Successful pilot of orthopedic physician assistants leads to permanent roles and expansion of innovation to other Nova Scotia Health services

When Nova Scotia announced it would be evaluating the role physician assistants could play in supporting orthopedic care, Erin Sephton jumped at the opportunity to return to her home province, bringing with her years of skill, knowledge and experience.

Now going into her tenth year of practice, Sephton graduated from McMaster University with a Bachelor of Health Sciences in Physician Assistant Studies, and prior to that worked as a paramedic in Nova Scotia. Recognizing the need for more access and collaborative care for patients, she saw that the role of physician assistant was one that could support these areas and expand the services that patients need to support their recovery.

Physician assistants (PAs) are health care providers who practice medicine in collaboration with, or under the supervision of a physician. They are trained to perform many clinical procedures traditionally performed by a physician, which can allow them to free up surgeons to focus on other aspects of care.

Sephton was one of three physician assistants hired to collaborate with orthopedic surgeons under a three-year pilot project that began in 2020. Based on the success of the pilot, all three have since become permanent and valued members of the orthopedic services teams delivering care at Dartmouth General Hospital, the Halifax Infirmary Site of the QEII Health Sciences Centre and Orthopedic Assessment Clinics in Halifax and Dartmouth.

Sephton is connected to three joint replacement surgeons through Dartmouth General Hospital and her role is dynamic and constantly evolving, with no two days alike.

“I can start my day in clinic seeing patients who are preparing for or recovering from surgery and get called over to Dartmouth General Hospital to assist with a complex surgery, and then be in the operating room for the rest of the day. My role really is involved in all aspects of following a patient.”

The physician assistants are key supports for wait list reduction efforts. When surgeons are unavailable to be on the floor or for requests for consults due to being in surgery, delays can be avoided as physician assistants are able to act as an extension of their surgeon.

“Having a physician assistant who can be there in ten minutes to go to the consult, answer questions, support pain management or discharges allows for no interruption in patient care,” said Sephton.

The physician assistant pilot was met with positive feedback from patients, staff, surgeons and orthopedics residents training to become surgeons.

“The addition of physician assistants was meant to improve access to care for patients with hip and knee arthritis, particularly to help improve wait times for patients going for joint replacement surgery,” said Alissa Decker, Director of Neurosciences, Orthopedics & Spine. “Our physician assistants were just joining us when the pandemic hit in March 2020 and scheduled joint replacement surgeries were among the services that were temporary halted or scaled back, and things pivoted to other orthopedic services that still needed support.”

A greater emphasis was placed on clinics, as well as rounds, and the physician assistant’s role became shaped by the areas of most need.

While Sephton continued alongside surgeons in joint replacements, her colleagues in the pilot have branched out into other areas of orthopedics. Brittany Belair works in orthopedic oncology services, which care for patients with cancers involving bones and soft tissues, and Laurel MacInnis works with orthopedic trauma services providing consults in emergency and helping to care for patients in hospital.

From seeing patients for their initial surgical consult, to being the surgeon’s right-hand person in the operating room, to supporting clinics and providing follow-up care to patients after their surgery, Sephton, Belair, and MacInnis, are helping improve access to allow Nova Scotians to receive the care they need.

The positive experience led to current efforts underway to recruit four additional orthopedics physician assistants, and the scaling of this innovation to other areas, where there is strong evidence of the impact physician assistants can have.

“The integration of physician assistants in emergency departments commenced last fall as a 'test and try' and has now scaled to multiple sites. Physician assistants will also be launched at multiple primary care sites this fall,” said Tara Sampalli, Senior Scientific Director, Primary Care.

Sampalli is working with her co-leads Grayson Fulmer, Senior Medical Director, Medical Affairs and Dr. Todd Howlett, Medical Director of Innovation, along with program leaders, to support the implementation of these providers in emergency and primary care settings.

“The implementation and learnings from orthopedic services has informed scaling this quickly across the province and we will continue to learn from all of these implementations and the impact they have on patient care and access,” said Sampalli.