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.
Tuesday, June 14, 2005
Tuesday, May 10, 2005
'Interesting' Times
It's true; I've accepted a position as a PA at Kelowna General Hospital. I'm in my 2nd week. There are PAs in Vernon and Penticton as well.
Anyone who is interested in helping out, please contact me ASAP (william.stinson@interiorhealth.ca).
We're surviving without the use of the slide digitizer and without the use of the web cam. Pathologists are providing frozen section service, at least for the time-being. A temporary Medical Director is in place. Replacement Pathologists are being sought (including an offer to the out-going Docs to accept a revised contract which stipulated, among other things, the use of PAs).
Since I have arrived, I have been interested (but not surprised) to learn that Cytotechnologists have not been utilized in this region for screening to the extent that they are everywhere else. FNAs are accessioned as surgicals and the slides [used to] go directly to the Pathologist. The utilization of Cytotechs for screening will likely be a permanent change for the future, much like the use of PAs.
There are other, more far-reaching changes that will be put into place as a result of the recent failed negotiations; affecting the other clinical labs.
There was a rumour that the PAs at Interior Health were not being paid within the union grid. This is not true. They are being paid at the level III.
I am glad that slowly-but-surely, I am being accepted among the group. The emotion built up as a result of this issue is not surprising at all. I'm pleased to see that I have not been specifically targetted by the Technologists (although I'd be lying if I told you that I'm immune to the obvious feelings surrounding me each day).
Please contact me if you are an experienced PA who would like to help us out for a few weeks or more and would like to find out what the Okanagan is like; possibly on a more permanent basis.
Anyone who is interested in helping out, please contact me ASAP (william.stinson@interiorhealth.ca).
We're surviving without the use of the slide digitizer and without the use of the web cam. Pathologists are providing frozen section service, at least for the time-being. A temporary Medical Director is in place. Replacement Pathologists are being sought (including an offer to the out-going Docs to accept a revised contract which stipulated, among other things, the use of PAs).
Since I have arrived, I have been interested (but not surprised) to learn that Cytotechnologists have not been utilized in this region for screening to the extent that they are everywhere else. FNAs are accessioned as surgicals and the slides [used to] go directly to the Pathologist. The utilization of Cytotechs for screening will likely be a permanent change for the future, much like the use of PAs.
There are other, more far-reaching changes that will be put into place as a result of the recent failed negotiations; affecting the other clinical labs.
There was a rumour that the PAs at Interior Health were not being paid within the union grid. This is not true. They are being paid at the level III.
I am glad that slowly-but-surely, I am being accepted among the group. The emotion built up as a result of this issue is not surprising at all. I'm pleased to see that I have not been specifically targetted by the Technologists (although I'd be lying if I told you that I'm immune to the obvious feelings surrounding me each day).
Please contact me if you are an experienced PA who would like to help us out for a few weeks or more and would like to find out what the Okanagan is like; possibly on a more permanent basis.
Friday, April 01, 2005
PAs in BC
PAs are all the buzz in BC these days. Fraser Valley Health Authority and The Interior Health Authority are both 'looking.' It seems that the Pathologists are reducing or nearly-eliminating their level of service in the two regions and the hospitals are scrambling to find some experienced individuals capable of dissecting more complex surgical specimens. Histotechs are currently handling the less-complex specimens.
The Interior HA has a really novel idea (has been done in a few centres; mostly in the USA) about using telepathology to perform frozen sections. It's a natural (if it works well) for multi-site hospitals which may not have Pathologists on staff. The scenario is one where a PA (possibly accompanied by a Histotechnologist) will go to the frozen section room (in the OR usually) instead of the Pathologist, who may be many miles away. Via a secure web cam, the PA will describe and dissect the specimen under the watchful eye of the Pathologist. Either the PA or the Histotech will perform the frozen section and the slide will be reviewed remotely by the Pathologist; manipulated on the stage at her/his direction. The PA will write (and sign on behalf of the Pathologist) the microscopic description and the diagnosis. Pretty neat, eh?! For the hospitals, this presents an opportunity for a significant saving in that the PA, rather than the Pathologist, will be travelling (and waiting if necessary); will be present at the F/S and will be paid substantially less per unit time. For the majority of cases wherein there is a single slide, the healthcare system stands to save substantially. There will be no discernable reduction in turnaround time or quality control.
I haven't discussed how autopsies will be handled yet but will soon learn what their plans are.
Fraser Valley HA is in a slightly less frantic situation wherein the Pathologists are reducing their level of service. As a result, they are looking at starting from the grassroots level and plan, in full consultation with the BC health ministry, to set-up a PA training program. It is my understanding that they hope (unlike Winnipeg which has a Masters-level program) to set-up a BSc-level program, probably with a 1-year post-grad practicum. I think they hope to do this at UBC.
Needless to say, the PAs will justifiably achieve a higher standing than MLTs; I believe their intent is to pay the PAs at least two levels higher on the same (unionized) pay scale. All of this is in its infancy and subject to considerable change as time progresses. The time line, however will seem to go at the speed of light compared to anything that has happened elsewhere in the country over the last 30+ years.
I sincerely hope that the organizers in BC keep the CAP apprised of their progress, especially in regards their training program. The CMA Accreditation Office can provide important direction in the formulation of a curriculum based upon the core expectations (essentially the job description) of PAs. As a result, BC may have the first nationally-accredited PA training program.
I may have more to say on the subject of telepathology in a week's time. A demonstration is being held in Kelowna in a few days' time and I'll be there with the Director of The Interior HA. I'll be able to consider trying to 'sell' my own Director at The Ottawa Hospital on the idea of telepathology as we too are a multi-site hospital with numerous client hospitals at a distance from Ottawa.
