How to Obtain a PA-C when you have a CCPA

PA-C – Physician Assistant Certification designation in the US
CCPA – Canadian Certified Physician Assistant

At present, PA-Cs can practice in the US and Canada, however, CCPAs can only practice in Canada, not the US.

How to become a CCPA in Canada

  1. Graduate from one of the four Canadian PA schools that is accredited by the Canadian Medical Association Conjoint Accreditation.
  2. Write the Exam – Once a PA graduate has completed an accredit PA program (In Canada or the United States), they may challenge the PA Entry to Certification Exam (which is overseen by PACCC). If they successfully pass they are designated “CCPA”, Canadian Certified Physician Assistant. 
  3. Maintain certification by completion “40 credits annually and must also complete at least 25 credits in each section of the Maintenance of Certification Program before their cycle ends.”

Therefore, both Canadian and American PA grads can obtain a CCPA designation. 

How to Obtain a PA-C in the United States

As referenced to in a previous post, a Canadian’s “CCPA” designation is recognized in the United States. Therefore to obtain a “PA-C” you must:

  1. Graduate from an accredited American PA school, PAEA provides a list of accredited schools
  2. Write the ExamWrite and pass the Physician Assistant National Certification Exam (PANCE) exam.
  3. Maintain certification by completing 100 CME credits every 2 years minimum, and write the Physician Assistant National Recertification Exam (PANRE) at the end of your 6 or 10 year cycle.

Why CCPAs cannot write the PANCE exam

For Canadian PAs with a CCPA designation, we would have to start at “Step 1” of the American PA-C process.

In order to take the PANCE, (regardless of PA education) you must graduate from a PA Program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), which only accredits PA schools which are physically located in the United States, and where their students are geographically located in the United States for their education (3)

Therefore, Canadian PA programs cannot be accredited by the ARC-PA, nor can Canadian PA graduates challenge the PANCE exam.

How can CCPAs write the PANCE Exam? 

Simply put, you would have to graduate from an American PA program accredited by ARC-PA, regardless of your previous medical education.

You could determine if some of your previous medication education is transferrable to a specific PA program, however you’d have to contact that specific PA program.

If you are a Pre-PA Student…

If you are a Pre-PA student considering where you would like to practice in the future, the American PA degree would provide flexibility in terms of where you can practice whether that be in Canada, the United States, or even the United Kingdom. In fact, the UK has been working on a National Physician Assistant Expansion Project (NPAEP) who is specifically recruiting US PAs (4).

However keep in mind that if you are Canadian, and go the United States for PA school  you may have to pay international student fees, the tuition may even be higher if you were to factor in how poorly the Canadian dollar has been doing recently.


(1) What formal education do Physician Assistants have? Accessed July 4, 2016.
(2) NCCPA. How and When to Maintain Certification. Accessed July 4, 2016.
3) ARC-PA. Entering the Process. Accessed July 4, 2016.
4) NPAEP. About the Project. Accessed July 4, 2016.


November 27, 2015 is National PA Day in Canada!

needpa_canadaThis year National Physician Assistant Day falls on November 27, 2015 this year, and what a year its been:

  • The 2015 CAPA Annual Conference was held in Toronto and had the highest attendance of any conference so far, offering 25 CPD credits.
  • CAPA reviewed its National Competency Profile and Scope of Practice and has recently introduced a new CanMEDS-PA Program which parallels the framework from for physicians (CanMEDS).
  • We had our first PA Awareness Day at Queen’s Park attended by 75 PAs, Minister of Health and Long Term Care Dr. Eric Hoskins, and 25 MPPs and two opposition health critics.

I’m extremely grateful to be part of a small (and thriving!) community of health care professionals dedicated to improving the health of Canadians. This profession truly allows for personal, academic and professional growth. PAs also support each other – in research, practice, and on a personal level as well (as I can attest to working with my PA colleague in Ortho!). Happy National Physician Assistant Day!

For more resources, visit the PA Day Resource page

Learn more about the 4 PA Education Programs in Canada:

Learn about PAs in Canada:

TEMPLATE - infographic

For high quality printable version of this infographic, download this PDF: Canada PA Infographic.pdf

Big thanks to Ian Jones, Dr. Maureen Gottesman and Natalie St. Pierre of CAPA for feedback and facts!


