Physician Assistant case study
A demonstration site for the role of physician assistant (PA) has been established by Health Workforce New Zealand in collaboration with the Northern Region DHBs (Northland, Waitemata, Auckland and Counties Manukau) and partnered by The University of Auckland’s Faculty of Medical and Health Sciences.
PAs are healthcare professionals trained in a clinical role that complements both nursing and medicine, and work under the supervision of a senior doctor. PAs are an established part of the US health system working in hospitals, clinics and other health facilities, and performing tasks such as taking patient histories, undertaking physical exams, diagnosing and treating illnesses, ordering and interpreting tests, and assisting in surgery.
The foundation training to be a PA generally involves medical school for three or four years, with one of those years being clinical.
Kristan Wheeler is one of the two US-trained PAs taking part in the demonstration, which began in September 2010. She says it is helping to establish a better understanding of the value of her role.
Kristan began her working life as a high school maths teacher but had always wanted to work in health. After having her children, she began working as a midwifery assistant then child birth educator and nursing mother’s counsellor. From there, she went on to train as a PA.
As a PA, Kristan worked for eight years in a rural health clinic. ‘This involved setting up a school-based clinic providing free health care, immunisation and education as well as rest home visits and delivering health care to a developmentally delayed boys’ home. I also had an internal medicine outpatients practice, where I managed my own patients.’
Kristan also worked at a large teaching hospital, supporting the training scheme in general surgery. ‘ In the USA I would assist in general surgery in theatre…I taught laparoscopic techniques to junior doctors and was considered a floating resource, someone able to fill the gaps as necessary’.
In New Zealand Kristan works with the surgical team at Middlemore hospital, taking care of patients on a ward, in a role that supports the house surgeon (resident medical officer). ‘I can evaluate patients, prepare them for discharge, take blood…. Basically I free up house surgeons so they have the freedom to do more of what interests them’.
A usual working day for Kristan starts with a run to the train station and a 6.30 am start at work. Rounds start at 7.00 am and she doesn’t usually leave until at least 5.00 pm, sometimes 7.00 pm. ‘It’s a long day but there are no weekends and no nights.’
One of the things Kristan enjoys most about her job here is working with the patients. ‘It’s very multicultural here at Middlemore, and everyone seems very grateful for the care they’re receiving.’ She says there is some lack of understanding of this new role. ‘It would be good to have a worldwide acceptance of the role. The lack of understanding does at times mean I can’t use all of my skills. Initially, there was some reluctance here in allowing me to do my job properly but I find now the house surgeons seem to be very happy to accept my help. We have an ongoing dialogue on how I can support them better.’
There is interest from other DHBs across New Zealand in developing the PA role. Following evaluation of the Middlemore demonstration, a decision will be made about roll-out of the project and whether a PA training programme should be developed in New Zealand.
On the PA role Kristan says, ‘You need a commitment to hard work, as well as needing to be a team player, to genuinely enjoy people and to be committed to excellent patient care and ongoing learning.’
