Physician Assistant
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These courses starting were mentioned during OP Med last week.
Basically, a PA in the military is a WO and hence requires the experience of 6-10 yrs of military service to achieve that rank.
There is little or no chance of PA becoming a officer MOC at this time.
But this course offers an intresting option for the Reserves. Recruit the students a Med Techs in their 1st or second yr, fast track them thru PLQ etc and upon their graduation they can be Sgts and WOs. Now you have university qualified PA in your units.
Basically, a PA in the military is a WO and hence requires the experience of 6-10 yrs of military service to achieve that rank.
There is little or no chance of PA becoming a officer MOC at this time.
But this course offers an intresting option for the Reserves. Recruit the students a Med Techs in their 1st or second yr, fast track them thru PLQ etc and upon their graduation they can be Sgts and WOs. Now you have university qualified PA in your units.
N
n1cfwe36
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Sorry to have to damper your vision, but you will not, or more importantly should not be fast tracked!
Why! Because you, and or your apprentice counterpart do not have the military leadership skills. This was discovered with the specialist's trades, such as OR Tech, Lab, X-Ray Tech, etc. where the base rank was downgraded to Corporal. On graduation they are promotion to MCpl, Spec 1 Pay.
Wonderful, one would say, and a great incentive for Occupational Transfer. However now you have an untrained Cpl/MCpl who has to go on their PLQ (JLC) course who (could) potentially be eaten up (by the Combat Arms Pers), because they are untrained in combat arms, and severely lack supervisory skills.
More importantly! I am/was a positive promoter of the direct entry process of trained civilian OR Tech's who could be enrolled as a Corporal and promoted to Master Corporal in 12 months. However, (to my dismay) they could potentially be eaten up on their PLQ course (ie: no leadership training), or even worst yet, in an operational deployment. (Actually, this was pointed out to me by a senior CWO within the Group).
I do appreciate the value of fast tracking Med Tech's (Med A's) and hopefully specialist, but there is evidence that this has not been a solution. (Which, I do think is correctable).
After examining these issues very carefully I think, we would end up with a lesser trained solider. Perhaps a good technician, but not a solider. Remember, â Å“A Solider First, A Tradesman Second)â ?
Please don't get me wrong. I am the greatest supporter, (and will continue to be) of hiring and recruiting Reservist/Ex-Reg Force. Especially trained Nurses & MO's and hopefully, in the near future the Specialist trades, ie: OR Technicians, etc. However the Reserves and CF must examine these issues and be careful of the consequences of doing so!
Why! Because you, and or your apprentice counterpart do not have the military leadership skills. This was discovered with the specialist's trades, such as OR Tech, Lab, X-Ray Tech, etc. where the base rank was downgraded to Corporal. On graduation they are promotion to MCpl, Spec 1 Pay.
Wonderful, one would say, and a great incentive for Occupational Transfer. However now you have an untrained Cpl/MCpl who has to go on their PLQ (JLC) course who (could) potentially be eaten up (by the Combat Arms Pers), because they are untrained in combat arms, and severely lack supervisory skills.
More importantly! I am/was a positive promoter of the direct entry process of trained civilian OR Tech's who could be enrolled as a Corporal and promoted to Master Corporal in 12 months. However, (to my dismay) they could potentially be eaten up on their PLQ course (ie: no leadership training), or even worst yet, in an operational deployment. (Actually, this was pointed out to me by a senior CWO within the Group).
I do appreciate the value of fast tracking Med Tech's (Med A's) and hopefully specialist, but there is evidence that this has not been a solution. (Which, I do think is correctable).
After examining these issues very carefully I think, we would end up with a lesser trained solider. Perhaps a good technician, but not a solider. Remember, â Å“A Solider First, A Tradesman Second)â ?
Please don't get me wrong. I am the greatest supporter, (and will continue to be) of hiring and recruiting Reservist/Ex-Reg Force. Especially trained Nurses & MO's and hopefully, in the near future the Specialist trades, ie: OR Technicians, etc. However the Reserves and CF must examine these issues and be careful of the consequences of doing so!
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Perhaps fast tracking is not the word that we are looking for here.
