Concerns remain around physician assistant proposal

Transcript: AMA Queensland President, Dr Nick Yim, ABC Radio Sunshine Coast, Mornings with Sarah Howells, Thursday 1 August 2024

Subjects: Physician assistants

SARAH HOWELLS: You know how it's hard to get a GP appointment because of a shortage of doctors on the Sunshine Coast? Well, that shortage isn't just here and it's not just the local clinics. That shortage is hitting our hospitals too and it's really affecting the availability of not just doctors, but nurses and nurse practitioners as well. And that has Queensland Health and the Sunshine Coast University Hospital looking for new ways to fill the gap. Enter the physician's assistant. Not a doctor, but someone with some medical training who would do a lot of the things that doctors do. And if you think that sounds a bit vague, you're not the only one.

Sunshine Coast University Hospital has just paused a plan to radically increase the number of physician assistants it employs, so it can consult more closely with medical staff, peak bodies and unions. ABC Sunshine Coast reporter Owen Jacques asked Dr Nick Yim from AMA Queensland his thoughts on this issue.

DR NICK YIM: There has been a great deal of confusion now. I guess there's elements of concern. We do acknowledge that across Queensland and across the country, even across the world, that there is a workforce shortage and that includes doctors, nurses, allied health, and pharmacists. But at the same time, we do need to work on how we're going to increase the numbers of doctors into our state.

One of the other big concerns is with regards to physician assistants. Currently in Australia, there is no university program, so they are going to be recruited from the UK and the US from our understanding. So how are we going to gauge that level of competence and how is that going to be assessed?

OWEN JACQUES: We obviously have medical practitioners and doctors, we have nurses, then we have nurse practitioners who walk that line between doctor and nurse. So why is a physician assistant so different from that? Essentially, someone with some medical training that is able to, I suppose, do some of the work that is at the lower end of what doctors and nurse practitioners do.

DR NICK YIM: I think this is the question that's always been proposed – what are the governance structures, what is the scope and then what is the regulation behind it? So, doctors, nurses and nurse practitioners, we're all under the regulation of AHPRA. So they are registered. Whereas, to our understanding, physician assistants don't go through the AHPRA process. So to say, physician assistant A versus physician assistant B, they could have come through different training programs from different countries. Are we going to assess that competency? Are they equal? That's something that we don't know at this point of time.

OWEN JACQUES: In the business plan released for the Sunshine Coast University Hospital internally, it talks about how their intention is for these physician assistants to be able to take patient history, do physical exams or pathology and imaging and then prescribing specific medications and delivering emergency treatment. Is that what you would imagine to be within this remit? Is that what you expect?

DR NICK YIM: What you've just described there, it seems like quite a large scope, and it's something where we do need to ensure that there's appropriate governance in play. The other big concern, and I think it's something for us as a community to be aware of, is how does this play out down the track? Because this is potentially a lot of the roles that we see that our junior doctors perform. So junior doctors, they will also take a history, they will also take an examination and they will also investigate those patients for part of their learning. And as they develop into consultants, they need that expertise to ensure that we continue to have those flow of doctors into our state.

OWEN JACQUES: One of the selling points of the physician assistant is that they work under the delegation of a medical practitioner. They're not out here alone doing this work, they are to be supervised. But then, I also note, in this business plan it refers to that supervision being either direct, indirect or remote. Would it be a concern to you if you had physician assistants being supervised remotely?

DR NICK YIM: I think one of the great concerns is also that we are seeing some reports coming from the UK of untoward or poor patient outcomes. So, supervision really needs to be clear. It's one of those situations where we also need to ensure that for the person that's supervising, the doctor that’s supervising the physician assistants, that they're actually covered by their medical indemnity. Because remote supervision is very, very different to say, if they're supervising on site.

OWEN JACQUES: Now, Sunshine Coast seems to be the health service that is really seeming to be pushing ahead or wanting to push ahead with this. At the moment, they've got a five-year plan where they're looking to bring in physician assistants from the equivalent of three full-time positions to 16, working seven days a week. But I understand that at the moment, that's hit a roadblock, because there has been that concern from the medical fraternity, unions, doctors’ groups and so on. What was your understanding of this plan and how it's come to be paused?

DR NICK YIM: We caught wind of it via social media from some concerned clinicians. Many clinicians were bringing up on social media. Some of the outcomes that were being achieved were untoward outcomes for patients from the UK. But one of the key things that we're concerned about is that many of these things potentially are just short-term fixes.

We know that in Queensland we do have a workforce shortage. We need to ensure that our next generation of doctors will have the adequate training pathways to ensure that they are training to be our consultant doctors, and they do stay in the state. That also means that we need adequate investment. So this is one of those areas, business cases, that we do have concerns about as to what are our unintended consequences, whether it be five, 10 or 20 years down the track. We do acknowledge there's potential for changes of models of care, but we need appropriate consultation of stakeholders. We also need to ensure that there is patient safety, because that is number one. We need to ensure that when patients are being treated, they are safe as we don't want untoward outcomes. And finally, we do need to have appropriate governance structures in place to ensure that we do protect our community from all registered practitioners.

OWEN JACQUES: In the response that I got from the Health Minister's office, it notes that there are physician assistants working around the state at the moment. They were introduced as part of a pilot about 15 years ago or so, and there's about seven scattered across Townsville, Sunshine Coast and Darling Downs. They have been working in these roles for quite a long time. Does it seem to be working or not working at the moment?

DR NICK YIM: It's really hard to say there. I think historically there was, I believe, two of the universities in Queensland did have a physician assistants’ course or degree, but obviously they do not offer that degree currently. So, it's hard to ascertain of how the physician assistants are working in those locations.

SARAH HOWELLS: That is Dr Nick Yim from AMA Queensland having a chat there with Owen Jacques.