Five places in Queensland are to trial the use of physician assistants — a type of health care worker that has proven invaluable overseas in providing care to rural, remote and other communities under-served by traditional health services.

The pilot, just announced by the State Government, will be watched closely by many interested groups and, if history is any guide, may face some opposition from organised medicine and nursing groups anxious to protect their turf.

However, we need to look beyond narrow sectional interests and consider the broad needs of the community.

PAs — people with qualifications or experience in health and sciences who receive intensive medical training and then operate under doctors’ supervision — will help overcome rural workforce shortages as well as helping to retain doctors and other health professionals. They differ from nurse practitioners because they work under delegation from doctors, rather than in independent practice.

We should not be arguing about whether we need more nurse practitioners or more young doctors or PAs to be working in rural and remote Australia. The fact is that we need them all — and as quickly as possible. Rural and remote communities are sinking under a burden of disease and health need. It’s all hands on deck for the sinking ship and all are necessary to bail.

Nurse practitioners are a good choice for career pathways for nurses and should be recognised as such. However, we cannot expect them to solve rural workforce shortages.

Nurse practitioners have been around for some 20 years now and have made little impact on the workforce, particularly in rural, remote and underserved areas. There has been no “receptive framework” including the policy environment to allow it to happen. When the NP is trained, it is more often in a specialised area, not the generalist one badly needed in rural and remote areas.

The increase in medical student numbers from 1200 to 3000 graduates per year has been raised as an argument against the introduction of PAs. Will these PAs take the valuable clinical material and training spots that will be needed to train medical students?

Rural Australia is certainly resource poor in infrastructure for such training. There aren’t enough preceptors, accommodation, or hospital positions to match the increasing numbers of graduates.

The rural workforce has a large proportion of International Medical Graduates (50% in many areas and more than 70% in some) who have been extracted from an ever-diminishing pool. Will they remain after they have Australian permanent residency? Why would we expect differently from this often urban-trained group? With our own Australian graduates interestingly enough, there are currently only 284 places nationally filled in the rural training pool in general practice. This isn’t going to solve much.

Where will this “tsunami” of young doctors end up? My suspicion is that they will not end up in sufficient numbers in rural or remote Australia. I hope to be proven wrong.

Physician assistants are an option for many countries, Australia being an obvious one, with numerous small isolated and underserved communities who have poorer health outcomes and an unhealthy dependence on imported health workforce. They are part of a broader strategy for retention of an already meager and ageing medical workforce.

They may also help us to make more effective use of existing workers, such as Rural and Remote Paramedics who would be ideal candidates for PA training. Research has shown that 85 to 95 % of their time in these communities is “down-time” and not involving their emergency response activities. In Queensland there is a curriculum to increase this group’s scope of practice to include clinical and primary health skills. They can then be incorporated into the primary health care framework of the health service.

The medical, nursing and allied health professions should be working together to help ensure the success of the new Queensland trial.

Peter Fray

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