Physician assistants provide workforce flexibility

PAs are staffing COVID-19 tents and clinics

MICHELLE SHKNEVSKY, a general surgery physician assistant at Brockton Hospital, is actually seeing fewer patients since the COVID-19 epidemic began. With no elective surgeries being performed, her unit needs fewer daytime staff, so her shift has been changed to nights and weekends only. Her hospital split the physician assistants into two teams so they have contact with fewer people. They stay in separate rooms and pass a pager between them outside the door, after wiping it down.

Shknevsky knows she may soon be sent to another part of the hospital, like the emergency room or a clinic to treat COVID-19 patients. “That’s essentially what PAs are here for,” Shknevsky said. “We go to school, are taught how to do multiple things, learn about different parts of medicine so one day we can be in geriatrics, the next day in pediatrics. It’s a seamless transition with some learning curves.”

There are about 4,000 physician assistants in Massachusetts, and the flexibility they bring to the health care system is becoming increasingly vital as hospitals prepare for an expected surge in patients with COVID-19. The state has generally been taking steps to increase the pool of available health care providers – letting medical students graduate early and making it easier for out-of-state clinicians to practice here – and it is also making it easier for existing clinicians to switch roles.

Physician assistants are trained in general practice medicine and can perform many functions a physician can – examining patients, prescribing medicine, and ordering and interpreting tests – under a physician’s supervision. The Department of Public Health issued an order March 18 letting physician assistants switch their supervising physician without state approval. A hospital still has to keep track of the assignments, but the move eliminates the administrative hassle and paperwork that typically comes with reassigning a PA from one department to another.

Now, physician assistants are staffing COVID-19 testing sites and specialized respiratory clinics, acting as backup labor pools for emergency departments, and working with doctors and nurses to make difficult decisions about patient care.

Josh Merson, president of the Massachusetts Association of Physician Assistants, said there are many specialties, like elective surgery or orthopedics, with few patients, since hospitals have cancelled all elective surgeries and patients are deferring routine care. “If there’s an immediate need in patient care, in COVID tents or the emergency room, we’re able to move PAs from some of those different areas directly to the areas of need,” Merson said.

At Brigham and Women’s Hospital, Jessica Britnell and Jessica Logsdon are taking advantage of the new order by organizing the hospital’s 350 physician assistants into a backup labor force for the parts of the hospital expected to be hardest hit by COVID-19. Logsdon, who works in neurosurgery, is senior director of PA services, while Britnell is in charge of physician assistants in emergency medicine. Britnell and Logsdon surveyed all the hospital PAs about their skills and are dividing them into teams, so PAs working in specialties with fewer patients will be available to staff the emergency department or specialized clinics. They are ensuring that all PAs have the badges and computer access they need to jump into their new roles.

Already at Brigham and Women’s, physician assistants are staffing COVID-19 screening sites, remote telehealth call centers, and a special respiratory clinic meant to isolate potentially contagious patients from other patients. Many PAs are also being instructed to work from home – providing telehealth services or calling people with results of COVID-19 tests – to make sure they are healthy and ready to work when needed.

So far, Logsdon said the situation has been manageable. But, she said, “As patient numbers do grow, it’s going to be really challenging to figure out how to deploy people in rapid fashion to where they’re needed. It’s where you see the value of the PA profession that we can float them across specialties at a moment’s notice.”

Cambridge Health Alliance’s chief primary care physician assistant Janice John has already started reassigning PAs. John is functioning as the medical director overseeing the implementation of a new respiratory clinic. The new order from DPH recently let her transfer a physician assistant with a primary care background who had been working orthopedics, where patient volume was dropping, to staff the respiratory clinic. The PA was able to easily switch her supervising physician from one specializing in orthopedics to one trained to deal with the community response to COVID-19.

“This made us more nimble in our response to COVID-19 in that we are able to redeploy her quickly,” John said.

John worries that hospital capacity will become an issue soon, and she said the flexibility PAs bring will be important. “The first few days we were seeing patients with fairly mild symptoms, but every day the patients are getting quite a bit sicker,” John said.

At Lynn Community Health Center, a physician assistant is organizing telemedicine efforts, with a goal of moving 90 percent of behavioral health clinicians and 80 percent of medical clinicians to performing telemedicine from home.

Gregory Hood, a physician assistant at the Lynn facility who is the medical director of a primary care team, said that will create a “reserve pool” of healthy clinicians to replace anyone who gets sick.

Physician assistants are also staffing a clinic for people under investigation for possibly having COVID-19. “The PA role is front and center in the trenches,” Hood said.