Could physician assistants (PAs) help fill the workforce gaps in rural, remote and Indigenous health, and improve access to healthcare for under-served communities?
Minister Warren Snowdon seems to think so, according to a Croakey contributor, Tony Wells, who heard his address to a national rural health students conference in Alice Springs last week.
Wells reports that the Minister said there were only a handful of physicians assistants in Australia but they were a significant option for adding to the health workforce in rural and remote areas. He also said there was potential for the role to expand workforce and career options, particularly for medics and Aboriginal health workers.
The Minister made similar comments earlier this year when I interviewed him for a profile for Australian Rural Doctor magazine. He told me: “I’m an advocate for physician assistants. I’ve spoken to quite a few practitioners in the bush who believe they’d be very helpful to them. But I’m also conscious there’s a whole debate, discussion got to take place in the broader medical community about workforce changes so I don’t think it will happen today. But it will evolve and there will be physician assistants.”
Interestingly, one of the gurus of the PA profession in the United States, Associate Professor Ruth Ballweg, was also speaking at the Alice Springs conference. When I interviewed her in 2008, she advised those seeking to introduce PAs into Australia to keep arrangements flexible and under the control of local doctors, rather than taking a centralised prescriptive approach which rigidly defines what PAs can and can’t do.
Ballweg, director of the MEDEX Northwest program at the University of Washington in Seattle, said that one of the reasons her training program has been so successful is that it was initially designed by doctors to help relieve their workload stresses.
“Washington State Medical Association was the co-sponsor of our program,” she says. “All these doctors were burning out, and they were miserable so this was seen as the fix. They got to design the fix. It wasn’t imposed on them from above, which never works.”
Physician assistants have also recently been in the news in New Zealand, where at least one hospital is trialling the role.
Meanwhile, Croakey thanks Professor Peter Brooks, Director of the Australian Health Workforce Institute, at the University of Melbourne, for reviewing a newly updated book that sounds like essential reading for those interested in the history and scope of physician assistants.
Physician Assistants – Policy and Practice – Roderick S. Hooker, James F. Cawley, David P. Asprey, 3rd edition (2010).
Peter Brooks writes: This is surely the PA ‘bible ‘ and is significantly updated from previous editions. It acts as a great source of data on how the PA movement started – essential reading for anyone who is interested in how the conservative silos that currently constitute the heath care system react when face with a change (challenge).
The book discusses what PAs do, what they don’t do, and how they learn. The text is surprisingly up to date – activities occurring during 2009 such as the opening of Australias first PA program are included and there is important information on the various types of programs and the registration and accreditation requirements from around the world.
The majority of PAs still work in the USA (73000 plus) but there is expansion in Canada, Europe and the UK with Australia and South Africa developing a number of training programs .
Of interest are the broad areas in which PAs work – primary care, emergency rooms, procedural medicine, rural and remote and in a wide range of hospital and ambulatory care settings.
They continue to contribute to the Military (from whence they came – the “medics” and corpsmen). PAs work in underserved areas more frequently than other health professionals and have different gender balance from nursing.
Although working primarily in the US and therefore a different health system, they do provide a cost effective model of care and allow doctors to see more patients – they are true medical “extenders”. The model therefore lends itself very much to a human resource constrained health system that continues to exist around the globe.
Fundamental to the physician assistant is the delegated model of care, emphasised significantly in the book . They are very much a part of the health care team and the role that they play with other members of that team – particularly nurse practitioners is again discussed, emphasizing their complementarity. Interestingly the issues of patient satisfaction and clinical outcomes are also discussed – and, as expected, they are no different from those of physicians.
This book is a must for anyone interested in provision of health services in 2020 and beyond, and will dispel some of the myths that always circulate when new ideas are developed in a very conservative environment such as health. We should thank the authors for stimulating this important debate about how we provide health services and by whom.
This has now become a global movement – which Australia has joined. PA programs have commenced at the University of Queensland and are being planned at James Cook , Adelaide and in Western Australia.
The South Australian and Queensland Health Departments have employed PAs from the US and are evaluating their performance in the Australian context and the results are awaited with interest.
With the ageing and chronically diseased population, we desperately need to increase health workers both traditional and new – PAs will be a welcome addition to the health care team.