Physician assistants Eugene Leung and Monica Monchis on Unit 15C at the Princess Margaret Cancer Centre where they are integral members of an interdisciplinary team which works with patients who undergo autologous stem cell transplant and immune effector cell therapy for treatment of lymphoma and multiple myeloma. (Photo: UHN)

Monica Monchis and Eugene Leung each took a winding path to their current destination at UHN.

Physician assistant (PA) colleagues at the Princess Margaret Cancer Centre, each had already worked in health care before going back to school to become a PA – further expanding their medical knowledge in diagnosing, prescribing and treating patients to take on a role that sees them extend the reach of their supervising physicians and deliver better quality patient care.

"As a PA, I can focus on direct patient care and working collaboratively with physicians and other Allied Health professionals," says Monica, who for a decade prior to becoming a PA held various roles in health care, including medical office assistant, clinical research, internships and volunteer work.

"I also like the lateral flexibility that being a PA offers in terms of working in various specialties without additional schooling in between."

Before becoming a PA, Eugene trained and worked as a radiation therapist in Ottawa and Victoria.

Despite loving the technical aspect of radiation therapy, Eugene wanted to have a greater direct impact on patient care, which he has the opportunity to experience now as a PA.

"As a PA, I have a broader scope of practice compared to when I was a radiation therapist," Eugene says. "As a result, I'm able to feel more involved in my patient's care and directly make a difference in their treatment, as opposed to feeling like I am standing on the sidelines."

Sunday, Nov. 27 is National Physician Assistant Day in Canada. There are more than 800 PAs practising in Canada, with 500 of them in Ontario. They train in three PA programs in Canada – at McMaster University, the University of Toronto and the University of Manitoba.

PAs are highly trained clinical professionals, who work in various health care settings across UHN, helping to reduce physician workload, wait times and improve patient access to timely care.

'Continuous presence of skilled PAs is a major contributor to patient safety'

Over the past 10 years, PAs have become an integral part of the UHN health care team, working in a vast array of service areas, including: general and specialized surgical services, benign hematology, oncology, cardiology, Emergency medicine, multi-organ transplant and general internal medicine services.

Both Monica and Eugene are part of this growing health care profession, that many are hoping will assist to reduce the heavy strains on the Canadian health care system.

At the Princess Margaret, the pair work with patients who undergo autologous stem cell transplant and immune effector cell therapy for treatment of lymphoma and multiple myeloma. Integral members of the LMT-IEC team, they also assist in managing patients on various clinical trials, as well as those who require urgent chemotherapy or are admitted with acute complications related to their treatment or underlying disease.

The LMT-IEC service on 15C at the Princess Margaret takes an interprofessional approach to patient care, with a multidisciplinary team consisting of bedside nurses, nurse practitioners, staff physicians, fellows, and as of three years ago, PAs.

"Monica and Eugene have been wonderful additions to our inpatient team," says Dr. Robert Kridel, a clinician scientist at the Princess Margaret and their supervisor. "As the care we provide to our patients is highly complex, the continuous presence of skilled PAs is a major contributor to patient safety."

Dr. Chloe Yang, a supervising attending at the Princess Margaret, echoes those sentiments.

"Monica and Eugene have both very quickly become experts in the care of our unique patient population," she says. "They are appreciated by our patients, learners, and Allied Health team.

"I definitely would not be able to do my job without their support!"

'An invaluable addition to the health care team'

The contribution made by PAs allows greater access to care for patients, during a time when there is an ever increasing void of health care providers. It also helps ease the workload of physicians.

"We act as extenders to the physicians who have busy clinics and other responsibilities to ensure that all our patients get the best care possible," Eugene says. "As well, given our intimate knowledge with the service, we ensure that patients get the proper follow-up."

When asked, what drew him to caring for complex cancer patients, it's clear Eugene's keen interest in scientific advances in health care, made him a perfect fit for the field.

"I knew I wanted to do inpatient medicine, as I liked the acuity of the patients compared to outpatient," he says. "Considering my background in radiation therapy, I was naturally drawn towards oncology."

There is a great deal of variety in each day for Monica and Eugene.

At the outset, they discuss with the team of medical providers concerns about the patient from the previous night and make plans for support and management. As the day progresses, they round on assigned patients with their attending physician, perform urgent procedures, engage in discharge planning and function as a resource of information and support for patients, their loved ones and other members of the Allied Care team.

Monica values the increased time her role as a PA permits her to spend one-on-one with patients.

"Since we are core members of the team, we provide continuity of care to our patients and offer consistency to the various rotating staff members on our service," Monica says.

Recognizing the growing importance of the PA's role in the future of the Canadian health care system, the Ontario government passed legislation to support regulation of the profession by the College of Physicians and Surgeons of Ontario.

"PAs are an invaluable addition to the health care team," say UHN PA Clinical co-Leads, Dr. Richard Tsang and Jessica Danquah. "We think the best for this profession is yet to come."

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