1. PHYSICIAN ASSISTANT PILOT IN THE NORTHERN REGION DISTRICT HEALTH
BOARDS, NEW ZEALAND
Governance Document No. 4
This position description is prepared specifically for the Physician
Assistant Pilot in General Surgery at CMDHB. The nature of the pilot will
require flexibility on behalf of the Physician Assistant in terms of the
details of the position, its responsibilities and locations, which may
change during the course of the pilot.
Position Holder's Name:
Position Holder's Signature:
Primary Supervisor's Name:
2. PURPOSE OF THE POSITION
The Physician Assistant (PA) role is not currently part of the New Zealand health workforce
but is to be piloted for a period of 12 months in general surgery at Counties Manukau
District Health Board (CMDHB). A commitment to working in the role for 12 months is
required from the PA. The position will require adaptability, flexibility, and the ability to work
in a multicultural environment.
The pilot will demonstrate how the PA role interacts with Nurses, Junior and Senior Medical
Officers and students, and will assist with in assessing whether the PA role can be adapted
and developed within the New Zealand Health system particularly in surgery.
The PA will be responsible to the primary supervising surgeon for the achievement of
agreed objectives and will operate within the confines of CMDHB. The position works with
the delegated authority of and under the oversight of the designated vocationally registered
The role is based at Middlemore Hospital with some specific duties at Manukau Health
Park (MHP) (ie, Manukau Surgery Centre and Manukau SuperClinic).
VISION AND VALUES
ORGANISATIONAL SHARED VISION
Our DHB shared Vision is to work in partnership with our communities to improve the
health status of all, with particular emphasis on Maori and Pacific peoples and other
communities with health disparities.
We will do this by leading the development of an improved system of healthcare that is
more accessible and better integrated.
We will dedicate ourselves to serving our patients and communities by ensuring the
delivery of both quality focussed and cost effective healthcare, at the right place, right time
and right setting.
Partnership Working alongside and encouraging others in health and related
sectors to ensure a common focus on, and strategies for achieving
health gain and independence for our population
Care and Respect Treating people with respect and dignity, valuing individual and
cultural differences and diversity
Professionalism We will act with integrity and embrace the highest ethical standards
Teamwork Achieving success by working together and valuing each other’s skills
Innovation Constantly seeking and striving for new ideas and solutions
Responsibility Using and developing our capabilities to achieve outstanding results
and taking accountability for our individual and collective actions
3. KEY ACCOUNTABILITIES:
Clinical • Participates in designated areas of clinical practice as defined and
delegated by the primary and secondary supervising surgeons, in
accordance with the individual practice plan and scope of practice.
• Actively works in partnership with the medical and nursing staff to ensure
safe, focussed care for the patient and their family in line with the vision
and values of CMDHB.
• Maintains professional standards of practice and competence and uses
these to support medical and nursing staff in the provision of acute and
non acute services, in the inpatient and outpatient settings at CMDHB.
• Provides support to clinical staff allowing the most efficient utilisation and
deployment of personnel and resources, thereby promoting best practice
in providing effective and efficient services to patients.
Teamwork • Works collaboratively with the wider multidisciplinary health care team to
ensure continuity of care is maintained and to achieve optimal patient
access to services and health outcomes
Quality • Participates in quality activities. Contributes, supports and encourages
improvement clinical service activities through identifying areas for improvement and
participating in implementation.
Cultural diversity • Demonstrates a commitment to the Treaty of Waitangi and honours
Health and safety • Recognises and accepts individual responsibility for health and safety in
the workplace and works within CMDHB’s health and safety policies and
Professional • Participates in service programmes and educational opportunities relevant
development to the role.
• In conjunction with the primary supervising surgeon, establishes annual
goals, objectives, performance targets and strategies to meet these.
Pilot • Participates in the evaluation of the pilot of the PA role in the NZ setting.
• The PA will be responsible for his/her own practice within the boundaries of supervision and
his/her defined delegated role, and is accountable to the primary supervising surgeon.
• The PA will be primarily responsible to his/her supervisors but will work closely with other
members of the multidisciplinary health care team.
