Physician assistants in primary healthcare “a game changer” for patients, doctors

Rick Reid has enjoyed a career full of travel and adventure, but he considers his current role the most rewarding. Rick is the first physician assistant in primary healthcare in Nova Scotia – a role for which he has advocated for many years. 

Rick works alongside Dr. Mayelin Figueroa at Penhorn Medical Clinic in Dartmouth, Nova Scotia; a massive practice with more than 2,600 patients. Rick met Figueroa while attending an appointment with his wife; he described the role of physician assistants and asked Figueroa if she would be interested in taking him on if the province approved the new role.

“Then one day I received an email saying Nova Scotia is planning a pilot project to bring PAs into primary care and to sign up if you are interested,” said Figueroa. “I said: ‘of course I'm interested – I’m going to be the first one!’” 

Rick settled in the province in 2006 following 25 years of military service, during which time he worked as an ophthalmology technologist, then studied to become a physician assistant. Physician assistants have provided care under a doctor’s supervision for nearly 70 years in the United States and in the Canadian military. 

After retiring from the military, Rick spent ten years as a physician assistant in the remote Canadian north and saw up to 1,000 patients on his own.

“We had a physician on call 24 hours a day so I would talk to the doctor with suggestions, and he would come back and either say, ‘yes, I agree with your diagnosis and your treatment program’ or he might change something if he thought of a newer approach or something else we should try.”

As one of the founding members and first Ontario president of the Canadian Association of Physician Assistants (CAPA), Rick and his colleagues began attending conferences in the United States to learn from the American experience of establishing physician assistant programs there. 

In Canada, the group first approached the University of Manitoba, who would eventually offer the country’s first physician assistant program, followed soon after by McMaster University. 

Rick says the appetite for bringing physician assistants to Nova Scotia has varied over the years “But we started pushing more and inviting the right people to sit down and have a serious talk. Finally, we got the go ahead with Mr. Houston who wanted to grab this opportunity.”

Dalhousie University launched the region’s first Masters of Physician Assistant Studies in the fall of 2023, with the rest of the country expected to follow suit, now that the benefits of the physician assistant role are better understood.

“I'm able to diagnose and prescribe anything outside of narcotics; I'm allowed to order X-rays and lab work, submit consults to specialists, develop treatment plans and do minor surgical procedures,” said Rick. “A lot of patients don't need to see the physician for blood pressure checks or prescription renewals, or for common ailments. If there is anything new to me, I would do the exam and then I would let Dr. Figueroa know what's going on and what I think we should do; there’s always consultation and her door is always open to discuss a plan with me.” 

Now that the public knows more about physician assistants, Rick says the warm reception he receives from patients has been overwhelming. 

“The first thing they usually say is, ‘It's about time’ and, ‘Dr. Figueroa needs so much help’,” he said. “They share that they’ve been worried about her because she was getting very tired and falling so behind that it was taking three to four months or longer to get in to see her. They could see the stress that she was under.” 

“I was worried myself,” said Figueroa, 52. “I didn’t know how much longer I could do this, but now our focus is on more access to primary care for patients; we're already seeing that people who would have gone to an emergency department or a walk-in clinic are now calling the practice and receiving services in their own clinic where the files are and where their doctor is. I must tell you; this is what's going to fix the struggles in healthcare.”

With Rick’s arrival in late January 2024, the practice can often offer same-day bookings rather than asking patients to wait six to eight weeks for an appointment. Rick admits he’s still learning the ropes but expects he will be able in increase his daily patient roster once he is fully up to speed.

“Right now, I’m seeing a patient every half hour while I become familiar with the system and administrative side; in another month I should be able to do every 20 minutes and then after another month, I’ll be seeing someone every 15 minutes, which will really increase our numbers and allow many more people to see Dr. Figueroa much sooner,” said Rick.

“It’s a game changer,” said Figueroa. “I usually have tasks that I need to address for about 300 patients per day, now I'm down to 130 per day. Our staff is delegating a lot of things to Rick that don’t need to come my way. Last week he was able to see 65 of my patients, so that’s 65 extra patients who received care. It's amazing.”

When asked how it feels to be increasing access to primary care, Rick struggles to put it into words.

“I am so happy I can do this job here and know that I'm helping,” he said. “I just wish my mom and dad were alive to be able to see this. And seeing Dr. Figueroa smiling with appreciation now because there's a load off her shoulders is extremely rewarding.”

Rick also has a message for his fellow physician assistants who are working outside the province. “Please come back - your family needs you; our primary care practices need you and Nova Scotia needs you,” he said. “I plan to reach out and try to convince them that we all need them to come home.”