This is the third article in a Croakey series examining the potential of physician assistants to help improve access to health care, particularly in rural, remote and other under-served areas.

Allan Forde and Sharon Barnwell write:

This American term – PAs – has been whispered more around health circles in Australia over the last few years. You may have met one in South Australia or Queensland, states that have taken the plunge in the PA experiment.

Soon you’ll be hearing about them a whole lot more – home-grown PAs trained in Australian courses will appear in the very near future.

But first you may be wondering, what exactly is a Physician Assistant, and why should I care? Don’t we have nurses and allied health professionals already?

Well, yes, but Physician Assistants are able to do things that some of these professionals are not. A unique characteristic of PAs is that they work as extenders of doctor’s services. As part of this team relationship, medical and surgical privileges are delegated by supervising doctors to physician assistants.

PAs work for doctors to provide medical and surgical procedures, prescribe medicines, advise tactics for preventative healthcare and diagnose and treat illnesses. They are usually ‘back-up’ to a doctor in rural areas, providing the doctor with a trusty offsider and the community with a second senior person to be available after hours.

In Australia this is particularly important. There are huge distances between health facilities in rural and remote areas and a shortage of doctors willing to work, often as the only doctor, in these areas. Physician Assistants are a new and exciting option for health services to consider.

A small scale but successful example of the Physician Assistant model working in Australia is when two US PAs were employed by the Cooktown Multi-Purpose Centre last year as part of a Queensland Health pilot project. The pilot finished in June 2010 and so missed are the PAs by the doctors, nurses and community that Medical Supervisor Dr Tash Coventry said she would like to have two PAs on her staff permanently.

James Cook University in northern Queensland is beginning a new course for PAs in February next year. Professor Richard Murray, Dean of the School of Medicine and Dentistry, says the values of JCU’s medical program lend themselves to the establishment of the Physician Assistant program.

“We produce skilled, work-ready graduates with a strong foundation of scientific and medical knowledge. Our graduates value social justice, innovation and excellence, which are all part of the university’s mission as well as our own,” Professor Murray said.

“The School is a leader in our focus areas of rural and remote health, tropical medicine and the health of Indigenous Australians, and is particularly suited to people with an interest in health care for underserved populations,” he said.

Not surprisingly, because of its great flexibility, the PA model is popping up all over the world. Most countries are training or piloting PAs with a particular focus on filling specific areas of need within their medical workforce. The majority of these nations are members of the Organisation of Economic Development (OECD) and the Commonwealth of Nations.

Ireland and New Zealand are particularly interested in using PAs in surgical services. The UK has found PAs to be of great help in public hospitals and Scotland is starting a program focusing on underserved public health and primary care. Canada has been training PAs for use in the military since 1984, and now has civilian programs centred on providing PAs to emergency care and family medicine. South Africa is training Clinical Associates, modelled on PAs, to work in district hospitals. Saudi Arabia now has a military PA program and The Netherlands has benefitted from PAs for a decade.

So it’s clear that Physician Assistants are not a new idea for JCU, or Australia for that matter.

Professor Ian Wronski, Pro Vice Chancellor of the Faculty of Medicine, Health and Molecular Sciences at JCU, is credited with first investigating the US PA model. His specific area of interest was augmenting Indigenous health care in Western Australia and he believed PAs could be part of the solution. He debated the merits of the PA model with other academics, healthcare leaders and doctors as far back as the late 1980s.

These ideas were picked up by Professor Murray and adjunct Professor Dennis Pashen, former Director of the Mt Isa Centre for Rural and Remote Health (MICRRH) and former President of The Australian College of Rural and Remote Medicine (ACRRM). They are now two of the most ardent proponents of developing a PA-modelled healthcare practitioner for Australia.

Professors Wronski, Murray and Pashen realised PAs would be an ideal complement for Australian rural doctors, rather than a threat to clinical training opportunities or other healthcare professions. For those of you who might know Dennis, rest assured he has been particularly vocal and challenging to naysayers and opponents. We’re glad he’s on our side!

JCU is not just intent on supplying highly trained PAs to underserved areas and populations, but to take advantage of a ready and willing pool of experienced healthcare workers looking for a new challenge. Professionals such as paramedics, military medics, Aboriginal Health Workers and various allied health personnel looking for ways to extend their contribution in the clinical arena are eager to step up to this challenge.

The University of Queensland PA Program has included students as diverse as physiotherapists, pharmacists, nurses, an optometrist and a podiatrist in the last two years. Many of these workers would otherwise be lost to the system, disillusioned with the lack of opportunities to diversify their practices or advance their careers.

JCU’s PA program will emphasise recruitment of applicants from rural, remote, Indigenous and tropical communities just as the medical school does. We think selecting candidates from cohorts of mature non-medical health professionals who are already well established in rural or remote communities is a good strategy to increase the health workforce in underserved areas.

Finally, JCU has supported the PA movement in a unique way by employing three PAs direct from the US as academic staff in the School of Medicine and Dentistry. In addition to developing the curriculum, we all carry teaching duties in the MBBS course, especially in clinical skills.

I (Allan Forde) look forward to being a part of this exciting transition phase for PAs in Australia, from novel idea to reality, knowing that not only will professional colleagues benefit from the course but that the people in underserved populations will receive quality healthcare long after the program’s establishment.

For more detail on the subject of utilising PAs in rural healthcare have a look at a paper that was done for the National Rural Health Conference in 2009: Augmenting the rural health workforce with Physician Assistants.

• Allan Forde is a PA and Senior Lecturer in the JCU School of Medicine & Dentistry, and Sharon Barnwell is a communications officer and journalism student at JCU


Previous posts in this series:

We’re about to get our first crop of PAs

The evidence shows that PAs could help improve access

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