining the specimen as fully as it deserves.
Published papers have shown that PAs are better at examining gross specimens than pathologists because it is their primary responsibility; their raison d’etre. PAs don’t have to rush through a ½ dozen specimens so that they can get to their office to sign-out yesterday’s surgicals. PAs can dedicate more time to finding every last lymph node in that peri-colic fat. Surgeons and oncologists want the specimens from their patients examined by a PA because they know that a PA will probably find more lymph nodes and will abide by a protocol which has been set for the examination of that type of specimen, every time. There will not be variation from one PA to the next.
Pathologists are very well paid for their time. They are paid roughly five times what a PA is paid (when you factor-in benefits). I think that there is a sound argument, when viewing the value of what PAs do and comparing the salaries of PAs and pathologists, for paying PAs a significant amount more than what they are now receiving. I have always contended that a PA is worth roughly ½ of a pathologist.
Yes, there are more-experienced, and there are less-experienced PAs. Yes, there are more dedicated, or more knowledgeable PAs, as there are those who are less so. Yes, there is no formal training, no certification and no regulation of PAs (and yes, it’s high time that this happened). The importance of what PAs do NOW however cannot be ignored. Putting it off until later simply ignores the reality and, from a PA’s perspective, makes the situation only more of an insult. PAs are grossly underpaid and I sincerely hope that the process begun by the CAP results in a situation where PAs can finally be remunerated in a manner more commensurate with their responsibilities (at the glacial rate that things are ‘progressing’ however, I doubt that I will ever benefit personally by any of the issues currently being considered).
Slotting PAs into a unionized pay grid is, I believe a mistake; it was a mistake when first forced upon yours truly in Ottawa many years ago and it is still a mistake. ‘You get what you pay for.’ There will always be exceptional individuals, regardless of the profession, just as there will always be those who are less exceptional. They all get paid the same amount when slotted into a pay scale. The training of Medical Laboratory Technologists does not prepare an individual to be a PA. There are insights into disease processes, physiology, inflammation and repair, neoplasia, etc. that are simply not taught to Technologists. They don’t need that type of training and they’re not paid to have that knowledge. It ought come as no big surprise that the best PA in many ways is a physician. Foreign-trained MDs who are not yet licensed to practise in Canada are well worth considering for PA positions. A potential drawback might be, however, that these individuals might be somewhat less compliant, or accepting, of the status quo; they might not be enough like MLTs to fit in. Wouldn’t it be nice if there was a position roughly mid-way between MD and MLT?!
PAs cannot exist in their role (performing a task which was heretofore the sole responsible of a medical doctor) without a foundation in medicine. If a PA could not be trusted to competently examine a specimen, even the simplest of specimens, s/he would require hands-on supervision by the pathologist. This would obviously take the pathologist away from her/his even more important duty of performing Microscopic Descriptions and rendering diagnoses and would make the PA redundant.
PAs are a part of the majority of pathology departments on the continent. They need to be trained to a minimum level of competency using an accredited curriculum so that the public, the employers and they themselves can be protected against errors. They need certification and regulation and the recognition that they deserve. It would appear that the movement currently is to mirror the model in the USA when training PAs; namely post-graduate training. I am inclined to agree.
I believe that it is well past the time that the employers of Canadian PAs ought to take a look at what they have and what they are paying for it. They need to examine the impact of error of each of their employees and pay an appropriate salary for each of those individuals. The task of performing Gross Descriptions is no less important to the provision of quality healthcare now than it was when pathologists were performing them.
Monday, September 05, 2005
CIHI, and other things
I just realized that my last post was way back in June. I should apologize to the masses (ha!) who no doubt were wondering whether something ill had befallen me. No such luck! I'm still here! I guess I've been busy is all.
I have probably mentioned at some time in the past that I had submitted a rather lengthy Request for Unit Values to the Canadian institute for Health Information (which is the federal body empowered with, among a ton of other things related to healthcare in Canada, the administration of the MIS Guidelines; which as all Lab Techs know is the reference to which our bosses refer, ideally, when doing things like billing or perhaps comparison studies of workload between groups, etc.). This Request (actually multiple Requests included in the same package) was submitted by myself and my Manager at the time, Mr. Roy Neifer, in 2002. After an initial period of enthusiasm and false optimism, I soon realized just how slowly the bureaucratic wheels turn in Ottawa. After a couple of calls within the first year inquiring as to the state of progress of my Request, I was told (my words) to stop calling. There are two issues (at least) at play here. First is the fact that all of the duties which PAs perform go essentially unnoticed (as far as workload units are concerned). As a result, any institution which employs PAs and which depends upon accurate reporting of workload units is not getting an accurate picture of its staff's workload. In essence, PAs are being supported by the efforts of others; or, an alternative view...the provincial Ministry is not receiving accurate accounting of that institution's workload.
