Physician assistants: an update on the policy, politics and state-of-play
Earlier this year, Croakey ran
Oct 21, 2011
Earlier this year, Croakey ran
Earlier this year, Croakey ran a series of articles examining the potential for physician assistants to extend the capacity of health services in under-served areas, particularly rural and remote Australia.
In the article below, Sharon Barnwell and Allan Forde provide an update – and a reminder that if you know someone who might be a candidate for PA training, applications are now open for the James Cook University course…
Despite some setbacks, momentum is gathering for the physician assistant role
By Sharon Barnwell and Allan Forde
Last time we wrote for this blog, we talked about the reasons James Cook University decided to implement a physician assistant (PA) program.
JCU had embraced the potential for an alternative to the one-doctor rural town and was pushing ahead developing the program, recruiting PAs from the United States and regularly consulting PA educational institutions and Queensland Health.
Spirits were high, with the University of Queensland’s first cohort almost completing their course and other universities considering implementing a similar course.
Queensland and South Australia had both run independently evaluated pilot programs, which were found to have more than reasonable potential.
Since then, however, the outlook in Australia for PAs has been less than clear – the University of Queensland’s program will be dismantling their course after the second cohort graduates in June 2012, and the PA model appears a political casualty in Queensland and South Australia, partially due to entrenched opposition from a few powerful organisations fearful of change.
It may seem that physician assistants have become the irrelevant victims of a negative media campaign even before they’ve gotten off the ground… But JCU does not buy this and continues to move forward in the development of a PA course.
There are many reasons physician assistants are not only a viable option for the Australian healthcare system, but an essential one. To name just a few:
• Australia shares key features with Canada in healthcare governance; an overburdened public health sector and substantial rural geography. Most provinces in Canada have adopted the PA model and following several successful trials implemented four tertiary education programs. Notably, the College of Family Physicians Canada officially endorses the profession, demonstrating their confidence in the function of PAs in the existing system.
• The US initiated the modern PA trend and now enjoys a vital and hugely popular profession. Other developed nations now utilising the PA model include the Netherlands, Germany, South Africa and Taiwan. Meanwhile, Ireland, Scotland, New Zealand and Saudi Arabia are either evaluating the PA role or actively incorporating it. There are variations of the role and its level of clinical education in Russia, India, Ghana, Tanzania, Mozambique, China, Malaysia, Fiji and Papua New Guinea. The highly effective and adaptable model has spread through the world, with literature amassed over 40 years based on PAs in the US confirming the model can deliver safe, high quality medical and surgical care.
• Existing rural and remote practice in Australia has deep-rooted traditions of team-based health care and flexible delegation of clinical tasks by rural doctors. PAs are the perfect complement to existing disciplines and have proven, during their 45 years in the States, that they are the ultimate medical team players.
Given the successful adaptation of the PA model internationally, it is difficult to see why it would fail in Australia, where it seems perfectly suited to the geography and health system structure.
Several prominent organisations and individuals have openly stated their support for rolling out a Physician Assistant prototype specifically to strengthen the rural health workforce.
The Royal Australasian College of Physicians (RACP), in its submission to the National Health and Hospitals Reform Commission in 2009, encouraged and supported task substitution and recommended the development of funding programs for physician assistants and other ‘workforce substitution’ programs to address rural and remote workforce distribution.
Warren Snowdon, Federal Minister for Indigenous, Rural and Regional Health, was quoted in Australian Rural Doctor magazine in April 2010. “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. I don’t think it will happen today, but it will evolve and there will be physician assistants.”
It’s not just the bush that will benefit from a PA rollout.
Major General Paul Alexander, Commander Joint Health of the Australian Defence Force, envisions PAs in the military. He addressed the PA students from UQ late in 2009 and told them there would be support from the ADF for clinical training and, he hoped, employment opportunities for those who were members of the military or had interest in joining.
However, political infighting at the highest administrative levels has stymied the ADF’s immediate recruitment of PAs. The Navy appears positioned to be the first in line for a roll out when the official green light is given.
Priority Recommendations from National Rural Health Conferences in 2009 and 2011 emphasised ‘the need to speed the rate of development of new health professional roles (eg physician assistant, nurse practitioner and advanced allied health practitioner) to help meet rural and remote health workforce shortages and to improve care’.
Gordon Gregory, Executive Director of the National Rural Health Alliance (NRHA), recently said that the NRHA had championed physician assistants for some years because they would be a great resource for regional and rural areas.
The Australian College of Rural and Remote Medicine (ACRRM) is currently considering a formal endorsement policy of the PA model. ACRRM has been very welcoming to US PAs and supportive of the new Australian PAs and PA students.
The push for PAs has gained, rather than lost, momentum over the last year or two amongst official channels.
Even the newest national healthcare policy and planning organisation, Health Workforce Australia (HWA), has presented PAs favourable light. HWA is the peak body for national policy development and has vowed to ‘foster workforce innovation and reform, exploring opportunities to better utilise the skills and competencies of the current workforce, redesigning existing roles and multidisciplinary teams and developing new roles’.
The Australian Health Ministers Conference (AHMC) is aware of the urgency of future health workforce challenges and the need to build on work developed through national and regional collaboration. They are seeking direction, and as a result HWA has developed a Draft for Consultation of the National Health Workforce Innovation and Reform Strategic Framework for Action.
With some apparent vexation, HWA has observed in the Framework draft:
“The pace of reform of health professional roles and service delivery models has been slower in Australia than in many other comparable OECD countries. New roles such as nurse practitioners, physician assistants, and lay health workers that are long established in other developed (and developing) countries have often faced barriers in Australia and continue to be the subject of debate, despite evidence of the effectiveness of these roles in achieving the same or improved patient outcomes.”
The final Framework for Action document is due for delivery to AHMC in the first half of 2012. In the meantime HWA has contracted a well-known consulting firm to produce a white paper on PAs for AHMC.
The facts are clear – physician assistants are not a fanciful idea but a genuine clinical option for Australia, even more so for rural, remote and Indigenous areas.
James Cook University has put itself in an excellent position at the forefront of health system reform. It has refused to bow to suggestive media and political reports, and instead forged ahead with the PA program, which is ready to commence in late January 2012.
The three-year undergraduate degree is suitable for students with a qualification (not necessarily a degree) in any sort of health science, such as physiotherapy or nursing, and for students from a range of clinical backgrounds, such as paramedics and Aboriginal health workers.
We are still welcoming applicants to be part of this exciting new course until mid-November 2011 – for more information visit this link.
• 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