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 .

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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?

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Update:

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…)