As physician assistants become increasingly visible and important to health care systems worldwide, more countries are showing interest in learning about the PA role and how the profession might effectively work for them. Australia is no exception. As such, the Department of Health, South Australia, is in the midst of contracting six physician assistants to spend a year showing them what PAs do as medical providers and how the role can be integrated smoothly into busy health care teams.

I am fortunate to be one of the PAs who was invited to join the pilot project and am teamed with Amy Schafer, PA-C, of Albany, New York. We are representing surgery and began work in the fall of 2008 at The Queen Elizabeth Hospital in Adelaide, South Australia, under the leadership and support of Mr. Guy Maddern, Professor of Surgery (equivalent to a chief of surgery in the United States). At this writing, the other teams have not begun their portions of the study.

As the first PAs contracted to work clinically on Australian soil, we face a great challenge. We are learning that knowledge does not equal know-how when it comes to a system where even simple words have meanings different from what we are accustomed to. For example, the terms physician and doctor are not interchangeable in Australia. In this system, doctors are considered physicians only when they complete an additional 8 years or more of training beyond their university medical training and specialize in a selected area of medicine. You can imagine how complicated it then becomes to add providers called physician assistants into that mix!

What's more, surgeons who have completed their training cease to be addressed as Doctor and revert to the title of Mister or Miss. This practice is rooted in the barber-surgeon tradition when, centuries ago, barbers were a highly skilled and respected profession often performing surgical procedures, in combination with haircuts. Not until the year 1416 was an ordinance placed to create some restriction on a barber's practice of surgery and dentistry.1 Although barbers and surgeons were at one time united under various guilds, separation of the crafts developed over many years and the term Mister was specifically used for surgeons who had been university trained—not to be confused with barber-surgeons, who had not. And so, the title Mister for surgeons has been deemed prestigious for centuries and is still used in parts of Australia today.

As you can imagine, quickly becoming familiar with such basic but critical differences is key for physician assistants working in Australia, as their health care system holds many more dissimilarities that require a greater focus. For example, they have a national health care system called Medicare, which insures all citizens of Australia!

Primary goals for the surgery team during the year are as follows: 1) gradually integrate the PA role into a very busy teaching unit, creating some consistency in the midst of frequent education-related turnover; 2) prove a cost benefit for health care services provided with PA support; 3) improve consistent and timely access to health care services despite an imbalance in population growth versus available providers; and 4) assist in clinical, inpatient, and surgical tasks without disrupting learning opportunities for physicians in training.

One of the most difficult aspects of the pilot in these early days is working within a system that is not structured to support several of the provider privileges that would help PAs prove our effectiveness. For example, we have just been granted prescriptive authority, after weeks of deliberation, but we cannot prescribe all of the medications that we can prescribe in the United States—and some of the missing drugs are important ones. Despite the inconvenience this may cause early on, making thoughtful decisions regarding this and other similar dilemmas is for the greater good of the study and increases its potential for long-term success.

Conducting international trials of PA utilization is not a new concept. Studies have previously taken place in the United Kingdom, Canada, and Scotland, where a 2-year trial of PA use recently concluded. Several more international projects are in the works for PAs as word gets out about the value they can provide.

As for this project, it is already proving to be an amazing professional and life adventure—one that I am grateful to be sharing. Although the next year is sure to be filled with uncertainty and hard work, I look forward keenly to the experiences that lie ahead! JAAPA

Dawanda Pesicka works in surgery at The Queen Elizabeth Hospital in Adelaide, South Australia. 

REFERENCE
1. The art of barbering and the history of the barber pole. Barbering through the ages. http://www.barberpole.com/artof.htm. Accessed January 20, 2008.