Military's physician assistants seek to help treat civilians

Certification granted to physician assistants in Canada's military, where they diagnose, treat and prescribe with MD's supervision.

Physician assistants may become a more familiar sight at hospitals across the country, as the health-care professionals sometimes called the best-kept medical secret in the Canadian Forces seek a greater role in the public health system.

The 127 physician assistants treating Canadian soldiers on relief operations and peacekeeping missions the world over act as a second set of eyes and hands for doctors. They are trained to take a medical history, perform physical exams, make basic diagnoses, order lab tests or X-rays, and prescribe some treatments.

Some 60,000 physician assistants work in the United States, but in Canada, only the military uses their services. Although there is no civilian equivalent, their job description resembles that of a nurse practitioner.

Though the military was the only place that certifies them in Canada, the Canadian Medical Association has granted them recognition them as well.

CMA accreditation means the training program for physician assistants meets a national standard of education for the profession.

In Manitoba, the only province that regulates them, the health-care professionals are known as clinical assistants.

The Canadian Forces have used physician assistants as part of their medical teams for about 50 years – since the Korean War. Doctors supervise physician assistants, although the physicians may not always be present.

"Sometimes the physician is with the PA," said Dr. Pierre Ozon, a former military physician who now acts as medical director for physician assistant training at the Canadian Forces Medical Services School. "However, sometimes the physician's only way of communicating with the PA is through things like satellite phones."

Medical training

Soldiers with at least 10 years of military experience and a background as a medical assistant or paramedic are eligible to take physician assistant training in Canada.

Up to 24 Canadian Forces personnel are trained each year. Their training consists of one year of medical theory at CFB Borden in Ontario, then another year of clinical rotations at eight civilian hospitals across Canada.

During rounds at civilian hospitals, trainees learn about trauma, family medicine, ear, nose and throat specializations, general surgery, internal medicine, sports medicine and orthopedics.

Ozon said the physician assistant model has worked well in the military but one hurdle to expanding their role in health care is there is no civilian equivalent to compare their training to. The legal liability for physicians supervising them also needs to be resolved.

Physician assistants aim to be recognized by civilians so they can help to fill the country's gap of health-care staff, said Chief Warrant Officer Robert Sylvestre, medical branch officer for the Canadian Forces.

A group of physician assistants is now in training at Montreal General Hospital, where the officers say they're often mistaken for doctors wearing scrubs.