Expert Insights from Program Leaders
February 21, 2022
Season 2: Episode 28 - The Canadian PA Model

Mr. Ian Jones, MPAS, PA-C, CCPA, DFAAPA is a certified PA in Canada and in the United States. Trained at the University of Washington MEDEX Northwest PA Program, Mr. Jones went on to serve in Alaska and Manitoba, Canada before being asked to lead the Uni...


Mr. Ian Jones, MPAS, PA-C, CCPA, DFAAPA is a certified PA in Canada and in the United States. Trained at the University of Washington MEDEX Northwest PA Program, Mr. Jones went on to serve in Alaska and Manitoba, Canada before being asked to lead the University of Manitoba Physician Assistant Program. He is an international leader and past president of the Canadian Association of PAs. He shares his insights on the growth of the PA profession and provides a perspective of what is different between our two models of practice.

 

Learn more about the University of Manitoba PA program at: https://umanitoba.ca/explore/programs-of-study/master-physician-assistant-studies-mpas

Learn more about the Canadian PA Profession at: https://capa-acam.ca

Learn more about land acknowledgements and their purpose here: https://nativegov.org/news/a-guide-to-indigenous-land-acknowledgment/

The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or policy of the University of Arizona.

Transcript

*Transcripts are provided by Otter.AI. While they are becoming closer to reality, there may be some editing errors that are transcribed by the software. We apologize for any discrepancies.

 

Season 2: Episode 28

SUMMARY KEYWORDS

pa, canada, people, manitoba, canadian, profession, pdas, students, year, provinces, graduate, alberta, program, university, government, physician, canadian armed forces, physician assistants, territories, reached

 

00:01

We respectfully acknowledged the University of Arizona is on the land and territories of indigenous peoples. Today, Arizona is home to 22 federally recognized tribes, with Tucson being home to the Ogden and yaqi. committed to diversity and inclusion the university strives to build sustainable relationships with sovereign Native nations and indigenous communities through education offerings, partnerships and community service.

 

00:36

Welcome to this episode of the PA path podcast, I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession.

 

00:52

I'm Steve, fourth civilian pa in Canada, regulated through the college and so I had an opportunity it's either sit back for a step up.

 

01:03

Well hello and thank you for joining us today as we speak with Mr. Ian Jones. In is a Canadian and American certified PA, a former Canadian Forces reservist and a national leader of the Canadian pa profession. Ian's timing on our podcast was perfect in that we are now supported by my new institution, the University of Arizona, which has deep ties to the lands of indigenous peoples in southern Arizona. They are deeply respectful of that fact and have a land acknowledgement prominently displayed and discussed throughout. Likewise, Ian shared his institutions land acknowledgement in Manitoba, and we think you will feel his deep respect for that history and the indigenous peoples in Canada. For those who are unfamiliar, please check out our website for additional information on why these acknowledgments are so important. Today, Stephen, I speak with Ian about his path to becoming a PA is returned to his home and the direction of the Canadian pa profession. As always, you may learn more about our guest and their institution and passions on our website at pa path podcast.com. Enjoy. Good morning.

 

02:08

Good morning to you.

 

02:10

Ian, thank you so much for joining us today. We're really excited to have you and to learn about Canada and also about your path to becoming a PA.

 

02:18

It's been a while since I've talked to my American cousins, but

 

02:24

yeah, well, I would say I think Steph and I have a little bit of Canada with us, right? Because Steph is married to Canadian. Yeah. And I remember that. And I did my interprofessional training at the University of Toronto. So

 

02:35

in Manitoba, we pronounce it toronto,

 

02:37

toronto. Good to know.

 

02:41

So my husband, my husband's from London and he hates he always laughs with real estate Toronto. He's like Toronto, just toronto, toronto. It's like two syllables.

 

02:51

Well, thanks for the lesson. Appreciate it. I've been sending my my teachers for a while now. And once you start by telling us about your path to becoming a PA,

 

03:01

first I just need to do a land acknowledgement that I'm broadcasting from the University of Manitoba, which is on the traditional territory of the Shelby Cree of Gibraltar, Cree, Danny Dakota and the homeland of the Matey nation. Thank you. It's really important that to be remembered that the mind we share and the wisdom that we are partaking in has been here for a long, long time. That's all wonderful. Thank you. It's part of what we do. So you had a question?