• The PA undertakes to work only within the defined scope of practice, or as delegated by
his/her supervisors, and agrees not to undertake work known to fall outside his/her scope of
4. POSITION DUTIES:
NB. It is expected that the duties and Scope of Practice will change and develop over time, but
• Works with the designated primary and secondary supervising surgeons to develop a practice
plan and a scope of practice appropriate for the individual PA’s skills and experience.
• Regularly reports to, meets with, and seeks feedback from the supervisors in accordance with
the practice plan, and as required by the supervisors.
• Integrates into the designated clinical team providing comprehensive care for acute and
elective surgical patients in both inpatient and outpatient settings.
• Integrates into the routine activities of the clinical team including acute duties, daily team
rounds, consultant rounds, clinical meetings, ward meetings, theatre sessions, outpatient
clinics, and as designated by the supervisors.
• Completes administrative duties associated with team activities including arranging and
following-up diagnostic and therapeutic tests, referrals, consultations, completion of
• Documents all relevant aspects of patient care and completes all required paperwork for legal
and administrative purposes.
• As delegated, provides comprehensive physical assessment of patients encompassing patient
interviews, medical histories and physical examination.
• Interprets consultation findings, initiates and interprets appropriate diagnostic tests, and
assists in developing management options.
• Initiates and monitors treatment after consultation with supervisors.
• Explains to patients the medical, diagnostic and management options.
• Performs specific ward-based procedures, including diagnostic physical exams and treatment
procedures, as delegated by the supervisors.
• Refers to, and consults with, surgeons and other health professionals, as indicated, in order to
manage specific patients, plan and co-ordinate activities, exchange information, and
investigate and resolve problems.
• Assists with the preparation of patients for theatre, including ensuring all appropriate tests are
completed, and patient consented and marked in accordance with CMDHB policies and
• Assists in preadmission clinics ensuring patients are appropriately assessed prior to surgery.
• Works to build good working relationships with all members of the multidisciplinary health care
• Provides advice on the management of patient care to the wider health care team, where
• Keeps up-to-date on relevant medical research, technology and related issues by attending
ongoing education courses and professional meetings, reading journals, etc, to ensure
continuing education, training and development is undertaken to meet clinical governance
guidelines for continuous professional development (much of this will be available internally at
• In exceptional circumstances, provides additional services on an emergency basis under the
direction and responsible supervision of a surgeon, as are within the PA's clinical competence
and which would not otherwise jeopardise the delivery of care to patients.
• Works within the NZ legal framework, the code of consumer rights and the policies and
procedures and Clinical Services Capability Framework of the CMDHB.
5. • Takes an active part in the formal pilot evaluation process of the PA role in New Zealand. As
determined appropriate, assists in developing a programme for the development and
mentoring of “home grown” PAs within New Zealand.
• The PA may be required to communicate about the PA role, both informally and formally.
Excellent communication skills are a key requirement.
• The PA will work in a professional manner with CMDHB’s multi-cultured client base including
compliance with the Treaty of Waitangi and by demonstrating a commitment to partnership.
• The PA will be required to develop and maintain effective relationships with a range of
CMDHB staff members and external contacts including clinical and administrative staff,
managers, patients and their family/whanau. Situations may often call for tact and diplomacy
and will require information to be handled in a discreet and sensitive manner. In conflict
situations the PA will be required to exercise sound judgement, negotiation and
persuasiveness skills, toward facilitating a workable outcome. Strong, well developed
interpersonal communication skills are essential.
• There will be a requirement to be able to prioritise issues and negotiate time frames, while still
providing a quality patient service. The range of problems will be diverse and require solutions
customised to meet the circumstances of the patient. Therefore opportunities will arise to
provide innovative options to the patient based on proven outcomes.
• There will be demands to meet deadlines, maintain accuracy and quality of information.
Failure to do so could impact on the organisation in terms of the ability to meet contracted
outcomes and provide quality standards.
Scope for Action
• The PA will be encouraged to use initiative and problem solving skills to put forward innovative
approaches to issues. Discretion is required to be exercised in releasing confidential
information to the appropriate parties.
• The PA will be responsible to ensure that procedures involving patients meet statutory
requirements and are ethical and clinically appropriate.
6. TEAM AND REPORTING RELATIONSHIPS
• The PA will work as a member of the surgical team and will therefore be expected to work
closely with medical, nursing and allied health staff. The PA will be expected to communicate
openly and build good working relationships with all members of the wider multidisciplinary
health care team to ensure safe and effective patient care.
