As you may have noticed, Croakey has recently been running a series of articles examining the potential of physician assistants to improve access to health care, particularly in rural and remote areas.
These articles have been positive about the role of PAs. But we know that a number of groups are on the record opposing or raising concerns about the introduction of PAs, including the Queensland Nurses Union, the Australian Medical Students Association, the AMA and the 2010 Australasian Junior Medical Officer Forum. No doubt others have been working against PAs behind the scenes.
If any of those groups – or any other PA sceptics – would like to contribute to the Croakey series, please get in touch. It would be good to hear your responses to the pro-PA arguments that have been made.
Meanwhile, Professor Peter Brooks, director of the Australian Health Workforce Institute, explains below why he believes that Australia needs PAs. (Incidentally, he is also due to speak at at a University of Sydney seminar on May 3 titled “Are we training too many doctors?”.)
Professional self-interest is blocking introducton of physician assistants
Peter Brooks writes:
Well done Croakey for running these stories on Physician Assistants (PAs). The opposition to the introduction of these health workers mirrors very much what happened in the US some 40 years ago.
Strident cries from the American Medical Association that their introduction would end life as we know it. But interestingly – it didn’t!
Why the nurses are so actively against it is interesting but one would have to ask all opposing groups are they interested in opposing for oppositions sake, are they interested in providing health services to patients who currently find it difficult to access them because the workforce is not there, or are they interested in preserving the status quo with siloed health professional practice?
The health service and its constituent parts is a very complex organism but every part of it should work together to improve patient care and not work only in the interests of the health professional – or have I got that wrong ?
The health and social welfare workforce is currently the largest in Australia – 1.4 million – and like the rest of the population, it is ageing.
We will need to recruit about half a million new workers at least to this sector over the next decade – a significant challenge that policy makers and politicians do not seem to be fully accepting at present.
Where are these new workers to come from? Current recruitment will not achieve these targets so perhaps some innovation is required. Trials of new models of care have been carried out by Queensland Health and the South Australian Health Commission in respect to PAs.
These trials, albeit small, did suggest that these new health professionals would be useful across a variety of health care situations. They actually assisted doctors in care delivery, worked together with Nurse Practitioners as part of the care team, and value added to teaching of students rather than impairing it.
So why the opposition? Sad to say but may I suggest pure self interest – as always wrapped up in cries that the introduction will impact negatively on patient safety and quality, reduce learning opportunities for medical and nursing students and generally speed the dumbing down of health care delivery – none of which can be supported by the many trials of PAs in Australia and overseas .
Now I have to declare my bias, having introduced the PA program at the University of Queensland in 2009. One of the reasons was that of recruitment, the fact that in the US those joining PA programs do not want to be doctors or nurses. So it adds to the health workforce, and that is what we have to do.
There is going to be so much work out there in health care, we need all the person power we can get.
Policy makers need to ensure that there is appropriate recognition of PAs and that the educational programs are well designed and provide graduates with the right competencies for practice.
This is a time when the professional organisations and policy makers need to rise to the occasion. They need to look outside their own silos and facilitate the introduction (and evaluation ) of new models of health care – which will all be team based – so that we can really reform what is a very good health system, but one that cannot cope with the challenges of an ageing and chronically diseased population as we move into the next decade .
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The previous articles in this series are:
We’re about to get our first crop of PAs
The evidence shows that PAs could help improve access
Why James Cook University is starting a PA program
So what are the arguments against PAs?
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Update:
I’ve just come across a recent systematic review, published in The Journal of Rural Health, in the US: The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature Lisa R. Henry, PhD;1 Roderick S. Hooker, PhD, PA;2 & Kathryn L. Yates, BA1
(If you’d like a copy, leave your details below or email me and I will send it on…)
Seriously Melissa? Seriously?
You must have read these previous blogs, considering you authored them. You are willing to publish this blatant rubbish? You publish talk about opposition being ‘pure self interest’ from people who either are PAs, run PA programs or have set them up! No conflicts there!
This is the most blatant one sided reporting I have ever seen on Crikey, and it is truly shameful
I had a discussion with Ben who wrote one of the other articles, and while he never really understood what I was saying, at least he was open to debate. You really couldn’t get any balance on this blog?
