By Dr. Reginald Broekmann
In the USA, the function of the Physician’s Assistant has been part of the health system for several decades. This member of the health team is a highly trained individual who has completed a degree course and has been intensively trained to work under the direct supervision of a doctor – usually a specialist – who is fully responsible for the actions of the Physician’s Assistant.
In the early 1980s I visited Jacksonville, Florida, USA, where I met up with a Physician’s Assistant (PA) and was able to discuss his role within the health system. The PA was fully qualified (a three-year university degree) and was employed by a cardiologist. The role of the PA was to visit the patients under the care of his employer – who were exclusively patients who had been admitted to the Cardiac Intensive Care Unit of the local hospital. The PA would regularly examine these patients and communicate with the cardiologist. The PA was entitled to prescribe medicines for the patients and give instructions to the ICU nursing staff.
South Africa does not intend to have the Clinical Assistant programme as a post-graduate course, but candidates will be trained for three years, will have to pass an examination set by the Board of Medical Examiners and will do an ‘internship’. He/she will function under an appointed supervising doctor.
The Minister has stated “Medical assistants will be placed in district hospitals and will be part of a team in different units such as emergency, maternity, out-patient or surgical (services). In operating theatres, for instance, the assistants will work with doctors on basic procedures like incisions, drainage and evacuations.”
Given the shortage of doctors in South Africa, one can see the logic of the process. However, there are potentially negative outcomes as well.
On the positive side, hospital doctors would be able to decant some of their time-consuming tasks to the Clinical Assistant, tasks such as taking blood for laboratory testing, writing up case notes, arranging transfers and the like. This will relieve some of the stresses of clinicians, especially in rural areas.
On the negative side, however, the provision of ‘relief’ to embattled rural doctors may reduce the perception of the urgency with which our whole health system needs to be re-modelled. Failure to deal with the ‘push’ factors in rural and public health delivery may leave the Clinical Assistants providing hospital care without the supervision of medically qualified staff – effectively a ‘downgrade’ of hospital level care.
Furthermore, the system is likely to generate ‘turf wars’ between nursing staff and Clinical Assistants where their scopes of practice overlap. There may also be a clouding of the issues of legal liability regarding patient care and this will have to be addressed by the State as a matter of urgency.
In terms of the South African Qualifications Authority mandate, learning should be modular and there should be pathways to higher qualifications. The Clinical Assistants – as a health profession – are likely to insist on the establishment of such a pathway. This could open the way to becoming recognised as a medical practitioner without having to go through university training.
Modern healthcare is becoming increasingly more complex and the need for properly schooled practitioners to adequately assess research findings and clinical options is becoming ever more important.
In my view, the training of Clinical Assistants is a risky policy that may, in the longer term, aggravate the problems it was intended to solve.
Regenesys Management (Pty) Ltd. is registered with the Department of Education as a private higher education institution under the Higher Education Act, 1997: Registration Certificate Number 2000/HE07/023.
Regenesys has been granted provisional registration as a Further Education and Training Institution under the Further Education and Training Act, 2006 (Act No.16). Valid until 31 December 2015, registration number 2009/FE07/023.
EBSCO Online Academic Library Catalogue
(Login details provided at comencement of courses)
Regenesys on Facebook
Save to del.icio.us
The initiative is appreciated taking into consideration the heavy burden of disease in our country and the shortage of qualified doctors.
Mid level workers may relieve work load on the routine tasks performed by Doctors, but the strategic focus must stil beto produce the right number of doctors, never to rely on the mid level workers. incountries where there was heavy reliance in mid level workers, the health system suffered as health need highly qualified personnel.
The other issue of overlapping function between nurse and PA; nurses would take care of nursing orders which will never be the same as tasks for nurses, I do not foresee problem in that area if nurses know their functions and are aware of their independent functions in nursing practice and their scope of practice.
South Africa needs to open two new medical schools and reopen several nursing colleges to keep up with demand. These processes take a long time but do not seem to be taking place at present. This is worrying because it suggests that undue reliance is being placed on ‘temporary imports’of doctors and the mid level worker to solve our long term problems.
As far as overlap of functions amongst health professions is concerned, there is already considerable overlap in the functions of e.g. ICU nurses and doctors. The introduction of an intermediate category of worker is bound to cause difficulty.
Dr Broekman if one looks at the history of the PA in the USA, it was established by Duke University to eliviate the workload of the medical staff under certain conditions. In South Africa I can see that there is a place for the PA, especially in the rural environment.
Regarding the pathway to become a fully fledged medical practitioner, I disagree with what is postulated – the PA should at the most get the first year of study off – as is the case with Wits Medical School that give some graduates off and they then start in their third year of study. This is someting SAQA should look at and advocate and then the problem should be lessen in the long run. Give it a change and lets pray this will work out well for those in dire need!.
As a Registered nurse that needs a stimulating enviorment, I find this field very interesting.
Cell 0845752818
I am currently working in the public sector and have recently been told that we will no longer be paid for extra overtime, due to financial restraints. so my questions is: where is the government going to get the money to pay these clinical assistants, when they are unable to pay the doctors they already have working for them?
In an ideal world i believe that these PA’s would lift some of the burden, however i fear that this will take the focus off the more important issues pertaining to our health system.