What does a physician assistant do?

They've been called essential, a driving force and, in a nod to their adaptability, "the stem cells of MD Anderson."

They're physician assistants (PAs), and few institutions employ more of them than MD Anderson.

PAs are medical professionals who can conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel patients on preventive care, assist in surgery, and write prescriptions. Supervised by physicians, they're sometimes called mid-level providers -- a category that also includes nurse practitioners and certified nurse anesthetists.

Of our 245 PAs, nearly half work in Surgery and Anesthesia. The others are divided among Cancer Medicine, Internal Medicine, Radiation Oncology and Pediatrics.

Our PAs also counsel patients, obtain informed consents and perform numerous medical procedures. In partnership with doctors, often they lead the evaluation and management of treatment for patients in special clinics.

Freeing up physicians
PAs are crucial to the operation of MD Anderson's 11 survivorship clinics, according to Todd Pickard, program director and mid-level provider in Medical Affairs. Transitioning cancer survivors to the care of PAs and internists frees our doctors to take care of newer and more complex cases.

In fact, Hagop Kantarjian, M.D., chair in Leukemia, says the contribution of PAs makes it possible for him to see twice as many patients.

"They improve patient care and research and help detect and eliminate errors," Kantarjian says.

Educators, sounding boards, advocates
Leukemia PA manager Mary-Alma Welch's career path "was about as nontraditional as you can get," she says with a laugh.

She left a successful career in journalism to go to PA school at Emory University 15 years ago.

PAs, she says, play a particular role in educating patients.

"We answer questions that patients are too shy -- or don't think are important enough -- to ask their doctors. About sex, about digestive issues they're having. Sometimes they ask us how they're going to die."

Recalling a patient she'd become close to who died last year, Welch calls such experiences heartbreaking.

"There's nothing fair about it," she says.

Still, Welch, who decided to become a PA because she couldn't stand the thought of not loving her work, is grateful every day for her choice.

"We're a sounding board, a resource. We make a difference in patients' lives."

Fellowship training spreads awareness of cancer's toll
PA Maura Polansky runs the fellowship program that trains one or two PAs annually. It's the only oncology fellowship for PAs in the United States.

MD Anderson hires about half of these fellows after they complete the program, Polansky says. Others typically seek positions in other academic cancer centers, often in their home communities.

We also train PA students from around the country during four-week elective rotations. Many of these students pursue careers in oncology.

"Those who go on to positions in primary care and other nononcology disciplines often report that they're more compassionate and have a better appreciation of the concerns of cancer patients -- and an enhanced passion for cancer screening," Polansky says.

Varied backgrounds and motivations
Before deciding to enter PA school, Pickard attended nursing school for two semesters.

"I'm glad I had exposure to other areas of health care," he says.

He preferred a career as a PA.

"I wanted to be the one making the diagnosis and doing therapeutic management rather than bedside care," he says. "Compared to physicians, though, PAs tend to be able to spend more time with patients. We implement everything the team has decided needs to be done."

Christen Treadway, a PA in Plastic Surgery, agrees. She says that besides working closely with their attending physicians, PAs across the institution collaborate with each other.

She recalls a patient who, shortly after surgery, learned she was needed at home because of a family emergency. She was unsure of her postoperative restrictions for travel and coordinating her follow-up appointments with multiple services. Treadway contacted a PA in another department and within 10 minutes, it was arranged.

"To be a successful PA, you have to be a team player, a hard worker and dedicated to patient care," Treadway says.

A longer version of this story originally appeared in Messenger, MD Anderson's bimonthly publication for employees.