Nova Scotia looks to get physician assistants into primary-care clinics

It was always Stephanie Konway’s goal to return home to work in Nova Scotia. But when she enrolled in the physician assistant program at McMaster University in Hamilton, Ont., she was training for a career that her home province did not recognize.

Then Nova Scotia launched a pilot program in 2019, adding three physician assistants in the orthopedic surgery division at the QEII Health Sciences Center in Halifax, and Konway sensed the beginning of a path back to the province.

“I knew for sure that, eventually, that would expand,” she said in an interview.

Konway would be proven right shortly after he graduated in 2021.

While working in Ontario, where physician assistants have long been integrated into the health-care system, Konway learned that Nova Scotia was adding four physician assistants in the emergency departments of both Dartmouth General Hospital and South Shore Regional Hospital in Bridgewater.

‘It’s been fantastic’

Today, she’s one of the people working at Dartmouth General.

“It’s been fantastic,” Konway said. “We’ve had a great working relationship so far.”

Physician assistants, or PAs, are trained in the medical school model and practice medicine under the supervision of a licensed doctor. They can handle straightforward cases, order and review tests, assist in surgery and prescribe some medications. The idea is for the role to help give doctors more time to focus on more complex cases.

After years of resistance to introducing the role in this province, an official with Nova Scotia Health says there are big plans to get them working in other emergency departments and primary-care clinics.

“The strongest health systems are where primary health care is really the foundational place for everything,” said Tara Sampalli, a senior director with the provincial health authority.

Promise of increasing access to care

In a province that has more than 145,000 people on a registry awaiting a family doctor or nurse practitioner, the provincial government is looking for any way to get more people access to care.

Sampalli said the initiative to bring more PAs to the province was part of that process, as is the recent news that Dalhousie University is working to launch a physician-assistant training program of its own.

“If you’re able to build [physician assistants] into the primary-care practices, we’d be able to see more people. We’ll be able to see more people sooner and get [them] the care they need.”

Dr. Todd Howlett, an emergency department doctor who works at Dartmouth General and the health authority’s medical director of innovation, said he experienced the benefits of a PA during a recent shift.

Howlett was already familiar with the role from his time in the military, where PAs have been widely used for years.

“It’s quite powerful when it works,” he said. “It allows us to see more patients. More patients to get care. It improves access.”

Howlett said the response from doctors working in primary-care clinics where there are plans to place PAs “has been overwhelming.”

“They really are interested.”

Konway said how PAs would be used in a primary-care setting would depend on the needs of a given practice. They can handle more straightforward cases so that doctors can focus on complex patients. But they can also provide options for patients who need to discuss a sensitive medical matter.

“If you have a male physician, a lot of female care can be done by female physician assistants, if the patient is more comfortable with that,” she said.

“So it’s really practice dependent, but there’s a lot of different ways that we can use.”