Helping care go further: Celebrating physician assistants
Every year, November 27 is Physician Assistant (PA) Day. At the University of Toronto Department of Family & Community Medicine (DFCM), we’re celebrating the immense value PAs bring to the health system.
For almost a decade, physician assistant (PA) Erika North and family physician Dr. Lara Rosenberg have been a duo, an extension of each other’s roles. Working at the New Family Medicine Network, a clinic specializing in obstetrics and pediatrics as part of U of T and the North York Family Health Team, North supports six family doctors, enabling them to see over 30 patients a day, virtually and in-person.
The role of a PA is often misunderstood, even within healthcare. But those that have worked alongside these physician extenders understand the immense value PAs bring to the health system.
“PAs are trained as highly skilled generalists and work alongside physicians to deliver primary care, as well as all other specialties,” explains Dr. Leslie Nickell, Medical Director of the Physician Assistant Professional Degree Program (BPsPA) at DFCM. “They can take histories, perform physical examinations, order tests, make diagnoses, triage and treat patients, speed up wait times and are often able to spend longer supporting patients who need it.”
Ultimately, this means that clinics can see more patients while maintaining high quality of care.
North received her PA degree from U of T in 2013. The program, which launched in 2008, is one of only two in Ontario—and is a collaboration between the Temerty Faculty of Medicine, Northern Ontario School of Medicine and Michener Institute of Applied Health Sciences. The program’s mission is to provide better health care for underserved areas, including northern Ontario and rural areas.
“The main benefit of a PA for patients is increased access,” says North. “As their PA, I’m another familiar provider who knows them well. They feel heard, cared for and satisfied.”
“There’s a strong relationship developed with both of us,” says Dr. Rosenberg, who is also Program Director of DFCM’s Enhanced Skills Program in Low-Risk Obstetrics. “Sometimes they’re closer to their family doctor and sometimes it’s Erika that spends more time with them.”
PA Erika North
Family physician Dr. Lara Rosenberg
The duo has worked together for so long that they know how the other thinks and how to maximize each other’s strengths, such as North’s deep understanding of musculoskeletal issues from her days as a Registered Massage Therapist.
“There’s a lot of overlap. We’re different parts of the same team,” says North. “If a patient has a simpler issue, like a UTI or blood pressure check, I handle it. But if it’s more complex, I’ll verify it with one of the physicians.”
“The way we work as a team is so integrated. It’s not as much about the role, it’s more about the person. Here, roles are avenues to providing good care,” explains Dr. Rosenberg.
As more people see the impact that PAs can have in primary care, demand continues to grow.
“Our 24-month program is very competitive,” says Melissa Rodway, DFCM’s PA Program Coordinator. “Last year, there were nearly 900 applicants and we have just 30 spots.”
For some, the flexibility of the profession is a real draw.
“Like physicians—particularly family doctors—PAs have a high level of close patient care and communication,” says Dr. Nickell. “But unlike physicians, PAs don’t have to limit themselves to one specialty. The focus of a PA’s practice depends on the physician or team they work with, so they have the flexibility to change direction as their skills and interests evolve.”
This versatility was hugely beneficial during the COVID-19 pandemic.
“PAs really stepped up and delivered much-needed health services. PAs are trained to serve patients and communities,” says Dr. Nickell.
This dedication is common among PAs across the province.
“As a PA, you need to be driven and a good collaborator with good communication skills,” explains North. “Broad medical knowledge will go a long way, but at the core you need to care about the patient. You have to like people and want to help them.”