The way I read Armymedics post says that the medical reserves should put more emphasis on recruiting pers in their first years of medical training rather than on the high school student. If we can get a PCP student, Nurse, Pharmacist or Tec in while they are in school then we can develop the soldier skills while the civi institution develops the medical side.
To accomplish this we need several "officer other" positions so that we can go out and specifically targate these professions.
I believe this two birds with one stone approach can work.
The progression could look something like this.
University year one/reserves year one
-BMQ/SQ in garrison or CITY training on weekends
Summer one
- QL3/RESO
University year two/ Reserves year two
-OJT in unit
-Driver wheel course weekend
Summer two
-QL4/BCT(med)
University year three/ Reserves year three
-Promote to Corporal / Lt.
-Det commander/ Platoon commander
Summer three
- Tasking
- possible PLQ
- ICT or MOSC
University year four / Reserves year four
-PLQ mod 2-5 in garrison or CITY
-Instructor or Course O for CITY
Summer after convocation
PLQ Mod 6
-Instructor
ACT if avail
It is a fast and furious progression. I would love to see more time but it is doable. At the end you have a qualified medic/university qualified medical specialist who is MCpl or Capt qualified.
The down side is that it will not work for MOs. The reason is that while they may have some time to devote while in medical school, once they start their residencies they will have zero free time for army, courses or even parade nights. For this reason we need to target MOs once they are out and practicing.
What we need IMO is a dramatic shift in the way we recruit, make BMQ/SQ available. Once we get them in the door early we can develop them and assist them with school with a part time job.
The way I read Armymedics post says that the medical reserves should put more emphasis on recruiting pers in their first years of medical training rather than on the high school student. If we can get a PCP student, Nurse, Pharmacist or Tec in while they are in school then we can develop the soldier skills while the civi institution develops the medical side.
To accomplish this we need several "officer other" positions so that we can go out and specifically targate these professions.
I believe this two birds with one stone approach can work.
The progression could look something like this.
University year one/reserves year one
-BMQ/SQ in garrison or CITY training on weekends
Summer one
- QL3/RESO
University year two/ Reserves year two
-OJT in unit
-Driver wheel course weekend
Summer two
-QL4/BCT(med)
University year three/ Reserves year three
-Promote to Corporal / Lt.
-Det commander/ Platoon commander
Summer three
- Tasking
- possible PLQ
- ICT or MOSC
University year four / Reserves year four
-PLQ mod 2-5 in garrison or CITY
-Instructor or Course O for CITY
Summer after convocation
PLQ Mod 6
-Instructor
ACT if avail
It is a fast and furious progression. I would love to see more time but it is doable. At the end you have a qualified medic/university qualified medical specialist who is MCpl or Capt qualified.
The down side is that it will not work for MOs. The reason is that while they may have some time to devote while in medical school, once they start their residencies they will have zero free time for army, courses or even parade nights. For this reason we need to target MOs once they are out and practicing.
What we need IMO is a dramatic shift in the way we recruit, make BMQ/SQ available. Once we get them in the door early we can develop them and assist them with school with a part time job.
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From the McGill University Health Center Website:
January 2005
Innovative teaching program receives accreditation
It's not uncommon to find military medical personnel nestled within the ranks of students learning medicine at the Montreal General Hospital (MGH). Seven years ago the MGH site of the McGill University Health Centre (MUHC) opened its doors to a novel military medical training program that provides hands-on clinical experience to Canadian Forces personal preparing to become physician assistants.
The Canadian Medical Association recently granted a two-year accreditation status to the military's physician assistant program. On November 18, the Canadian Forces Medical Services School recognized the MGH for its commitment and contributions by presenting a certificate of accreditation to Dr. Arthur T. Porter, Director General and CEO of the MUHC, and Dr. Françoise Chagnon, MUHC director of Professional Services. "The MUHC is proud to be a designated site for the clinical training of physician assistants," said Chagnon during the presentation..........
http://www.muhc.ca/media/ensemble/2005jan/teaching/
January 2005
Innovative teaching program receives accreditation
It's not uncommon to find military medical personnel nestled within the ranks of students learning medicine at the Montreal General Hospital (MGH). Seven years ago the MGH site of the McGill University Health Centre (MUHC) opened its doors to a novel military medical training program that provides hands-on clinical experience to Canadian Forces personal preparing to become physician assistants.
