Physician assistants
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7339.735 (Published 23 March 2002) Cite this as: BMJ 2002;324:735
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The Uk already has a post half-way between that of patient care
(nursing) and diagnosis/treatment (the doctors), namley the Nurse
Practitioner.
GPs already usually defer, for wound management, to their District
Nurse colleges. Also for (minor) obstetric queries to Midwives (I'll refer
possible premature labour to the Labour Ward's Midwife Sister, not delay
waiting for the new Obstetric SHO to anwser their bleep and prove clueless
as to the unit's protocols).
Nurse Practitioners, with their concentrated training in chronic
disease management, acute triage (what A&E does not now use nurse
triaging?) have a significant role to play in the NHS. Sure there are
arguments that GPs can't be reserved just for the "difficult" or "complex"
cases for fear of deskilling in more routine cases; but a toxic looking
(normally well) child with swollen glands and pus pouring over their
tonsils needs analgesia and a (non-allergic) antibiotic via a health-
worker, not wait 24hours to see the GP.
A good, well-trained, experienced Nurse Practitioner with motivation
and common sense (my locum experience suggests some GPs lack that latter
quality) is a joy to work with and can provide a breadth and depth of
healthcare provision that is often lacking with just doctors proving the
input.
Competing interests: No competing interests
Editor:
Dr. Gavin is absolutely right: development of a
Physician Assistant role would go a long way towards
solving workforce shortages, geographical inequities,
and rumbling discontent in the medical community.
According to the President of the General Medical
Council, “the American healthcare system … has
evolved a very solid foundation of knowledge, expertise
and experience upon which we can all draw.” The
visionaries were right thirty years ago when they tapped
a vast reservoir of wasted and unused skills and
developed the Physician Assistant role in the United
States. Acute shortages were alleviated and access to
health care for millions of poor and uninsured improved
.
We now need to do the same in this country. If
healthcare in the future is to be delivered at the least
resource intensive level consistent with quality , it
seems beyond doubt that any medical team should
include a cost-efficient generalist like a Physician
Assistant. PAs’ rigorous medical education, versatility,
and commitment to continuity of care can help
traditional practices function more fully. They are trained
to complement the extensive education of doctors and,
with collaboration as their mandate, provide a good
example of safe and co-operative practice. Their
behavioural science training facilitates good
patient-provider rapport, and PAs rate highly in terms of
productivity and patient acceptance , .
When, in 2001, the RCP strongly recommended the
creation of a new post of Health Care Practitioner, it
was envisioned that the role in this country might prove
attractive to groups currently under-represented in the
(nursing) workforce, such as men and ethnic minorities
. Physician Assistants in the United States are selected
from mature candidates with varied prior experience
and from all socioeconomic groups; they must show a
commitment to working with needy communities. The
profession provides opportunities to enter the health
care field for many talented people who might not
otherwise consider such a career.
If we are serious about retaining the NHS and solving
the current workforce crisis, we should start training
Physician Assistants in this country as soon as
possible.
Irvine D. (2001). The Changing Relationship Between
the Public and Medical Profession. The Lloyd Roberts
lecture delivered to The Royal Society of Medicine on 16
January 2001 by Sir Donald Irvine CBE.
American Association of Physician Assistants. (2001).
Issue Brief: The Physician-PA Team. Obtained from
www.AAPA.org on 4/3/02
Royal College of Physicians. (2000). Hospital Doctors
under Pressure: New Roles for the Health Care
Workforce. April. RCP: London
American Medical Association (1994) Socioeconomic
Monitoring System Survey. www.ama-assn.org
Jolly DM. (1980). Patients’ Acceptance of Physician
Assistants in Air Force Primary Medicine Clinics. Santa
Monica. RAND Corporation. Reported in the AAPA
bulletin on PAs in Practice, obtained from
www.AAPA.org on 4/3/02
Royal College of Physicians. (2000). Hospital
Doctors under Pressure. Op.Cit
Competing interests: No competing interests
Re: The Role Of Nurse Practitioners
The role of nurse practioners is valuable indeed, but it must be
remembered that one of the main reason for stress amongsts doctors is that
they are not doing simple tasks and by giving up on simpler tasks we give
up opportunities of interacting with patients on a more friendly term and
also deprive ourselves of some easier tasks that provide most valuable
opportunity to relax and be reflective in our attitudes to life and work.
Ask a Concorde Pilot the value of driving around town in a mini!
Competing interests: No competing interests