Women’s health

Introduction

From the beginning of the physician assistant (PA) profession, primary care has been a key focus in training PA students. The special health care needs of women are an essential part of primary care. PA students will provide care for obstetric or gynecologic patients on a variety of clinical rotations, including obstetrics and gynecology (OB/GYN), family medicine, internal medicine, emergency medicine, and pediatrics. Most PA students, however, also have a dedicated clinical placement in OB/GYN. Obstetrics is unique in that the provider treats two patients (mother and child) at the same time. Gynecology encompasses the spectrum of a woman’s life from menarche through menopause and beyond. Practicing OB/GYN offers the opportunity to build a lifelong rapport with patients. Women’s health providers encounter acute, subacute, and chronic conditions each day. The approach to a gynecologic patient is comprehensive. Many times, an annual wellness visit is the only time the woman visits a clinician. For this reason, it is the provider’s responsibility to provide wellness education and recommend appropriate screening tests. Women’s health practitioners have an especially strong understanding of how to treat chronic conditions in the setting of pregnancy.

The approach to the patient is based on the multiple roles women’s health providers have in a woman’s life: to provide preventive care; to help a woman make decision about fertility and childbearing; to care for her before, during, and after a pregnancy; to guide her through menopause; and to treat acute and chronic medical conditions. The specific approach to each patient will be guided by her needs at the moment of care. Young women who have never had a pelvic examination have different needs than a woman who is pregnant with her third child. A college student who is seeking contraception requires a different approach from a woman newly diagnosed with ovarian cancer. Watch your preceptors and learn how they adapt their approach to each patient’s needs.

What do physician assistants in women’s health typically do on a daily basis?

The scope of practice varies widely for PAs in the field of women’s health. PAs in OB/GYN work in surgery, in labor and delivery units, on inpatient floors, and in clinics. Many women’s health PAs work in several of these settings each week. In the surgical setting, PAs assist with gynecologic surgeries and cesarean sections and assist with or perform vaginal deliveries. A small number of states allow PAs who have obtained additional experience and qualifications to perform vaginal deliveries autonomously. OB/GYN PAs also provide care to hospitalized patients. Some of these patients have undergone surgery, and others are hospitalized for childbirth or for cancer treatment. PAs working in the hospital round on patients, provide and request consultations, perform procedures, place orders, and provide patient education. They also can be the link between the inpatient floor team and the attending doctor, who is often working in the operating room (OR). In the clinic setting, PAs practice full spectrum OB/GYN. They provide preventive, prenatal, and postpartum care. They also care for patients with acute and chronic health problems, such as endometriosis, sexually transmitted infections, cervical cancer, infertility, uterine fibroids, and polycystic ovarian syndrome. PAs are able to read and interpret ultrasounds; perform Papanicolaou (Pap) smears and culture collection; counsel patients regarding appropriate contraceptive practices; and perform intrauterine device (IUD) insertions, endometrial biopsies, and colposcopies.

What will I be expected to do on this rotation?

Your role as a PA student will differ based on the environment in which you are working on any given day. Common environments include the surgery service, the inpatient service, the outpatient clinics, and the labor and delivery suite.