The Canadian Medical Association recently granted a two-year accreditation status to the military's physician assistant program. On November 18, the Canadian Forces Medical Services School recognized the MGH for its commitment and contributions by presenting a certificate of accreditation to Dr. Arthur T. Porter, Director General and CEO of the MUHC, and Dr. Françoise Chagnon, MUHC director of Professional Services. "The MUHC is proud to be a designated site for the clinical training of physician assistants," said Chagnon during the presentation..........
http://www.muhc.ca/media/ensemble/2005jan/teaching/
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Armymedic said:
Okay this is good. But what happens to the man-management skiills and most important of all the medical experience that you get with TI. I for one would like to see junior trades persons get the opportunity to advance but not at the expense of the profession and the quality of care that is given to the solider,sailor or airman. If anything there should be minimum requirements to be given the opportunity to attend this course and not just merit listing.
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Just to bring another thought to this thread,
In the McGill article I placed a link to above, I think the statement about the military PA course being
accredited by the Canadian Medical Association (CMA) is very significant.
I think this is going to bring CFMG to a crossroad eventually. The number of PA's currently with CFMG
is very small. As universities become accredited by CMA to teach, the number of civilian PA's in this country
will quickly dwarf those trained by the military.
This probably means that sooner or later, CFMG is going to be faced with an applicant or existing NCO who
comes in the door qualified as a PA with a sheep skin from a major university. Probably in combination with
an RN degree or an ACP/CCP diploma.
The first time this happens or possibly at some point before this happens, someone will have to look very
carefully at the whole Med Tech trade again. CFMG won't be able to ignore medical qualifications recognized
by a professional governing body and the Canadian Medical Association. The current Medical Service Instructions
(MSI's) already outline a process for equating civilian paramedics with the NCO TQ/QL to just below PA level.
The qualification of PA was generally restricted to the CFMS. Inside that structure, time in and rank could be set
out before you achieved that skill set. With civilian PA's just ahead, the day a junior NCO walks in qualified PA
will logically follow.
In the McGill article I placed a link to above, I think the statement about the military PA course being
accredited by the Canadian Medical Association (CMA) is very significant.
I think this is going to bring CFMG to a crossroad eventually. The number of PA's currently with CFMG
is very small. As universities become accredited by CMA to teach, the number of civilian PA's in this country
will quickly dwarf those trained by the military.
This probably means that sooner or later, CFMG is going to be faced with an applicant or existing NCO who
comes in the door qualified as a PA with a sheep skin from a major university. Probably in combination with
an RN degree or an ACP/CCP diploma.
The first time this happens or possibly at some point before this happens, someone will have to look very
carefully at the whole Med Tech trade again. CFMG won't be able to ignore medical qualifications recognized
by a professional governing body and the Canadian Medical Association. The current Medical Service Instructions
(MSI's) already outline a process for equating civilian paramedics with the NCO TQ/QL to just below PA level.
The qualification of PA was generally restricted to the CFMS. Inside that structure, time in and rank could be set
out before you achieved that skill set. With civilian PA's just ahead, the day a junior NCO walks in qualified PA
will logically follow.
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True if and when the Universities start this program it will more than likely outstrip the CF. Then again it will allow the CF to use their facilities and educators Vs us doing it. With this I believe we will get a better PA. As the program will use the medical facialties associated with the university allowing for a more in-depth and consistant training package.old medic said:
As for excepting those with qualifications already. I hope that, that does not happen. As for RN with PA like qualification they are called Nurse Practitioner's. The day this happens you can kiss the rank of private solider good by, if you think nothing gets done now wait for this day. Remember it is the private solider that does all the SLJ's. By promoting within the profession we keep those Jr NCM interested. Lets not forget you may be a PA/Med Tech but you are also a Solider, Sailor or Airman and those skill can't be taught in no University.
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JAFMA said:
Please clarify, are you referring to those with a skill set comming in directly or are you refferring to accepting NPs directly.
If you are referring to the later, how does a NP as an officer eliminate the private soldier? Yes we need medtecs but how does an NO with a higher skill set eliminate the need?
