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    Perhaps a more succinct way of putting it is, Australia already has PAs: they’re called RMOs. In large public hospitals there simply isn’t a workforce gap to fill as there will soon be heaps of people at that skill/wage level in the system.
    That leaves GPs and district hospitals, where RMOs are (with a few minor exceptions) forbidden to work courtesy of the 1996 provider numbers legislation, and the quota of junior doctors allowed to move to GP is tightly regulated by DoHA, the enforced maximum is still, after 16 years, barely at the level of Keating’s last year of office. (around 800/year offhand)
    This raises a broader point that the workforce restrictions *within* medicine are just as important as the restrictions between medicine and the other professions. Given we are (rightly or wrongly) about to get many more doctors, it may be more efficient to look at loosening some of these restrictions before creating new health professions.

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    I recently accompanied an 82 yo woman to emergency. the consultants were sh*ts and the RMO was a saint, respected her personal space, communicated and was a human.

    Whatever we’re doing to fix the health system has to learn how to keep the humanity because I gotta say, the attitude coming off the senior staff is .. dire.

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    This is a nice, educated and informed piece, Dr. Rayner. I think that one of the points that is often missed in this “supervision and training slots” dilemma is that Australia could recruit highly experienced PAs from the US and Great Britain (as examples) who do not require a training slot. During the trials in SA and QLD, these highly experienced PAs quickly adapted to the Australian medical system.

    Now what does this bring? It brings another body into play who can help train some medical students and does not require the level of supervision that a new medical student graduate requires. Additionally, these highly experienced PAs can train the Australian grown PAs.

    When you refer to the supervision of PAs, I think this gives the perception of a Doctor needing to look over the PA’s shoulder constantly. As you would know from your experience with the SA PAs, very little actual time was required to properly monitor their work.

    Most importantly, you hit the nail on the head by pointing out that the entire training system is systemically flawed when it has not already identified where each medical student can be trained. PAs are one answer to that puzzle because they have historically provided training capability, and in fact were active in this role in the SA and QLD pilot programs.

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    Dan Stalnaker PA-C, MS, CLCP

    I don’t know what RMO’s are I’m a PA-C in the US. I’m posting this comment in a few places hoping that someone will see it and give it some thought.

    I’m a practicing Physician Assistant (PA-C) in the US. I would like to add that a Physician Assistant can help train doctors. The name ASSISTANT is a very negative name. We are well trained and most of us have many years of medical experience and in many areas of medicine. I have worked in Cardiology doing all aspects from rounding, office, Pacemaker/Defibrillator follow-up and reprogramming, I’ve literally done thousands of stress tests, worked as a Hospitalist and have been on call for my patients many times, due surgical clearance and pre and post op work. I have worked Emergency Medicine and have trained or helped in the training of many medical and PA students. ( Do you think a Student Doctor can’t learn from a seasoned PA?)I have done Primary Care and Urgent Care medicine. I have personally saved a lot of lives and I am very proud of that fact. If you are serious about using PA’s forget they all have to be trained from scratch thought and look at them as partners in your quest to deliver quality healthcare. I would not even dream of using the name physician assistant. Develop an appropriate title that gives them real defining characteristics just as the name Doctor does for you. Treat them as if they are important and not a burden. I personally would love to be a part of helping you develop a system of healthcare that incorporates qualified medical professionals into a well-defined system of care that your country and the world can be proud of; as I would like to do in the US. Doctors please this is not a turf-war, as I’ve heard it defined and feel the same way here in the US. I’ve seen much to often where a good, solid, ,well-trained, Physician Assistant was cast aside for a less capable provider. We are all Healthcare Professionals and most of us have the ability to do the job as most of you do as well.

    Concerned about your debate,
    Dan Stalnaker PA-C, MS, CLCP


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