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Australia needs physician assistants. So why aren't we getting them?

As you may have noticed, Croakey has recently been running a series of articles examining the potential of physician assistants to improve access to health care, particularly in rural a


As you may have noticed, Croakey has recently been running a series of articles examining the potential of physician assistants to improve access to health care, particularly in rural and remote areas.

These articles have been positive about the role of PAs. But we know that a number of groups are on the record opposing or raising concerns about the introduction of PAs, including the Queensland Nurses Union, the Australian Medical Students Association, the AMA and the 2010 Australasian Junior Medical Officer Forum. No doubt others have been working against PAs behind the scenes.

If any of those groups – or any other PA sceptics – would like to contribute to the Croakey series, please get in touch. It would be good to hear your responses to the pro-PA arguments that have been made.

Meanwhile, Professor Peter Brooks, director of the Australian Health Workforce Institute, explains below why he believes that Australia needs PAs. (Incidentally, he is also due to speak at at a University of Sydney seminar on May 3 titled “Are we training too many doctors?”.)

Professional self-interest is blocking introducton of physician assistants

Peter Brooks writes:

Well done Croakey for running these stories on Physician Assistants (PAs). The opposition to the introduction of these health workers mirrors very much what happened in the US some 40 years ago.

Strident cries from the American Medical Association that their introduction would end life as we know it. But interestingly – it didn’t!

Why the nurses are so actively against it is interesting but one  would have to ask all opposing groups are they interested in opposing for oppositions  sake, are they interested in providing health services to patients who currently find it difficult to access them because the workforce is not there, or are they interested in preserving the status quo with siloed health professional practice?

The health service and its constituent parts is a very complex organism but every part of it should work together to improve patient care and not work only in the interests of the health professional – or have I got that wrong ?

The health and social welfare workforce is currently the largest in Australia – 1.4 million – and like the rest of the population, it is ageing.

We will need to recruit about half a million new workers at least to this sector over the  next decade – a significant challenge that policy makers and politicians do not seem to be fully accepting at present.

Where are these new workers  to come from? Current recruitment will not achieve these  targets  so perhaps some innovation is required. Trials of new models of care have been carried out by Queensland Health and the South Australian Health Commission in respect to PAs.

These trials, albeit small, did suggest that these new health professionals would be useful across a variety of health care situations. They actually assisted doctors in care delivery, worked together with Nurse Practitioners as  part of the care team, and value added to teaching of students rather than impairing it.

So why the opposition? Sad to say but may I suggest pure self interest – as always wrapped up in cries that the introduction will impact negatively on patient safety and quality, reduce learning opportunities for medical and nursing students and generally speed the dumbing down of health care delivery – none of which can be supported by the many trials of PAs in Australia  and overseas .

Now I have to declare my bias, having introduced the PA program at the University of Queensland  in 2009. One of the reasons was that of recruitment, the fact that  in the US those joining PA programs do not want to be doctors or nurses. So it adds to the health workforce, and that is  what we have to do.

There is going to be so much work out there in health care, we need all the person power we can get.

Policy makers need to ensure that there is appropriate recognition of PAs and that the educational programs are well designed and provide graduates with the right competencies for practice.

This is a time when the professional organisations and policy makers need to rise to the occasion. They need to look outside their own silos and facilitate the introduction (and evaluation ) of new models of health care – which will all be team based – so that we can really reform what is a very good health system, but one that cannot cope with the challenges of an ageing and chronically diseased population as we move into the next decade .


The previous articles in this series are:

We’re about to get our first crop of PAs

The evidence shows that PAs could help improve access

Why James Cook University is starting a PA program

So what are the arguments against PAs?



I’ve just come across a recent systematic review, published in The Journal of Rural Health, in the US:  The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature Lisa R. Henry, PhD;1 Roderick S. Hooker, PhD, PA;2 & Kathryn L. Yates, BA1

(If you’d like a copy, leave your details below or email me and I will send it on…)


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17 thoughts on “Australia needs physician assistants. So why aren’t we getting them?