 

03:40

Yeah. So your path to becoming a PA. That's okay.

 

03:45

A long time ago, in a province Far, far away. I was a Army Cadet. I joined the Canadian Armed Forces reserves, liked what they were doing in the medical units, because it allowed me to go out on a whole lot of different operations and exercises, found that I was really good in chaos. And from there, start working on the animal service. From there became a firefighter paramedic and suffered a life changing back injury, losing all sensation, my right leg and not able to carry my kids that type of thing. So I did an acumen test about what I could do because I didn't want to keep being a fire inspector. And I came up with three possibilities. It said Postal Inspector, fire inspector, and it said this weird names called physician system. And this is back in no the 80s and I had never heard of physician systems in Canada. I was in Edmonton at the time. So in a smart guy I got on the computer I connected to the American Academy of Physician Assistants who told me that there were a couple PhDs working at this place called the University of Alberta hospital. And if did I know it? And it was quite funny because I was actually looking at it out of my window. And they told me what unit they were on. So I made some connections. I met pa named Jan grits, who was a graduate of catering, who was actually from Alberta, the goddess school in Ontario, they ended up in going to catering and was working in cardiac sciences. And so I met him, and I met a student named Norman bison, who was also from Alberta and fell in love with the profession. I thought. This is right. This is something that I want to do, got a undergrad degree in physiology, apply to five PA programs in states got rejected by all of us and worked on my application. The following year, I applied to two and was lucky enough to get into the University of Washington medics Northwest PA program, where Ruth Baldwin took me under her arm and basically shaped me into something that I am today. And as we all know, Ruth is a force to be reckoned with.

 

06:28

She is yeah, she's tenacious back. She She is opening up Season Two for us. And you're the second episode. So how perfect that you're following Ruth?

 

06:38

Oh, yeah, I think everybody follows sort of, to be honest. So I graduated from medics, I worked locally part time position came up in Alaska and Skagway went to and I wanted to do real primary care because I thought the PA profession would be perfect in Canada, but I needed to see how it worked. So I ended up in a the booming metropolis of Skagway, Alaska, population 450. In the winter 3000 residents in the summer and 15,001st day, got quite the education. My supervising physician was in general and usually talked to a lot to the emergency department. After a year my wife was kind enough to say, get me the hell out of here. And since I wanted to keep my wife we did. And so I moved the last place in the world that my wife wanted to work, which was gentle. And I fell in love with it spent six years there. And then Manitoba was calling Manitoba as a province. And so I decided it was time to move my family back home and ended up in the city. I was born. Working in neurosurgery. I mean all of its history.

 

08:02

But yeah, yeah. So I'm curious the the experiences you you obtained in Juneau and Skagway and I met X, how did those prepare you to negotiate navigate creating a position in Manitoba?

 

08:21

Well, one of the things about the medics program was the founder, Richard Smith, believe that pa should be built into the system. And that the clinical placements in the first couple years of the program were in communities where the legislators were living so that anytime a bill came up, the legislators knew what PDAs were because they'd been taken care of. And that the PA was joined at the hip building on their prior military experience with the community and with the physician and adapting to the needs. And that's what I liked. And that's what I thought would work good in Canada, you know, my experiences in Alaska were long distances, remote communities, you know, high quality medical care, but it just took you about a day to get there. Which is kind of like Canada and a lot of areas. I mean, we do have some cities in Canada. But, you know, in Manitoba where I am, we have population of 1.7 million and a landmass just a little smaller than the state of Texas. We need to be able to put our healthcare workers out into rural communities. And so when I decided to come back to Canada, I wanted to make a difference with a model that I knew would work. And so I was the fourth civilian pa in Canada, regulated to the college and so I had an opportunity it was either set back or step up for my Life, I've been one of those people if I have some free time, I'm using it to find another project to work on. Sure. And lo and behold, I ended up working with a group of amazing fellow TAs to help shape the curriculum, we reached out to maybe a dozen programs throughout the states, and saying, Hey, how do you teach your PS? We pulled that material together. We threw out the stuff that we thought it was, yeah. And put the stuff in it that we felt was valuable at some expertise, who came in, like Mary warner came in, took a look at us and said, This is what I would suggest doing. As you know, Mary Warner at that time was from Yale, kind of shaped a lot of the things we did, the military in Canada had PDAs, they shared their knowledge, and we kind of shaped a program. Somebody else came in was a program director for a few years, didn't have a lot of experience as a PA, but had educational experience. We were credited by the Canadian Medical Association didn't do too well, but on probation, and they tapped me on the shoulder and said, We need you to take over while we find somebody qualified to do the job. And so after six months, they decided that I was faking it until I made it. And I became the program director for my sins.