As well, if we were to accept PAs directly in with the degree, how is it different from accepting an MD in with advanced practice or a CCNO?
If they have the clinician skill set but no command authority I see no differentiation. Perhaps the easies thing to do would be to give those with command authority an identifier on the uniform. Like a Cpl who is in a leadership position, MCpl.
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Just to clarify, I see PA as the final step in the PCP/ACP/CCP progression, not the RN progression. I've worked with
a PCP/Nurse Practitioner in the past, and have a PCP/RN working with me currently.
I blurred those two lines on purpose, based on the people I know who are both Nurses and Paramedics.
Cheers
a PCP/Nurse Practitioner in the past, and have a PCP/RN working with me currently.
I blurred those two lines on purpose, based on the people I know who are both Nurses and Paramedics.
Cheers
There can be little doubt that post secondary institutions will eventually offer Physician Assistant training. This parallels the American experience where the military started the occupation. The civillian health care sector soon realized the value of these physician extenders and began to train PAs at civ Universities. The US military also continued to conduct PA trg at Fort Sam Houston. PAs in US military were promoted Warrant Officer on completion of trg. The rank progression was CW1 to CW4. In mid 90s the US military made PA a commissioned officer occupation. They have been accepting grads of civ programmes for years. This is no different than the CF accepting Engineers with a degree from a civ university vice RMC. I fully expect that we will accept PAs form civ schools in the future, in fact , I believe our programme will give way to those conducted by the medical faculty of civ universities.
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This is a more than likely to happen regarding PA's, they will be trained at Civilian Universities, that is a given.
However don't assume that they are going to run and join the military with this new found skill. Take a look at the MD's that are out there. Then go to a recruiting center and see how many of them are breaking down the door to get in, my understanding is not a hell of a lot and the same goes for nurses. Hell most of them don't want to leave the big city centers and go to the small cities in northern Ontario or wherever. Besides I think the lot of you are missing the point. We have to promote this within our own. And the only way we are going to do that is with the young Med Tech's advancing and attaining his/her PCP/ACP/CCP in a good and timely manner. Not waiting until they have just 4 - 5 years left in the CF. Along with this advancement they will attain the required experience both in the medical field with hands on and within the military field in both operational exposure and man managemen exposure. These last two skills are gained by going on operations and through leadership course. Remember people leadership is taught no one is born with it.
As to the reference of NP/RN's this was in regards to what Old Medic suggested
"This probably means that sooner or later, CFMG is going to be faced with an applicant or existing NCO who comes in the door qualified as a PA with a sheep skin from a major university. Probably in combination with an RN degree or an ACP/CCP diploma".
I was referring to the fact that if people joined with these skill sets as Jr tradespersons we would end up with a situation we had a few years ago and that is not having any private soldiers in any Field Ambulances or Base clinics. As for having command Identifiers we already have that. It is called the rank structure.
We have to stop using the Amercians as an example. Sure we can look at what they have done, but we should model our system in our own way. This is by no way re-inventing the wheel just improving on it.
Anyway to sum it up we have to fix this problem from within the branch and not from the outside. We have to make it so that people will want to take this course and serve the service, and not leave when it looks greener on the the other side. Maybe we should take another read of what ORT stated, I think he may be on to something there.
However don't assume that they are going to run and join the military with this new found skill. Take a look at the MD's that are out there. Then go to a recruiting center and see how many of them are breaking down the door to get in, my understanding is not a hell of a lot and the same goes for nurses. Hell most of them don't want to leave the big city centers and go to the small cities in northern Ontario or wherever. Besides I think the lot of you are missing the point. We have to promote this within our own. And the only way we are going to do that is with the young Med Tech's advancing and attaining his/her PCP/ACP/CCP in a good and timely manner. Not waiting until they have just 4 - 5 years left in the CF. Along with this advancement they will attain the required experience both in the medical field with hands on and within the military field in both operational exposure and man managemen exposure. These last two skills are gained by going on operations and through leadership course. Remember people leadership is taught no one is born with it.
As to the reference of NP/RN's this was in regards to what Old Medic suggested
"This probably means that sooner or later, CFMG is going to be faced with an applicant or existing NCO who comes in the door qualified as a PA with a sheep skin from a major university. Probably in combination with an RN degree or an ACP/CCP diploma".
