Extending rural and remote medicine with a new type of health worker: Physician assistants

Abstract

The purpose of this paper was to demonstrate that the medical workforce shortage is an international phenomenon and to review one of the strategies developed in the USA in the late 1960s: the physician assistant model of health service provision. The authors consider whether this model could provide one strategy to help address the medical workforce shortage in Australia. A systematic review of the literature about medical workforce shortages, strategies used to address the medical workforce shortage, and the physician assistant role was undertaken. Literature used for the review covered the period 1967-2006. Physician assistants provide safe, high-quality and cost-effective primary care services under the direction of a doctor and respond to workforce shortages in rural and remote areas, family practice medicine and hospital settings. This model of health care provision has been adopted in several other developed countries, including England, Scotland, the Netherlands and Canada. The physician assistant concept might provide Australia with a novel strategy for addressing its medical workforce shortage, particularly in rural and remote settings.

Addressing the barriers to accessing therapy services in rural and remote areas

“…This approach provides a local solution, and also builds local capacity [29,30]. Assistants are used extensively in CBR and health services but less so in disability services [31][32][33]. Nonetheless, therapy assistants are an emerging workforce group in disability services who are extending the reach of therapists, particularly in remote locations.…”

Determinants of the physician assistant/associate concept in global health systems

“…[18,19] Following the pilot projects the University of Queensland inaugurated a PA program. [20] That program graduated two classes (2012 and 2013) and then closed due to opposition by the medical community. In 2014 James Cook University (Northern Queensland) started a PA program with a class of 4 students.…”

The association of medical student debt on choice of primary care specialty and rural practice location.

“…213 They perform a variety of medical services usually in collaboration with or under a physician's direction, including physical examinations, diagnosing and treating sicknesses, ordering and interpreting tests, aiding in surgery, writing prescriptions, and delivering patient education, health promotion and preventive healthcare. 213,214 Like NPs, PAs' emergence sprung in the late 1960s to fill physician shortages, specialty maldistributions as physicians shifted to specialty practices 186 , and geographical maldistributions. 215 After the Korean War, the PA profession took returning…”

“…First, PAs are flexible and adaptable. 186,213 All PAs get training in primary care and other specialties, so even though they may practice in one specialty, they can easily transition to another. 186,213 Almost half have reported practicing in primary care during their careers and report working in two or three specialties over their work lives.…”

“…186,213 All PAs get training in primary care and other specialties, so even though they may practice in one specialty, they can easily transition to another. 186,213 Almost half have reported practicing in primary care during their careers and report working in two or three specialties over their work lives. 186 Further, PAs train in a broad range of clinical settings; 213 PAs' educational programs are brief and on average take two years, with one year of training being in a clinical setting.…”