Who do I want to work with? RDWA Conference

Wilpena PoundNovember 2009

Dr Ian Cameron

NSW Rural Doctors NetworkCEO

Physicians Assistants

History

What are they ?

What do they do ?

Training

Structural matters

Place in Australia?

Physicians Assistant

Physician assistants are health care professionals licensed, or in the case of those employed by the federal government they are credentialed, to practice medicine with physician supervision.

Physicians Assistants

• > 68,000 PAs in USA, 2008

• USA, Canada, England, Scotland, Netherlands, Taiwan, South Africa, Ireland, Ghana, Kenya, Nicaragua, Thailand

History

● 1650 Feldschers, Peter the Great

● 18th and 19th C, loblolly boys, Royal Navy and US Navy

● 1803 Officiers de Sante, France

● WW2, Medics, hospital corpsman

● 1960s, rise of PAs in USA

● 1972 AMA supports Assoc PA Programs, national certification

Physicians Assistant

SCOPE OF PRACTICE● Physicians may delegate to PAs those

medical duties that are within the physicians scope of practice and the PAs training and experience.

● State medical and PA practice acts and regulations generally allow physicians broad delegatory authority, which permits flexible, customized team practice.

● All 50 states, the District of Columbia, and Guam authorize PAs to prescribe.

Extend - Complement - Substitute

Extend / substitute: Do some of what the doctor would usually do

Complement: provide a wider range of services than the doctor would

PAs tend to extend rather than complement - do not increase costs

Morgan et al, Impact of Physician Assistant Care on Office Visit Resource Use in the US

What do they do?

History taking, patient examination

Patient management including

•Investigation ordering

•Prescribing (limited)

•Minor procedures

•Counselling

•Preventative health

Many also have role in practice management, administration

What and where

● About 50% in primary care (35% GP)

● Many rural but:● Urban esp as specialists

● Shorter training, more likely to stay rural

Quality etc

In numerous studies over 30 years,

•Quality of care has not been eroded

•Patient acceptance well documented

•Cost savings

•No increase in liability claims

Training

Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training.

Training 2

● 2 Years post college

● One year basics, one year clinical

● 100 hours CME every 2 years

● Recertification every 6 years

Training 3

Queensland - UQ and JCU

● Master of Physicians Assistant Studies

● 1.5 years

● Post graduate (biological sciences prerequisite)

Australia?

● Positive not negative

● Funding changes

● Education

● Regulatory body

● Queensland trial

Aboriginal Health

We need:

● A workforce to provide for Aboriginal people

● A workforce which includes Aboriginal people

Physician Assistants

● Extend services available

● Provide careers for Aboriginal people

● In USA, 17% of PAs from minority groups

Other non-doctor clinicians

● Medical assistant

● Practice nurse

● Nurse Practitioner● PA not in competition with NP

● Broader range of people

● Career ascension

● Specialist technician

● Aboriginal Health Worker

Left field

International medical graduates

University of Washington, Seattle

http://rcpsc.medical.org/publicpolicy/imwc/BallwegIMG_IWMC2008.pdf

Resources

•American Academy of Physicians Assistants http://www.aapa.org/

•National Commission on Certification of Physicians Assistants http://www.nccpa.net

•Dr Rhonda Jolly, Health workforce: a case for physician assistants?http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/037-ahwi/$FILE/037%20Australian%20Health%20Workforce%20Institute%20Appendix%201.pdf

•Teresa O’Connor and Rod Hooker, Extending rural and remote medicine with a new type of health worker: Physician assistants. Aust J Rural Health (2007) 15, 346 - 351

•Anything by Roderick S Hooker on Physicians assistants

•Dennis Pashen at Mt Isa UDRH has keen interest and has presented widely

•Jane Farmer et al, Evaluation of Physicians Assistants to NHS Scotland: Final Report

UHI Millenium Institute, Inverness

A320

THANK YOU & GOOD TRAVELLING