Media release from Health Workforce New Zealand

Six months ago Health Workforce NZ (the Clinical Training Agency Board) was formed to address the issues faced in health sector workforce development.  Its aim is to provide a single, coordinated response to improving our ability to train, recruit and retain our health workforce.  The need for this agency has become more critical as graduates of many health disciplines leave New Zealand and the health needs of our population increase.

The recently appointed board, chaired by Auckland Medical School's Professor Des Gorman, is a collection of committed health professionals with diverse backgrounds.  Some initial key areas of focus for 2010 have now been established and will be rolled out from January 2010.

"We need to deliver health services more effectively.  A commitment to significant and long-term changes to workforce planning needs to be made over the entire health sector to ensure a sustainable and equitable health system.  Innovative ways of providing healthcare services for a growing and aging population need to begin to be implemented now," said Professor Gorman.

An innovation already approved will see the first demonstration site to test potential for the introduction of the Physician Assistant role.  This will begin with Counties Manukau DHB trialling a model that works well in many other countries including the USA, Canada and Britain.  This is a joint initiative between the four northern region DHBs and the University of Auckland Faculty of Medical and Health Sciences. Physician Assistants are trained in a medical environment with a two year post-graduate programme and work under the specific direction and delegation of senior doctors. The doctor always remains responsible for the overall management of the patient.

Making greater use of mid-level practitioners like Physician Assistants is one possible strategy for meeting growing health service demands.  Overseas, Physician Assistants have contributed to better health outcomes through improved access for patients and reduced waiting times.  Professor Gorman believes that the Physician Assistant role also provides the potential to grow our health workforce and to provide new opportunities for those wishing to join the health workforce or change their practice. "We believe the trial will help to determine whether Physician Assistants can deliver these benefits to NZ," he said.  Two Physicians Assistants from the USA will begin the trial toward the middle of 2010.

Another area identified for further development is the medical Post Graduate Year 2.  This is the year when doctors are typically registered and it can also be the time where their expertise is lost either overseas or into locum positions. This means it may be difficult for them to source advice regarding professional development and receive mentoring.  From the end of January 2010 there will be increased input into Post Graduate Year 2 Doctors.  Career guidance, professional development and mentoring will be formalised to make sure these doctors are well supported and can be retained in the NZ health workforce.

"Innovation is the only way forward if we want to secure a health service for all New Zealanders into the next generation and beyond.  Our ability to plan and be open to new ways of doing things will mean better, more accessible health care now and sustainable health care into the future," according to Professor Gorman. The two initiatives outlined are just the beginning of a change which will see a health workforce which stays in New Zealand and is specifically trained to meet the needs of New Zealanders," he concluded.

Health Workforce NZ Q & As
1. What does Health Workforce NZ - the Clinical Training Agency Board  - (HWNZ) do?
Health Workforce NZ was created to address the need for a single comprehensive entity to plan for the future health workforce needs of NZ health services.  It will be looking across all health sectors to see what can be done more efficiently and explore new ways of doing things.

2. Who oversees HWNZ?
The Board of HWNZ provides advice to the Minister and Director-General of Health, and works closely with the National Health Board, the Medical Council of NZ, Medical Colleges and other professional organisations.

3. Does this mean HWNZ is about cutting costs?
HWNZ is about doing things differently and more efficiently, as a result of this it is likely that savings will be made.

4. Under what authority can HWNZ change things such as when doctors can be registered?
HWNZ will be working together with the Medical Council of NZ and the Medical Colleges  to establish what changes need to occur, when and how.

5. Is changing the stage at which doctors are registered an attempt to control choice to give DHBs in particular a cheaper, more available work force for a longer period of time?
Doctor training/apprenticeships used to involve RMOs working particularly long hours.  The restriction on the number of hours doctors can work also means that many doctors get significantly less hands-on experience than doctors used to at registration.  The change in structure and timing takes this into account while providing more value to doctors at Post Graduate Year 2.  It is important that PGY2s obtain good experience in an environment that develops them professionally.  The changes are adding value, not taking anything away.

6. Most Post Graduate Year 2s will have student loans.  This is changing the rules without any consultation and affecting their ability to earn a higher hourly rate on the spot market to get ahead.  Isn't that tantamount to restriction of trade?
It is understandable that paying off a student loan would be a priority but we would like to recognise that every PGY2 deserves to have access to all the opportunities that these changes will provide. A stronger more supportive apprenticeship experience, with associated career guidance, professional development and mentoring will enhance their long-term marketability.  The intention is to phase in any changes to registration. Conversations with RMOs, their senior colleagues and professional organizations and other interested groups will be part of this process.

Physician Assistant Demonstration Site Q& A

1. What is a Physician Assistant?
A Physician Assistant (trained in the USA medical model) is an individual who works within a scope of practice delegated to them by their supervising vocationally registered medical practitioner (Senior Medical Officer (SMO) in DHB setting).  Typically a Physician Assistant will have an undergraduate qualification in health sciences and a postgraduate qualification tailored to the vocation.

2. Isn't that what Post Graduate Year 2s do?  How will that affect the way they work?
This is why it's important to have PGY2 more vocationally focused with professional development and mentoring opportunities.  A Physician Assistant works as a support to doctors while PGY2's are progressing through their training.