Learn about PAs in Manitoba:

TEMPLATE - infographic - MANITOBA

For a high quality printed version of “PAs in Manitoba”, download this PDF: TEMPLATE – infographic – MANITOBA.pdf

Big thanks to Ian Jones, MPAS, CCPA, PA-C for supplying the facts + feedback for this infographic.

Learn about PAs in Ontario:

TEMPLATE - infographic - ONTARIO

For a high quality printed version of “PAs in Ontario”, download this PDF: Infographic – ONTARIO.pdf

Big thanks to Deniece O’Leary, CAPA Ontario Chapter President, Natalie St. Pierre, Natalie Dies, Dr. Maureen Gottesman, MD (Medical Director of the PA Consortium), Dr. Penny Thompson MD (McMaster University) and Nancy Weller, MWO/Adjum May Machoun (PA Program Director, Banting Compagny, Canadian Forces Health Services Traning Centre)


A Primer on Medical Directives for Physician Assistants

Angela Cassell, CCPA and Deniece O’Leary, incoming CAPA Ontario Chapter President presented a great session on Medical Directives at this past Annual CAPA Conference that took place in Toronto.  I know a large challenge for PAs is that there aren’t a lot of resources available to PAs – especially around templates or best practices for implementing medical directives.

In this post:

  1. How do PAs practice Medicine in Ontario?
  2. What are Medical Directives?
  3. Keeping Medical Directives Updated
  4. How are Medical Directives helpful to PAs?
  5. What do Medical Directives Look Like?
  6. How do you Implement a Medical Directive?
  7. A Word on Competency
  8. Where can I find examples/templates of Medical Directives? [various templates from ER, family med included]
  9. Do all PAs need Medical Directives?
  10. Resources on Medical Directives

Each province’s college has different policies surrounding delegation of controlled acts. What’s presented here is based on the Ontario experience.

How do PAs practice medicine in Ontario?

By nature Physician Assistants are not independent practitioners, we work under the supervision of physicians. As outlined by OHA, the definition of “supervision” varies – this can be direct (direct observation) or indirect (physician offsite, but accessible via phone, electronic means). At the beginning of a PA’s employment, it may be more appropriate to have “direct” supervision, however as the PA/MD relationship develops, and the PA builds knowledge, competency and skills in their area of practice, the supervision may transition to “indirect”.

In Ontario, Physician Assistants practice through the Regulated Health Professions Act (RHPA), which outlines controlled medical procedures that can be delegated to PAs by physician orders – written, verbal or medical directives. This differs from province to province, so check each province’s college website to determine how PAs can practice in your jurisdiction.

What are Medical Directives?

According to the College of Physician and Surgeons of Ontario (CPSO),

“Medical directives are written orders by physicians…. to other health care providers that pertain to any patient who meets the criteria set out in the medical directive. When the directive calls for acts that will require delegation. It provides authority to carry out the treatments, procedures or other interventions that are specified int he directive, provided that certain conditions and circumstances exist.”

In other words, the medical directive allows a supervising physician to delegate duties to another person without requiring the physician’s physical presence. CPSO has a list of 14 controlled acts that can be delegated. The medical directive expands on these delegated tasks to outline certain conditions under which PAs can perform those delegated asks.

Although a very simplistic example, think of medical directives like a “Protocol” with many “If, then” statements. “If patients presents with X, PA is to perform Y.

  • X being condition specific, or certain presentations, or a list of indications. It can also be related to preventative care (e.g. when patient is due for a well baby exam).
  • Y being assessment (history & physical exams), ordering or performing diagnostic or therapeutic procedures and prescription of medications . Contraindications included.

Keeping Medical Directives Updated:

Two great tidbits from Angela Cassell, CCPA during the Medical Directive Roundtable Discussion at the Toronto CAPA Annual Conference:

“Medical directives are living documents”they should be updated frequently (at most ever 3-4 years) as guidelines change.

“Include References in Your Medical Directives”, which may include a “See Canadian Diabetes Association Clinical Practice Guidelines for Screening & Diagnosis of Diabetes” with a link to the website. You may include the actual guidelines as an Appendix at the end of the medical directive, or built right into the medical directives, however this does require a lot of upkeep when the guidelines update.

Try to keep your directives broad instead of specific”  i.e. instead of listing individual medications list classes or medications or group together by disease processes.

  • An example would be to say you can prescribe Sulfonylureas (class of medication) instead of Diamicron (speciic medicaiton) or even better, all antihypoglyemic medications (by disease process). This ensures directives don’t need to be udpated every time a new medicaiton comes on the market.”

