UP-165 Impact of Physician Assistants on patient volume at an outpatient Canadian urology clinic
Thursday June 27, 2019 from

James Misurka, Canada

Physician Assistant

Surgical Oncology



Impact of physician assistants on patient volume at an outpatient Canadian urology clinic

James Misurka1, Miran Kenk1, Jaime O. Herrera-Caceres1, Katherine Lajkosz2, Dhiral Kot1, Antonio Finelli1, Neil E. Fleshner1.

1Surgical Oncology, University Health Network, Toronto, ON, Canada; 2Biostatistics, University Health Network, Toronto, ON, Canada

Introduction: Physician Assistants (PAs) are being utilized to increase access to healthcare and reduce cost, throughout Canada. We set out to determine if the introduction of PAs into a tertiary centre urology oncology practice improved access for patients, while maintaining cost effectiveness. 

Methods: We retrospectively reviewed OHIP billing codes, broken down quarterly, since the introduction of PAs into outpatient urology practice for 2 attending urologists at Princess Margaret Cancer Centre. Data were grouped into two separate periods — introduction of the first PA into the practice (1 PA: 2014 Q2 - 2015 Q3) and introduction of second PA (2 PA: 2016 Q4 - 2019 Q4).  Data points were displayed using scatterplots demonstrating number of services provided for each quarter and period, along with the fitted regression lines. All regression analyses were conducted using Newey-West standard errors of lag 1. Cost associated with PAs are presented as Health Force Ontario recommendations for a new graduate PA hire.

Results: Upon introduction of the first and second PA, average number of visits increased by 308 and 191 patient visits, respectively. This translates into approximately 1000 additional patient visits per year per urologist.  Linear regression coefficients for each time period and corresponding slope, CI and P-value are displayed in Figure 1.  A trend towards statistical significance was observed within each time period and between the two periods.  A mild net benefit was demonstrated in annual patient billing by a modest $9,000 per attending surgeon.  Moreover, the average number of patients seen by PAs (~3740) exceeds the additional patient visits created by the introduction of PAs, allowing physicians to spend more time with complex patients.

Conclusions: The introduction of PAs to outpatient urology clinics represents a relatively cost-neutral and effective way for improving patient access while allowing physicians to dedicate more time to complex patients.

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