I was referring to the fact that if people joined with these skill sets as Jr tradespersons we would end up with a situation we had a few years ago and that is not having any private soldiers in any Field Ambulances or Base clinics. As for having command Identifiers we already have that. It is called the rank structure.
We have to stop using the Amercians as an example. Sure we can look at what they have done, but we should model our system in our own way. This is by no way re-inventing the wheel just improving on it.
Anyway to sum it up we have to fix this problem from within the branch and not from the outside. We have to make it so that people will want to take this course and serve the service, and not leave when it looks greener on the the other side. Maybe we should take another read of what ORT stated, I think he may be on to something there.
The initial concept did not envisage every medic becoming a PA. The medical branch needs to identify the hard PA positions i.e. Bn UMS vice an MO There would be 2 career streams: Med Tech/PA. Those Med techs who do not meet the pre-requisites for PA or who are not interested in the employment, would be able to continue to progress to MWO/CWO as a Med Tech. Does the CSM Evac Coy need to be a PA? Probably not. He/she needs to be a competent, up to date and very experienced Primary Care or Advanced care paramedic. The UMS could employ a PA as senior clinician and a Sgt Med Tech (PCP with experience) as the 2i/c. This system would also allow for direct entry PAs from civ Universities when this becomes a reality.
All too often in the past we maintained our competence only by virtue of attending another course QL3/4/5/6A/6B. We often went to positions that did not allow for any clinical experience...med fin clerk at Bhosp/med records NCO at HQ etc.
I believe 2 career streams will work.
All too often in the past we maintained our competence only by virtue of attending another course QL3/4/5/6A/6B. We often went to positions that did not allow for any clinical experience...med fin clerk at Bhosp/med records NCO at HQ etc.
I believe 2 career streams will work.
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http://www.chroniclejournal.com/story.shtml?id=28648
Prescription for North: help from military
By Jim Kelly - The Chronicle-Journal
August 27, 2005
Dr. Jack Remus has an idea on how to relieve the physician shortage in Northern Ontario.
Remus, an orthopedic surgeon, would like to see physician assistants, who are currently members of the Canadian Armed Forces, posted to communities with doctor shortages for periods of six to 12 weeks.
They would work in the emergency departments which are presently covered by locums or temporary doctors.
Once their period is up, they would be relieved by other assistants again for six to 12 weeks.
Remus said the assistants are trained to take a medical history, perform physical exams, make basic diagnoses, order lab tests or X-rays and prescribe some treatments.
He said they currently provide medical services to Canadian soldiers in major centres.
Remus said he wouldn't expect the assistants to bring their families with them as they would be only short-term replacements. Their salaries would be paid by the Canadian military.
"It's a win-win situation," Remus said in a recent interview.
"By utilizing physician assistants in Northern Ontario, all parties win.
"The physician assistants receive further medical, surgical and pediatric training which they would otherwise probably not obtain.
"And the physicians in these communities who are usually short-staffed would receive well-trained assistants who could cover for them (particularly at night) and could then call them at home for any emergencies that may occur."
Even the provincial College of Physicians and Surgeons thinks physician assistants working in northern communities is a good idea.
But there is a problem.
"We'd like the provincial government to develop and implement a physician assistant program," said Kathryn Clarke, the college's senior communications co-ordinator.
But liability insurance is not available for this group if they work a community context, she said.
Also, Clarke said, physician assistants aren't regulated the way other health-care professionals are.
"There would need to be a change to the current Regulated Health Professions Act," she said.
In Manitoba, the only province that regulates them, they are known as clinical assistants.
Remus has run his suggestion past local MPPs. One has discussed the idea with federal Defence Minister Bill Graham.
"The two levels of government have to get together and utilize something that is already in place," Remus said.
Liberal MPP Michael Gravelle (Thunder Bay-Superior North) said he wrote to provincial Health Minister George Smitherman about the assistants.
"It's a good idea," Gravelle said.
"It has real practical applications. Hopefully this can some to something."
Remus has been associated with the Canadian Armed Forces for 25 years and has been a medical officer with various units, including the Toronto 4th Field Artillery and ultimately the medical units in Thunder Bay, where he eventually became commanding officer.
