Australia Needs Physician Assistants. So Why Aren’t We Getting Them?

General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare

(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 didnt! 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.

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The quality of spatial GP data is integral to adequately examining geographic access to GPs. The aim of the analyses presented here is to explore the issue of spatial GP data quality by comparing various geographically explicit GP datasets in Australia with different conceptualizations of the workforce metric (headcounts and workload aware statistics). Further, in order to understand the effect rurality has on data quality we implement our analyses across different degrees of rurality. The following discussion outlines the relevant context to this analysis. We first describe the issues salient to spatial GP data quality. We then discuss geographical GP datasets in different jurisdictions followed by a short description of GP datasets in Australia. Finally, we discuss existing research on GP datasets in Australia and elsewhere. Geographic GP datasets: what are we measuring? Two aspects of data quality are salient to GP accessibility studies. First is the geographic resolution or scale. If the available GP data are aggregated to coarse scales, for example the state level, then locally relevant analyses cannot be performed. Second, is the conceptualization of the workforce metric. While it is common to use GP headcounts or mere presence of a GP as a metric of GP access, there is evidence that this may produce misleading results [ 1 ]. In the Australian context, it is known that while the average GP work more hours per week with increasing rurality [ 8 ], there are also substantial numbers of GPs who provide short term locum services (henceforward called locum GPs) in rural Australia whose inclusion or exclusion from simple headcounts may skew workforce analyses [ 9 ].



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