Anyway, I figured that I had been patient enough after three years. I couldn't contain myself any longer so I contacted the CIHI and they were good enough to return my call. They were very polite and, as they had 3 years previously, assured me that my Request had been lumped together with a number of other major Requests; now part of a 'reform' of workload units. I shuddered at the thought of having my Request being considered along with a number of others. I told the CIHI that I believed, insofar as this Request, unlike most others, was a totally new Request, not a revision of existing workload units. I told them that although I did not expect any special treatment, that 1. some urgency ought to be given this because it was totally new and 2. that the process which was being used to consider other Requests ought not be applied to this Request because it would be doomed to fail. I elaborated upon the evolution of PAs and that they perform duties which have heretofore been the sole responsibility of physicians. I got silence; then a promise that I would receive a call from the CIHI in the fall (this fall). I'll be patient but I'll also be realistic. I don't think that this Request can honestly be considered until PAs have the recognition that they deserve; until they achieve national certification. Which brings me to my next subject...
If memory serves (I don't know...time sure does seem to fly!), it was in the 2003 CAP summer Newsletter wherein a Position Statement was published that recognized that PAs exist; that they provide a valuable addition to healthcare; that they should have an accredited training program; should be certified nationally and regulated provincially. Dr. Cook circulated nationally a questionnaire to all pathology departments with an aim to compiling a list of all of Canada's PAs (every PA to whom I have spoken within the last 6 months or so has told me that they have their name on the CAP's list. This is indeed encouraging). The CAP AGM was held in June, 2005 and one of the ad hoc meetings concerned PAs and the strategy to achieve their certification. My offer of volunteering to sit on a committee was well received. I have yet to hear any news (and would dearly appreciate hearing something).
On a more positive note, UBC is working on drawing-up a curriculum for PAs, with the assistance of a PA! Now that IS good news, I think. I believe that several universities will have curricula drawn up long before PA certification actually takes place considering the glacial pace at which this important issue is 'progressing.'
If, as I expect, the final curriculum will be something like a 4-year BSc with, perhaps, an internship year added afterwards, it will be interesting to see what becomes of The University of Manitoba's PA program, which was expected to graduate its first 2 (Masters-level) PAs this past spring.
Things at Kelowna General Hospital are going very well. I have almost completed the first draft of a surgical pathology manual. Once a Medical Director is hired, we'll be able to proceed on approval of a final version of the manual (after consensus amongst the pathologists is achieved). The addition of an autopsy manual for Interior Health would be a welcome addition to ensure consistency throughout the Authority. I've started writing it but am a long way from completion on this one. With the prospect of QMPLS-like BC lab accreditation becoming a reality within the next 2-3 years, a Quality Manual will need to be a high priority very soon.
I was glad to receive an email from a fellow PA who was moving to BC from Ontario and was planning to look for employment in Vancouver or Victoria; he having found my address via this blog. I wish him luck (and welcome!).
I have probably mentioned at some time in the past that I had submitted a rather lengthy Request for Unit Values to the Canadian institute for Health Information (which is the federal body empowered with, among a ton of other things related to healthcare in Canada, the administration of the MIS Guidelines; which as all Lab Techs know is the reference to which our bosses refer, ideally, when doing things like billing or perhaps comparison studies of workload between groups, etc.). This Request (actually multiple Requests included in the same package) was submitted by myself and my Manager at the time, Mr. Roy Neifer, in 2002. After an initial period of enthusiasm and false optimism, I soon realized just how slowly the bureaucratic wheels turn in Ottawa. After a couple of calls within the first year inquiring as to the state of progress of my Request, I was told (my words) to stop calling. There are two issues (at least) at play here. First is the fact that all of the duties which PAs perform go essentially unnoticed (as far as workload units are concerned). As a result, any institution which employs PAs and which depends upon accurate reporting of workload units is not getting an accurate picture of its staff's workload. In essence, PAs are being supported by the efforts of others; or, an alternative view...the provincial Ministry is not receiving accurate accounting of that institution's workload.
Anyway, I figured that I had been patient enough after three years. I couldn't contain myself any longer so I contacted the CIHI and they were good enough to return my call. They were very polite and, as they had 3 years previously, assured me that my Request had been lumped together with a number of other major Requests; now part of a 'reform' of workload units. I shuddered at the thought of having my Request being considered along with a number of others. I told the CIHI that I believed, insofar as this Request, unlike most others, was a totally new Request, not a revision of existing workload units. I told them that although I did not expect any special treatment, that 1. some urgency ought to be given this because it was totally new and 2. that the process which was being used to consider other Requests ought not be applied to this Request because it would be doomed to fail. I elaborated upon the evolution of PAs and that they perform duties which have heretofore been the sole responsibility of physicians. I got silence; then a promise that I would receive a call from the CIHI in the fall (this fall). I'll be patient but I'll also be realistic. I don't think that this Request can honestly be considered until PAs have the recognition that they deserve; until they achieve national certification. Which brings me to my next subject...
