Task substitution threatens patient safety and student training AMSA responds to UQ plans to introduce physicians assistant course Doctors occupy a unique and important role in the Australian healthcare system, however this role is coming under increasing threat by the prospect of task substitution. Task substitution is the adoption by other health care workers of roles traditionally fullfilled by doctors, for example prescribing. There has always been a limited role for task delegation in Australian healthcare, for example the use of Nurse Practitioners in remote areas, however a new two year undergraduate Physicians Assistant course being planned by UQ could see the introduction of a new hybrid medical practitioner. Such a role not only threatens the quality of patient care but also jeopardises clinical training places for medical students which are already in short supply in Queensland.

Both AMSA and the AMA oppose the introduction of Physicians Assistants. This month AMSA released it's Physicians Assistant Policy which was authored by 2007 UQMS president Michael Bonning.

AMSA is focussed on improving patient outcomes through quality medical education and clinical experience. AMSA believes that Physician Assistants (PA) are an inappropriate measure to address current workforce shortages in the Australian healthcare system. AMSA believes that their training will undermine and diminish the available resources for medical students and junior doctors. Reducing training opportunities may have a negative impact on the level of clinical experience for Australia’s future medical workforce and hence compromise patient safety. For their impact on student teaching, patient safety and the community, AMSA opposes the training and employment of Physician Assistants in Australia in the current climate where clinical training places are insufficient.

AMSA believes that:

1. the education of PA will reduce the access of medical students and junior doctors to patients and clinicians, to the detriment of their medical education and therefore future patient care.

2. the training and employment of PA does not represent a long-term solution to medical workforce shortages.

3. there are more appropriate ways to support the Australian healthcare system than PA. For example the resources for the training of PA would be better invested in medical education and greater administrative support.

4. the breadth of knowledge required to appropriately diagnose and manage a patient is deeply rooted in medical education and before PA take on such roles their impact on patient safety must be rigorously investigated.

5. the State and Federal governments, along with universities, need to invest in medical education rather than new models of health-care professional programs in light of increasing medical student numbers.

6. AMSA with the AMA should lobby for a moratorium from governments on the employment of Physician Assistants in Australia, until there is clear clinical evidence of effectiveness.

Currently it is not known whether Qld Health or any other health services in Australia will employ Physicians Assistants who graduate from the proposed UQ course.

In an update (23/12/07) to what is occurring with the Physician Assistant program:

•  Professor Peter Brooks has been appointed interim director of the newly created Australia Health Workforce Institute (AHWI). The explicit aims of this group are to "expand the health workforce by creating new models of care, involving nurse practitioners, physician assistants, carers and other doctor extenders."
• Queensland Health is currently preparing to undertake a trial of Physician's Assistants at a number of sites around Queensland. The team charged with evaluating the effectiveness and applicability of this model of care to the Australian market will include UQMS Past President Michael Bonning.
  
• The University of Queensland Physician Assistant Program is now slated to commence in 2009 but will depend on a number of factors associated with the trial of Physician's Assistants.
• Although it has been quoted differently elsewhere, the AMA is strongly committed to ensuring the training of their junior colleagues and are currently producing a position statement to guide the advocacy of the profession.
  
• A PA pilot is also slated to occur in South Australia.