A plan to introduce some physician assistants to the country’s health system has Australian Medical Association president Rosanna Capolingua very upsetabout patient safety, of course. THE head of Australia’s peak medical body has criticised a plan to introduce US-style physicians’ assistants who would carry out less complex medical procedures, saying it puts patients at greater risk and could deny junior doctors training opportunities. Queensland Health Minister Stephen Robertson yesterday released the five sites for a pilot program to train doctors’ assistants, who would perform the procedures under the guidance of a qualified doctor. The pilot is based on a scheme developed in the US and has been trialled in countries including Canada and Britain. Australian Medical Association president Rosanna Capolingua said that, although assistants would work under a doctor’s supervision at all times, their use in surgical procedures could compromise patient safety. “The physician’s assistant understands how to do the task and they may be useful as a ‘tool’ but, for our own junior doctors, they need to have that holistic training and experience as well,” she said. “Patient safety must always be our first priority, not just the delivery of a service to a patient.” Doesn’t sound like Dr. Capolingua is going tomake a great teammate. The nurses aren’t thrilled, either. Beth Mohle from the Queensland Nurses Union said the Government should spend the money expanding the role of existing nursing staff. “They’re not actually testing physicians’ assistants against positions like nurse practitioners,” she said. “If you’re going to have a trial, you should actually at least test those positions against currently existing positions such as nurse practitioners.” Sounds like the beginning of a major turf war. Or it would be if it wasn’t all about patient safety.
Health Workforce Australia report gives the nod to physician assistants
It says there is demand for PAs in rural and remote general practice; the private, non-government and community sectors; Aboriginal medical services; and defence. Rural and remote doctors are the strongest advocates for an urgent and positive consideration of the roles of PAs, it says. Interestingly, NSW is the only jurisdiction not to back PAs: all other states and territories were willing to consider PAs as part of their health workforce. (NSW representatives instead wanted more generalist medical positions such as hospitalists). The report notes that those with direct experience of PAs or PA students are confident about the safety and acceptability of PAs for the Australian health system. They also say that PAs would improve the productivity of other health professions, and would be unlikely to threaten the training of medical graduates or the advanced practice roles in other professions. Despite a decade of discussion and two successful pilot programs, says the report, there remains a high level of misunderstanding about the clinical role and professional attributes of PAs and how they might complement and add value to existing team structures. On a related note, the report says: Those who openly declared their opposition to introducing PAs in Australia were likely to advocate for the interests of existing professions, either nursing or medicine. (Croakey wonders if this gives any hint of the reason for the NSW resistance: are the medical and nursing lobbies more influential in NSW?) The report also notes the potential of PAs to reduce health care costs by providing a new workforce group to provide safe and effective services at lower cost. The report, considered by the Australian Health Ministers Advisory Council (AHMAC) in February, has been keenly awaited by PAs and their supporters, including one of the first PAs to graduate in Australia,Ben Stock, who writes below that action is now needed. *** Report represents overwhelming support for PAs Ben Stock writes: In 2011, Health Workforce Australia commissioned a report into the Physician Assistant and their potential role in the Australian health workforce. This report was completed in November 2011 and earlier this year was tabled to the Australian Health Ministers Advisory Council for consideration and it has now just been formally released. This comprehensive report conducted an extensive literature review of supporting documentation regarding Physician Assistants from overseas evidence and considered the impact of the two Australian Physician Assistant trials, which were conducted in Queensland and in South Australia. In addition the report also considered submissions from various key stakeholders such as personnel from the rule and remote health sector, Physician Assistant graduates and students from the Australian PA programs conducted by University of Queensland and other professional bodies representing nurses and doctors. The findings of this report are overwhelmingly supportive of the introduction of the Physician Assistant into the Australian health workforce. A number of concerns were raised by some respondents about introducing a new health professional, such as the competition of training placements for junior doctors and medical students, and potential competition with the existing nurse practitioner role. It is interesting to note that the report could not find any evidence that supported either of these two arguments.