If memory serves (I don't know...time sure does seem to fly!), it was in the 2003 CAP summer Newsletter wherein a Position Statement was published that recognized that PAs exist; that they provide a valuable addition to healthcare; that they should have an accredited training program; should be certified nationally and regulated provincially. Dr. Cook circulated nationally a questionnaire to all pathology departments with an aim to compiling a list of all of Canada's PAs (every PA to whom I have spoken within the last 6 months or so has told me that they have their name on the CAP's list. This is indeed encouraging). The CAP AGM was held in June, 2005 and one of the ad hoc meetings concerned PAs and the strategy to achieve their certification. My offer of volunteering to sit on a committee was well received. I have yet to hear any news (and would dearly appreciate hearing something).
On a more positive note, UBC is working on drawing-up a curriculum for PAs, with the assistance of a PA! Now that IS good news, I think. I believe that several universities will have curricula drawn up long before PA certification actually takes place considering the glacial pace at which this important issue is 'progressing.'
If, as I expect, the final curriculum will be something like a 4-year BSc with, perhaps, an internship year added afterwards, it will be interesting to see what becomes of The University of Manitoba's PA program, which was expected to graduate its first 2 (Masters-level) PAs this past spring.
Things at Kelowna General Hospital are going very well. I have almost completed the first draft of a surgical pathology manual. Once a Medical Director is hired, we'll be able to proceed on approval of a final version of the manual (after consensus amongst the pathologists is achieved). The addition of an autopsy manual for Interior Health would be a welcome addition to ensure consistency throughout the Authority. I've started writing it but am a long way from completion on this one. With the prospect of QMPLS-like BC lab accreditation becoming a reality within the next 2-3 years, a Quality Manual will need to be a high priority very soon.
I was glad to receive an email from a fellow PA who was moving to BC from Ontario and was planning to look for employment in Vancouver or Victoria; he having found my address via this blog. I wish him luck (and welcome!).
Tuesday, June 14, 2005
Not bad; not too bad
I thought I should check in; just in case some of you were wondering whether I had dropped off the face of the earth.
I am pleased to report that I am alive and well, living in the Okanagan (I even spelled it right!). I have been working at Kelowna General Hospital for just over a month. I am now doing all of the gross descriptions of the surgical specimens and am filling my spare time with writing a policy and procedure manual for surgical pathology (autopsy to come next). Some time after the Interior acquires a permanent Medical Director and s/he gets settled, etc. I'll present the manual for her/his amendments and/or approval. The manual was originally written -- by me -- (in the 80's) using Ackerman/Rosai but has undergone many amendments and improvements since that time. This manual will of course encorporate BCCA requirements which are specific to this province.
I am very pleased to report that things seem to be running rather smoothly. At first, there were a few administrative hiccups which briefly hampered optimal operations but now that procedures have become somewhat more routine, I dare say that day-to-day operations seem to be going smoothly and the turnaround time, from the clinicians [and patients'] perspective, is at least as good as it was prior to the enactment of the contingency plan at the beginning of May.
I am slowly but surely making friends (I sincerely hope that they see it this way also) amongst the Histotechnologists and the MLTs in the other labs at least recognize me now. I think I am convincing the Techs, and hopefully the Pathologists (if not others) that Pathologists' Assistants are not the ogre that they may have been made out to be. It is regrettable I suppose that the PAs were perceived to be the 'instrument of change,' at least in the eyes of the Pathologists and Techs. I am very appreciative of the maturity, professionalism and restraint shown by everyone in giving this new wrinkle a fighting chance. PAs, with the tolerance and support of the staff of the hospitals making up the IHA have made the difference, at least from where I sit, between keeping the division of anatomical pathology open for business, and closing the service completely. The latter scenario clearly would have been enough to induce genuine panic amongst the entire community, not to mention the staff of the entire hospital. Although I still sense some resentment on the part of some of the staff, I feel that they are realizing that the PAs are there, like them, primarily for the patient.
I think that the IHA ought to thank Marty Woods and Jennifer Rice BIG time for their efforts on behalf of the population of the Okanagan. They have, with amazing calm, managed to piece together a plan which is actually working and which will see us through until the IHA acquires sufficient personnel to once again stand alone and move ahead to a bright future of superlative care, academia and research. I see great things for the IHA as in the future it becomes a centre of excellence in British Columbia; training medical Residents in other services and (I hope) laboratory medicine for UBC. The production of papers for publication in peer-review journals is what, in part, will move the IHA ahead in the future. The staff will benefit by their collaboration with Residents in the production of these papers, regardless of how basic the papers may be. The involvement of the Technical staff (resulting in acknowlegements and co-authorships) induces involvement amongst the other staff and, like a wave over the deparment, convinces other staff to behave in like fashion. The involved staff have a new, revived perspective of their profession and of their routine work.
