Working in Oncology as a PA
What is Oncology?
Oncology is the treatment cancer. It can be done as an outpatient, as an inpatient. PAs can be in any of the settings, it just depends on what the needs are of the environment. I work primarily as an inpatient oncology hospitalist PA.
I look after cancer patients admitted to hospital. Any complications from their cancer or from their treatment is what our service sees. We were doing haematologic oncology up until about 6 months ago. We would see new leukemic patients and do their induction treatments.
Goals of Care in Oncology is when when you are trying to articulate whats important to a patient: What are their values? Trying to match that with their treatment plan. Seeing what is available. There are so many avenues that you can go down with Oncology. There are several lines of chemotherapy available, there is radiation and surgery might be possible. You also have to look at the whole picture. Not only in life span but also quality of life for patiens.
There are many patients who might go through treatment and get so sick that its not worth it to them to go through all of that if it means an extra few days or an extra month. Whereas for some patients, they might think that they want all the treatments possible even if there is a chance it actually makes life shorter for them. Its trying to figure out that balance and figuring out how far they want you to go. Would they want you to take them to ICU or do CPR? Its all of those tough conversations and trying to figure out what’s appropriate for a patient.
Common Conditions in Oncology
As an Oncology Hospitalist PA I manage some of the following common conditions:
- Febrile Neutropenia
- Hypercalcemia Malignancy
- Bowel Obstructions
- Related conditions secondary to immunotherapies patients going on (e.g. Colitis)
- Neutropenic Enterocolitis
- Spinal Cord Compression or Cauda Equina Syndrome
Rare Conditions I manage
Because we are a tertiary care centre we see a lot of :
- neuroendocrine tumors
- Paraneopalstic syndrome
- refractory leukemias and lymphomas à This includes patients who go through multiple inductions and the complications.
- Aplastic Anemia
- Acute Promyelocytic Leukemia (APL)
Why I am drawn to Oncology
I think it’s the combination of interesting medicine and the human side to it. I really enjoy we see complex cases, sometimes you are seeing the sickest people in the hospital. At the same time you really get to know them.
I love getting to know people’s stories, I think there is always something so authentic about going through the hardest moments of life with someone and making it easier for them. But also learning some really interesting medicine and interesting philosophies of life from patients. That is what drew me from the first day that I did that shadowing opportunity in first year of PA school, that is what kept me going since then.
What to Expect from an Oncology Hospitalist PA
There is nothing too different to expect from seeing a PA versus seeing one of the hospitalists. Because the way our program works we have several hospitalists who see the patients and there’s me as well. I am seeing the patients that my supervising physician would have been seeing, but he is also doing administrative work because he is the most responsible physician for the whole service.
If a patient is seeing me, they would expect:
- daily medical visits from me
- any diagnosis
- treatment and management plans
- initiating/continuing medications and discharge medications
- procedures (e.g. lumbar punctures, paracentesis, thoracentesis, bone marrow biopsies).
- We would discuss goals of care.
- We would talk about any discharge planning.
- Family Meetings – If it involves one of my patients, then I am running the meeting, or the social worker and I acting as a close right hand provider for medical updates.
All the things they would expect to see from a doctor on the team, they could also receive that from me.
Breaking Bad News
Breaking bad news is not always at the later stages. If there is progression of disease, or there is a new diagnosis, that is a difficult scenario. Or if they lose function of their legs, they could live for another year, but if it means they’re not walking that’s may also be devastating for someone. I’ve definitely had to break bad news and I think that was one of the most overwhelming things during the first year of practice. I thought to myself, “I’m 23 years old, and I’ve been breaking a lot of bad news, and its very difficult”. One of the palliative care physicians I met actually actually said that her job makes her feel like she appreciates life even more. When you look at it from that perspective sometimes it’s a job keeps you grounded.
Day in the Life of an Oncology Hospitalist PA
Usually we start at 9 o’clock. I come and meet with the rest of the hospitalists and my supervising physician. He divides up the patients amongst us. Typically the hospitalist will see patients and I will see 8 patients per day.
We each go in for bullet rounds where we discuss our plans for our patients with the rest of the allied health team and team leader. Throughout the day, I am seeing patients in order of acuity. Whoever is least stable gets seen first.
I try to save any family meetings or procedures for the afternoon. I also started a research project in hospital. I am co-principal investigator within our own ward. I work with the research assistants and guide them along the process as well.
My schedule My job is 9 to 5. There could be option to do call. Typically we do have residents doing call.
Impact of a PA on the Oncology Service
My supervising physician is able to dedicate more time to administrative work. Typically he would have split his time between seeing patients, overseeing the whole service and having go back and do the administrative work.
He has been able to assign his patient load to me while he attends to everything else. This has really helped our group function smoothly. Our group has been able to evolve because of that.
Challenges of working in Oncology
There is a higher likelihood of burnout. I have found myself finding emotionally burnt out at times. That is where the you have to do a lot of self care and also really remember the moments you’ve made a difference in someone’s life.
It gets difficult if you feel attached to a patient or you meet someone who is young, just started their life and they are diagnosed with a very serious illness. Those can be difficult. I also feel that when you feel you’ve made a difference in their life, and you’ve made this horrible situation a little bit better for them, it’s also quite rewarding.
Who would do well in Oncology?
Someone who is optimistic, who is also very introspective and knows how to reflective. Those are the types of people that would do well with Oncology.
Also having a good sense of humor helps as well. Its interesting because even patients will have a really good sense of humor about things. Sometimes you think you are coming in and you’re feeling glum, but the patient will crack a joke that you may think is inappropriate for their situation – but that’s how you get through things.
If you can have a good a balance of being resilient, having a sense of humor, but also be introspective and be a sensitive person I think that’s a good fit for oncology.