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It’s time to make physician assistants part of the Australian health workforce

Ben Stock, OAM, will become one of Australia’s first “home-grown physician assistants” when he soon graduates from the University of Queensland.

Stock has already had 23 years experience as a medic in the Royal Australian Navy, and is used to working in isolated, challenging conditions. During his time at sea, he has been responsible for the health care of surface ships and submarine crews, often without even having radio backup. In short, he’s worked in more isolated and challenging conditions than many health professionals.

Here is his response to the University of Queensland’s announcement this week of the closure of its PA program, which has been generating some revealing commentary at Croakey.

***

It’s time for real action on health workforce shortages

Ben Stock, President of the Australian Society of Physician Assistants, writes:

The University of Queensland decision to suspend it PA program is disappointing, particularly for those who will be graduating in five weeks time.

It is nothing new for universities to drop programs due to financial constraints, it happens everywhere. Dropping such an innovative program which would have aided our health workforce issues must have been a difficult decision.

I note that in the University media release, personnel issues such as the resignation of the program director and difficulty recruiting a replacement were given as some of the key points in the decision.

This is unfortunate because my organisation gets weekly enquiries from international PAs wanting to work in Australia, and the very strong Australian dollar makes work here even more attractive. I wish we had have known that this was such a big issue, as we may have help avoid this part of the factors influencing the UQ decision.

Another factor was listed as the uncertainty of the future of the PA. Therefore, it is clearly apparent that it needs to be addressed and now. So what do we need to do? Let’s address some of the issues.

Health workforce shortage

We are short of health professionals and there are increasing problems with access to healthcare for Australians. Why are we waiting when PAs can help with this issue?  PAs have made significant, safe contributions in this area, worldwide, for over 40 years. PAs are part of the medical team, and work with doctors, not against them.

We are training more medical students. That’s great but they aren’t trained now, not all will pass, or care to practise when they graduate, and the population increases and ages daily. In the 1980s, PAs in the US were told there would be a glut of doctors coming into their workforce and they wouldn’t have a job. In 2011, with over 75,000 PAs in healthcare, what is the US healthcare system like? Still stretched to capacity. Australia needs to introduce PAs as one option for healthcare workforce. Or should we sit on our hands, wait until things get even worse despite increased training, and then say, ‘oh that didn’t work’?

Impact on medical student trainin.

I note the Australian Medical Students Association’s statement released after the UQ announcement. Same argument, PAs will rob medical graduates of training positions etc, etc. In a previous Croakey article, I addressed this issue, where the small numbers of PA students compared to medical students is 2% of the training burden. And now with UQ down, for now, it will be just over 1%. Again, the argument isn’t valid, and I would look at the US model and that thousands of PAs being trained there doesn’t really impact medical student training either.

Impact on internships

It has been said the PA will prevent medical graduates starting internships due to PAs taking jobs. As a PA, I would love to see that many PAs in Australia. The PA isn’t a doctor, so they don’t take the doctors place, they do things that can free up the doctor to do other stuff. Like train medical students and supervise interns.  It is unfortunate that AMSA feels threatened by PAs, where the PA can actually contribute to a better training outcome for medical students and junior doctors. Given the acceptance by many senior and highly qualified doctors of the PA role, perhaps it would be worthwhile for medical students to listen to them, and benefit from their experience. The PA isn’t a doctor, and doesn’t want to be, otherwise all being able to pass a Masters Level medical course they would have gone to medical school. We aren’t ‘cheap doctor replacements’ and people who can’t get into medicine. As a PA, I look forward to seeing the medical students and graduates enter the workforce, so I can work with you. Not against or in competition.

PA graduates

UQ ceasing their program reduces the PA graduates, noting two universities are commencing their own PA programs next year. If we decide to address the health workforce issues now, and introduce PAs as part of the workforce solution, Australian universities could produce graduates as soon as June 2011. That’s right, there will be Australian graduates looking for a job in 2011. So we already have people ready to start once a decision is made.

Safety

Are PAs safe? PAs have supervision by doctors, with the degree of supervision dependant on the role and setting. PAs are trained and already possess previous clinical experience. Again, look to the overseas models and years of PAs practicing in health care and the answer is, yes they are safe and effective. Supervision is not new in medicine. Isn’t the Intern supervised and consults with registrars and consultations? Isn’t the Registrar supervised and consults with consultants? Don’t Consultants seek opinion from their peers and colleagues? Supervision and safety is built into the medical model.

So what is the answer?

Is the PA the sole answer to the problem? No, it is part of the overall solution. We still need more doctors, more nurses, more allied health, and better health infrastructure. The list goes on. What we need to do is make a decision.

We don’t need any more trials to see if PAs will work in Australia. Two trials in two states showed that it will work.

We need to introduce PAs into the workforce and stop the debate. The first step is to get PAs into the workforce and register them. Let’s have some medical colleges provide some support and endorsement for PAs. PAs need to continue with the CME and training, and perhaps existing medical colleges are in the best place to help manage and guide the PA. This would provide even more safety and oversight.

Now is the time to really address health work force issues, and we have one of the tools to do this, the PA, ready to start. The closure of the UQ PA program demonstrates that the uncertainties of Australian health workforce problems are real and need to be addressed urgently.

Let’s stop dancing around workforce problems. Let’s introduce the PA into the workforce now, and then move onto the next step in fixing the problems we face in delivering healthcare to a growing and aging population.

Or should we continue to stick our heads in the sand and hope it all miraculously sorts itself out?

Comments 3

  1. chickencoop says:

    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.

  2. SoulmanZ says:

    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?
    https://croakey.org/another-point-of-view-on-physician-assistants/

    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!

  3. Immune in Queensland says:

    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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co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
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Health Care Homes
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health reform
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HIV/AIDS
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HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
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Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
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non communicable diseases
nurses and nursing
oral health
organ transplants
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pain
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Pharmaceutical Benefits Scheme
pharmaceutical industry
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Pregnancy and childbirth
primary health care
Primary Health Networks
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rural and remote health
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TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
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health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
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Web 2.0
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Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
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#OTCC2017
#ResearchTranslation17