Physician extender program application

Is this program sponsored by a provincial health authority?

YesNo

Program oversight

Health Authority senior leadership representative overseeing the program.

Does this program expect to hire Associate Physicians and/or Physician Assistants? You may select both below.

Extender position – Detailed description

The position description must be available for the physician extender, program director, and department head. It must form part of the formal record for the physician extender.

Will the extender's work include night calls?

YesNo

Location of night calls

Supervision

Frequency of night calls

Responsibilities during night calls

BI•1.“×

• Assigns physician extender to services or duties within the division
• Determines training requirements initially and ongoing
• Assigns on-call duties
• Obtains feedback and evaluations (from supervisors, co-workers, nursing, and allied HCP)
• Maintain record for each physician extender
• Act as liaison with the College
• Ensures annual report sent to the College
• Provides formal and informal feedback
• Participates in College accreditation
• Advises the College if the Physician Extender is no longer working within the program

Process specific to Physician Assistants 

The Health Authority adopts:

Maintenance of Certification

The Physician Assistant (PA) must be a graduate of an accredited physician assistant education program within Canada or the United States.

 A certified Physician Assistant must have one of the following credentials:

• Canadian Certified Physician Assistant (CCPA), granted by the Physician Assistants Certification Council of the Canadian Association of Physician Assistants; or 
•  Physician Assistant–Certified (PA-C), granted by the National Commission on Certification of Physician Assistants (NCCPA). A PA must maintain CCPA designation in order to practice under delegated practice. The Physician Assistant Certification Council of Canada (PACCC) maintains a strict policy regarding the maintenance of certification that involves partnering with the Royal College of Physician and Surgeons of Canada. 

All certified PAs must annually renew their CAPA membership and earn and report their Continuing Professional Development credits.

Credits are documented using the Mainport ePortfolio, the CPD reporting tool for the RCPSC maintenance of competency program.

The PA will provide proof of CAPA membership and an annual CPD Adherence Report from the RCPSC Mainport ePortfolio website to verify CCPA certification.

A staff person will supervise the physician extender during the initial probationary period.

All training, supervision, and evaluation will be directed by the program director.

The probationary period is a minimum of 12 weeks and includes an evaluation of competencies for the scope of practice required for the position.

There must be monthly evaluations with a final report after the 12 weeks of probation.

The evaluation must include but not be limited to the assessment of the following:

• Basic clinical skills
• Communication skills
• Ability and willingness to function as a member of the clinical team
• Special knowledge and skills applicable to the intended clinical placement
• Clinical decision-making and the appropriate use of clinical and diagnostic resources
• Prescription writing
• Clinical documentation
• Procedures required to function effectively (during the initial months of the probationary period) and to be added to as needed or circumstances and demonstrated competence permit

If the Physician Extender moves to a different Physician Extender Program, there must be a period of training in  the new program as determined by the relevant Program Director. 

The physician extender may prescribe medication under the delegated authority of a licensed physician. Physician extenders are not authorized to prescribe medication independently; however, a physician extender acting under the authority of a physician may evaluate patients, initiate an order, and prescribe medication as established by their delegated authority.

The physician extender shall:

• Prescribe and dispense authorized pharmaceuticals and supplies as delegated within the physician extender Practice-Delegation Agreement (please attach below).
• Prescribe within the Physician Extender Pharmaceutical Formulary - (please attach below).
• Ordinarily be approved to continue medications previously prescribed for chronic disease management provided in a clinical evaluation conducted by the supervising physician. The supervisor determines the chronic disease is under suitable pharmacological control and surveillance.

A prescription generated by a physician extender pursuant to delegation shall include the following:

• The name, designation, and contact information of the physician extender issuing the prescription (if the prescription is to be filled using an external pharmacy).
• A written reference to the fact that the prescription was generated via delegated authority.
• The name and contact information of the authorizing physician (including license number if using an external pharmacy). 

Supervision

Physician extenders are never the most responsible provider, and their supervisor must be available at all times. There must be documentation of a daily review process with the attending supervisor.

Initially, physician extenders must have hospital orders and prescriptions co-signed when appropriate. As competence is demonstrated, the program director determines when these activities can occur without co-signature.

The program director must document the required level of supervision.  

Evaluation

The evaluation will be formal and informal and must address roles and responsibilities.

Evaluations will form the basis of Continuing Professional Development. There must be written evaluations and reporting by the program director to the physician extender and department chief at least every six months.

There must be a central file for each physician extender with the program director and Health Authority representative which contains all position descriptions, documents, evaluations and surveys.

All physician extender programs must undergo an accreditation process as outlined in the policy Physician Extender Programs - Accreditation. Regular accreditation surveys will be conducted within the first 12 months of the start of the program and every four years thereafter unless determined otherwise by the College's Registration Committee. All costs related to the accreditation of physician extender programs must be borne by the program. 

• Maintains central file
• Liaises with Health Authority, program director, etc.
• Records continuing professional development (CPD)
• Ensures adequacy of facilities (call rooms, computers, workspace, etc)
• Liaises with College
• Ensures there is a yearly satisfaction survey of work/life balance, training, supervision, and relationships. Survey must address:
  • supervision
  • evaluation
  • certification of procedures
  • opportunities for CPD
  • working environment
  • collegial working relationships with team
  • must be maintained in central file for review as necessary
  • must be evidence that significant and/or repetitive concerns expressed are addressed in timely manner and outcomes demonstrated

The physician extenders must have the opportunity to attend clinical rounds and other educational sessions as responsibilities permit.

They must complete a minimum of 50 hours of CPD per year. The CPD must be documented in a file and should be based on evaluations.