 

11:31

And you have a long history of leadership at the at the national and I know the local level in the Canadian Academy and local and professional organizations. One of the things that's required of us PA programs is that history of the profession is is taught and so I think most of our listeners probably have a good grasp on kind of how the profession evolved in the US. Tell us a little bit maybe give us a short primer, the 30,000 foot primer on really the evolution of kind of the genesis of the PA profession in Canada and how it has evolved.

 

12:05

The Canadian Armed Forces have had advanced care practitioners and medical technicians who are providing primary care in adverse situations. For example, during the Korean War, there was a shortage of doctors in battalions. And so the IPAS are the medical tech stepped up on Navy ships. We had the independent duty corpsman equivalent that were out at sea. I then they were building a level of expertise in their military medical technicians. They decided that they needed to step up the game and run at Fort they adopted the name of physician assistant they realized they needed develop more knowledge in 1999. They afforded the Canadian Association of Physician Assistants, which incidentally was at the exact same year that the Manitoba College of Physicians surgeons, regulated physician systems. So we had two pathways that were suckering the military decided physician systems on in the two year stream was good. A group of senior techs met as most Canadian projects are in a garage with a bunch of beer and they decided this is how we're going to do it. And so they formed a group and these amazing people like Tom Ashman Where's Chapman and Pierre Fontaine. I'm blanking on all the names, please forgive me, I stand on the shoulder of greatness. They set up the Canadian Academy of Physician Assistants, which had to change his name to the Canadian Association of Physician Assistants due to federal funding rules and regulations. And so they started lobbying and pushing and with the support of the Canadian Armed Forces, they built a relationship with the Canadian Medical Association with the Royal College of Physicians, Surgeons of Canada. They networked they built and they developed a curriculum and format. And from there, they reached out to the few more Canadian civilian PDAs. And they reached out to the the Americans that conferences in the United States, why would they attend the APA conference and have a display and then kind of reach out to expat Canadians. And that's how I got involved with the professional association. I ended up in San Antonio, Texas. I was stopped by the booth and was chatting with them. And people were asking questions about the health care in Canada, and this is 2004 2005 when I was practicing in neurosurgery, but I started answering the questions for them because I understood the Canadian healthcare system and next thing they know they made me the vice president. And before I know it, I'm ending up as the president and at the same time we had to move away from the military becomes federally Incorporated. which allowed us to change the bylaws, and you organize and start building a network and make connections to a lot of other people. And from there, we just grew, we already had developed a national accreditation exam. For graduates, Manitoba decided that they needed to train their own PDAs. So we worked on a curriculum. At the same time, McMaster decided that they needed to train pace in Ontario, our lobbying efforts were meeting with government officials. And so we've got a pilot project introduced in Ontario. They liked them. They really, really liked them. And they decided to fund a university. So McMaster University started, I'm happy to say two weeks after the University of Manitoba started. And, and slowly we started building and expanding the the volume of people we had and the leadership capacity. People were leaving the military and finding jobs in the civilian sector, which then allowed us to demonstrate that pa know what we're doing, we can make a difference. So, yeah. Thanks.

 

16:13

So first, congratulations, because I've been so impressed by the Canadian efforts to expand the scope of practice and also the recognition across all the provinces. As I understand it, you have practice laws set up a regulation set up in Manitoba, Ontario, New Brunswick. And is it Alberta? Alberta? Yes. And so you've got a few other provinces to tackle. I see you kind of a two front war going on Quebec, Quebec. But I said that more appropriately.

 

16:47

The belt province, yes.

 

16:49

And then you've got the British Columbia as well, and Saskatchewan, and also the territory. So tell us, where are you at in all those different provinces? How are things going for you in terms of the growth of the profession in Canada? What are your barriers?