How are Medical Directives helpful to Physician Assistants?

There are three methods to take orders from physicians:

  • Verbal Direct Order – in person or over the phone. Requires presence of physician.  This takes place after the PA has interacted with a patient.
  • Written Direct Order – having the physician spell out/write out orders and signing off. This takes place after the PA has interacted with a patient.
  • Medical Directives – PAs are able to implement an already-agreed upon  list of frequently delegated tasks under certain circumstances. This takes place in advance of the PA interacting with a patient.

In all cases, how the order was implemented (and method – verbal, written, medical directives) should be documented in the patient’s chart.

Medical directives allow PAs to perform various delegated acts under the supervision of a physician. The physician does not necessarily need to be present for the PA to perform these delegated tasks that have been outlined in the medical directive. Medical directives allows PAs to function more efficiently, especially in settings with indirect physician supervision.

It can be quite cumbersome to require your supervising physicians to give you verbal or written orders, or to chase after physicians (around a hospital, or smaller practice) for routine ordering of imaging, lab tests, and prescription of routine medications (narcotics/controlled substances fall out of this scope). Time is spent instead on patient care.

If there is an a controlled act, e.g. an investigation you would like to order, medication that you would like to prescribe (such as a narcotic/controlled substance), or an intervention you would like to implement that falls outside of the medical directives, this is where you would require a direct order (e.g. written order) from the physician. 

What do Medical Directives Look Like?

Medical directives can be very broad or specific. They will be formatted to best suit the practice setting – Emergency Medicine Medical Directives will look very different from Medical Directives in a Family Medicine Setting, and are often institution-specific.

Some practice settings have already prepared Medical Directives, other places require the PA to develop the medical directives, which can be an enormous (but not impossible!) undertaking.

Basic Outline of Medical Directive – full word document template available onlineScreen Shot 2015-11-07 at 10.18.01 AM


Family Health Team Medical Directives – full directives available online
Click thumbnails below to view larger version.


Emergency Medicine Medical Directives – full directive templates available online

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Example of Emergency Medicine Medical Directives


How do you implement a medical directive?

Medical Directives & Medical Documentation – Whenever you perform a delegated act outlined in the medical directive, there should be a reference to it when you are documenting your patient encounter.

  • e.g. “Counseled patient  on medication use and compliance, self monitoring of blood glucose levels, smoking cessation, alcohol consumption, exercise and diet as per medical directive #12c”
  • e.g. “After explaining risks and benefits, and obtaining informed consent, 80 mg of Depo-Medrol along with 4 cc of 2% Xylocaine without Epinephrine was injected into the right knee using sterile technique, no complications. Intervention performed as per medical directive #12d”

Medical Directives & Ordering Investigations – Ensure local imaging facilities have a copy of the medical directives. When signing at the bottom, sign your name, designation, medical directive reference, your supervising physician name and their CPSO number.

  • e.g. John Smith, CCPA, as per medical directive #2a for Dr. Jane Appleby, CPSO # 86070. Clinic: Peach Tree CHC, 123 Long Street, Toronto, ON M3U 5Y5″

Prescription-WritingMedical Directives & Prescription Medications –  Ensure the pharmacies that your patients go to (whether hospital/inhouse pharmacy or community pharmacy) have a copy of your medical directives. Take it a step further and introduce yourself personally to the pharmacist with a copy of a photo resume, medical directives (with sections marked/highlighted as relevant to the pharmacists), a copy of the Ontario College of Pharmacists Bulletin on PAs (its page 13 and 14), clinic address, at the bottom of the prescription write e.g. John Smith, CCPA “as per medical directive #1a”, your supervising physician name and their CPSO number.

  • e.g. John Smith, CCPA, as per medical directive #2a for Dr. Jane Appleby, CPSO # 86070. Clinic: Peach Tree CHC, 123 Long Street, Toronto, ON M3U 5Y5″

A Word on Competency

Being able to implement a medical directive (and also being able to delegate a controlled act) requires a few things:

  • The supervising physician can only delegate an act that they themselves are competent at, and are within their scope/area of medicine that they practice in. They cannot delegate acts that fall outside of this.
  • CPSO outlines that the delegate (PA) should be evaluated by supervising physician to ensure the PA has the appropriate knowledge, skill and judgement to perform the act just as well as the supervising physicianHow this can be evaluated is a competency checklist. For instance, your supervising physician (or designee) can observe you do a certain delegated act (e.g. performing a lumbar puncture) 10 times, at certain time points. This can be implemented directly into the medical directives. And this can be checked annually, biannually or whatever frequency the practice deems fit.
  • You can decline the delegated act for any reason, you cannot be forced by the delegating physician to perform the act.