It has been good to make contact with several PAs across the country recently. I feel a slow re-kindling of enthusiasm for the certification issue. I am very very appreciative of the CAP's efforts thus far. Please remember to ask every PA who you know whether or not they have received and replied to the letter from Dr. Cook (Pres. of the CAP).
The Interior HA has a really novel idea (has been done in a few centres; mostly in the USA) about using telepathology to perform frozen sections. It's a natural (if it works well) for multi-site hospitals which may not have Pathologists on staff. The scenario is one where a PA (possibly accompanied by a Histotechnologist) will go to the frozen section room (in the OR usually) instead of the Pathologist, who may be many miles away. Via a secure web cam, the PA will describe and dissect the specimen under the watchful eye of the Pathologist. Either the PA or the Histotech will perform the frozen section and the slide will be reviewed remotely by the Pathologist; manipulated on the stage at her/his direction. The PA will write (and sign on behalf of the Pathologist) the microscopic description and the diagnosis. Pretty neat, eh?! For the hospitals, this presents an opportunity for a significant saving in that the PA, rather than the Pathologist, will be travelling (and waiting if necessary); will be present at the F/S and will be paid substantially less per unit time. For the majority of cases wherein there is a single slide, the healthcare system stands to save substantially. There will be no discernable reduction in turnaround time or quality control.
I haven't discussed how autopsies will be handled yet but will soon learn what their plans are.
Fraser Valley HA is in a slightly less frantic situation wherein the Pathologists are reducing their level of service. As a result, they are looking at starting from the grassroots level and plan, in full consultation with the BC health ministry, to set-up a PA training program. It is my understanding that they hope (unlike Winnipeg which has a Masters-level program) to set-up a BSc-level program, probably with a 1-year post-grad practicum. I think they hope to do this at UBC.
Needless to say, the PAs will justifiably achieve a higher standing than MLTs; I believe their intent is to pay the PAs at least two levels higher on the same (unionized) pay scale. All of this is in its infancy and subject to considerable change as time progresses. The time line, however will seem to go at the speed of light compared to anything that has happened elsewhere in the country over the last 30+ years.
I sincerely hope that the organizers in BC keep the CAP apprised of their progress, especially in regards their training program. The CMA Accreditation Office can provide important direction in the formulation of a curriculum based upon the core expectations (essentially the job description) of PAs. As a result, BC may have the first nationally-accredited PA training program.
I may have more to say on the subject of telepathology in a week's time. A demonstration is being held in Kelowna in a few days' time and I'll be there with the Director of The Interior HA. I'll be able to consider trying to 'sell' my own Director at The Ottawa Hospital on the idea of telepathology as we too are a multi-site hospital with numerous client hospitals at a distance from Ottawa.
It has been good to make contact with several PAs across the country recently. I feel a slow re-kindling of enthusiasm for the certification issue. I am very very appreciative of the CAP's efforts thus far. Please remember to ask every PA who you know whether or not they have received and replied to the letter from Dr. Cook (Pres. of the CAP).
Sunday, March 06, 2005
Spreading The Word
Surprise! All hospitals and referral centres have yet to hear of Pathologists' Assistants (and their merits). It seems there are still some places where Pathologists are spending hours (and their employers paying their salaries) performing tasks which can easily be handled by PAs. Interestingly, the Pathologists are complaining about how hard they're working; are threatening job action unless additional resources are provided, and yet they have not considered delegating significant portions of their work to PAs and Technologists.
I have come to the conclusion (much like London HSC) that a fully-trained PA ought to spend most of her/his time handling the more complex surgicals and performing medical autopsies. The less-challenging surgicals (eg. GI biopsies) can easily be handled by Technologists. I also believe (again, London's way ahead on this one) that PAs ought to have a minimum of a BSc (whereas obviously, MLTs are college-trained).
I have a meeting with a representative of a British Columbia hospital pathology department in a week's time. They have never used PAs and are investigating their value. My job, based on The Ottawa Hospital's 30 year experience (and London's), will be to convince them that they should hire PAs with a BSc and to save the small surgicals, etc. for their Junior Prosector (rather than training the Junior Prosector to be a PA). Time is of the essence; the province is pushing for a major revision in the structure of healthcare and managers are mandated to cut costs.
I have to wonder how many other major centres continue to have highly-paid MDs performing the tasks which, at many centres, are delegated to PAs? Please let me know if you are aware of any by submitting a comment to this post.
I have come to the conclusion (much like London HSC) that a fully-trained PA ought to spend most of her/his time handling the more complex surgicals and performing medical autopsies. The less-challenging surgicals (eg. GI biopsies) can easily be handled by Technologists. I also believe (again, London's way ahead on this one) that PAs ought to have a minimum of a BSc (whereas obviously, MLTs are college-trained).
I have a meeting with a representative of a British Columbia hospital pathology department in a week's time. They have never used PAs and are investigating their value. My job, based on The Ottawa Hospital's 30 year experience (and London's), will be to convince them that they should hire PAs with a BSc and to save the small surgicals, etc. for their Junior Prosector (rather than training the Junior Prosector to be a PA). Time is of the essence; the province is pushing for a major revision in the structure of healthcare and managers are mandated to cut costs.
I have to wonder how many other major centres continue to have highly-paid MDs performing the tasks which, at many centres, are delegated to PAs? Please let me know if you are aware of any by submitting a comment to this post.
Tuesday, February 22, 2005
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.
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.
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.).
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