Prescription for North: help from military
By Jim Kelly - The Chronicle-Journal
August 27, 2005
Dr. Jack Remus has an idea on how to relieve the physician shortage in Northern Ontario.
Remus, an orthopedic surgeon, would like to see physician assistants, who are currently members of the Canadian Armed Forces, posted to communities with doctor shortages for periods of six to 12 weeks.
They would work in the emergency departments which are presently covered by locums or temporary doctors.
Once their period is up, they would be relieved by other assistants again for six to 12 weeks.
Remus said the assistants are trained to take a medical history, perform physical exams, make basic diagnoses, order lab tests or X-rays and prescribe some treatments.
He said they currently provide medical services to Canadian soldiers in major centres.
Remus said he wouldn't expect the assistants to bring their families with them as they would be only short-term replacements. Their salaries would be paid by the Canadian military.
"It's a win-win situation," Remus said in a recent interview.
"By utilizing physician assistants in Northern Ontario, all parties win.
"The physician assistants receive further medical, surgical and pediatric training which they would otherwise probably not obtain.
"And the physicians in these communities who are usually short-staffed would receive well-trained assistants who could cover for them (particularly at night) and could then call them at home for any emergencies that may occur."
Even the provincial College of Physicians and Surgeons thinks physician assistants working in northern communities is a good idea.
But there is a problem.
"We'd like the provincial government to develop and implement a physician assistant program," said Kathryn Clarke, the college's senior communications co-ordinator.
But liability insurance is not available for this group if they work a community context, she said.
Also, Clarke said, physician assistants aren't regulated the way other health-care professionals are.
"There would need to be a change to the current Regulated Health Professions Act," she said.
In Manitoba, the only province that regulates them, they are known as clinical assistants.
Remus has run his suggestion past local MPPs. One has discussed the idea with federal Defence Minister Bill Graham.
"The two levels of government have to get together and utilize something that is already in place," Remus said.
Liberal MPP Michael Gravelle (Thunder Bay-Superior North) said he wrote to provincial Health Minister George Smitherman about the assistants.
"It's a good idea," Gravelle said.
"It has real practical applications. Hopefully this can some to something."
Remus has been associated with the Canadian Armed Forces for 25 years and has been a medical officer with various units, including the Toronto 4th Field Artillery and ultimately the medical units in Thunder Bay, where he eventually became commanding officer.
medicineman
Army.ca Legend
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I believe 2 career streams will work.
I seem to remember a few years back that we were supposed to be heading in that direction - you hit the rank of Sgt and make a decision to go PA and be clinical or become a 719 Health Services Manager if you wanted to be a Sgt Maj type. In alot of respects, that made (and still makes) sense - likely the reason why it didn`t occur I guess. Let`s face it - what happens to these people when they finish 2 years of hard clinical training - they end up looking after sick DA`s instead of people. A bit of a waste of time and tax payers` money if you ask me, forget about the waste of talent. We do need people in senior leadership positions with the experience, materiel and man management skills, who are great leaders but also like doing tht sort of thing. Some people like the clinical aspect of their work more than Sgt Maj side and should stream that way, just as those who were cut out for Sgt Maj ship should go in that direction. Those that are cut out for both can branch back onto whatever road they didn`t choose at a later time.
My $0.02.
MM
I seem to remember a few years back that we were supposed to be heading in that direction - you hit the rank of Sgt and make a decision to go PA and be clinical or become a 719 Health Services Manager if you wanted to be a Sgt Maj type. In alot of respects, that made (and still makes) sense - likely the reason why it didn`t occur I guess. Let`s face it - what happens to these people when they finish 2 years of hard clinical training - they end up looking after sick DA`s instead of people. A bit of a waste of time and tax payers` money if you ask me, forget about the waste of talent. We do need people in senior leadership positions with the experience, materiel and man management skills, who are great leaders but also like doing tht sort of thing. Some people like the clinical aspect of their work more than Sgt Maj side and should stream that way, just as those who were cut out for Sgt Maj ship should go in that direction. Those that are cut out for both can branch back onto whatever road they didn`t choose at a later time.
My $0.02.
MM
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