Frequently Asked Questions about Physician Assistants

What is a Physician Assistant?

Physician Assistants (PAs) are highly skilled members of the health team who have undertaken intensive post graduate medical training.

Experience overseas shows those who have taken up PA training already have a few years of working experience in healthcare within a variety of backgrounds, including nursing, paramedic and allied health.

The role was first developed in the United States in the 1960s to address health workforce shortages and has since been established in several other countries including the United Kingdom and Canada.

The role has flexibility to work across settings and the scope of practice gets defined by the needs of that setting. The PA is under constant clinical supervision in an apprenticeship model throughout their career and has a focus on teamwork.

The American Academy of Physician Assistants (AAPA) definition of the profession is "Physician assistants are health professionals licensed or, in the case of those employed by the federal government, credentialed, to practice medicine with physician supervision. Physician assistants are qualified by graduation from an accredited physician assistant educational program and/or certification by the National Commission on Certification of Physician Assistants (NCCPA). Within the physician/PA relationship, physician assistants exert autonomy in medical decision-making and provide a broad range of diagnostic and therapeutic services. The clinical role of physician assistants includes primary and specialty care in medical and surgical practice settings in rural and urban areas. Physician assistant practice is centred on patient care, and may include educational, research, and administrative activities" [1].

What kind of training do they have?

PAs are trained in a medical model that complements doctor and nurse training. In other countries PAs undertake two years of intensive post graduate clinical training in the medical model, developing a broad range of competencies.

The first year’s study is theoretical learning, while the second year is on placement in clinical rotations. It is a competence-based curriculum specifically focussing on clinical and communications skills to create high performance within a team environment.

Following this generic medical training, PA roles are then developed and shaped to suit individual specialties. The PAs learn a certain skill set appropriate for particular settings, for example in emergency medicine, primary care practice, general surgery, orthopaedics, geriatrics and so on.

What kind of tasks might a PA do?

There is great variety in what a Physician Assistant may do including:

• Completing patient histories and physical examinations
• Ordering and interpreting the laboratory and radiological tests for which they have been trained
• Screening, triaging, diagnosing and treating the illnesses and injuries for which they have received specific clinical training and authorisation
• Developing and implementing a treatment plan as approved by their supervising doctor and coordinating care across multiple specialities
• Educating and advising patients and their family
• Taking part in hospital rounds, if working in this setting, writing patient orders and notes
• Managing the discharge of patients from hospital

Many of these general skills are transferrable across both primary and secondary/tertiary care settings, with additional specific skills developed during their supervised work in a particular setting.

What’s the difference between a Physician Assistant and other professions?

The PA role is a bit different from and complementary to existing roles and other professional groups such as Nurse Practitioners, who are able to work more independently.  The key difference between PAs and other professions is that PAs are trained in the medical model and work under the constant supervision of a doctor.

Secondly, the scope of practice of a PA is tailor-made by the supervising physician according to the needs of the team and the skills of the PA. The PAs are registered to practise under the supervision of a particular doctor, but that does not exclude them working with other doctors in complex teams.

Overseas experience has shown that PAs have a unique role, which allows the team to provide more holistic healthcare delivery, directly benefiting the patient. The role has the ability to work across traditional vocational boundaries – with PAs often quoted as ‘the glue’ that holds the team together.

What benefits might they bring?

Performance of the PA role in healthcare settings in other countries has been continually evaluated since the role was first introduced. 

Consistently, PAs have been found to be a valuable member of the healthcare team. Substantial empirical and health service research evidence has shown they improve productivity and are cost effective in clinical practice in almost all of the settings studied.

The role has specific value in team environments where the flexibility to perform a variety of tasks to complement medical and nursing teams (including nurse practitioners) becomes an asset. For example:

• PAs can take on a wide range of clinical and communication tasks within a team, freeing up time and resources for other members deliver on their core skills
• PAs can reduce stress levels within teams by bridging communication gaps and facilitating timely decision making
• PAs have been found to enhance quality of care and safety for patients across settings, by not only having time to enhance patient communication, but also providing continuity of care in face of high turnover of locums and trainee positions
• PAs can enhance teaching and learning opportunities for junior doctors by sharing tasks and freeing up their time in busy teaching hospital environments. Senior PAs have been valuable resource for induction of new trainees.

From a wider health workforce perspective, an additional role adds to the development of a flexible, fit for purpose team configuration – particularly useful in a multi-disciplinary, integrated health delivery environment.

The role could also improve recruitment and retention, by providing a new career pathway to encourage more people to take up a health profession, provide a new avenue for those already in the sector looking for new challenges or career opportunities, or who are looking to return to the workforce after a period away. Adding another skilled medical staff member to the team, who provides the opportunity for doctors to practice at the top of their scope and share their workload, has the potential to improve doctor retention and satisfaction levels.

How do they fit into the New Zealand health service?

New Zealand’s health services are increasingly dynamic environments with multi-disciplinary teams now essential to the delivery of care. This approach brings together a range of professionals so the patient can receive their care in an integrated fashion.

The generalist medical training, followed by the ability to develop more specific skills aligned to a particular specialty, means PAs can fit into a range of environments to complement existing roles and enable a full range of services to be provided to patients in one place. The PA role provides a great degree of flexibility to clinical teams, especially in hard to recruit settings.

To see how PAs might fit into the New Zealand health sector, a demonstration has already been held at Counties Manukau DHB and another demonstration, also with US-trained PAs, is about to begin across several sites including primary care and emergency care in rural hospital. These demonstrations will further help to answer questions related to their appropriateness in the New Zealand health environment.

What’s the aim of the demonstrations?

It is hoped these demonstrations will highlight how the role could be adapted to a range of settings and complement the existing multi-disciplinary workforce.

Reports from the evaluation of the demonstrations, along with international evidence, and full consultation with the sector and international experts, will inform the next steps in New Zealand. Consideration will also be given to possibilities for education and training of PAs, and regulating the profession in New Zealand.

Click here for more information about the next demonstration of the Physician Assistant role