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Earlier this year, I had a Twitter discussion with colleagues about independent vs. dependent PA practice. I had a very narrow understanding of independent practice. I thought it meant that PAs wanted to separate from doctors and work in isolation without oversight. 1/
I especially didn't understand the idea of independent practice in a surgical setting. Do PAs think they can do complex surgery that surgeons spend 5-10 years training on in residency/fellowship on their own? I was vehemently opposed to this...but decided to educate myself. 2/
It turns out independent practice is not a quest to divorce from doctors or perform surgeries alone. It turns out it has more to do with transparency, responsibility and ease of integration within healthcare systems. 3/
Independent practice means that a PA works under no one else's licence but their own. That decisions about collaboration are made at the practice level. A new grad is placed on a healthcare team with closer mentorship while an experienced PA works autonomously within a network.4/
Independent practice also means that administrative decisions and integration paperwork can flow more seamlessly at each institution. A PA is not disadvantaged in the job pool because of bureaucratic burden around government-managed, often ceremonial, supervisory agreements. 5/
Independent practice does not mean unsupervised surgeries. It means PAs will be more readily available to assist multiple surgeons based on need. It also means they will be held accountable for the work they do in and out of the OR, like all other healthcare professionals. 6/
In reality, not much will change on a practice level when independent practice is implemented. PAs will still work with physicians and the Interprofessional team to provide safe, high-quality care to patients, like they are trained to do, within their level of competence. 7/
Presently, Canada is in a dependent model of practice for PAs. But we have successful examples of independent practice with our Nurse Practitioner colleagues in Ontario. They are well-integrated in collaborative healthcare settings but are ultimately independent practitioners. 8/
The dependent PA model seems to work at present, but I appreciate why US colleagues are looking at independence & there may come a day when that'll be necessary here. I don't claim to be an expert on independent practice, but I admit that I no longer oppose it. 9/9
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