More information can be found on CPSO’s Delegation of Controlled Acts Page.

 Where can I find templates/examples of Medical Directives?

If you google “Physician Assistants Medical Directives” there ARE a few clinics and departments that have PDFs of their medical directives online:

Do all PAs need Medical Directives?

This answer is very institution dependent.

Many Community Health Centres (CHCs), Family Health Teams (FHTs) and hospitals have medical directives in place as part of their policy. In instances where PAs practice with a lot of indirect physician supervision medical directives can be extremely helpful.  (e.g. wards, inpatient units, hospital settings, or at a family practice setting where you have your own roster of patients),

In more direct supervision settings, medical directives may not be necessary. 

Resources for Medical Directives


Winning Tom Ashman PA of the Year Award!

IMG_3758The Canadian Association of Physician Assistants 2015 Annual Conference in Toronto, ON was extremely eventful. Apart from the excellent CPD sessions, high calibre speakers (including Andre Picard, Globe and Mail Health Journalist, Dr. Virignia Walley – OMA President Elect and Dr. Cindy Forbes – CMA President Elect), personal development/advocacy roundtable sessions, and networking opportunities.

I also enjoy attending the conference because it really gives you a sense of where the profession stands in Canada and each of the provinces/territories, (in terms of funding, regulation, reimbursement/billing, advocacy, awareness) as well as provide great resources and ideas to tackling barriers to practice and employment.

I’ve attended past CAPA conferences as an attendee where I collected CPD and networked, however this year I took on a few more roles since the conference was taking place in my hometown of Toronto. There were several highlights of the conference this year for me, including  being part of the Conference Planning Committee (a voluntary role), moderating a few conference sessions, having the opportunity to present (student breakfast session on Launching your PA Career), working with my PA colleague to have a poster abstract submitted for the conference, then presenting the poster at the conference (taking 2nd place in the poster session!), and being the recipient of the Tom Ashman PA of the year award!

Awards Ceremony

Tom Ashman PA of the Year


Thank you Robert Brunet for presenting the award and for the wonderful powerpoint presentation showcasing my involvement in social media & PA advocacy!

I received a call about the nomination a few weeks in advance. I learned the individual who nominated me was Robert Brunet, CCPA current CAPA Board of Director and well established Physician Assistant actively involved in teaching, clinical work and advocacy! He is someone whom I’ve worked closely on different initiatives (committees, social media strategy) over the years and upon hearing about the nomination it was so humbling. We connected several times over the conference.

I had come prepared with an acceptance speech, acknowledging friends and family, mentors and teachers, CAPA staff, colleagues, as well as my co-worker and good friend who was the first person I had ever spoken to about potentially entering the PA profession, and continues to be a PA who inspires me. When writing this I reflected on all the opportunities these individuals had afforded me – giving me a chance to make changes to the CAPA site, install a forum, volunteer on various subcommittees, but also encouraging my efforts in PA advocacy in social media. The PA community is small, but really supports and uplifts each other in achieving success in many ways.

Pictures from Kayce Photography

2nd Place Poster Presentation

IMG_9578 IMG_9719

Ohood and I receiving our award for the Poster Presentation (left)
and presenting our poster with powerpoint presentation (right). 

We were completely surprised to receive 2nd place for our Poster, as CAPA did have a panel of judges evaluate posters prior to the Awards Ceremony. Ohood and I then presented our poster with a 5 minute synopsis and fielded questions from the audience.

This was actually a really fun experience! The poster session is a great way to encourage PAs to participate in research. After the recognition, and poster presentation we excitedly discuss doing this for future conferences.

A screenshot of our poster PDF that we submitted for printing, case-baed study on massive rotator cuff tears treated with Graftjacket Repair.

Presenting at the Student Breakfast Session

I did a presentation on Launching your PA Career: Tips for Success for New PA Grad Hires. This was my first time presenting at the CAPA conference and it was a great somewhat informal session! I presented alongside Kevin Kendal, CCPA an experienced PA working out west who had a lot of insight working in an ER department.