 

17:03

Well, there are 10 provinces and three territories. And we each of the provinces has its own responsibilities for health care professions, and also for the administration, the health system. So in Canada, we have a national universal insurance in 13 different jurisdictions plus the military forces. So every time that we lobby for physician assistants, we have to go to the governments in the organization. So like the doctors associations, the colleges, we deal with it the nurses. So, right now, Manitoba has had regulations since 1999. And the first pa started in 2003. Ontario introduced PDAs and 2006 2007. But only recently has developed the legislation that will allow them to regulate the PA profession there. It is not yet regulated in Ontario, okay. Alberta, developed PDAs first in 2009. And then, last April, April 2021 regulated the profession through the College of Physicians surgeons of Alberta, we in 2009, New Brunswick changed their medical act to allow PA to practice they only have three in the civilian sector. And then we are have a demonstration project going in Nova Scotia. One of the interesting things about Canada is every province always wants to do a new pilot project. They don't trust what any other provinces done. So in Ontario, it started with the pilot project in emergency medicine, and then in long term care, then eventually went into family medicine then in the hospital areas and that sort of thing. Nova Scotia has a pilot project in orthopedic surgery, and it's going over really well because it's solving their needs. The PA are the connectors, the communicators they're providing the continue ality of care, they are building relationships and not making the enemies they are showing that because there are connectors that can build a team and support the team, which gets all the members of the medical alphabet invested in making it work. Canada we tend to stand on the shoulders of others to move forward. And we're lucky we have giants to stand on the shoulders of so that we can start making a difference. BC the first paper I ever read about introducing physician systems in British Columbia was dated in 1994. And even though it is a great concept, it is not a priority at this time. That's according to the BC government. Doctors British Columbia, the sociation to family groups and all this Love pa they love the concept. We have 35 to 40 pa living on Vancouver Island, ex military, they're retired, they want to work. They want to reach out to make a difference. The concept, we have advocates in British Columbia, we have champions who've been going forward and trying to make a difference. But you know, there's politics. Yeah. And you need a mass to actually create an influence. And then just as you started to get your foot in the door, the political cycle changes, governments changed. Ministers change. And you're back. It's step one. Sure. Saskatchewan. What can I tell you? It's not Manitoba, they have their own way of doing things. Quebec, there's a lot of interest in Quebec. I've been people have asking us about for competency profiles or frameworks, examples of how we would deliver it, how do we work with the medical schools, and we share that I mean, all the programs share. The nice thing about having three PA programs in Canada, plus the military, is that we know each other, yeah, we can all talk to each other on a zoom screen and not feel too small. We are able to share information, and we will support people who asked for it.

 

21:20

And in the territories, are you finding that there the need is not there or it absolutely is there because of the disparate health care of the populations being so spread apart and things of that nature.

 

21:35

We have physician systems working industrial health in a lot of different communities. And they work closely with the local emergency departments in say, Whitehorse or Yellowknife, they reached out the so they're aware of PS. But they don't know if they can really afford it. There's a lot of different reasons why they they don't know we have a reality that family physicians are fee for service practice. And so as Eugene stead said, a long, long time ago, you start taking money out of the wallets of Doctor, they're no longer your friend, or you taking money out of anybody's wallet, they're not your friend. So all those billing and funding issues have to be settled. And it's a complex system, where we can't just simply cut and paste from our American cousins, because it doesn't necessarily work in the same way. And trying to explain that to people is probably one of the biggest challenges. How do we fund PDAs. And then universal health care system, we have governments responsible for providing care for all citizens, we know that calculations or salary models work, alternate funding proposals work. But anytime you start producing the same class of 15 to 20 students, you're adding up like to $2.1 million onto the provincial budget. So you have to be careful about how you're doing it, and how you fund it. And yes, everybody agrees that VAs will add, improve access to care, that will solve a lot of the issues. But then there are other services as well. There are nurse practitioners whose laws are slightly different the as we all know, it becomes more and more complex. And unless you have degrees in Health Economics and Policy and are prepared to spend time at a national or in provincial level lobby, you can't get an in Yeah. And if we don't have the people to do it, this is only like 750 TAs and population of what 37 million. So I'm good, but not that good.