I expect that there will be other PAs hired at the IHA within the next several months. Hopefully, an intersted Histotechologist or two will come forward and will express an interest in learning how to dissect and describe the more complex surgicals and how to perform autopsies, write clinical histories, take photographs, etc.
A medical autopsy has not been performed in the IHA for over a month; clearly, we need to re-start this much-needed service (before it takes another nail in its coffin). I personally lament how the autopsy service was considered 'expendable.' I am positive that there are enlightened clinicians in the IHA who feel otherwise (although I must admit that I am somewhat surprised that I have not heard any comments to that effect).
I hope that Pathologists, Technologists and Clinicians in the IHA (and for that matter, elsewhere in BC) do not view PAs as a threat, but rather as colleagues who can help to provide the finest level of health care that the population can possibly get.
I am pleased to report that I am alive and well, living in the Okanagan (I even spelled it right!). I have been working at Kelowna General Hospital for just over a month. I am now doing all of the gross descriptions of the surgical specimens and am filling my spare time with writing a policy and procedure manual for surgical pathology (autopsy to come next). Some time after the Interior acquires a permanent Medical Director and s/he gets settled, etc. I'll present the manual for her/his amendments and/or approval. The manual was originally written -- by me -- (in the 80's) using Ackerman/Rosai but has undergone many amendments and improvements since that time. This manual will of course encorporate BCCA requirements which are specific to this province.
I am very pleased to report that things seem to be running rather smoothly. At first, there were a few administrative hiccups which briefly hampered optimal operations but now that procedures have become somewhat more routine, I dare say that day-to-day operations seem to be going smoothly and the turnaround time, from the clinicians [and patients'] perspective, is at least as good as it was prior to the enactment of the contingency plan at the beginning of May.
I am slowly but surely making friends (I sincerely hope that they see it this way also) amongst the Histotechnologists and the MLTs in the other labs at least recognize me now. I think I am convincing the Techs, and hopefully the Pathologists (if not others) that Pathologists' Assistants are not the ogre that they may have been made out to be. It is regrettable I suppose that the PAs were perceived to be the 'instrument of change,' at least in the eyes of the Pathologists and Techs. I am very appreciative of the maturity, professionalism and restraint shown by everyone in giving this new wrinkle a fighting chance. PAs, with the tolerance and support of the staff of the hospitals making up the IHA have made the difference, at least from where I sit, between keeping the division of anatomical pathology open for business, and closing the service completely. The latter scenario clearly would have been enough to induce genuine panic amongst the entire community, not to mention the staff of the entire hospital. Although I still sense some resentment on the part of some of the staff, I feel that they are realizing that the PAs are there, like them, primarily for the patient.
I think that the IHA ought to thank Marty Woods and Jennifer Rice BIG time for their efforts on behalf of the population of the Okanagan. They have, with amazing calm, managed to piece together a plan which is actually working and which will see us through until the IHA acquires sufficient personnel to once again stand alone and move ahead to a bright future of superlative care, academia and research. I see great things for the IHA as in the future it becomes a centre of excellence in British Columbia; training medical Residents in other services and (I hope) laboratory medicine for UBC. The production of papers for publication in peer-review journals is what, in part, will move the IHA ahead in the future. The staff will benefit by their collaboration with Residents in the production of these papers, regardless of how basic the papers may be. The involvement of the Technical staff (resulting in acknowlegements and co-authorships) induces involvement amongst the other staff and, like a wave over the deparment, convinces other staff to behave in like fashion. The involved staff have a new, revived perspective of their profession and of their routine work.
I expect that there will be other PAs hired at the IHA within the next several months. Hopefully, an intersted Histotechologist or two will come forward and will express an interest in learning how to dissect and describe the more complex surgicals and how to perform autopsies, write clinical histories, take photographs, etc.
A medical autopsy has not been performed in the IHA for over a month; clearly, we need to re-start this much-needed service (before it takes another nail in its coffin). I personally lament how the autopsy service was considered 'expendable.' I am positive that there are enlightened clinicians in the IHA who feel otherwise (although I must admit that I am somewhat surprised that I have not heard any comments to that effect).
I hope that Pathologists, Technologists and Clinicians in the IHA (and for that matter, elsewhere in BC) do not view PAs as a threat, but rather as colleagues who can help to provide the finest level of health care that the population can possibly get.
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