Military physician assistants: How one medical technician is changing the game

By Tarzan Kay

Like many others of her rank and training, Medical Technician Corporal Stephanie Shaw had reached a bottleneck in her military career. With her qualification five paramedic training (QL5) nearing completion in early 2012, and having only just been promoted to the rank of corporal, Shaw would be facing a long six years before another opportunity to advance her career was likely to arise.

Canadian and British Armed Forces medical personnel engage in a debriefing during Operation SIRONA pre-deployment training at the Army Medical Services Training Centre in Strensall, UK in 2014. 

Canadian and British Armed Forces medical personnel engage in a debriefing during Operation SIRONA pre-deployment training at the Army Medical Services Training Centre in Strensall, UK in 2014. 

It was toward the end of her QL5 that one of Cpl. Shaw’s instructors asked if she’d considered doing her physician assistant (PA) training. A slight hitch: In order to be considered for the PA Program through the military training centre in Borden, she would need to complete two years as corporal, minimum two as master corporal and minimum two more as sergeant, at which point she’d need to be placed on a merit board and rank near the top, among a host of other requirements in the complex matrix that is the military’s selection process for PA training.
“Frankly, I don’t want to wait for another seven years before I do something else,” she told him. “So no, not really.”

For Shaw, the traditional path was simply too far away and, as she told her instructor, she would be ready to progress in her career long before the option of physician assistant training was likely to arise. In a moment of inspiration he suggested studying at a civilian school.
“Can we do that?” Shaw asked. “We don’t know that you can, but we don’t know that you can’t,” he said. “Nobody’s ever done it before, but I think you’d be the perfect candidate.”

Wasting no time, Shaw did her research, and applied to the physician assistant professional degree program at the University of Toronto. The university’s mixed delivery program — a combination of two- to four-week blocks on campus interspersed with online learning from home — was likely the only program that would allow Shaw to juggle her studies with her military duties.

The immensity of what she was attempting cannot be understated. The program is intense to say the least.

“Typically we discourage people from working because the program itself is very intensive,” says program manager Elizabeth Whitmell. “It’s not like your typical undergraduate where you have fifteen hours of classes per week. [...] Most students put in about 30 to 60 hours a week even when they’re not on campus.”

Still, for Shaw it was a more realistic choice than asking to go away to school for two years and return to the military as a physician assistant.

Once accepted to the program, a daunting process unto itself, the hard work began — making it work within the military structure. Corporal Shaw and her Commanding Officer Maj. Jeff Ridgeway have approached her education one step at a time. Each block of studies is approved piece by piece through two channels: an individual learning plan in combination with Special Leave (Academic Advancement).

“The chain of command all the way up through [...] Commander of the Royal Canadian Medical Services Brigadier General Bernier have been supporting this as it develops,” says Maj. Ridgeway. “Everyone’s looked at this and thought, ‘Wow, what a great idea.’”

But as Maj. Ridgeway points out, everyone in the chain of command realized that this was something new and that it will take some effort to establish a method through which personnel can become a PA via a non-traditional route.  

Physician assistant Master Warrant Officer Lorne Turner (right) and medical technician Master Corporal Richard Robichaud (centre) of 2 Field Ambulance in Petawawa, Ontario, examine Ranger Robert Buckle of Aklavik, Northwest Territories, as medical technician Ordinary Seaman Dave Finamore records their findings.

Physician assistant Master Warrant Officer Lorne Turner (right) and medical technician Master Corporal Richard Robichaud (centre) of 2 Field Ambulance in Petawawa, Ontario, examine Ranger Robert Buckle of Aklavik, Northwest Territories, as medical technician Ordinary Seaman Dave Finamore records their findings.

Cpl. Shaw used her own vacation time to cover her first block of training in early 2014, and the Special Leave Program to cover three additional blocks of training this year, each of which has been authorised by BGen Bernier. Between each block, she returns to working as a military med tech at the clinic in London, juggling this with the rigours of a full-time PA program.

Come January 15 the plot will thicken. This is when Shaw begins her practicums, one tour in southern Ontario and another in northern Ontario, the sum of which will take her away from her role as a med tech in the clinic for nine rotations of four to six weeks each, totaling 40 weeks in 2015.

Leave passes have been submitted, and will travel up the chain of command to the minister of National Defence to obtain approval for Shaw to be able to continue her studies completely away from the Canadian Armed Forces. Whether or not they’ll get it is up in the air.

CIVILIAN POACHING

The larger implications of this undertaking are enormous. The military has to take a look at what could be a ticking time bomb within the organization — the civilian sector poaching PAs from the military, and the problem of how to replace them.

“Physician assistants are about to be highly sought after in the civilian sector [...] we are running the risk of being very short-staffed if we don’t do something about it,” says Cpl. Shaw. “Every doctor that I know that knows how this can work positively in the system wants a PA.”

What’s slowed the process so far is that many provinces don’t have permanent programs in place that make it easy for doctors to hire physician assistants. Yet. And that’s a big part of what’s coming.

Though the military has used PAs for a long time, they’re brand new to the public system. As doctors and medical practitioners become aware of what physician assistants can do and the enormous value they offer, poaching could potentially explode.

Their military training and years of experience make them ideal for the world of operating rooms and trauma units. “We’re losing a lot of physician assistants to mining operations and oil fields in western Canada,” says Maj. Ridgeway. “They’re a highly sought after skill set.”

Already there are more jobs than there are bodies to fill. The Ministry of Health has a 50 per cent salary matching program through Health Force Ontario that gives doctors a way to hire PAs. The program gets two, perhaps even three, applications for every graduating student.

“There’ll be a big exodus of people going where the jobs are if we don’t deal with this problem,” says Shaw.

These are people the Forces can’t afford to lose. In Ridgeway’s words, “A physician assistant is part of the life insurance policy for our personnel when they are deployed. These are the people that keep us alive when we’re out doing the dangerous things that we need to do. They are critical to us.”

FUTURE MILITARY PAs

Cpl. Shaw is often asked by her fellow students, “How do I join the military as a PA?”
The answer is: you can’t. This potentially fruitful recruiting stream doesn’t exist yet. Candidates eligible for military PA training have at least twelve years’ experience. From the military’s perspective, a PA also needs to have a certain level of field experience.

“I think there are a lot of military medics that are definitely experienced enough to be taking on this type of program,” says Shaw. They’re going on to be nurses or civilian paramedics because there is an established method for transition into these professions.

This problem isn’t just reserved for QL5 med techs. Sergeants who don’t want to undertake physician assistant training can’t progress either. They hit a wall. Currently, the jobs associated with the ranks of warrant, master warrant or chief warrant officer, can never be attained, despite years of experience, without holding the qualification of physician assistant.

OBLIGATORY SERVICE

As it stands today, the military has no way of locking in Shaw when she graduates. Because she’s doing her training via an Individual Learning Plan, she has not incurred obligatory service.
“She’s going to be master corporal in December, which is still two ranks below where I can employ her as a PA. By rank, I have no way of employing her to the level that she will be certified,” says Maj. Ridgeway.

But it’s obvious that Shaw loves being in the military and is deeply committed to her work there. Her superior officers, her colleagues and her instructors have nothing but glowing reports of her dedication, knowledge and service.

It’s unclear how the military plans to move forward with Shaw. So far they’ve remained tight-lipped, careful to avoid speculation. It would take a very extraordinary person to replicate what Shaw is doing, but while future military PAs may not follow her path exactly her unique case has the potential to instigate change on an institutional level — change that could pave the way for a whole new wave of physician assistants.