Prioritizing Pregnancy Care in Family Practice

The Role of the Physician Assistant in an Innovative Prenatal Care Model


  • P.A. Sarah Flanagan Sanctuary Refugee Health Centre



Prenatal, Refugee, Health, Physician Assistant, Obstetrics, Family medicine


This poster presents the qualitative and quantitative outcomes of the two-year review of the antenatal clinic at SRHC. It shows the exponential increase in number of pregnancies managed at SRHC per year (from 61 in 2016 to over 200 projected in 2019), with over two-thirds of all pregnancies followed to term by our MD-PA team. When all options are available for antenatal care, 85% of our patients choose the MD-PA prenatal care model and, thus far, 100% of repeat prenatal patients have requested the same model of care for subsequent pregnancies. Also, owing to the continuity of care throughout the prenatal period, we have seen an increase in timely attendance of well baby check ups and adherence to vaccination schedules for the families followed through our antenatal clinic. SRHC’s unique prenatal care model has been recognized by local health authorities, and orientation to our program has been incorporated into mandatory continuing education for the nurses and midwives at the local hospital, providing opportunities to advocate for the Physician Assistant role. In conclusion, this poster shows how SRHC’s innovative prenatal care model uses the PA role to bridge family medicine and obstetrical care, in order to provide a full-time antenatal clinic, while optimizing our obstetrical specialist’s time in clinic and improving patient care outcomes.

Author Biography

P.A. Sarah Flanagan, Sanctuary Refugee Health Centre

Sanctuary Refugee Health Centre (SRHC) is a dedicated primary care practice for refugees in Kitchener, Ontario. Founded in 2013, it is now a thriving interdisciplinary care team with approximately 4500 rostered patients. In November 2016, through the Health Force Ontario New Graduate Grant, SRHC hired a Physician Assistant (PA) with goal of using this role to expand the women’s health services provided at the clinic. Owing to the diverse cultural and religious backgrounds of our patients, there is a propensity for large, young families, so antenatal services account for a significant proportion of care provided. By early 2017, SRHC was struggling to find enough local obstetricians and midwifery groups to accept the influx of complex antenatal referrals for refugees in the region. In June 2017, Sanctuary partnered with a local family-obstetrics provider to offer to-term antenatal care and 24/7 peripartum call for our patients. Since then, SRHC has worked to develop a PA-led prenatal care clinic that addresses medical needs and social determinants of health in a trauma-informed, culturally-sensitive and language-specific model. All pregnant patients in the clinic are followed by the PA, which streamlines and standardizes pregnancy care. After advocating for the importance of this role, we were able to secure dedicated funding through the Local Health Integration Network. This funding allows the PA to provide extended appointments that address complex migration medical needs in pregnancy care, and allows the fee-for-service physicians in the practice to simultaneously optimize their billable appointments per day. SRHC’s family-OB physician attends clinic one afternoon per week, and remotely supervises the PA in provision of full-time prenatal care at the clinic.


Gagnon, A. J., Merry, L. Robinson, C. (2002). A Systematic Review of Refugee Women’s Reproductive Health. Refuge: Canada’s Journal on Refugees.

Hach, M. (2012) Common threads, common practice: working with immigrant and refugee women in sexual and reproductive health. Collingwood: Multicultural Centre for Women’s Health.




How to Cite

Flanagan, P. S. (2019). Prioritizing Pregnancy Care in Family Practice: The Role of the Physician Assistant in an Innovative Prenatal Care Model. The Journal of Canada’s Physician Assistants, 1(3), Annex 3.