  1. Australia Needs Physician Assistants. So Why Aren’t We Getting Them? | My New Cool and Trendy Blog

    […] is going to be so much work out there in health care, we need all the person power we can get. Australia needs physician assistants. So why aren’t we getting them? Share this:TwitterFacebookLike this:Like Loading… Bookmark the […]

  2. Another point of view on physician assistants | Croakey

    […] were asked to speak up if they had concerns about PAs or wanted to address any issues raised by the […]

  3. SoulmanZ

    cheers melissa,

    fair point. I will admit I skipped the introduction. Whoops. Feeling a little sheepish

    I am happy to put something to paper, although it will take a few days at least. Hopefully I can put something together up to standard

    I would love to see that review too – soulmanz at hotmail if you wouldnt mind

    Thanks again. I am sorry for coming off so cantankerous. I am sure I had reasons, although if you are willing to publish a reply I guess it doesnt matter.

  4. Melissa Sweet

    SoulmanZ – the top of the post has a clear invitation to those with concerns about PAs to write a post for Croakey. I haven’t had one bite.

    I have, however, had private emails from people expressing their support and appreciation for the series.

    The invitation stands – if any of those groups named, or others, or individuals who are prepared to put their names to a piece would like to submit a post, please get in touch.


  5. SoulmanZ

    Cheers Liquid8, that is all I was saying (for the last week, without real engagement)

    Crikey shouldnt just be the left wing paper or whatever some people think it is, it should fight against bias. So many blogs on crikey do that – pollbludger, pollytics, pure poison to name a few

    This is a simple equation, and liquid8 has maybe expressed it more clearly than I have. In the current setting, allowing one sided diatribes about “doctors and nurses protecting their turf” or whatever is totally journalistically unethical

    It is totally rational to say, in the current climate, that not allowing any further training burdens, PAs or otherwise, is actually protecting patient safety

    To not even consider that valid concern, despite a week long series on PAs in Australia, is frankly unbelievable

    I am honestly waiting for a reply. Do you (Melissa) not think this is a valid concern? If it is, why not even mention it in your articles/published pieces? Why allow one (fairly clearly wrong, at least absolutely biased) opinion a soapbox without any balance?

    Cheers again

  6. Liquid8

    It is impossible to have a sensible discussion on the role of Physician Assistants in the Australian health system without acknowledging the acknowledging the problem of the Medical Student Tsunami.

    “The number of domestic graduates from Australian medical schools is set to increase by 81% in 7 years, from 1348 in 2005 to 2442 by 2012.” (Riding the wave: current and emerging trends in graduates from Australian university medical schools MJA 2007; 186 (6): 309-312)

    The Medical Student Tsunami already is a legitimate training issue that cannot be merely dismissed as scaremongering against the idea of PAs. There is anecdotal evidence suggesting that public teaching hospitals are already at overcapacity. My peers and I have seen student numbers increase significantly over the last few years, and the physical limit to the number that can fit in a consulting room is noticeable! It’s not solely restricted to medicine either: stories of nursing students being forced to go interstate for their clinical placements would have been unheard of years ago.

    The issue of intern placements for those graduating in 2012 or later are strong concerns among medical students – there are numerous articles on either of the major Australian medical student forums (PagingDr.net, medicalstudentsonline.com.au). There have been articles in the media about international students are having difficulty securing work – this may also extend to domestic students in the future. Based on the PA job descriptions which essentially mimic intern duties, the acute need for PAs is somewhat questionable based on medical graduate numbers.

    If I were able to somehow ignore that the above was actually happening, I would have no issue with the introduction of PA.

    However, I’d like to see them in working in areas of shortage or need – the major areas being mental health, rural general practice and emergency. However, I am also highly cynical and suspect that if PAs do take off in Australia, they (like doctors) will be attracted to the more lucrative areas – i.e. private surgical or procedural assisting in urban areas.

  7. SoulmanZ

    gryph – I honestly don’t get what you are talking about, but if the Commonwealth is trying to constrain graduate numbers … good! That will open a bit of room for PAs! There are too many graduates to train

    That doesn’t make a conspiracy, just a stuff up. That is all this is.

    Melissa – Your articles remain the one and only stressful thing here. I can’t believe you are honestly not seeing a problem. I am not trying to offend, but please see the material you are publishing is offensive

    The evaluation stated that having graduated PAs could relieve the training stress – clearly that is true. But we are talking about training PAs, not magically creating them from nothing. Training them places a burden on the system. If you disagree, provide evidence

    Despite a clear logical reason why training any significant number of PAs over the next 6-10 years is physically impossible in our current system, you are willing to publish attack articles on doctors

    So the burden of proof is on you. I can back up all of my statements with fact (medical student numbers increased, supervisor numbers unchanged, interns not getting jobs etc)

    Prove that this is a turf war. Require your contributors to prove it if they want it published. Give us quotes. Give us evidence that outweighs the clear, rational reason why what they want is impossible

    If you cannot provide that evidence, then what you are publishing is not journalism. It is opinion, and inflammatory opinion at that. It is FOX news. It does not deserve to exist on Crikey. I haven’t yet, because I fully expected you to be able to understand this, but I will make a formal complaint if you cannot continue to publish such extremely biased work as if it is fact, without support.

