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    Physician Assistant, occupational therapist, registered nurse, paramedics they are all health clinicians doing not vastly different things (in a rural setting) with not vastly different core competencies, skills and knowledge…you know its true. Physician assistants arent special, unique and different, they are an example of expanded nursing scope and – if applied with ill concieved motivations – potentially a cheaper less trained medical workforce option. Creating yet another classification that could easily be undertaken by the nursing workforce or allied health instead of streaming more undergrads into nursing and allied health is crazyness. Rural and remote australia wants more doctors and better appreciated/remunerated nurses and allied health professionals with greater scope to provide essential care, not another made up classification to experiment on them. The health workforce issue is one that is unavoidably restrained by the industrial relations landscape. If a practical solution this decade is possible it is only possible if you work with the pieces currently on the chess board. Its time to concede that point and get on with the task of solving some significant workforce problems via medical, nursing and allied health graduates.

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    Hi again Ben.
    I really do feel you contradict yourself several times here.

    For example in the paragraph on internships you say (paraphrasing) “PAs don’t take interns places” but follow with “PA supervision is nothing new. Interns need supervision”

    No-one would ever argue that PAs will actually take an intern’s job, because that makes no sense. But they take a ‘slot’ for supervision. In a lot of training settings, like the US, that is fine, because there are enough senior doctors to supervise the juniors and the PAs. In Australia, right now, we don’t have that luxury. 1 in 4 interns is already struggling to get an internship. Every PA added will stretch supervision further.

    Did you read this article?

    Very unexpected to see UQ close up though. The discussion of the closure has been very interesting. I think it is a shame myself, setting up a training school is expensive and a lot of resources have been wasted if it is shut forever. I would prefer a small PA program compared to that waste!

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    Immune in Queensland

    As someone who has faced disappointment in my medical career, I sympathise with those who will be disadvantaged by this move.

    However, the only reason this was introduced was ideologic, i.e. replace doctors with cheaper people and pretend they have the same skill set. This is now being rolled out as Nurse practitioners who have a real and useful role working in teams not as individuals.

    Ben seems to think ideaology is the same in the US and here. One of the few things the US does well is respect for intellect, training and success. In Australia, this seems to count against people. Ben has sadly been used as a tool by Peter Brooks et al. To compare the US health care system (which costs lots more than ours for less care and coverage) to Australia’s is silly.

    As with all things in Australia, political rubbish gets in the way of actual improvement. Multi-tasking is a critical skill that is involved in being a doctor and one cant learn this when tasks are removed from the doctors domain. Role erosion is something that politcians like in health care; quality health care is expensive and will get ever more so. This scares politicians, who wont tell voters they cant have everything they want. Instead they seek to enforce and encoruage role erosion and task substitution in the guise of health care reform.

    Prior to change, one needs evidence that change will help, not just that change is needed!


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