The 12-month pilot of using US-trained physician assistants has ended with both PAs intending to return to the US, but more could follow them in a wider pilot.
Brenda Wraight, director of Health Workforce New Zealand, said the pilot at Counties Manukau District Health Board had been very successful and they were considering rolling out the demonstration in four other sites.
The full evaluation of the pilot, which ended in mid-September, was due out in October, but Wraight said HWNZ needed to trial PAs in other roles in areas like emergency departments and primary care.
Wilbur Farmilo, acting chief medical officer of Counties Manukau DHB, said the physician assistants had been almost universally accepted by staff across the hospital. The two US-trained PAs had been working as part of the surgical team providing ward management care at Middlemore Hospital. “They’ve been working in a supportive role to junior doctors and junior doctors have found them extremely successful,” Farmilo said.
The contracts of the two PAs ended in September and Farmilo said both intended to return to the US mainly to upskill and keep their US registration open. “There is no New Zealand registration (body) and for legislative reasons they have not been able to work to their full scope of practice like they could in the US,” said Farmilo. “So they want to go back to the US to ensure their registration remains current over there.” (The PAs have been unable to prescribe in New Zealand.)
He said they had had enquiries from other PAs interested in working at Middlemore, but until there was a registration body it was unlikely people would be willing to stay for more than a year.
An initial evaluation of the first three months of the pilot said physicians, nurses and allied health staff spoken to had all fully accepted the two PAs and valued their work. “They had far exceeded hopes and expectations,” the report said. It also noted that the PAs had been working “exceedingly long hours” of typically 11 to 12 hours, which they had been willing to do as a pilot, but this could not be expected in a permanent role.
Farmilo said there had been interest from other areas of the hospital about PA roles and the DHB was in the process of considering further developing the PA role or other possible extended practice roles. “Clearly there is a gap in our workforce for this sort of work.”
Wraight said early on they had interest from another group of DHBs keen to look at the role and the next phase would be to discuss which boards were ready to fund a demonstration site. She said the role needed to be tested in a range of settings and a robust model set up with employer ‘buy-in’ before considering setting up a New Zealand physician assistant education programme. “The Australian experience was that the education (providers) got ahead of the readiness of employers to employ graduates of the programme.”