    The only evidence I have seen that ‘doctors resist PAs’ is anecdotes that the same thing happened in America, in the 60s. Anecdotes are not evidence, even when the anecdotes are spatially and temporally appropriate. Comparing contemporary Australian medical culture to 60s American medical culture is ridiculous, clearly.

    If you have respect for your readers, and for your writing, justify it, or stop publishing extreme bias


  8. Melissa Sweet

    SoulmanZ – chill! That outbreak of CAPS looks positively stressful.

    If you read my article for Australian Rural Doctor (link was provided in first article in the series) you will see that some of those quoted championing PAs were doctors (not surprisingly, there is often a difference between the views of grassroots doctors and the organised medical lobby). If you read the evaluations of the trials, particularly the Qld one, it suggests that PAs could help relieve the pressure on medical training. I’m sure there are plenty who agree with your points about medical training system being completely over-stretched – the University of Sydney seminar mentioned above is timely.

  9. gryphonark

    Posted April 13, 2011 at 11:17 am | Permalink
    Seriously Melissa? Seriously?

    Melissa is right on the money, SoulmanZ, you are naive and have bought into ‘the law’ and ‘training’.

    This is a turf war and ALSO the Govt is trying to stop Medical students graduating and Dr’s giving out services by cutting access to medicare through provider number bans.

    This began since 1996 by making access to provider numbers contingent on getting specialist training, and is now carried on by charade medical rural bonded schemes which sends Dr’s to where there are too few people to make living and then hits them with a 12 year ban on medicare.

    here is a link FOI documents from the fed govt about this I have more, I am also suing the federal govt and syd uni on this as the Cth paid of my uni to kick me out from med so as to stop me accessing a provider number because I would not sign up to this sham scheme. It much cheaper to give $20K per annum to a uni to stop a medical student graduating then let them access medicare for a career.

    the article was insightful and balanced and spot on Healthcare is self interested.


  10. SoulmanZ

    Seriously Melissa? Seriously?

    You must have read these previous blogs, considering you authored them. You are willing to publish this blatant rubbish? You publish talk about opposition being ‘pure self interest’ from people who either are PAs, run PA programs or have set them up! No conflicts there!

    This is the most blatant one sided reporting I have ever seen on Crikey, and it is truly shameful

    I had a discussion with Ben who wrote one of the other articles, and while he never really understood what I was saying, at least he was open to debate. You really couldn’t get any balance on this blog?

    I can’t even express how poorly balanced this blog has been on the issue. It is Fox news for health care

    The issue IS NOT TURF WARS. I am a doctor and I 100% support the eventual introduction of PAs into Australian health care. They play a great role, I have worked with them and they do amazing work. They really support doctors, not take their jobs. No doctor I have ever talked to who has experience with PAs has ever thought they were a negative thing. No doctor I have talked to could not easily be convinced that PAs could be useful

    There is one big issue, currently, and it is a problem caused by short sighted politicians. MEDICAL TRAINING IN AUSTRALIA IS OVER-CAPACITY. There are not enough doctors to train medical students/junior doctors. It is illegal to train more doctors currently, due to lack of supervision, even though politicians keep burdening the system with more students

    PAs require doctors to train them clinically. They require medical supervision. The system that is already overburdened and FAILING to meet the numbers of student who have already trained for 6 years will have to take on the burden of PAs too?

    It is not that I oppose PAs. I support PAs wholeheartedly, as a profession, in Australia. What you are suggesting is ACTUALLY IMPOSSIBLE. It is like saying lets double the size of farmland in Australia. The arable land just doesnt exist.

    Sorry for the caps, sorry for getting a bit worked up, sorry for the tone. Whatever. Just listen. Stop posting articles that can only inflame inter-professional tensions. I am not saying those tensions don’t exist, but c’mon. The champions of the PA pilot tests in Australia were doctors! This is not even vaguely honest

    Croakey – fair and balanced

https://www.crikey.com.au/2011/04/12/australia-needs-physician-assistants-so-why-arent-we-getting-them/ == https://www.crikey.com.au/free-trial/==https://www.crikey.com.au/subscribe/

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