Queensland Health extends deadline for physician assistant feedback

Health Minister Shannon Fentiman will determine whether there is an ongoing role for physician assistants in the state.

---

Queensland doctor groups have one more week to submit feedback on the role of physician assistants following outrage over a proposal to expand the role at Sunshine Coast hospitals.  

The saga has been unfolding since mid-July, when snippets of a business case surfaced on social media and revealed a push to increase the PA workforce across Sunshine Coast University Hospital, Nambour General Hospital and Gympie hospital from three full-time equivalent roles to 16. 

For those playing along at home: the proposal is still live, albeit delayed, and this consultation will be make or break for PAs in the Sunshine State.  

To say it was controversial is an understatement; a petition started by the Australian Salaried Medical Officers’ Federation received more than 1000 signatures in a matter of days.  

Within a week, state health minister Shannon Fentiman told media that Queensland Health had no current plans to recruit PAs.  

That’s not the same as the proposal being scrapped, a point which Ms Fentiman had to correct the next day.  

“Local consultation was paused so that a statewide consultation process could take place in partnership with stakeholders like ASMOFQ, AMA, RACGP,” she told The Courier Mail in July. 

“Once this has concluded, we will take the advice of stakeholders including clinicians and nurses, to determine if there is a role for physician assistants in the future health system.” 

PAs are not AHPRA-registered health professionals, nor are there any existing educational pathways to becoming a PA in Australia. 

Queensland Health’s statement of core duties for PAs includes statements like:  

• “Under supervision, manage complex situations using, undertaking a wide range of clinical investigations and coordinating and managing patient care.” 

• “Provide general and clinical advice to a diverse range of patients, their families and communities.” 

• “Actively contribute to planning caseload management and delivery and evaluation of a diverse range of general and/or specialist clinical services.”  

• “Effectively plan, manage, coordinate and evaluate patient care activities under the guidance of senior clinical practitioners.”  

There is no publicly available equivalent statement of core duties for Queensland’s junior doctors. 

What is available, though, is the role description for resident medical officer positions (i.e. postgraduate years 1-3) within Queensland Health.  

The key accountabilities include:  

• “Interview and examine patients to identify clinical problems.” 

• “Select appropriate investigations.”  

• “Assemble clinical information and the results of investigations.” 

• “Plan overall clinical care through a comprehensive management plan.” 

• “Utilise clinical practice guidelines and evidence-based care principles.” 

When the Australian training pathway for PAs did exist, there was the option to do either a three-year undergraduate course at James Cook University or an 18-month Masters at the University of Queensland.  

About 65 PAs were trained in Australia before the last course was discontinued around 2018. 

Training in other countries is not much more extensive. 

In the UK, where PA roles have been rapidly expanded in recent years, training tends to consist of a two-year postgraduate course.  

The main argument presented in the business case for expanding PAs on the Sunshine Coast was that Queensland Health is in the middle of a workforce shortage and PAs were able to fill certain gaps.  

It’s worth noting, then, that the extensive Physician Assistant Clinical Governance Guidelines state that “the principal supervising medical practitioner retains … accountability for the overall management and clinical outcomes of the patient”, even though the “PA is responsible and accountable for making a professional judgement about when an activity is beyond their capability”. 

The PA’s principal supervisor also has to review at least 10% of PA-treated patient charts. 

Despite the fact that PAs spend around one third of the length of time training as a first-year intern doctor, Queensland Health classifies PAs as Professional Officer Level 4 employees, meaning they draw a salary of between $120,000 and $130,000. 

Meanwhile, junior doctors earn $90,000 in their first post-graduate year, $98,000 in their second year and $105,000 in their third year.  

Queensland Health will be taking submissions from selected stakeholders until Friday 6 September.  

Responses will be collated and sent to Ms Fentiman, who will make the final call.