International interest in physician assistant utilization continues to grow, as evidenced by the number of trials being conducted in countries worldwide. Last fall, I had the pleasure of joining a trial being conducted by the South Australia Department of Health.
Interested in learning about the profession and how PAs might work effectively in its health care system, the South Australia Department of Health planned to recruit six PAs for 1 year. The logistics involved in relocating internationally yielded a group of four PAs, rather than six. Health care teams at three medical centers were able to experience firsthand how PAs work.
In October 2008, Amy Schafer, of Albany, New York, and I joined surgery teams at The Queen Elizabeth Hospital (TQEH) in Adelaide, South Australia, under Primary Supervisor Professor Guy Maddern. Ms. Schafer was assigned to the colorectal unit, and I was assigned to the upper GI team. Unsure of how we might fit in, a variety of clinical, surgical, administrative, and research tasks were designated to each of us. My role remained broad-based for the whole year; however, a more focused approach was eventually taken with Ms. Schafer. This resulted in consistent participation in surgical and procedural tasks, including leading a rectal bleeding clinic, and performing procedures, such as flexible sigmoidoscopy, proctoscopy, hemorrhoid banding, and biopsy. Commenting on her experience, Ms. Schafer said, “It has been quite similar to that of a surgical PA in the United States. It took some time to evolve, but I believe the integration of the role into the colorectal team was quite successful.”
The primary goals were to (1) gradually integrate PAs, creating some clinician consistency in an area with frequent education-related turnover; (2) prove a cost benefit of PA-provided health care services; (3) improve consistency, timeliness, and access to health care services in an area with a high population-to-provider ratio; and (4) assist in clinical, inpatient, and surgical tasks without disrupting the learning opportunities for physicians in training. Although both of us felt that headway was made in these areas, the final evaluations will best determine if the physician assistant role is useful within this system and if the initial goals were met.
Challenges present at the beginning of the trial, such as authorization limitations for prescriptions and some imaging studies, had persisted and created some practice inefficiencies. These were countered by the PAs working even more closely with their respective Australian clinicians. More independence came with time and demonstration of a thorough understanding of the assigned duties. This pacing was expected and necessary given the newness of the PA role and the multiple work environments.