Experience with physician assistants in a Canadian arthroplasty program
Eric R. Bohm, BEng, MD, MSc,* Michael Dunbar, MD, PhD,† David Pitman, MBA, MPH,‡ Chris Rhule, MHS, PA-C/CA (Cert.),§ and Jose Araneta, MD§Hip Knee
Background
Recent increases in orthopedic surgical services in Canada have added further demand to an already stretched orthopedic workforce. Various initiatives have been undertaken across Canada to meet this demand. One successful model has been the use of physician assistants (PAs) within the Winnipeg Regional Health Authority (WRHA). This study documents the effect of PAs working in an arthroplasty practice from the perspective of patients and health care providers. We also describe the costs, time savings for surgeons and the effects on surgical throughput and waiting times.
Methods
We calculated time savings by the use of a daily diary kept by the PAs. Surgeons’, residents’, nurses’ and patients’ opinions about PAs were recorded by use of a selfadministered questionnaire. We calculated costs using forgone general practitioner (GP) surgical assist fees and salary costs for PAs. We obtained information about surgical throughput and wait times from the WRHA waitlist database.
Results
In this study, PAs “saved” their supervising physician about 204 hours per year; this time can be used for other clinical, administrative or research duties. Physician assistants are regarded as important members of the health care team by surgeons, nurses, orthopedic residents and patients. When we compared the billing costs with those that would have been generated by the use of GP surgical assists, PAs were essentially cost neutral. Furthermore, they potentially freed GPs from the operating room to spend more time delivering primary care. We found that use of the double operating room model facilitated by PAs increased the surgical throughput of primary hip and knee replacements by 42%, and median wait times decreased from 44 weeks to 30 weeks compared with the preceding year.
Conclusion
Physician assistants integrate well into the care team and can increase surgical volumes to reduce wait times in a cost-effective manner.
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