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.
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.
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?