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The evidence shows that physician assistants could help improve access to healthcare

Yesterday, Croakey kicked off a series examining the potential of physician assistants to help improve access to health care, particularly for people in rural, remote and other underserved areas.

Today, Associate Professor Moira Sim, from the School of Nursing, Midwifery and Postgraduate Medicine at Edith Cowan University in Perth, explains why her university plans to introduce a PA program.

Moira Sim writes:

It is projected that the health workforce in Australia will be insufficient to meet population demand in the future1 2 3. The current medical workforce shortages, particularly in rural and remote areas are well documented4 5 6 7.

Despite increased medical student training places and international medical graduates to fill the gap, modelling of the medical workforce by the National Health Workforce Taskforce in 2008 showed that a gap remains1.

New models of healthcare provision are needed. Physician assistants (PA) were introduced to the US workforce in the mid 1960s in response to a physician shortage and have since been introduced in Canada, the UK, the Netherlands and South Africa.

PAs add value wherever routine and less complex tasks medical tasks can be delegated. The PA role has been described as an evolution in the division of medical labor responding to medical workforce shortages, the increased complexity of medicine, and preference for greater work-life balance8.

The practice level of a PA can be compared to that of a junior medical officer (JMO) who remains with the team over an extended period. PAs are trained in the same model as medical practitioners and can be highly responsive to the population’s healthcare needs, changing specialties as needed.

The published data shows that PAs provide safe and high quality care9 10 11 and patients are likely to accept their role10 12 13. Compared with doctors, PAs in the USA are more likely to work in the non-metropolitan area and PAs have improved access to healthcare for rural communities, vulnerable population areas and government designated primary health care shortage areas14 15 16.

Many medical practitioner groups recognise the need to consider alternative models of healthcare provision. Submissions by the Royal Australasian College of Physicians and Australian and New Zealand College of Anaesthetists have identified the willingness to investigate physician assistant roles17 18 19.

The rapid rise in medical student places since 2000 at universities in Australia has led to fear of loss of student placements as well as JMO positions. However across Australia the number of PA students is too small to impact on clinical placements for the large numbers of medical students. In Western Australia PA students will not compete for medical student placements as placements are planned in new areas.

JMO positions have both a training and service purpose and are important for the preparation of unsupervised doctors. It is in the interests of health services to have JMOs who will become consultants and referrers to their service. Unlike JMOs, PAs have a service-only role within the team and can take on some of the routine tasks which are not of value to JMOs. PAs who are employed within health services can also free up doctors’ time, creating greater capacity for teaching. In other countries PAs also provide education for JMOs and medical students on routine procedures.

At present PAs are not recognised as a profession in Australia. While recognition by the Australian Health Professional Regulation Agency (AHPRA) is not a requirement for employment, this is important for patient safety and the future of the profession.

At present there is no Medicare funding for PAs. Initially they will need to work either in the public sector where the efficiencies they create can increase capacity or in the specialist private sector where the extension of capacity of the medical practitioner will generate increased funds.

ECU is one of four universities in Australia which is developing a PA program. At this point we are aiming for a first intake in 2012 and are working with other universities to progress the recognition of PAs as one strategy to meet the future workforce needs of Australia.

• Also coming in this series will be a post from Ben Stock, president of the Australian Society of Physician Assistants

***

References

1. Carver P. Self sufficiency and International Medical Graduates – Australia. Melbourne: National Health Workforce Taskforce, 2008.

2. Joyce MJ, McNeil JJ, Stoelwinder JU. More doctors but not enough: Australian medical workforce supply 2001-2012. Med J Aust 2006;184:441-46.

3. Hocking S, Draper G, Somerford P, Xiao J, Weeramanthri T. The Western Australian Chief Health Officer’s Report 2010. Perth: Department of Health Western Australia, 2010.

4. O’Connor T, Hooker R. Extending Rural and Remote Medicine with a New Type of Health Worker: Physician Assistants. Aust J Rural Health 2007;15:346-51.

