The picture you get from the media of the US health system at the moment is that it is very resistant to reforms aimed at improving peoples’ access to care. But it’s now 40 years since America introduced a landmark health reform that improved access for many disadvantaged groups but that is only now starting to gain traction in Australia.
After the Korean War, the American healthcare system started an experiment with a new type of health worker, the physician assistant. These were often returned military paramedics with considerable skills but nowhere to go.
The United States had a workforce problem and physician assistants helped fill the need. They acted under direct supervision of a medical practitioner following his/her usual protocols for assessment and treatment. They were able to carry out intravenous line insertion, urinary catheterisation, order blood investigations, x-rays and routine prescribing.
As a surgical physician assistant, they would assist at operations and assess patients post-operatively. This allowed the doctor to focus on the more complicated, less routine care and to be able to influence the care of more patients and allow routine post-operative care and plans to go forward under their supervision. Patients seem to enjoy the extra time such support provides, and standards of care do not appear to have suffered in America.
In more recent years, entrants into physician assistant programmes in the US have come from a range of backgrounds including science, psychology, ambulance, nursing and health sciences. Their course is usually an intensive two year programme followed by an internship in their area of specialisation.
Currently there are over 60,000 such individuals working in America. A trial of physician assistants has been underway in Australia for the last ten months. They have been warmly embraced by surgeons, patients, nurses and junior doctors.
Many of the overseas advantages have translated into the Australian context. With decreased working hours for medical staff, a doctor shortage in outer metropolitan and rural centres and an ageing population, physician assistants may be part of the solution to our medical workforce crisis.
It is to be hoped that Commonwealth Departments of Health as well as State Health Departments will show the necessary vision to introduce this commonsense pioneering approach into our overburdened healthcare system.
Guy Maddern is professor of surgery at the University of Adelaide. St Anywhere is fictitious, but the events and issues are real
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Why prefer physician assistants to nurse practitioners, who are better established in Australian health care altho still at the margins? Is it that physician assistants are ‘under direct supervision of a medical practitioner’ while nurse practitioners are more independent?
Gavin, you read my mind and beat me to it. 🙂
What is the difference between a nurse practitioner and a physician assistant, Prof Maddern?
SRNs are denigrated once again; marginalised by neglect and disinterest amongst specialist service providers at St Everywhere. Rather than trying to reinvent the wheel, Maddern and his colleagues may find their patients and the system better off if they made more efficient use of the practitioners they already have available. Try giving them more professional support, perhaps even paying nursing practitioners realistically for their expertise and the work they do.
Dear Professor Maddern, you must know as well as I that the AMA would immediately go onto a war footing and fight to the death to kill that idea. I resigned from them in 1976 over their intransigence about GPs working in health centres and I have seen no change in attitudes towards protection of the profession’s monopoly over the succeeding years. Professor. PATIENTS WILL SUFFER AND DIE A HORRIBLE DEATH !!! (just as in home birthing and with nurse practitiioners).
Sounds like ‘MASH’ revisited