Opposition To Physician Associate Regulation Ill-informed Patch Protection

Opposition to Physician Associate (PAs) regulation is patch protection that threatens a genuine solution to health inequities in hard-to-staff and remote areas, the New Zealand Physician Associate Society (NZPAS) and a rural health leader say.

Late last week, the unions for doctors, nurses, and practice owners called for the Government to delay the path of regulation of PAs - expected to be voted on by Cabinet in December.

There are about 50 PAs spread across 27 clinics throughout New Zealand, who work in the same scope of care as their supervising doctors.

NZPAS President Shelly Collins said by resisting the integration of PAs, these groups effectively limited options that could improve healthcare access, reduce wait times, and deliver equitable care to all New Zealanders.

“We urge the government to look beyond the vested interests of these professional bodies and consider the evidence and international success of PAs as a valuable part of a comprehensive healthcare solution.”

Government agencies are responsible for developing and enforcing regulations that ensure safety, quality and effectiveness of healthcare services. Regulation of PAs aligns with the country's existing rules for regulating professions that provide medical services.

It was essential that policy decisions prioritised patient access and system improvement, ensuring that all healthcare professionals, including PAs, can work effectively to meet the needs of New Zealanders, she said.

Collins said it was important to address both the inaccuracies presented and the potential underlying concerns these groups may have about shifting roles within the healthcare sector.

PAs provided critical support to doctors, helped reduce patient wait times and increased access to healthcare in under-served areas, she said.

Integrating PAs with appropriate regulatory oversight would ensure they continued to complement, rather than compete with, existing healthcare professionals, promoting equity rather than hindering it. Regulation would immediately reduce the burden of oversight and supervision that accompanies an unregulated workforce.

“Integrating internationally trained PAs while long-term investments in local training are implemented will help ensure New Zealand’s healthcare system remains functional and effective in the short term while building capacity for the future.”

The claim by these unions that PAs were “less experienced” and “less qualified” and would compromise patient safety ignored the reality of the rigorous PA training and certification process.

The suggestion that PAs should retrain as other healthcare professionals suggested a motive to limit competition and maintain the monopoly of certain professional groups, Collins said.

“It is critical to view these objections for what they are: efforts to maintain existing professional monopolies rather than a genuine attempt to address the healthcare crisis facing New Zealand.”

Collins also referenced the results of the 2015 Evaluation Report of the PA demonstration sites in New Zealand from a 2010-15 pilot where more than 90% of doctors and nurses surveyed said they were satisfied with the roles PAs were performing. During the successful pilot there were no adverse patient outcomes across 30,000 patient visits. It alerted the workforce that there was a reputable profession that was “fit for service" and qualified to offer an addition to the team.

NZPAS will support the cost of regulation and believed it was money well spent to offer safety, full scope, and an additional option for training New Zealanders that are passionate about working in healthcare, Collins said.

Gore Health CEO Karl Metzler said the unions’ stance was nothing more than patch protective nonsense.

“You can’t go out crying into your hanky about the workforce crisis and then thumb your nose at a solution.”

Gore Health has employed PAs since 2012 and they would not have been able to maintain the 24/7 Emergency Department without them, he said.

Their presence had also reduced the load on doctors, consequently reducing burnout and retention issues, Metzler said.

“Physician associates have been of enormous value to the health and wellbeing of the Gore community and have brought immeasurable benefits with them.”

He added that he had never received a complaint about a PA relating to treatment or behaviour.

The criticism was ill-informed and Metzler said he fully supported Health Minister Dr Shane Reti and the Ministry of Health – Manatū Hauora’s intention to regulate the profession.

Metzler said he would love to see a PA training programme up and running in New Zealand within three to five years.

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