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Reaction to University of Queensland’s closure of physician assistant program: what a shame for rural health

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.

***

Update:

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”.

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  • 1
    Raymond Bange
    Posted May 12, 2011 at 1:55 pm | Permalink

    While I am supportive of the potential role of Physician Assistants and speaking as a former senior academic who has battled with budgetary constraints and course funding issues, I must agree with Kim Webber.

    It is always a challenge to mount a new or modified course program in the face of existing demands and I applaud those who have the foresight and fortitude to drive change and innovation in health care and other fields.

  • 2
    Paul Roberts PA-S
    Posted May 12, 2011 at 8:37 pm | Permalink

    As a student of the program I cannot help but be disappointed – its a normal reaction. But looking beyond the emotive personal aspect, one has to ask why?
    Why now? The timing seems rather unusual with the Health Workforce Australia report not out yet and the first group about to finish and be looking for positions. It is too coincidental to not be a coincidence.
    Fiscal constraints are an ongoing serious issue for the university community, and unfortunately always will be. But other universities are commencing courses, they see it as a viable course.

    As for myself, how do I see the role of a PA? It is one that is almost self explanatory by its title – Physicians Assistant.
    It is the position of supporting a medical officer, of allowing that physician to time manage and to ‘work up to licence’.
    It allows medical practices to be more productive and have greater patient satisfaction, better outcomes and fiscal return.
    It does not undermine nursing roles – it is entirely different. The PA is a dependent role, and Nurse Practitioners are independent.
    Many of my fellow students are nurses – the PA role is a different avenue for them to pursue.
    As even the initials suggest – PA is a personal assistant, but as a medical model. Just as CEO’s perform to their capacity only with a good Personal Assistant, this is how I envisage a Physician Assistant will function and support their doctor.
    With as little as 20 students requiring clinical learning placements each year from UQ, its hardly a case of large numbers swamping the system. So the AMSA position somewhat confuses me. We are not a large number.
    And as more doctors qualify, we can assist their practices to flourish and grow. Assist them to succeed and provide more services to the public.
    The general profile of my class mates are mature adults with extensive & diverse clinical backgrounds. We are certainly not a threat to young new students first entering university. Again, there is not a large amount of us.

    It is certainly my intention to practice rurally, as this is where I see that I can make the greatest benefit. And it’s where I want to be. At my age of years and medical service, I am looking for a community appreciation and thus job satisfaction. I fail to see how I am jeopardising anyones learning path, post graduate career, or independent practitioner rights. It is unfortunate but I believe that Dr Webber is correct. Australian medicine is conservative in its culture and change will be hard. But hopefully evidence and patient care will prevail.

  • 3
    0mitch0
    Posted May 13, 2011 at 2:37 pm | Permalink

    I too am a PA student in Australia and this recent information does raise anxiety about the future. I personally do not feel this spells the end for the development of this profession and that this hurdle has been the experience of our colleagues (PA’s) overseas, with the inception of their respective programs.

    My motivations for completing this program have always been to work in a collaborative team of healthcare professionals to provide healthcare to the Australian people.

    I applaud UQ for pioneering the program in Australia and the other universities for taking the reins in training PA’s into future.

  • 4
    dcgnr
    Posted May 13, 2011 at 11:47 pm | Permalink

    I am a PA-S about to graduate and have found employment.

    I have nearly finished a year of clinical rotations in Townsville and have seen ample examples of where my employment would not only de-load an already busy health care provider, but also free up time for that provider to contribute to education of interns and medical students.

    The chief difference of a PA working for a doctor and an intern to rotate with them, is the doctor has no obligation to continue our education any further than what is necessary to assist in our work. The intern however is in that rotation to continue their education to progress into their chosen specialties. These are not conflicting roles but complementary ones.

    By not supporting the PA role in Australia UQ leadership has shown a short sightedness, as we will be facilitating the education of future doctors and not be in competition.

    I am currently in the US as a PA-S and being supervised by a PA. Lightening the load for the doctors in the ED by seeing the lower categorised patients.
    This is a medical model that is proven to work and UQ has proven that they are no longer the recognised or preferred university they used to be.

    JCU will lead the way and continue to champion the cause of rural Queensland.

    Deb O’Kane

  • 5
    Rod Hooker
    Posted May 15, 2011 at 6:18 pm | Permalink

    In who’s best interest has UQ served by closing down their PA program? I can’t help but wonder how Australian will train all the doctors they need for their population in the next 20 years. With doctor shortages looming both in Australia and worldwide, will the medical establishment keep inviting overseas trained doctors to fill their ranks? Such brain drain activity of taking a country’s best and brightest and bringing them to Australia is unpopular domestically and robs the exporting country of its intellectual investment. The PA development was Australia’s nobel effort to do something proven and meaningful for its citizens. Perhaps those citizens who voted against Australian having their own PAs should weigh in instead of medical students.

4 Trackbacks

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