The movement toward using nonphysician providers is an attractive option in the current healthcare environment. The use of nonphysician providers, including physician assistants (PAs), can expedite timely care, reduce inefficiencies, and improve continuity of care. PAs who specialize in oncology are transforming busy oncology practices at academic centers around the country. The Oncology Nurse-APN/PA spoke with Jeremy Heinerich, PA-C, Chief PA of Inpatient Oncology at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City, about the evolving role of the PA at his institution and other centers.
Can you tell me about how PAs were incorporated into oncology departments at your institution?
Jeremy Heinerich (JH): I was hired in 2006 as the first PA to specialize in oncology at New York-Presbyterian/Weill Cornell inpatient unit. My role was to help organize a busy leukemia service with increasing numbers of patients and a need for more continuity of care. The interns/residents and attending physicians in the service rotated every 2 weeks, so the new ones who came in were unfamiliar with the patients. My job was to be a focused presence for the oncologic aspects of care. In a relatively short period of time, the benefits of having a PA in the leukemia service were evident, and a second PA was hired. The patient volume increased, while the length of stay and throughput decreased. PAs educated interns and residents about issues that included the effects of chemotherapy and early warning signs of problems in oncology inpatients. We also performed procedures that included bone marrow biopsy and lumbar puncture, thus freeing up the attending to focus on other aspects of care.
Over the following years, the number of PAs specializing in oncology has expanded at our center. Currently we have 45 PAs (33 full-time and 12 on a per diem basis) working the night shift, the bone marrow transplant service, the leukemia service, and the lymphoma service. In general, a PA will see from 8 to 10 patients per day. There are additional PAs working on other inpatient as well as outpatient oncology services at Weill Cornell.
We continue to evolve and expand the service to accommodate the growing number of patients, and now we have sick days, vacation days, and maternity leave incorporated into our algorithm to ensure a smooth functioning service.
What exactly is the role of a PA in oncology?
JH: We are an extension of the physician. We see inpatients on the floor. We do pre-rounding and collect data on patients so we can present that to the attending physician. We update the attending on patient status, we do admissions and discharge, and we can write prescriptions for drugs. We also follow up on the recommendations of the attending physician.
How does having PAs focused on oncology care improve outcomes for patients?
JH: A PA is a consistent presence for the patient. We get to know patients well and also know them from repeated admissions. We develop a bond with the patient and family. We know what needs to be done for a particular patient on a specific treatment regimen, and we can schedule appropriate follow-up appointments in a timely way, streamlining the process of care. PAs are readily available on the floor for nurses who need help.
Is the use of PAs in oncology care a trend in the United States?
JH: Yes, you will see this at many of the academic cancer centers, including Memorial Sloan-Kettering Cancer Center, Fred Hutchinson Cancer Center, H. Lee Moffitt Cancer Center, and others.
How has the role of the PA evolved over the years?
JH: The first class of PAs graduated from Duke University in 1968. The PA profession has grown exponentially over the past 45 years. We are able to fill gaps where there are shortages of physician providers, and help fill a niche market in specialty areas. Hospitals have incorporated PAs into many resident services so that residents would be compliant with work hours and could focus on education.
What inspired you to become a PA?
JH: I was drawn to the medical profession from a young age, because I wanted to help people. Originally I was planning to go to medical school, but that didn’t happen for a variety of reasons. Then I found out about the PA profession, and it was the best choice I could have made. It’s a great profession with a lot of flexibility. I can change my specialty if I want to and get on-the-job training, and also I can adjust my work schedule based on my personal needs.
What advice would you give to a PA just starting out?
JH: I would say not to take the first job you get offered. Find something that interests you as a potential career path. Also, keep an open mind, and be willing to put in hard work. New PAs who work in oncology should be aware of the Association of Physician Assistants in Oncology (APAO), an organization about 19 years old that has now evolved into a large network. We have increased membership and visibility for the organization, as well as increased opportunities in oncology. It is a great networking organization. I was president in 2007. The website is www.apao.cc. APAO has an annual conference, which is highly attended.
If you weren’t a PA, what would you be doing?
JH: Well, my job is emotionally draining at the same time that it is very rewarding. For diversion and for balance, I seek out entertainment—shows, museums, concerts. I would probably be in the entertainment industry.