Patch protection a barrier to physician assistants

1 May 2012

Patch protection a barrier to physician assistants by Fiona Cassie

The need for further physician assistant trials was more to do with professional ‘politics’ and ‘demarcation disputes’ than the need to prove the role’s usefulness, says the physician assistant evaluation report.

The report found that the two American-trained physician assistants had a positive impact and were well-accepted during their one-year trial providing ward-based support to surgical teams at Counties Manukau District Health Board’s Middlemore Hospital.

The Australian consultants Siggins Miller report for Health Workforce New Zealand found the two PAs had “mildly positive effects” on operating theatre efficiency and team productivity; positive effects on communication, workload, and stress levels; and improved the speed of patient treatment by taking on a first-responder role in emergencies and always being on the ward.

It found teams with PAs made nearly 25 per cent fewer patient at risk calls than teams without PAs, that the PAs freed up junior doctors’ workloads, and patients reported positively on the approachable and helpful bedside manner of the PAs.

The report concluded that, based on the trial results, overseas finding, and international experience, it would “appear that there is no need to further test the role as useful, safe, and appropriate for New Zealand”.

The exception was skeptical “nursing and medical stakeholder groups”, whose concerns included that PAs were an expensive “band-aid” option and that other options, including nurse practitioners, had not been adequately considered.

“Accordingly, the decision whether or not to conduct further trials appears to be more about managing ‘small p’ politics and demarcation disputes than it is about the need to conclusively test the usefulness and suitability of the role in New Zealand,” the report concludes.

The report recommended that instead of conducting more “expensive and time-consuming” trials, it could be more faster, more effective, and less costly to invest in “robust stakeholder engagement, strong leadership, and competent change management.”

The trial was completed last winter, the final report published in February, and released publicly in March, by which time HWNZ had already announced further pilots of PA roles in primary health for later in 2012.

Nurses interviewed for the report stated they could step into the PA role with similar training but they “doubted” they would receive the same level of support from the medical profession.

“We do not advise pursuing the “upskilling” of nurses to fill a ‘PA-like’ role or using nurse practitioners to fill the role,” the report recommends.

“To have the same impact on productivity, efficiency, continuity of care, patient satisfaction, and adverse outcomes, nurses would have to do a full two-year postgraduate PA course, where they would receive training in the medical model.

“The nurse practitioner role is an agreed, valuable, and different role and should be the subject of parallel but different efforts to support its uptake by nurses and its roll out, acceptance, and support in the health system.”

The full 70-page report can be downloaded at