'Physician extenders': Inside the work of Michael Garron Hospital’s physician assistants

They aren’t doctors-in-training. They aren’t nurses. Nor are they administrative staff.

Rather, physician assistants act as “physician extenders,” working closely with supervising licensed physicians to provide patient care. Physician assistants are advanced practice clinicians with medical school training but no formal residency requirement.  

Some roles and responsibilities include clinical assessments, contacting families, patient documentation, managing admissions and discharges, prescribing medication and ordering diagnostic procedures among many others.

Enoch Choo, Alex Kim and Andla Zaigham are all physician assistants at Michael Garron Hospital (MGH). Andla and Alex are international medical graduates, and were drawn to the opportunity to work in in-patient hospital care at MGH. For Enoch, he says he was attracted by the idea of working in a role that improves access to health care in Canada.

Andla has been at MGH for roughly 10 years and was among the first physician assistants to join MGH. One thing she has noticed during her time at the hospital is that the trust between physician assistants and supervising physicians has grown significantly, which has allowed her and her colleagues to work more independently.

“Now, I can assess my patients, review with the physicians and we can order investigations, tests, and make a treatment plan,” she says. “They trust our judgement.”

“Our role has become more autonomous,” she adds.

Alex attributes this trust to the close working relationships physician assistants have developed with MGH physicians. Physicians feel more comfortable delegating tasks and trusting in physician assistants to deliver quality patient care.

Through providing this support, physician assistants play a key role in reducing patient wait times and improving access to health care. They have the training and experience to provide patient care if physicians are unavailable.

“Ultimately, the patients are under the care of the physicians,” Enoch says. “But our role allows the physician to see many more patients than they would be able to before.”

Dr. Jeff Powis, medical director, infection prevention and control, has worked closely with MGH physician assistants as a supervising physician. He says this support from physician assistants is key in providing effective treatment to patients.

“I think it drives high quality care, but also efficient care,” he says. “They help things get done expeditiously so we can help patients get better and transition them back home and into the community safely.”

Enoch notes that physicians are also able to focus on other tasks outside of working directly with patients.

"Our role also allows the physician to open up their time to increase their capacity in non-clinical work such as in research, administration and quality improvement than they would be able to before,” Enoch adds.

Enoch says he values the opportunity to provide this patient care and support for physicians.

“When I’m seeing people and addressing their concerns from a health provider point of view, that gives me a lot of satisfaction,” Enoch says.

“We’re a team,” says Dr. Powis, who is grateful for this support, and says he values the opportunities he has to get to know the MGH physician assistants and help them grow professionally and learn new skills.

During the pandemic, Enoch says the team faced challenges with adjusting to a larger patient load, shifting between specialties and the reduced amount of “person-to-person contact” between colleagues.

“We’ve had to become more resilient to see patients more efficiently and effectively,” he says.

Over Andla’s time at MGH, she has noticed that clinical staff around the hospital have come to appreciate what she and other physician assistants bring to the table as care providers. She notes that the number of physician assistants at MGH has steadily grown over the years, with a team of 10 specializing in areas such as internal medicine, infectious disease, neurology and more.

“We know we do a lot of essential work at the hospital,” Enoch says. “We really enjoy working as a team to give the best patient care to our community and our hospital.”

Ultimately, MGH physician assistants are grateful for the support they have received from the hospital and supervising physicians over the years as the team has grown and evolved.

“We would like to thank all the physicians that have contributed to make our role successful,” Andla says.