Nursing Online – June 2008

Health care solutions: physician assistants and nurse practitioners

Addressing the skills shortage in the Australian health system requires a multidimensional strategy which includes short and long term measures. In NSW we have seen the development of the nurse practitioner role and the introduction of endorsed enrolled nurses. Another new role that is attracting growing attention in this country and which has potentially significant implications for nursing and midwifery is the physician assistant. Nurses and midwives should be aware of what is being proposed and prepare for a strong debate in defence of nurses’ and midwives’ roles.

Health workforce: a case for physician assistants?
By Dr Rhonda Jolly

Various attempts have been made to resolve the health workforce shortage problem in Australia.
Since the mid 1990s, these have included the extensive use of the services of overseas trained doctors and nurses, resulting in what has been criticised as an over reliance on the services of overseas trained doctors.

More recently, attempts have included substantial increases in student numbers for nursing, medicine and some allied health courses.
However, there are structural pressures on demand and supply that increasing student numbers and importing health workers alone are not likely to address.

As a result, like other developed nations, Australia has begun to examine the possibility of implementing new models of care and workforce practices into health planning ‘to accommodate and utilise the wider range of treatment possibilities’.

This paper considers one such model that involves the introduction of a type of medical ‘assistant’, usually referred to as a physician assistant, who can supplement the services of doctors by undertaking routine and less complex care at both primary and tertiary care levels.

Physician assistants and nurse practitioners: the United States experience
By Roderick S. Hooker

In the United States, medical care has evolved to be a role shared between doctors and non-physician clinicians — physician assistants (PAs) and nurse practitioners (NPs).

These non-physician clinicians were introduced in 1967 and provide services that overlap with the traditional roles of doctors. As of 2006, there are 110,000 clinically active PAs and NPs (comprising approximately one sixth of the US medical workforce). Approximately 11,200 new PAs and NPs graduate each year.

PAs and NPs are well distributed throughout primary care and specialty care and are more likely than physicians to practise in rural areas and where vulnerable populations exist.
The productivity of NPs and PAs, based on traditional doctor services, is comparable and the range of services approaches 90% of what primary care physicians provide. The education time is approximately half that of a medical doctor and entry into the workforce is less restrictive.

The medical care practitioner: developing a physician assistant equivalent for the United Kingdom
By Jim V. Parle, Nick M. Ross and William F. Doe

Although the existing professional roles have served health care delivery well in the past, many factors, including changing demographics and working patterns, have generated new demands for a more flexible medical workforce to enhance the delivery of frontline clinical services.

There is now preliminary evidence to suggest that the introduction of the medical care practitioner role (MCP), based on the proven North American PA model, may make a valuable contribution to clinical care in the NHS, and represents an effective strategy for increasing medical capacity without jeopardising quality.

The MCP role offers the prospect of increased flexibility and stability in the medical workforce.
Further studies are required to determine whether introducing MCPs in England will also enhance effectiveness and efficiency of service delivery.

Several fundamental issues remain to be resolved, including regulation, registration and prescribing. The realisation of this new profession for the UK now awaits the outcome of the national consultation process.