Physician assistants work across many departments at UHN. Anne Dang (L) and Robyn Kapelner (R) are PAs in the Orthopedic Surgery Department at Toronto Western Hospital, where they work alongside other members of the multidisciplinary team, including orthopedic surgeon Dr. Tim Leroux (C). (Photo: Courtesy Anne Dang)

Robyn Kapelner was a pioneer of sorts when she arrived four years ago in the Orthopedic Surgery Department at Toronto Western Hospital (TWH) – the division's first physician assistant (PA).

The PA position was long established in the United States, and prior to coming to work at UHN, Robyn had worked in New York at a large orthopedic surgery department.

"I was excited to bring my experience as the first PA hire and demonstrate how PAs can impact patient care," says Robyn.

Since Robyn arrived, another PA has joined the Orthopedic Surgery team at TWH, which is part of UHN's Sprott Department of Surgery. And, the two of them have had a very positive impact.

"The addition of PAs has unquestionably improved our ability to provide high quality, patient-centred care," says Dr. Michael Zywiel, orthopedic surgeon in hip and knee arthroplasty. "Their role and skills perfectly complement those of the surgeons. They have been equally invaluable in the operating room, providing patient care in clinic on the wards or through virtual care, and extending our ability to handle urgent consultations.

"It has been almost four years since our first PA joined the team and it's hard to imagine how we managed without them. It's truly a case where by working together, the whole is greater than the sum of the parts."

Nov. 27 is National Physician Assistant Day in Canada. There are more than 800 PAs practicing 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.

Earlier this year, legislation was introduced in Ontario that will bring PAs under the regulatory authority of the College of Physicians and Surgeons of Ontario. It will make Ontario the fourth province to do so, following Manitoba, New Brunswick and Alberta. Read more about the profession in Canada.

UHN employs 44 PAs working in general and specialty surgery, oncology, emergency, inpatient and ambulatory care.

Robyn Kapelner (L) is an American-trained PA from New York Pace University/Lenox Hill Hospital. Anne Dang is a Canadian certified PA trained at McMaster's Physician Assistant Education Program. (Photo: Courtesy Anne Dang)

Anne Dang, who joined the Orthopedic Surgery Service at TWH soon after the start of the pandemic following eight years as a PA in a private surgery group practice in the community, says she enjoys "delivering hands-on, high-quality care.

"Our flexible scope of practice mirrors the physicians we work with, allowing us to extend medical services, and work collaboratively with all members of the healthcare team to provide care for patients," Anne says.

Dr. Christian Veillette, a shoulder and elbow reconstructive surgeon and Head of the Division of Orthopedic Surgery, says the division and UHN's Schroeder Arthritis Institute have invested in interdisciplinary care models to best meet the needs of patients with orthopedic joint and spine conditions.

"Each discipline in our team has unique skills and competencies that enable the best care for our patients," says Dr. Veillette, adding that PAs are "invaluable in their role" as they are one of the few disciplines involved across the entire continuum of care from orthopedic and fracture clinics to preoperative risk assessment, assisting with the surgical procedure and postoperative care.

"Being involved along every step of the patient journey makes physician assistants an integral part of our orthopedic team to provide the best outcomes for our patients," Dr. Veillette says.

Dr. Tim Leroux, orthopaedic surgeon in shoulder reconstruction, first encountered PAs during his fellowship training in the U.S. and says he was "excited to see this modernized model of care being integrated here at UHN.

"Anne and Robyn bring so much to the Orthopaedic Service, including knowledge and skillsets that enhance patient care and add value to the patients, staff and medical learners they work with," Dr. Leroux says. "With demands increasing on the department, especially with the backlog of care created by the pandemic, PAs have been force multipliers during this time.

"They work to improve access to quality care for our patients, and expand services and coverage to help reduce physician burnout, and enhance medical learner education."


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