• The PA will be able to formulate and implement various aspects of management whilst
ultimately reporting directly to the supervising surgeons.
For the purposes of selecting USA trained PAs for the pilot, the required professional
competencies for PAs are drawn from the American Academy of PAs (AAPA) -
“Competencies of the PA Profession” (adopted in 2005) – refer Attachment.
Professional competencies for PAs include:
• the effective and appropriate application of medical knowledge
• interpersonal and communication skills
• patient care
• practice-based learning and improvement
• systems-based practice
Plus an unwavering commitment to continual learning and professional growth, and the
supervising medical practitioner–PA team, for the benefit of patients and the larger
community being served.
Physician Assistants are not currently a part of the New Zealand health workforce. This
pilot will be the first time PAs will be employed within the New Zealand health system. As
the pilot progresses the role is likely to change and develop as the opportunities PAs
provide are further identified. Consequently, PAs in the pilot will need to demonstrate:
• ability to integrate in to a new team
• ability to adapt as the role develops. This will include initially working within a more
limited scope of practice than is currently practiced in the USA
• ability to identify how PAs can add value to the current team
• willingness to learn new skills
• willingness to take on the challenge of developing a new role in the New Zealand
health care setting
QUALIFICATIONS & EXPERIENCE
Essential Education, Training and Experience
• Current membership of USA-based National Commission on Certification of PAs
(NCCPA) and the eligibility to maintain membership for the duration of the employment
contract. (Membership of NCCPA will provide evidence that a practitioner holds a
qualification from an accredited training programme and has passed the PA National
Certifying Exam (PANCE) that assesses basic medical and surgical knowledge. To
maintain NCCPA membership PAs must show evidence of continuing medical
education (CME) and complete a recertification exam in the fifth or sixth year of a six-
7. year certification maintenance cycle.)
• Hold a current licence to practice in the USA state he/she is coming from
• Minimum of three years recent (current) practice in a PA role in the USA in surgery
• Demonstrate evidence of continuing medical education (CME)
8. Attachment to Physician Assistant Position Description
USA Professional Competencies for Physician Assistants in New Zealand Pilot
For the purposes of selecting USA trained Physician Assistants (PAs) for the Northern
Region pilot, the required professional competencies for PAs will be drawn from the
American Academy of PAs (AAPA) - “Competencies of the PA Profession” (adopted in
Professional competencies for PAs include the effective and appropriate application of
medical knowledge, interpersonal and communication skills, patient care, professionalism,
practice-based learning and improvement, systems-based practice, as well as an
unwavering commitment to continual learning and professional growth, and the supervising
Medical Practitioner – PA team, for the benefit of patients and the larger community being
These competencies are demonstrated within the scope of practice, whether medical or
surgical, for each individual PA as that scope is defined by the supervising medical
practitioner and appropriate to the setting.
The PA profession defines the specific knowledge, skills, and attitudes required and provides
educational experiences as needed in order for PAs to acquire and demonstrate these
competencies. In addition to these skills and attributes, PAs are expected to uphold the
values and practices described in the profession’s Guidelines for Ethical Conduct.
Medical knowledge includes an understanding of pathophysiology, patient presentation,
differential diagnosis, patient management, surgical principles, health promotion, and
PAs must demonstrate core knowledge about established and evolving biomedical and
clinical sciences and the application of this knowledge to patient care in their area of
In addition, PAs are expected to demonstrate an investigatory and analytic thinking approach
to clinical situations. PAs are expected to:
• Understand aetiologies, risk factors, underlying pathologic process, and epidemiology for
• Identify signs and symptoms of medical conditions
• Select and interpret appropriate diagnostic or lab studies
• Manage general medical and surgical conditions to include understanding the
indications, contraindications, side effects, interactions, and adverse reactions of
pharmacologic agents and other relevant treatment modalities
• Identify the appropriate site of care for presenting conditions, including identifying
emergent cases and those requiring referral or admission
• Identify appropriate interventions for prevention of conditions
• Identify the appropriate methods to detect conditions in an asymptomatic individual
• Differentiate between the normal and the abnormal in anatomy, physiology, laboratory
findings, and other diagnostic data
• Appropriately use history and physical findings and diagnostic studies to formulate a
• Provide appropriate care to patients with chronic conditions.