I can’t even express how poorly balanced this blog has been on the issue. It is Fox news for health care
The issue IS NOT TURF WARS. I am a doctor and I 100% support the eventual introduction of PAs into Australian health care. They play a great role, I have worked with them and they do amazing work. They really support doctors, not take their jobs. No doctor I have ever talked to who has experience with PAs has ever thought they were a negative thing. No doctor I have talked to could not easily be convinced that PAs could be useful
There is one big issue, currently, and it is a problem caused by short sighted politicians. MEDICAL TRAINING IN AUSTRALIA IS OVER-CAPACITY. There are not enough doctors to train medical students/junior doctors. It is illegal to train more doctors currently, due to lack of supervision, even though politicians keep burdening the system with more students
PAs require doctors to train them clinically. They require medical supervision. The system that is already overburdened and FAILING to meet the numbers of student who have already trained for 6 years will have to take on the burden of PAs too?
It is not that I oppose PAs. I support PAs wholeheartedly, as a profession, in Australia. What you are suggesting is ACTUALLY IMPOSSIBLE. It is like saying lets double the size of farmland in Australia. The arable land just doesnt exist.
Sorry for the caps, sorry for getting a bit worked up, sorry for the tone. Whatever. Just listen. Stop posting articles that can only inflame inter-professional tensions. I am not saying those tensions don’t exist, but c’mon. The champions of the PA pilot tests in Australia were doctors! This is not even vaguely honest
Croakey – fair and balanced
@SoulmanZ
Posted April 13, 2011 at 11:17 am | Permalink
Seriously Melissa? Seriously?
Melissa is right on the money, SoulmanZ, you are naive and have bought into ‘the law’ and ‘training’.
This is a turf war and ALSO the Govt is trying to stop Medical students graduating and Dr’s giving out services by cutting access to medicare through provider number bans.
This began since 1996 by making access to provider numbers contingent on getting specialist training, and is now carried on by charade medical rural bonded schemes which sends Dr’s to where there are too few people to make living and then hits them with a 12 year ban on medicare.
here is a link FOI documents from the fed govt about this I have more, I am also suing the federal govt and syd uni on this as the Cth paid of my uni to kick me out from med so as to stop me accessing a provider number because I would not sign up to this sham scheme. It much cheaper to give $20K per annum to a uni to stop a medical student graduating then let them access medicare for a career.
the article was insightful and balanced and spot on Healthcare is self interested.
http://www.wikileaks.ch/wiki/Too_sneaky_by_half:_plan_to_keep_local_Australian_doctor_numbers_low,_assorted_documents,_2000-2009
SoulmanZ – chill! That outbreak of CAPS looks positively stressful.
If you read my article for Australian Rural Doctor (link was provided in first article in the series) you will see that some of those quoted championing PAs were doctors (not surprisingly, there is often a difference between the views of grassroots doctors and the organised medical lobby). If you read the evaluations of the trials, particularly the Qld one, it suggests that PAs could help relieve the pressure on medical training. I’m sure there are plenty who agree with your points about medical training system being completely over-stretched – the University of Sydney seminar mentioned above is timely.
gryph – I honestly don’t get what you are talking about, but if the Commonwealth is trying to constrain graduate numbers … good! That will open a bit of room for PAs! There are too many graduates to train
That doesn’t make a conspiracy, just a stuff up. That is all this is.
Melissa – Your articles remain the one and only stressful thing here. I can’t believe you are honestly not seeing a problem. I am not trying to offend, but please see the material you are publishing is offensive
The evaluation stated that having graduated PAs could relieve the training stress – clearly that is true. But we are talking about training PAs, not magically creating them from nothing. Training them places a burden on the system. If you disagree, provide evidence
Despite a clear logical reason why training any significant number of PAs over the next 6-10 years is physically impossible in our current system, you are willing to publish attack articles on doctors
So the burden of proof is on you. I can back up all of my statements with fact (medical student numbers increased, supervisor numbers unchanged, interns not getting jobs etc)
Prove that this is a turf war. Require your contributors to prove it if they want it published. Give us quotes. Give us evidence that outweighs the clear, rational reason why what they want is impossible
If you cannot provide that evidence, then what you are publishing is not journalism. It is opinion, and inflammatory opinion at that. It is FOX news. It does not deserve to exist on Crikey. I haven’t yet, because I fully expected you to be able to understand this, but I will make a formal complaint if you cannot continue to publish such extremely biased work as if it is fact, without support.
The only evidence I have seen that ‘doctors resist PAs’ is anecdotes that the same thing happened in America, in the 60s. Anecdotes are not evidence, even when the anecdotes are spatially and temporally appropriate. Comparing contemporary Australian medical culture to 60s American medical culture is ridiculous, clearly.
If you have respect for your readers, and for your writing, justify it, or stop publishing extreme bias
Cheers
It is impossible to have a sensible discussion on the role of Physicia