Redesigning Australia’s health workforce with Physician Assistants

We are often keen to adopt the latest medical technology or new ‘wonder drug’ from other countries but seem less eager when it comes to importing their innovations in health workforce practices.  Yet if we are to meet our health care needs in the future, we will need a health workforce that is continually evolving in line with consumer and community expectations and preferences.  Physician Assistants have a potentially important role in the global health workforce of the future but Australia currently lags behind many other countries in integrating these health professionals into the health system. 

In the following piece, Ankur Verma discusses successful trials of Physician Assistants (PAs) in Australian hospitals and the regulatory and political barriers which exist to increasing the numbers of PAs in Australia.  

Ankur is a student in Health Sciences at James Cook University who recently attended the annual Organisation for Economic Cooperation and Development (OECD) Forum in Paris as a delegate of Global Voices. 

Global Voices is a not-for-profit, youth-led organisation that facilitates opportunities for young Australians to engage with international policy. Ankur was one of four students we selected this year to represent the Australian youth delegation at the OECD Forum. 

Ankur Verma writes:

Australia’s healthcare system needs a quadruple bypass to re-route the flow of healthcare workers in the diseased training pipeline.

The Australia’s Future Health Workforce report predicts that we need another 1000 specialty positions to be funded and accredited to fill the training deficit that we’ll have by 2030.

How realistic does this sound to you when we know that training of specialists is a long-term process? In fact, any policy adjustments made at the beginning of the training pipeline will not have a full effect at the service delivery end for more than a decade.

According to the Australian Medical Association, “medical workforce planning in Australia has stalled since the abolition of Health Workforce Australia in the May 2014 Budget.”

What does the failure of such planning mean for us tax-payers?

If planning fails to get the balance right between supply and demand for the medical workforce there are potentially wasted health dollars spent on training and the supply of services. Especially when the demand for health services is projected to increase due to elevated burden of chronic diseases and greater consumption expectations by the ageing population.  

 This raises an emergency alert for an effective and coordinated medical workforce planning to ensure we have a highly skilled medical workforce in the right numbers and in the right places to meet the future health needs of the Australian community.

Therefore, we need to redesign the workforce so that services we currently see as ‘medical’ or ‘nursing’ are provided by a broader range of professionals than just doctors and nurses, as declared by the National Rural Health Alliance (NRHA).

One potential solution? A Physician Assistant model (PA).

The Physician Assistant (delegated-workforce) model is the prescription to the current workforce shortage and training deficit problems that could ensure a capable and qualified workforce.

Not only this, Physician Assistants  could increase the supply into health workforce through an even distribution of health workers in terms of geography, and of the types of services provided which have already been demonstrated successfully through pilot trials in Queensland and South Australia.  Recently, a pilot program in the Queensland Health system has seen successful recruitment of Emergency Department PAs in Townsville Hospital and Cherbourg Hospital.  This model could also support the Indigenous health workforce by offering an advanced career option for Aboriginal health workers who would otherwise be lost to the healthcare system. Finally, it could address pressing health workforce shortages in regional, rural and remote Australia.

What makes the PA model so attractive in all these settings?

It is a delegated, flexible, and potentially extensive scope of practice, training under the medical model and negotiated performance autonomy tailored to fit the needs of the practice.

 Question of every politician: Can PAs add to the productivity and quality of health care service?

Pilot trials from Queensland and South Australia have resulted in effective outcomes including increase in number of patients seen, whose survey responses have affirmed that PAs clinical practices are safe, effective, acceptable to patients and other health practitioners. Some State and Territory informants have suggested that PAs would result in productivity benefits when used in areas where work is more structured such as pre-operative and procedural work, or where protocols are in place to manage care, freeing doctors to do more complex cases.

In opposition, some stakeholders are concerned that PAs might move into medical specialist positions rather than generalist roles, prompted by recent trends in the United States. However, this argument is opposed by the policy tools existing under the State and Territory jurisdictions in Australia which would determine where and at what pace PA positions are created.

Medicare, as the principal funder of private medical practice, can influence what type of PA services would be remunerated under the schedule.

Therefore, there is scope for Australian health policy makers and employers to determine what elements of the US experiences with PAs are worth adapting to the local health system and which ones are not.

Australia is not the first country to pilot the United States PAs. The PA concept has actively moved from the United States to other parts of the world including Netherlands, South Africa, Canada, and the UK, in addition to continuing progression in developing countries like India.

The pace of reform of health professional roles and services delivery model has been slower in Australia than in many other OECD countries. This raises a code blue for Australia to catch up as much remains to be done in Australia for the national registration and accreditation of PAs with Australian Health Practitioner Regulation Agency (AHPRA).

PAs need to be professionally registered to protect the public from the risk of sub-standard health care by maintaining appropriate professional standards, and to legitimise the profession with other health care providers.

Although the Australian Society of Physician Assistants (ASPA) has already began the process of getting the PA profession registered, in the meantime PAs are practising as an unregistered profession to meet the demands. It can be argued that the government arrangement for the registration of the PA profession under the Medical Board of Australia should be similar to the management of registration for dental hygienists and oral hygienists under the Australian Dental Board.

Progression towards getting the National Registration for 70 graduated PAs to this date should not be delayed any further now that there is a better clarification of the PA role supported by case studies, pilot trials, and current PAs employed under the Queensland Health.

Policy implementation is hampered by multiple veto or decision points between an idea and its implementation. A state could ‘go it alone’ and change its laws to allow Physician Assistants to prescribe or order diagnostic tests. However, to be fully effective, introduction of PAs to rural and remote Australia needs collaborative and coordinated action by the Commonwealth and State governments. This is important in order to give some certainty to people thinking of signing-up for Physician Assistant training, and for universities to run the PA course.

Australia needs to be proactive in addressing its healthcare workforce shortage, and we have the tools and model we need – now all we need is action.