 

23:55

So you were trained and worked in a variety of settings in the US healthcare system. And certainly you've been entrenched in both the education side and practice in the Canadian system as well. Can you talk a little bit about the primary differences in the way that PA or utilize the relationships that PA is have with their the physicians with whom they work, you can just kind of talk about some of the main differences that you have identified. And I know there's wide variability in both systems. But if you were to if you were to kind of at a high level hit it, some of the big differences that you see between the way Canadian PA is work and the way Americans PA is work, what would those be?

 

24:35

Well, the big similarity is the fact that we're all focused on patient care. We're all focused on meeting the patient's needs. That difference is that I don't care about the cost. I'm not worried about if the patient can pay us or that if we need something, we do something. Now there's a lot of stewardship that comes along with that responsibility. Where we don't order MRIs on the knee. I mean, it's really doesn't add to the decision that needs to be made. We don't have to worry about delaying a diagnosis in order that the 18 year old kid can qualify for Medicaid or Medicare. One of my experiences in Alaska, we had to deal with somebody who had a Marfan syndrome with the aortic arch that was a little bit too large for everybody's comfort. We spent hours discussing that and figuring out how to best treat the patient Canada, we say, No, that's fine, right? Bang here, do this. Here's a console. This is what's going on. And we just move on with it. An example. When I was in neurosurgery, we had somebody from none of it, who was diagnosed with a brain tumor. Plane, they called the neurosurgeon and said, We need to send this patient down to you. They were on the plane, I was in the emergency department, when they came in through the door, I got them a CT, got the an MRI ordered, called My surgeon told them what was going on, had the or scheduled for 10 o'clock, after the patient was originally told we were coming to him at less than 12 hours before surgery was done. Patients taking care of discharge one week later sent back cost of the patient zero, not a single no CO payment, nothing like that. And I remember that distinctly because when I had my health issues, when I was in the States, it was like a $5,000 co payment. It was like $55,000 to get from Juneau, Alaska down to Seattle, get everything done and back home. You know, I was lucky, I had insurance that would bankrupt me, the great thing about being a PA and Canada's, my students will never have to deal with those types of issues. They we don't teach about health economics, in the micro level, we focus on, this is what we need to be able to do to help the system work. This is why we don't have a lot more PDAs. And we're focusing money and other things. This is the bigger picture issue. You know, every class we graduate will add so much onto the the provincial budget, and it's small potatoes, but it's something I'm aware of we our universities are not for profit, meaning that to expand our class to meet the demand, I have to go to several different layers within government to get approval to expand the class size. And then I have to deal with the university bureaucracy of doing all that. And then I have to, you know, negotiate for clinical sites and all the rest of it. But I also have to worry about so I graduated these students, will they have jobs? Will the government be able to fund those positions, I think that is kind of the big differences that you face in a under two minute discussion.

 

27:57

That's a very different level of complexity for a program director than we experience here. I mean, so there's some similarities, for sure. But you, you have to go so much deeper in terms of the bureaucracy, as you said, to maintain what you're doing or growing, which is your immense challenge, obviously.

 

28:15

And then, the other thing is that the government also decides they like Bas, and they send me an email saying, We want you to double the class size tomorrow, and they have no clue that okay, that means I have to acquire roughly 35 clinical sites and different services don't have them. You know, we're there's only so many training spots for residents, so many for nurse practitioners, and we have to cooperate with each other and to make it work. So the thing about being in Manitoba, is that there's two degrees of separation. If if I'm having a problem, I can talk to somebody and they will likely know who's responsible for solving. It's amazing. I was sitting with a colleague of mine at a tavern, discussing the inability to get devices for people involved in motor vehicle accidents, because the system required it to be signed off by a physician. And we're saying, well, that's adding hours onto it, and days, and we're trying to get people discharged. So it's any a cost of the hospital. And it's a simple device. And the person behind is turned over tapped us on the shoulder and says, Oh, I'm the vice president of the provincial insurance company, told me more about this, and how can I solve this? Two weeks later? There was a memo we didn't have to worry about a piece could sign off on it. That's fantastic. I mean, that's Manitoba. works the other way around, too. But yeah.

 

29:45

Well, and then at the at the outset, as you described, the the start of your program, you've been there it looks like you've been there about 11 years now. I love it. So can you help us understand what the typical curriculum is like and what do you look for in students who are applying to your programs?