View the Full Presentation Online

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Launching Your PA Career: Tips for Success for New PA Grad Hires

For the 2015 Canadian Association of Physician Assistants Annual Conference in Toronto, ON, I presented a session on Launching Your PA Career on October 24, 2015 with Kevin Kendal, CCPA. We had a few PA students attend from University of Toronto, McMaster and the Military. The session was very early in the morning (7 am) following an intense Game 6 with the Blue Jays so we suspected attendance wouldn’t be high, but it was actually a good turnout!

We were advised approximately 10 minutes to present, so included as much as I could that I felt was relevant and generalized to PAs in different practice settings based on my experience working in Ontario.

We fielded a few questions from the audience in the end, and I left feeling like it was a productive session!


A Copy of the Presentation:

Screen Shot 2015-10-26 at 9.24.04 PM Continue reading


CAPA Conference 2015: Day 3 [Toronto, ON]

CAPA Conference Highlights

I try to attend CAPA conferences each year as they rotate between hosting it in different parts of Canada (last year was in Halifax, this year Toronto, next year in Winnipeg). This year’s conference was the largest attended (240+ delegates, that is 1/3rd of CAPA’s entire membership!) which I believe is because Toronto tends to be a bit more central, and is close to two of the four PA programs in Canada.

I left the conference exhausted, but oddly also energized and inspired (as great conferences tend to do!) for several reasons:

  • PA conferences feel like one big reunion: Because the PA profession is a small community (but growing) PAs often work in their own individual settings with some contact with other PAs. You meet a lot of PAs in different practice settings and learning about their successes and struggles in the PA profession. Its often a relief to hear that you aren’t the only one struggling with certain barriers to practice. You also get great ideas for what you can do to improve and work on professional development.
  • There was an incredible amount of Continuing Professional Development (CPD) lectures/talks. We are required to have 25 MainPro Credits to maintain our CCPA designation/certification. CAPA has been able to offer 25 at this one conference, so for me attending the conference as an easy sell. The calibre of lecturers/talks seems to improve with each year.
  • You get a great snapshot of what work needs to be done to move the profession forward. There are excellent discussions around advocating the profession, networking, data-driven research proving cost-effectiveness and clinical efficacy of utilization of PAs, and mentoring. You learn about the efforts of our national organization to meet with Ministers of Health, build relationships with stakeholders and organize initiatives (like PA Lobby Day) so that decision makers can hear our personal stories.
  • It encourages excellence in Delivery of Clinical Care and Research. Participating in the Poster Session was a first for me, and it was motivating to see other PAs working to publish research as well.
  • You get to engage and network with PA students There was a pretty good representation of students at this conference, many of whom wrote their PA Entry to Practice Certification Exam one day prior to the conference starting. I learned a lot about how they felt there was a need for increased communication between students and alumni for mentoring and guidance, more communication between the PA student groups. I think its important for PA students to attend conferences because:
    • You get to speak with and get advice from well-seasoned PAs in various areas of practice – giving you a better idea of the transition from school to work
    • PAs are more than willing to allow PA students to shadow or complete elective rotations with
    • You can network and meet other PA students, and discuss ideas for promoting the PA profession and creating resources for current and future generations of PA students
    • Each year there is a student session related to PA success.
    • It helps give you context about the issues facing the profession, with some resources on how to tackle those issues moving forward.


Overview of Day 1 of the CAPA Conference

Overview of Day 2 of the CAPA Conference

Overview of Day 3 of the CAPA Conference

We had an excellent Plenary Presentation about Integrating the PA Profession with Perspectives from around the Globe, with representation from US, Australia and the Netherlands:

  • Australia (Al Forde, PA-C MPAS)
  • United States (1st female Oregan PA and PA trailblazer, Ruth Ballweg PA-C)
  • Netherlands PA Association President Wijnan van Unen

We learned that each country has had its successes and struggles with implementing the PA Continue reading


CAPA Conference 2015: Day 2 [Toronto, ON]

Day 2 of the conference we had big names like Andre Picard, Globe and Mail Health Journalist and Maureen Taylor, former CBC journalist and now Physician Assistant speak at the conference today.

Today began with the Student Breakfast Session: Launching your PA Career bright and early at 7 am.

I loved having the opportunity to speak with students and impart some tips on how to succeed as a new PA grad hire.

I then helped moderate the “Lab Testing in Rheumatic Diseases” with Dr. Vu Kiet Tran

Continue reading