Regular readers will know of Croakey’s interest in the potential for physician assistants (PAs) to help improve access to health care in rural, remote and other under-served areas.
The Australian College of Rural and Remote Medicine (ACRRM) recently endorsed a policy statement giving strong support to the potential of PAs “to extend the reach of doctors in rural and remote communities and stabilise health care services”.
An extract from the statement follows below, and beneath that is an interview with a PA working in Townsville, Deborah O’Kane. The orthopaedic surgeon with whom she works, Jim Price, says that she is helping patients – and also has been a boost for him personally.
The ACRRM statement:
acknowledges that the PA model represents an extension of informal delegated medical practice arrangements that already exist in rural and remote Australia, strengthened by formal vocational training and a local clinical governance framework;
recognises that PAs, under the direction and supervision of doctors, are part of a broader range of solutions for increasing participation in health care to meet the needs of communities;
recommends broader adoption of clinical governance frameworks that support local delegated medical practice in determining appropriate clinical roles and supervision within a health care team, enabling PAs (and others) to work to the full extent of their evolving abilities with the support of medical practitioners;
notes that an Australian PA training pathway represents a route into expanded, flexible, clinical careers for interested paramedics, allied health practitioners, nurses, Aboriginal Health Workers and military medics who might otherwise be lost to the health care system;
supports a model of accredited tertiary educational programs for PA in the interest of standardisation, quality assurance and professional credibility, ideally housed within medical schools;
acknowledges in the context of the more than doubling of medical student numbers, that clinical training is under pressure and that while PAs can assist in the supervision and teaching of medical students and junior doctors, the demands on clinical placements and training opportunities must be managed;
expects national registration for PAs through the Australian Health Practitioner Regulation Agency (AHPRA); and
welcomes the participation of PAs in ACRRM-accredited continuing medical education courses.
Meanwhile, meet a PA
No doubt, many readers aren’t familiar with PAs or what they do.
Below is a short interview with one of the first Australian graduates, Deborah O’Kane.
Q. Tell us a bit about yourself. What were you doing before, why did you decide to train as a PA and when did you graduate?
Hi, I am one of the first graduating cohort of Australian PA’s from UQ, we graduated June this year.
I decided to take the risk and enter this new profession because I was a senior physiotherapist (of twenty years) and was looking for a change. I didn’t want to lose the knowledge that I had gained, and thought this was a great way to build upon my clinical experience but still make a change personally.
Q. Where are you working now? Please tell us something about the area, the demographic of the patients, the nature of the practice, its staffing, and its workload.
I am working for Dr Jim Price, an orthopaedic surgeon in Townsville. We are a small practice with only the primary surgeon, two reception staff, a part time nurse and me at the practice. We see patients from the Townsville and surrounding regions, but “surrounding” is pretty big – we just operated on someone from Julia Creek and another from Winton.
Jim was finding that the practice was getting pretty busy for him and was looking for some help, but not looking for the practice to expand necessarily.
Q. How did you come to be working there?
I spent two rotations in my clinical year as a PA student with Jim which was a great opportunity to learn if that was the area I wanted to move into, and a chance for Jim to see if the PA model (and me in it ) would work in his practice.
Q. What does your role entail?
I have taken over some of the more clerical side of Jim’s practice to free up his time, so I triage his incoming referrals and if necessary organise for investigations to be performed before they come in for their appointments. I assist with liaising with doctors and patients with the practice, maybe referring patients to other health professionals or checking on the day surgery patients post operative recovery.
Clinically I perform the initial assessments on our new patients and then present the patients to Jim so that he can look at the relevant features of that patient to decide their treatment options from there.
I also assist with the running of the post op clinic – being trained in plaster application and experienced in applying braces and other orthotic appliances.
I also work in an education role in preparing the patients for their operative procedures, or in conservative treatment options for them. I still regularly teach the patients exercise programs to help them in their recovery.
Q. What difference do you make for the practice, the medical staff, the patients?
I hope that I am improving the access to Jim’s practice, by improving the communication between our practice and the interested parties, be that the referrers or the patients or their family. I can be available when Jim is in surgery to answer queries and hopefully head off any problems in the early stages. I also have the time to spend with preparing the patients for their surgery so hopefully they are feeling more confident about the procedure and the post operative period.
Q. Would you be able to get some comment from the doctor about what difference you’re making?
Dr James Price: “Deb has been working for me now since the middle of 2012 in my Orthopaedic Surgical Practice. Deb is officially employed as a physiotherapist as the registration etc has not come through for physician assistant at the moment. I found it to be extraordinarily helpful having someone who has done physician assistant training working in my practice and assisting me with patient care and certainly taking the load off a lot of the work I would previously did.
Deb’s previous qualification as a physiotherapist of course is extremely helpful in an orthopaedic practice but the training she has done, as a physician assistant also is very useful in the day to day ongoing care of my patients.
I think the level of care my patients are receiving has certainly risen since Deb has started working here and it has taken a lot of the load off myself and therefore has made my working life more enjoyable again.
I would certainly recommend the employment of a physician assistant for a specialist in a busy practice to assist them with their duties as it has certainly made a big difference to my medical practice.”
Q. What is your big-picture vision for yourself for the future? And for PAs more broadly?
There are legal limitations to my practice at present that are a little frustrating. I am able to practice with Jim at present because I work within the limitations of a physiotherapist. I would love to have prescribing rights so that I could assist Jim more broadly for example, with admitting his patients into hospital or if a patient runs out of a script.
One of my personal goals would be to be able to assist Jim in theatre, so that I am seeing the patient from the initial assessment through to the post operative care and have a full understanding of what that patient has experienced. As a physio, working in theatre is a fun change and such a great way to appreciate the anatomy that you are dealing with.
For the PA profession as a whole I would love to see us accepted into Australia. I had the opportunity to spend one clinical rotation in Tennessee and could see the PA model at work. I practised alongside with the other health professionals, including a nurse practitioner and other docs, and we are just another member of the team providing health care and access for the patient.
Q. What have you learnt about PAs along the way?
Boy, how long have you got? It has been a steep learning curve for me, but the challenge I was looking for personally. I think the quickest thing to say was if someone was opposed to PAs, it’s always been in theory and the minute you meet one, or work alongside them, that opposition falls away.
Q. What are some of the common misconceptions that you encounter?
The biggest misconception for me has been that I am a nurse, which caused some confusion during my clinical rotations. It’s always a conversation starting point when someone new asks the polite….so what do you do?
One of the arguments that I have read opposing the implementation of PA’s is that there won’t be as much training available for the junior docs, but since I have been with Jim he has found he has more time and has been supervising 6th year med students from JCU for their ortho experience.
Q. What else would you like to tell us?
I think the PA movement is gaining momentum so if you are interested in joining the profession have a look at the JCU website.