Interpersonal & communication skills
Interpersonal and communication skills encompass verbal, nonverbal, and written exchange
of information. PAs must demonstrate interpersonal and communication skills that result in
9. effective information exchange with patients, their patients' families, Medical Officers,
professional associates, and the health care system. PAs are expected to:
• Create and sustain a therapeutic and ethically sound relationship with patients
• Use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit and
• Appropriately adapt communication style and messages to the context of the individual
• Work effectively with medical staff and other health care professionals as a member or
leader of a health care team.
• Apply an understanding of human behaviour
• Demonstrate emotional resilience and stability, adaptability, flexibility, and tolerance of
ambiguity and anxiety
• Accurately and adequately document and record information regarding the care process
for medical, legal, quality, and financial purposes.
Patient care includes age appropriate assessment, evaluation, and management. PAs must
demonstrate care that is effective, patient-centred, timely, efficient, and equitable for the
treatment of health problems and the promotion of wellness. PAs are expected to:
• Work effectively with medical staff and other health care professionals to provide patient-
• Demonstrate caring and respectful behaviours when interacting with patients and their
• Gather essential and accurate information about their patients
• Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment
• Develop and carry out patient management plans
• Counsel and educate patients and their families
• Competently perform medical and surgical procedures considered essential in the area
• Provide health care services and education aimed at preventing health problems or
Professionalism is the expression of positive values and ideals as care is delivered.
Foremost, it involves prioritizing the interests of those being served above one's own. PAs
must know their professional and personal limitations.
Professionalism also requires that PAs practice without impairment from substance abuse,
cognitive deficiency, or mental illness. PAs must demonstrate a high level of responsibility,
ethical practice, sensitivity to a diverse patient population, and adherence to legal and
regulatory requirements. PAs are expected to demonstrate:
• Understanding of legal and regulatory requirements, as well as the appropriate role of the
• Professional relationships with medical supervisors and other health care providers
• Respect, compassion, and integrity
• Responsiveness to the needs of patients and society
• Accountability to patients, society, and the profession
• Commitment to excellence and ongoing professional development
• Commitment to ethical principles pertaining to provision or withholding of clinical care,
confidentiality of patient information, informed consent, and business practices
• Sensitivity and responsiveness to patients' culture, age, gender, and disabilities
• Self-reflection, critical curiosity, and initiative.
Practice-based learning and improvement
10. Practice-based learning and improvement includes the processes through which clinicians
engage in critical analysis of their own practice experience, medical literature, and other
information resources for the purpose of self-improvement. PAs must be able to assess,
evaluate, and improve their patient care practices. PAs are expected to:
• Analyze practice experience and perform practice-based improvement activities using a
systematic methodology in concert with other members of the health care delivery team
• Locate, appraise and integrate evidence from scientific studies related to their patients'
• Obtain and apply information about their own population of patients and the larger
population from which their patients are drawn
• Apply knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness
• Apply information technology to manage information, access online medical information,
and support their own education
• Facilitate the learning of students and/or other health care professionals
• Recognize and appropriately address gender, cultural, cognitive, emotional, and other
biases; gaps in medical knowledge; and physical limitations in themselves and others.
Systems-based practice encompasses the societal, organizational and economic
environments in which health care is delivered. PAs must demonstrate an awareness of and
responsiveness to the larger system of health care to provide patient care that is of optimal
value. PAs should work to improve the larger health care system of which their practices are
a part. PAs are expected to:
• Use information technology to support patient care decisions and patient education
• Effectively interact with different types of medical practice and delivery systems
• Understand the funding sources and payment systems that provide coverage for patient
• Practice cost-effective health care and resource allocation that does not compromise
quality of care
• Advocate for quality patient care and assist patients in dealing with system complexities
• Partner with supervising physicians, health care managers, and other health care
providers to assess, coordinate, and improve the delivery of health care and patient
• Accept responsibility for promoting a safe environment for patient care and recognizing
and correcting systems-based factors that negatively impact patient care
• Use information technology to support patient care decisions and patient education
• Apply medical information and clinical data systems to provide more effective, efficient
• Utilize the systems responsible for the appropriate payment of services (not required in New