 

30:00

Oh, the magic question. All right, our curriculum is almost identical to, I could possibly pass the our PA accreditation standard. Not that I would want to even try. You know, we have a basic medical sciences feeding into medical, we have the genetics, complex pharmacology, or anatomy classes, cadaver based, we have a second year, that's all clinical rotations, we have set standards, so very similar. So our students are the University of Manitoba, we have a word graduate program, the only graduate program in Canada, we require a four year degree. However, I require a four year bachelor's degree, it doesn't need to be science, I have some core courses, biochemistry, anatomy and physiology that are the only courses that have been documented show to make a difference in your learning ability to be a PA. And we've actually demonstrated in the first two years, they did not have a bio chemistry requirement, and students were failing courses. So we put the enforced above chemistry requirement. And we've been doing much better, I think we have like a 2.7% attrition rate in our programs over 11 years. So not too shabby. Ideal students, they almost have a academic performance demonstrated over a degree. So we're looking for high GPAs. We're looking for people who are more Wolfpack than great white shark. Meaning we don't want people who have eaten other people to get ahead, we're looking for those who have demonstrated that they can work in teams. So students coming into the University of Manitoba of all being team players in sports or research aspect. A third of our intake is graduate levels with a high number of PhDs in our program, the community, being able to have demonstrated that they've worked for advocacy in a underserved is essential to me, I want people who know what it's like to be either needing a food, I'm looking for people who have worked on food lines, or have worked for underserved looking for people who've worked in counseling, suicide, distress lines, students services, who serve the community, that we want to serve with our graduates, who understand that making a difference. And helping people does not mean that you need to be a physician or a PA, you can help people as a crossing guard, if you do it right. You know, you can keep people alive. I'm looking for people who have serving the community who are connectors, who are communicators who have done something with their lives. They may not have a lot of life experience. But they've done something with the time they've had.

 

33:14

And was there an evolution Ian for you? And maybe it hasn't changed at all. But I would imagine when you're first starting this and your your your first few batches of students, you're you know, I would presume you were looking for people that could go out and be ambassadors for the profession. So they had to have rock solid team play, they had to have rock solid community engagement, the ability to advocate and and somebody who you'd have complete faith that they would continue to shine a light on the profession so that it could grow. Has that changed at all? Are you still so youthful as a profession in the country that you're still looking for those kinds of things,

 

33:52

still looking for? Because I'm a believer that PA is our advocates, we are communicators, we are connectors, we medicine is not simply about writing prescription a piece of paper. But saying, Hey, you could get this benefits if you did your taxes. So this is how we're going to help you do your taxes. This is how we can help you take better care of yourself that you know what? Doing a zoom conference doesn't make sense if you don't own a laptop, so but you have a cell phone, so why don't you call me instead of having to spend what is a 425 to get here and back on a bus. It's probably closer to $7. Now it's been a while but so reaching out and people who are innovative and can think outside the box. One of the biggest changes that had since we started writing the curriculum is we used to have a requirement for clinical experience. But we've changed that too. You have to have experience with people because one of the things I did discover is if you are a customer service agent, and you're dealing with a lot of angry people like if you work for an airline. Man, you have skills, you have conflict, de escalation, you have skills that they won't teach you in any paramedic program or nursing program or respiratory therapy program. And I have discovered that even though I went to medics where if you didn't have eight years of clinical experience, you didn't have a chance of getting in that experience dealing with people means a lot more. And so that's what I'm looking for. Yeah, I kind of like them to know that Blood is red. And that, you know, Eric goes round and round and bleeding stops eventually, and you know, having that type of knowledge. But in essence, being able to walk into a room with a total stranger, and striking up a conversation, and finding out who they are and what's going on in their life. To hear that narrative, that patient narrative, to understand the issues that they're dealing with will make you a great PA, I can teach you how to be a good PA, but you need to be able to come in with the ability to be a great PA.