3. What could a Physician Assistant do?
This is dependent the Physician Assistant's experience and on the area of medicine they are practicing in, but could typically involve:
• Obtaining patient histories
• Performing physical examinations within the scope of their training
• Arranging for diagnostic and therapeutic procedures
• Developing and implementing a treatment plan, as approved by their supervising physician
• Monitoring effectiveness of therapeutic interventions
• Offering education to meet patient need
• Making appropriate referrals
• Prescribing and dispensing medications

4. What other countries have Physician Assistants?
The scope of practice was developed in the USA during the 1960s as part of an effort to address a skills shortage.  In the last five years the role has been implemented in many other countries including Canada and the United Kingdom.  Canada and the UK have successfully implemented tertiary training programmes and pilot employment programmes in a variety of clinical settings.  South Australia and Queensland are currently implementing pilot employment programmes in different clinical settings using US qualified Physician Assistants.  Queensland is also implementing a training programme through the University of Queensland.

5. What is happening in the Northern Region?
The Northern region DHB Chief Executives have agreed that a demonstration site should be undertaken in order to investigate the medical model Physician Assistant role in the region. 
As a first step, in conjunction with Health Workforce NZ, there will be a demonstration site in elective surgery at CMDHB.  It is anticipated that there will be two Physician Assistants at CMDHB for 12 months, commencing mid 2010. 
This will be a joint initiative between the HWNZ, the DHBs and the University of Auckland.

6. Why are Physician Assistants being investigated?
There are insufficient doctors and nurses in New Zealand and we will not be able to recruit sufficient numbers from overseas.  Accordingly, there is an urgent need to look at new types of health workers and new configurations of the health workforce for elective surgery.  Overseas experience suggests that Physician Assistants are one of the possible new scopes of practice that have the potential to address some of these workforce issues.  In the USA, 25% of Physician Assistants work in general surgery and surgery subspecialties.

In the medium to longer term, the DHBs are concerned that current workforce initiatives will not be enough to meet growing service demands in all areas of health.  Overseas, Physician Assistants have contributed to improved health outcomes through improved access for patients and reduced waiting times.  Physician Assistants are about growing and expanding our health workforce - they are one of a number of initiatives aimed at addressing our wider workforce issues.

7. If the demonstration site was successful, would Physician Assistants replace doctors and nurses?
It is becoming clear that current and projected health workforce shortages can not be addressed simply by training more doctors and nurses.  Overseas, Physician Assistants are seen to be operating at a mid-level and are able to fill a distinct, complementary role within the multidisciplinary health team.

8. Would Physician Assistants replace nurse practitioners?
Physician Assistants have a different training and work in a different way to nurse practitioners.  Overseas experience suggests that there is a role for both Physician Assistants and nurse practitioners in the health services and the pilot will help to answer this question for New Zealand.

9. Would Physician Assistants increase doctors' workloads?
The overseas pilots have found that Physician Assistants can actually free up a doctors' time and can reduce their workload overall.  This is something we will want to evaluate in the demonstration site.

10. As Physician Assistants are not trained doctors are there be any patient safety issues?
The Physician Assistants in the demonstration site will work under the delegation and supervision of a vocationally registered medical practitioner (SMO in DHB setting).  The supervising medical practitioner(s) will always remain responsible for the overall management of the patient, and for their decision to delegate and the level and nature of the supervision they provide.

Patient satisfaction with Physician Assistants overseas has been high.  A number of studies have shown that the quality of care given by Physician Assistants is at the level of that given by doctors in comparable situations.  Also, it is worth noting that Physician Assistants have been operating in the USA since the 1960s and there are over 68,000 in practice.

11. Will the Physician Assistants be regulated?
Preliminary advice suggests that the Physician Assistants in the demonstration site will not need to be registered in NZ.  We will be investigating this further as part of the planning process.  The Physician Assistants will be required to hold current certification from their national certification body in the USA (the National Commission on Certification of Physician Assistants) and they will work under the delegated authority of a NZ registered medical practitioner.  This is also the situation in the current Australian pilots.

12. Would Physician Assistants actually increase the health workforce or will existing health professionals train as Physician Assistants?

Overseas Physician Assistants are recruited from both existing health professional groups and from groups who have not traditionally considered a health care career.  The UK experience of recruiting Physician Assistants with a biomedical degree suggests that Physician Assistant roles could be very attractive to New Zealand domestic students, who obtain undergraduate degrees in the biomedical and health sciences and also to those students, who after successfully completing undergraduate year one are not accepted for medicine as these students do not typically choose nursing or another health care career as an alternative.  There is also some evidence to indicate that the opportunity for health professionals to transition into other opportunities within the same field may increase retention rates within the health workforce.

13. Is there a training programme for Physician Assistants in New Zealand?

Currently there is no training programme for Physician Assistants in New Zealand.  Several institutions have expressed an interest in providing such a programme as long as employers can commit to employing graduates.  Tertiary education providers would have to develop their own business case for implementing such a programme and successfully put this case to the Tertiary Education Commission to secure funding.