Doctor aides raise worries over care, says institute

Photo / Herald on Sunday

An influential medical group has expressed concerns about patients' safety in a trial of employing "physician assistants" to do some of the work of doctors.

Physician assistants are common in the United States, but not in New Zealand.

Two American physician assistants, who have retained their US registration, started work last month in the general surgery department at Counties Manukau District Health Board.

They are involved in a year-long pilot programme to see if the role might, as hoped, help to solve New Zealand's health workforce shortages, which are predicted to worsen.

It is also hoped that physician assistants, who perform some tasks now done by nurses and doctors, will bolster the ranks of the 800 extra health workers needed to staff the 20 new elective surgery theatres promised by the National Government.

But the College of Anaesthetists - which oversees the specialist training of anaesthetist doctors - says it is worried about health workers without medical degrees doing the work of doctors, although the health board has dismissed the concerns.

"... the chief concern was standards of patient safety and maintenance of a high quality of practice," says an article in the Australasian college's bulletin, quoting the chairwoman of its New Zealand national committee, Dr Vanessa Beavis.

Dr Beavis said: "The mantra that it is cheap and efficient is untrue but ... has been repeated so many times no one is questioning it any more."

She was also concerned that doctors might lose opportunities to learn some tasks.

But Counties Manukau's deputy chief medical officer, Wilbur Farmilo, a general surgeon and supervisor of the two female physician assistants, rejected the college's concerns.

"We've gone to a lot of trouble to develop a supervision regime. There is no circumstance where we believe patient safety will be compromised."

The training of resident doctors would be enhanced - in line with the recommendations of last year's Commission on Resident Medical Officers - because they would be freed from some routine tasks, giving them more time to learn from their assigned senior doctors.

What are they

* Physician assistants work under the supervision of a senior doctor.

* They may initiate and monitor treatment in consultation with supervisor, but are not allowed to prescribe medicines.

They can:

* Insert blood-line luers and urinary catheters.

* Order blood tests and basic x-rays.

* Change wound dressings.

* Take medical histories, do physical examination and develop a "working diagnosis".

* Record medical notes and help with discharge summary.

Training

* Postgraduate qualification in United States.

Pay

* $80,000 to $100,000 for year-long trial, but expected to be less if the role becomes established.