Who do I want to work with?

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Who do I want to work with?

  1. 1. Who do I want to work with? RDWA Conference Wilpena Pound November 2009 Dr Ian Cameron NSW Rural Doctors Network CEO
  2. 2. Physicians Assistants <ul><li>History </li></ul><ul><li>What are they ? </li></ul><ul><li>What do they do ? </li></ul><ul><li>Training </li></ul><ul><li>Structural matters </li></ul><ul><li>Place in Australia? </li></ul>
  3. 3. Physicians Assistant <ul><li>Physician assistants are health care professionals licensed, or in the case of those employed by the federal government they are credentialed, to practice medicine with physician supervision. </li></ul>
  4. 4. Physicians Assistants <ul><li>> 68,000 PAs in USA, 2008 </li></ul><ul><li>USA, Canada, England, Scotland, Netherlands, Taiwan, South Africa, Ireland, Ghana, Kenya, Nicaragua, Thailand </li></ul>
  5. 5. History <ul><li>1650 Feldschers, Peter the Great </li></ul><ul><li>18th and 19th C, loblolly boys, Royal Navy and US Navy </li></ul><ul><li>1803 Officiers de Sante, France </li></ul><ul><li>WW2, Medics, hospital corpsman </li></ul><ul><li>1960s, rise of PAs in USA </li></ul><ul><li>1972 AMA supports Assoc PA Programs, national certification </li></ul>
  6. 6. Physicians Assistant <ul><li>SCOPE OF PRACTICE </li></ul><ul><li>Physicians may delegate to PAs those medical duties that are within the physician s scope of practice and the PAs training and experience. </li></ul><ul><li>State medical and PA practice acts and regulations generally allow physicians broad delegatory authority, which permits flexible, customized team practice. </li></ul><ul><li>All 50 states, the District of Columbia, and Guam authorize PAs to prescribe. </li></ul>
  7. 7. Extend - C omplement - Substitute <ul><li>Extend / substitute: Do some of what the doctor would usually do </li></ul><ul><li>Complement: provide a wider range of services than the doctor would </li></ul><ul><li>PAs tend to extend rather than complement - do not increase costs </li></ul><ul><li>Morgan et al, Impact of Physician Assistant Care on Office Visit Resource Use in the US </li></ul>
  8. 8. What do they do? <ul><li>History taking, patient examination </li></ul><ul><li>Patient management including </li></ul><ul><li>Investigation ordering </li></ul><ul><li>Prescribing (limited) </li></ul><ul><li>Minor procedures </li></ul><ul><li>Counselling </li></ul><ul><li>Preventative health </li></ul><ul><li>Many also have role in practice management, administration </li></ul>
  9. 9. What and where <ul><li>About 50% in primary care (35% GP) </li></ul><ul><li>Many rural but: </li></ul><ul><ul><li>Urban esp as specialists </li></ul></ul><ul><ul><li>Shorter training, more likely to stay rural </li></ul></ul>
  10. 10. Quality etc <ul><li>In numerous studies over 30 years, </li></ul><ul><li>Quality of care has not been eroded </li></ul><ul><li>Patient acceptance well documented </li></ul><ul><li>Cost savings </li></ul><ul><li>No increase in liability claims </li></ul>
  11. 11. Training <ul><li>Because of the close working relationship the PAs have with physicians, PAs are educated in the medical model designed to complement physician training. </li></ul>
  12. 12. Training 2 <ul><li>2 Years post college </li></ul><ul><li>One year basics, one year clinical </li></ul><ul><li>100 hours CME every 2 years </li></ul><ul><li>Recertification every 6 years </li></ul>
  13. 13. Training 3 <ul><li>Queensland - UQ and JCU </li></ul><ul><li>Master of Physicians Assistant Studies </li></ul><ul><li>1.5 years </li></ul><ul><li>Post graduate (biological sciences prerequisite) </li></ul>
  14. 14. Australia? <ul><li>Positive not negative </li></ul><ul><li>Funding changes </li></ul><ul><li>Education </li></ul><ul><li>Regulatory body </li></ul><ul><li>Queensland trial </li></ul>
  15. 15. Aboriginal Health <ul><li>We need: </li></ul><ul><li>A workforce to provide for Aboriginal people </li></ul><ul><li>A workforce which includes Aboriginal people </li></ul><ul><li>Physician Assistants </li></ul><ul><li>Extend services available </li></ul><ul><li>Provide careers for Aboriginal people </li></ul><ul><li>In USA, 17% of PAs from minority groups </li></ul>
  16. 16. Other non-doctor clinicians <ul><li>Medical assistant </li></ul><ul><li>Practice nurse </li></ul><ul><li>Nurse Practitioner </li></ul><ul><ul><li>PA not in competition with NP </li></ul></ul><ul><ul><li>Broader range of people </li></ul></ul><ul><ul><li>Career ascension </li></ul></ul><ul><li>Specialist technician </li></ul><ul><li>Aboriginal Health Worker </li></ul>
  17. 17. Left field International medical graduates University of Washington, Seattle http://rcpsc.medical.org/publicpolicy/imwc/BallwegIMG_IWMC2008.pdf
  18. 18. Resources <ul><li>American Academy of Physicians Assistants http://www.aapa.org/ </li></ul><ul><li>National Commission on Certification of Physicians Assistants http://www.nccpa.net </li></ul><ul><li>Dr Rhonda Jolly, Health workforce: a case for physician assistants? </li></ul><ul><li>http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/037-ahwi/$FILE/037%20Australian%20Health%20Workforce%20Institute%20Appendix%201.pdf </li></ul><ul><li>Teresa O’Connor and Rod Hooker, Extending rural and remote medicine with a new type of health worker: Physician assistants. Aust J Rural Health (2007) 15, 346 - 351 </li></ul><ul><li>Anything by Roderick S Hooker on Physicians assistants </li></ul><ul><li>Dennis Pashen at Mt Isa UDRH has keen interest and has presented widely </li></ul><ul><li>Jane Farmer et al, Evaluation of Physicians Assistants to NHS Scotland: Final Report </li></ul><ul><li>UHI Millenium Institute, Inverness </li></ul>
  19. 19. A320
  20. 20. THANK YOU & GOOD TRAVELLING

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