19 December 2006

A new breed of health professionals known as physician assistants could help answer predicted deepening health workforce shortages.

This was a key conclusion of the recent Mount Isa Medical Delegation Conference, a gathering of experts from Australian and overseas organisations including The University of Queensland and James Cook University.

Delegates agreed that Australia needs physician assistants, who would work under doctors’ supervision – as they do in other developed nations.

“Australia is training more doctors and nurses to meet the rising demand for health services, which is essential, but it is unlikely to be enough,” said Professor Peter Brooks, Executive Dean of UQ’s Faculty of Health Sciences and one of the conference organisers.

“There is significant potential to improve access to health services by better using the potential of all members of the health care team and by creating new types of assistant health workers,” said Associate Professor Dennis Pashen, Director, James Cook University Mount Isa Centre for Rural and Remote Health.

“Physician assistants now form part of healthcare teams in countries including the USA, Canada, England, Scotland, the Netherlands and Taiwan,” said international expert Professor Rod Hooker of the University of Texas.

The World Health Organisation has estimated that there is a global shortage of 4.3 million doctors, nurses and midwives.

In rural and remote Australia, one in five doctors is aged 55 years or older, and these regions continue to struggle to attract doctors and nurses.

Australia does not have physician assistants but does have a long tradition of delegation of clinical tasks in medical practice to other members of the health care team.

“Overseas research has shown that delegated medical care is delivered with the same or better quality and patient safety, effectiveness and patient acceptability,” said Professor Brooks.

“However we need to do action research to develop flexible, local medical delegation models for Australia and demonstrate they are safe and effective.”

“A consistent approach nationally to developing competencies for clinical associates, such as physician assistants, is needed quite urgently,” said Dr Pashen.

Actions recommended by the conference included:

• Better evaluation of medical delegation already occurring
• Action research to determine the best models for Australia and to demonstrate that these deliver the same or better quality, safety and acceptability
• Changes to poisons regulations to allow a range of healthcare workers to obtain, possess and administer medicines when acting under the local delegated authority of a medical practitioner
• Increasing access to payments by the Medical Benefits Schedule for primary care services to a broader range of health professionals.

The Mount Isa Medical Delegation Conference attracted 40 Australian and international delegates, including Indigenous health workers, military medical assistants, ambulance paramedics, university experts and representatives of professional colleges.

It took place in the outback Queensland mining city of Mount Isa on December 13-14.

An official statement from the conference follows.

For further information:

Associate Professor Dennis Pashen: 0418 771 441

Professor Peter Brooks: work (07) 3365 5103 / 0411 408 581; or Fiona Kennedy (UQ communications) (07) 3365 1088 / 0413 380 012

Professor Roderick S. Hooker (Dallas, Texas): 0011 1-972/355 9616


Mount Isa Medical Delegation Conference

Australia has both an opportunity to innovate and a responsibility to continuously improve health service delivery. Roles and relationships of health professionals within teams should reflect the health care needs of all Australians for quality health care. There are a number of challenges, including: poor health outcomes in rural and remote areas and in Indigenous Australian communities, an ageing population and rising levels of chronic disease.

The health system should optimally utilise existing health professional groups and explore new classes of health professional to best meet the long-term needs of the community.

There is a long tradition of flexible delegation of clinical tasks in medical practice to other members of the health care team according to individual demonstrated competence. Contrary to common views, there are few legal barriers to clinical care being provided by other members of the health care team. Use of medicines is the main area of practice restricted by law.

Current payment systems in health care contain perverse incentives which are a barrier to optimal teamwork, especially in primary care.

Health care innovation should be driven by community needs and responsive to local requirements, based on the best available evidence and subject to critical evaluation. There is a growing and active community interest in improving access to quality, sustainable health care services.

All members of the healthcare team have a responsibility for the quality and safety of the care that they provide. Patient safety is a fundamental principle underpinning health professional practice and systems of health care.

Any education program that aims to prepare practitioners for delegated practice should be based on a generalist model with flexible entry, recognition of prior learning, be regionally accessible and have a common competency framework. The aim should be to expand participation in the health workforce.

What is required:

• Action research is needed to develop an evidence base for sustainable team-based care with medical delegation of clinical tasks using outcome measures of quality, efficiency, safety, effectiveness, accessibility and consumer satisfaction.

• Changes to Poisons regulations are required to enable various healthcare workers to obtain, possess and administer restricted medicines when acting under the delegated authority of a medical practitioner.

• The Commonwealth government should consider broadening the range of health workers able to access delegated ‘practice nurse’ Medicare item numbers and expand the range of items.

• A formative and summative evaluation framework is required for current and planned models of delegated practice including the Queensland Ambulance Service, defence health service, Aboriginal Health Workers and various assistants to specialists in the private and public sectors.

• A series of future meetings and workshops to further develop policy on delegated medical practice will be held.