Queensland physician assistants paid more than junior doctors

New physician assistant roles at three southeast Queensland hospitals would have them remunerated at up to $130k per annum.

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Further details of the proposal to expand physician associates (PA) at Queensland hospitals have revealed that they would be paid similarly to a principal house officer or registrar, despite just two years of training.

As reported in The Medical Republic on Wednesday, a document from the Sunshine Coast Hospital and Health Service which outlines the business case for hiring additional PAs is circulating on social media.

We originally reported the salary as being around $75,000 per annum.

That was incorrect; it’s actually between $120,000 and $130,000.

Queensland Health pays doctors a salary of $90,000 in their first post-graduate year, $98,000 in their second year and $105,000 in their third year.

It’s not until they reach principal house officer in their fourth post-graduate year that a doctor’s salary of $130,000 matches or eclipses a PA salary.

The Sunshine Coast business case, which has been sighted by TMR, proposes increasing the current PA workforce from three full-time equivalent roles (FTE) to 16.

Sunshine Coast University Hospital, where the three current roles are utilised, would be bumped up to eight FTE.

Nambour General Hospital and Gympie Hospital would get four FTEs apiece.

PAs in Queensland Health have been authorised to prescribe medicines via in-hospital imprest systems and order scans requiring ionising radiation since 2013.

The full position description includes managing “complex situations using expert decision making, undertaking a wide range of clinical investigations” and applying “professional clinical judgement and problem-solving skills, as per the PA scope of practice, in delivering clinical services with indirect and infrequent clinical practice supervision”.

According to Queensland Health’s clinical governance guidelines, PAs must work under the direction of two supervising medical practitioners and in accordance with a practice plan. This supervision can be direct, indirect or remote.

The reasoning for the expansion given by the business case is the ongoing health workforce squeeze.

“Solutions need to be sustainable, multi-disciplinary, cost effective, patient centred and focused on the future workforce requirements of Queensland Health,” it said.

“This will require embracing models that look at new and different ways of delivering healthcare and maximising the scope of all available health professionals to better serve the community.”

The proposal contended that the additional PAs would provide stability to emergency departments across the Sunshine Coast health district without affecting the existing workforce.

“Each health professional brings a different approach and depth of expertise to clinical tasks that are often very complex,” it read.

“This complements the work completed by colleagues, allows us to deliver care to a rapidly growing patient group, and releases other health professionals to focus on higher complexity tasks, not just clinical tasks but also important teaching, research and leadership duties.

“There is enough unmet clinical demand, both current and future, that this model will not impact on the existing workforce or on patient safety.”

PAs are classified as level four professional officers, rather than health practitioners or doctors, and the specific salary point within that classification level is based on the individual’s previous experience.

It’s not clear how this would be evaluated, given that there are no longer any training programs for PAs in Australia after James Cook University ceased to offer its three-year Bachelor’s course.

The only other Australian qualification to become a physician assistant was an 18-month Masters at the University of Queensland, which was nixed more than a decade ago.

All told, only around 65 PAs were ever trained in Australia, and roughly one third went on to work in formal physician assistant roles. It’s understood the majority work in the private sector.

According to the Sunshine Coast business case, of the Queensland’s 15 hospital and health service districts, only three – namely Townsville, Darling Downs and Sunshine Coast – currently employ PAs.

A serious expansion of PAs in Queensland, then, would likely rely on overseas-trained PAs.

The standard training for a physician assistant in the UK, where they tend to be called physician associates, is a two-year postgraduate qualification.

According to a series of Freedom of Information responses posted to X (formerly Twitter) by British clinician Dr Sandeep Bansal, the majority of these courses have extremely high pass rates.

I think we have our current leader when it comes to PA exam results now.

Bristol.

Check out these absolutely phenomenal results and students.

Genuine question: why are these brilliant people not doing medicine (to become a doctor) at Bristol?

94% distinctions https://t.co/a5O41cjbhk pic.twitter.com/Gf1doVU9Lo

— Dr Sandeep Bansal (@iDrSunny) July 16, 2024

Bradford University, Brunel University, Bangor University, the University of the West of England Bristol, the University of Portsmouth and the University of Worcester all reported a fail rate of less than 5% for their PA courses over the last three years.