 

36:03

So being sibling countries on the same continent, I hear oftentimes questions about, you know, the ability for American students to apply for Canadian PA programs or Canadian students to apply to American PA programs. And likewise, graduates to work in their their respective countries. Can you talk a little bit about kind of that transportability of both kind of educational opportunities and work opportunities between countries, to your to your knowledge,

 

36:34

maybe an educated PA is not allowed to work in the United States, the RPA does not provide accreditation of any non US program. So our graduates have a skill set and skill knowledge. But with issues of immigration, and with the certification, they're not able to, to work in the States, Canada had for the first 10 years of our developing a shortage of Physician Assistants. And so we reached out and retract attracted them, that college of physicians, surgeons of Manitoba, still allows Americans to who are certified to apply for jobs, which allows our Canadian citizens who pay the exorbitant amount of tuition that you guys charge to get their education in the United States and then return to Canada and work. I'm not really interested in advocating and promoting and pushing that because I'm training Canadians for Canadians, or I want Manitobans to work in Manitoba. I know it would be attractive for students to try experiencing in the United States for a while. But that's not really my thing. I want people who were more interested in working with First Nations communities, or dealing with the underserved in Winnipeg, or Brandon or Toronto, or Toronto. And that's where I want to

 

38:04

talk about salary differences is if if the US opened up and allowed Canadian train TAs to come to the US if they could get nationally certified by the NCCPA. Here, would that be a real challenge for your work? Because the salary differences are so great that might attract more Canadians to come down to the US or am I miss representing what's really going on?

 

38:29

The starting wage for a graduate from my program is about $83,000 Canadian tops out around 125,000 cost of living is better. You guys pay more in taxes than we pay in health care. You know, the if you add on the cost of what American health care costs, it's dramatically higher than what I pay in taxes here in Canada. So understanding the differences between the two of them. I don't know why anybody would want to look down in states. I mean, I don't want guys to find jobs where you come on up here making

 

39:04

I mean, honestly, depending on which party is in play, they're always saying, hey, let's move to Canada. And I think Canada's saying no, we're good. We're fine sitting right there.

 

39:16

A few years ago, the number of letters and emails I was getting from people saying Are there jobs for us? Up there? That was really quite high. Like November, they were averaging about 10 a

 

39:27

week. Oh my goodness. Wow. Yeah. I have a lot of friends who would like to come up? That's great. I will say having Luton Phoenix, we had 17,000 expats from Canada that would would spend time they lived in the Phoenix area. So yeah. And I know down in South and Central America, it's very popular for the Canadians as well. So my guess is it's your chance to thaw out and then you head back north for the good food and health care.

 

39:55

Yeah, for the real football and

 

40:00

And I just have to first I want to congratulate you on really, you know, as we've watched you from down south, I think you've done such amazing work for the profession up there and had been such a friend to the your cousin's down here. And it's been a pleasure watching your country grow. And I've just said this to one of my bosses the other day, we were talking about Canadian PAC, and I just said how impressed I am by your social media work across the country. And the messaging that you all are doing to try to increase the profession across all the provinces and territories. So congrats.

 

40:33

Well, we have some truly amazing people who understand the value of communications and connections and the use of the social media. Very, very impressive. Every year, you know, I have 15 students, I would say five of them could get jobs in media relations, they are so good in what they do is not something I need to worry about, for attracting new students and applicants to the program. The big issue is, are we getting to the right people? Are we reaching the politicians who can make the decisions or the civil service that can actually make the decisions that the government's will prove? Smell? There's so much awareness of politics required to promote a profession in a country, you know, the, our experiences and watching and observing the things that have happened in around the globe? Like, why do some programs grow like the ones in Britain and the Netherlands, but yet other programs don't seem to get going, even though the model is just as good and just as valuable? And anyone who was involved in PA education reads any the journals notice which countries I'm talking about? So?

 

41:52

Well, Ian, thank you so much for joining us today, it was truly interesting to hear how the profession has evolved, and some of the challenges that you face and some of the opportunities that Piazza Canada have. So thanks for being with us. And good luck in the future.

 

42:06

Happy to be here. I just want to give a shout out to somebody who actually really another person who influenced my life. That was rod hooker, he bought me lunch in San Antonio sat down, told me to get off my butt and start writing papers and start doing research. And he's always been a mentor and a supporter. I tell you, Rod has been a huge influence in supporter of Canadian PAC. He's always been there when anybody asks him the question, I gotta be honest, he doesn't always give the right answer, but he's always there. And I utmost respect for the man. He is. You guys have something truly remarkable in that math.

