Below is some reaction to the University of Queensland’s decision, announced yesterday, to close its physician assistant (PA) program. It comes from two prominent proponents of PAs.
Update: more reaction is being added at bottom of post as it lands…
Rural communities have been sold out, again
By Dr Dennis Pashen, Adjunct Professor at the James Cook University School of Medicine and Dentistry (and former president of the Australian College of Rural and Remote Medicine)
I think that it is a shame that UQ has ceased its program. It was a brave and innovative approach that they took in commencing the program and deserved success.
In the light of the positive outcome of the trial of the PAs in Qld, when the evidence was there as to the potential benefits for the rural and remote communities, to withdraw now is premature and unfortunate.
I think that there is a strong future for PAs in Australia and others will carry the program forward.
It is also unfortunate that the opposition of the AMA and nursing bodies has similarly avoided all of the evidence and have bowed to sectarian and metropolitan interests.
Once again rural and remote communities have been short changed by the metropolitan colleges and professional self interest groups who have consistently failed to come up with real solutions to rural and remote health.
Once again rural communities have been dudded by our metropolitan colleagues.
Shame on the University of Queensland
By Professor Peter Brooks, Director of the Australian Health Workforce Institute at the University of Melbourne (who helped establish the UQ PA program when dean there)
Yes, it is a sad day for health workforce reform – and reflects a lack of leadership at UQ and raises questions as to how the decision to cease the program, without even seeing a graduation, could have been made.
Certainly there has been a lack of support for the program over the last 12 months, because of worries that registration would not be available and, I suspect, influenced by the AMA.
Health Workforce Australia has been asked to consider how Physician Assistants will / should be incorporated into the health workforce and it would be sad if this decision by UQ were to pre-empt any decision.
This is of course exactly what happened in the US where it took some brave and visionary medical school leaders to defy the conservative elements of the American Medical Association and press on to register their programs, and within 2 years PAs were registered in some 10 states of the union.
Now 75,000 PAs work across the American health system and many provide primary care particularly to rural and remote areas – working with doctors who are based in regional centres and communicating by phone and video conference.
A recent paper on the Queensland Health trial (positive like the SA Health Commission pilot as well) suggested that the PA model had great potential for rural Australia – perhaps it would be useful to at least look at it when other ways of providing either GPs or specialists have been challenging to say the least.
In that regard, one would have to question UQ’s commitment to the health of rural Queenslanders, let alone the rest of the country.
Is it not interesting that we now have nursing assistants, pharmacy assistants, physio assistants – in fact virtually every other type of health professional assistant – but not a medical assistant, someone who will work closely with the doctor in a delegated model of care – oh, but I forgot – we do – it’s the nurse. Well done UQ and back to the future.
So rather than seeing this as a win for the forces of conservatism, this is a great opportunity for the other universities around the country to press on and lead in this exciting new addition to the health workforce – they are needed just like nurse practitioners, generalists, allied health practitioners and health system facilitators – but not more specialists.
Finally, to those graduating PAs from the UQ program: I don’t think you will have any problem getting a job. You will be soaked up by the private sector because they can recognise your worth. You will be the vanguard.
Be proud that you are the first – but certainly not the last PA graduates. Perhaps you will be the only UQ PA graduates and that, amongst other things, will be your uniqueness.
A triumph for the power of the status quo and vested interests
Dr Kim Webber, Chief Executive Officer, Rural Health Workforce Australia
I don’t think it is fair to blame UQ for this decision. If the employers and governments of Australia were not prepared to partner with UQ around this, then I can’t blame them for their action.
It really shows how hard it is to implement any change in relation to health workforce – the vested interests in preserving the status quo are just too powerful.
I look forward to seeing this issue covered by The Hollowmen TV show.
From a Croakey reader who wishes to remain anonymous:
(a) The other thing no one’s mentioned so far is that Queensland Health is extremely risk averse at the top. So it was pretty clear that no further support for the employment of PAs (either in terms of registration issues or money) was going to be forthcoming. I think universities do have to think carefully about putting graduates on the market where there is no clear registration status. I don’t think Peter Brooks’ “pioneering universities” line is as convincing as might appear. The whole point of the HWA process shouldn’t be to recognise new workforce roles without an assessment of the whole.
(b) It’s certainly right that opposition from nurses is key. While the AMA often rightly cops criticism for entrenched defences of existing professional interests, it needs to be recognised that nursing bodies and unions can be equally conservative except when it comes to workforce changes which advantage nurses specifically.
(c) The elephants in the room here are cost and industrial issues. While pilot studies in selected locales often find good outcomes, attempts to implement workforce changes and collaborative care more broadly often see savings becoming illusory, or costs being added. In part this is because the creation of more semi-professional categories produces a bidding up process where other groups (for instance, advanced nurses and allied health professionals) demand higher remuneration and more status.
(d) In addition, it’s becoming clearer that interprofessional care is very difficult to implement outside relatively unrepresentative settings where the preconditions are already present. It’s not just vested interests and professional demarcations, but a range of very complex factors, and real reform will probably take decades rather than years. We’re only at the beginning of studying and isolating the drivers and barriers for the sorts of health workforce and systems reforms which are often trumpeted as if they could provide quick fixes.
(e) It’s not true that UQ has signalled its lack of interest in rural and regional health – the opening of clinical schools in cities such as Bundaberg and Toowoomba belies that.
Australian Medical Students Association statement says the closure “demonstrated the ongoing uncertainty regarding the exact role and scope of physician assistants in the Australian health workforce at a time when the number of medical graduates is growing dramatically”.