5. Department of Health and Aged Care. The Australian Medical Worforce. Occasional Papers: New Series No. 12. Canberra: Department of Health and Aged Care, 2001.

6. Australian Medical Workforce Advisory Committee. The general practice workforce in Australia: supply and requirements to 2013. AMWAC Report 2005.2. Sydney: Australian Medical Workforce Advisory Committee, 2005.

7. Jolly R. Health workforce: a case for physician assistants. Research Paper no. 24 2007-08. Canberra: Parliament of Australia, 2008.

8. Hooker RS, Cawley JF, Aspry DP. Physician Assistants: Policy and Practice. 3rd ed. Philadelphia, PA: F.A. Davis, 2010.

9. Ho P, Pesicka D, Schafer A, Maddern G. Physician assistants: trialling a new surgical health professional in Australia. ANZ J Surg 2010;80:430-37.

10. Farmer J, Currie M, West C, Hyman J, Arnott N. Evaluation of physician assistants to NHS Scotland: final report. Inverness: Centre for Rural Health, UHI Millenium Institute, 2009.

11. Nicholson JG. Physician assistant malpractice history: comparing PAs to physicians and nurse practitioners. Journal of Medical Licensure and Discipline 2009;95(2).

12. Hooker RS, Harrison K, Pashen D. Are Australians willing to be treated by a physician assistant? Australasian Medical Journal 2010;3(7):407-13.

13. Dehn RW. The relative value and risks of nonphysician health care providers. J Am Acad Physician Assist 2010;23(4):50-52.

14. Henry L, Hooker RS. Retention of Physician Assistants in Rural Health Clinics. J Rural Health 2007;23(3):207-14.

15. Henry L, Hooker RJ. Autonomous physician assistants in remote locations: perspectives from the communities they serve. J Physician Assist Educ 2008;19(1):34-37.

16. Grumbach K, Hart LG, Mertz E, Coffman J, Palazzo L. Who is caring for the underserved? a comparison of primary care physicians and nonphysician clinicians in California and Washington. Ann Fam Med 2003;1(2):97-104.

17. Royal Australasian College of Physicians. Interim Report of the National Health and Hospitals Reform Commission ‘A healthier future for all Australians’: submission on behalf of the Royal Australasian College of Physicians. Sydney: Royal Australasian College of Physicians, 2009.

18. Royal Australasian College of Surgeons. New Zealand surgeons support trial of physician assistants: Royal Australasian College of Surgeons, 2010.

19. Australian and New Zealand College of Anaesthetists. ANZCA Submission to Victoria’s Workforce Redesign Toolkit: a call for tools and case studies. Melbourne: Australian and New Zealand College of Anaesthetists, 2009.

Comments 3

  1. SoulmanZ says:

    I have no problem with physician assistants, but this paragraph
    [The rapid rise in medical student places since 2000 at universities in Australia has led to fear of loss of student placements as well as JMO positions. However across Australia the number of PA students is too small to impact on clinical placements for the large numbers of medical students.]
    makes next to no sense.

    The entire piece is based around the need to expand/introduce PAs in numbers to serve communities that doctors can’t/won’t and then as your answer to the only justified criticism you address, simply say “well, there isn’t enough of them to matter anyway”.

    The only valid way introducing PAs can make sense is for there to be enough of them to fill many of the roles junior doctors do now, otherwise you are not achieving anything.

    To train PAs requires supervision and training by medical practitioners. We already cannot train the existing batch of interns, because of inadequate supervision. In fact, soon it will be illegal to hire all of the interns in Australia for safety reasons.

    Do you have some evidence that PA trainees require no training or supervision by medical practitioners? Because unless you have that evidence, you have ignored the entire concern.

    I am not trying to knock PAs. You can train them quicker and thus produce more in a shorter time. But the current training ability of the system here is already at capacity, so unless you are recommending cutting medical school places, and training PAs in 6-10 years time, I dont know how this could work. PAs work, true. PAs can be trained in numbers to service the shortage in the community? Doubtful

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