 

42:47

I think you know, your your observation about riders is the same observation we keep hearing from other guests related to the you know, the with followings of the world, the James Callie's of the world. Tony Miller's, I think it's interesting to see that in Canada, you have the same socio logic bandha teams because of the collaborative nature of your programs. And and I certainly think our profession grew because of that willingness to share and lack of ego, lack of concern about people, you know, they were actually encouraged to copy and make it better. So I'm excited. I think you'll have a great, great path forward for your country.

 

43:24

Yeah, it's we've come a long way. It's slow. But when you've been there from the beginning, when there was like, literally four of us in Manitoba, to now we've got about 150 practicing. Yeah, it makes a difference.

 

43:42

We want to thank Mr. Ian Jones for his time and insights into the development of the PA profession in Canada. His insights on where they are and where they're heading provides all food for thought, as we see the profession grow

 

43:53

with our cousins to the north. Tune in next week as we speak with Dr. Lisa Mustonen. Alexander,

 

44:00

as we discussed the development of the PA profession in Ireland. Dr. Alexander is currently a professor in the Department of PA studies at the Royal College of Surgeons in Ireland, and the director of their Physician Associate Program is also well known to American PDAs for decades long leadership at the George Washington University PA program. Until next time, we wish you success with whatever path you're walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views expressed in the podcast are those of the hosts and guests and do not necessarily reflect the official position or policy of the University of Arizona.

Stephane VanderMeulen, MA, MPAS, PA-C Profile Photo

Stephane VanderMeulen, MA, MPAS, PA-C

Department Chair and Director

Stephane VanderMeulen MA, MPAS, PA-C is Chair of the Department of Health Professions and Program Director of the PA program at the Creighton University School of Medicine in Omaha, Nebraska. Ms. VanderMeulen is a 1994 graduate of the University of Nebraska Medical Center PA program and she also holds a Master of Social Gerontology from the University of Nebraska Omaha. Stephane practiced clinically in the fields of rural family medicine and orthopedics/sports medicine before beginning her career in PA education in 2005. She is an active advocate for PAs in education and practice and has served in professional organizations at both the state and national level. Ms. VanderMeulen served on the board of directors of the Physician Assistant Education Association for seven years, with two terms as Director at Large before being elected President in 2015. She is dedicated to the professional development of PAs in education and remains active as a mentor for PA educators.

Ian Jones, MPAS, PA-C, CCPA, DFAAPA (He/Him) Profile Photo

Ian Jones, MPAS, PA-C, CCPA, DFAAPA (He/Him)

Program Director and Associate Professor

Married and father of two, Ian Jones is a Canadian and American Certified Physician Assistant,
former Canadian Forces Reservist and Firefight-Paramedic, with education in public
administration, Clinical Health Services, and a Master of Physician Assistant Studies’ degree. A
graduate of the University Of Washington MEDEX-NW PA Program, he uses his passion for the
profession to advocate at provincial, national and international venues. His professional
experiences in Alberta, Washington, Alaska and Manitoba include Primary Care, Addictions,
Emergency Medicine, and Neurosurgery. Appointed Assistant Professor and Program Director
of University of Manitoba's Master Physician Assistant Studies in 2010. Professor Jones enjoys
finding solutions, developing PA Education, and seeks a better understanding of population
health and health workforce issues. He has authored several peer-reviewed articles and provided
sections for PA textbooks. In 2021, as member of a team of PA-Educators restructured the
National Competency Framework for Canadian Physician Assistants.
Ian was the Canadian Association of Physician Assistants President (CAPA), serving on the
CAPA Board between 2008 and 2013, and the Medical Council of the College of Physicians and
Surgeons in 2014 and 2015 and currently President of the Canadian PA Educator Association.
He has a Lifetime Achievement Award from the University of Washington, and CAPA’s PA of
the Year and Honorary Membership, and was recently informed of an academic promotion to
Associate Professor.

Learn more about the University of Manitoba PA program at: https://umanitoba.ca/explore/programs-of-study/master-physician-assistant-studies-mpas

Learn more about the Canadian Association of PAs at: https://capa-acam.ca

Learn more about Indigenous Land Acknowledgements at: https://nativegov.org/news/a-guide-to-indigenous-land-acknowledgment/