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ADVANCE Blog for PAs

Australia Top Doc: Physician Assistant Use Too Risky

Published August 18, 2008 10:40 AM by Stephen Cornell

The PA profession is causing a ruckus in Australia. A plan to introduce some physician assistants to the country's health system has Australian Medical Association president Rosanna Capolingua very upset—about patient safety, of course.

THE head of Australia's peak medical body has criticised a plan to introduce US-style physicians' assistants who would carry out less complex medical procedures, saying it puts patients at greater risk and could deny junior doctors training opportunities.

Queensland Health Minister Stephen Robertson yesterday released the five sites for a pilot program to train doctors' assistants, who would perform the procedures under the guidance of a qualified doctor.

The pilot is based on a scheme developed in the US and has been trialled in countries including Canada and Britain.

Australian Medical Association president Rosanna Capolingua said that, although assistants would work under a doctor's supervision at all times, their use in surgical procedures could compromise patient safety.

"The physician's assistant understands how to do the task and they may be useful as a 'tool' but, for our own junior doctors, they need to have that holistic training and experience as well," she said.

"Patient safety must always be our first priority, not just the delivery of a service to a patient."

Doesn't sound like Dr. Capolingua is going to make a great teammate.

The nurses aren't thrilled, either.

Beth Mohle from the Queensland Nurses Union said the Government should spend the money expanding the role of existing nursing staff.

"They're not actually testing physicians' assistants against positions like nurse practitioners," she said.

"If you're going to have a trial, you should actually at least test those positions against currently existing positions such as nurse practitioners."

Sounds like the beginning of a major turf war. Or it would be if it wasn't all about patient safety.



I have been a PA in the US for 17 years, before that I was an RN w 15 years experience.  I have worked as a first assistant in surgery for 10 years and the last few years have been working Emergency Medicine in remote underserved areas.  If people understand that midlevels are physician extenders and not intended to be physician replacements it is easy to see how midlevels compliment medical practice.  There is a philosophical difference between advance practice nursing and the PA profession.  By nature of the training PA's remain in a supervised role and easily remain in collaboration with their supervising physicians.  At least in the US the advance practice nurse typically prefers to see their role as independent from physicians.  However either profession is held to the same standards of care that the medical profession is held to.  As a rule I see PAs as being thorough and detail oriented, and quick to ask for advice when a situation is not straight forward.  The concerns that people are having in Australia atm are very similiar to concerns that people had in the US about 20 years ago.  Today in the US,  PAs and NPs are an accepted and respected part of the health care team.  I believe that as PAs are introduced to the Australian health care team they will prove themselves to be invaluable.

Sandy Beeman, PA-C, Rural health care - Physician Assistant , Indian Health Service November 11, 2012 11:16 PM
Polacca AZ

Anyone know how to find potential jobs in Australia.  Have 22 years experience in General Surgery, including wound care, and 4 years experience in Dermatology, including office surgery - no cosmetics.  

Expect family will be in Australia in a year or two, and would like to see if I could get work there

Victoria Rhodes, Derm/Surgery - PAC-MPAS, local dermatology office May 18, 2012 4:41 PM
Kinston NC

I've practiced in many areas of medicine as a Physician Assistant. I personally HATE the name Physician Assistant. It just gives people and superiors alike a feeling that we do not have the skills to practice medicine. I've always tried to explain it like this; if you had the opportunity to see a PA with many years of experience with a very good reputation would you do that or see a Doctor right out of residency?

I've worked Cardiology, Internal Medicine, Primary Care, Geriatrics and Emergency Medicine. It's hard to get that experience from sitting on a couch or rotations in med school. Would I want my Primary Care performing Neurosurgery? NO That's why we have specialities and specialists. I personally would restrict the NP's to their specialty. They work outside there training all the time. I was involved in a clinic and had a new FNP (family nurse practitioner) that couldn't even suture a simple lac. I know that's not all but they move around freely with very little need for supervision. Are they trained better than me to work in Internal Medicine, Cardiology etc? Same way with a few docs we have I had been trained by a cardiologist to do stress testing and interpret EKGs etc. The ER doc use to come and get me when he had something he needed a second look at. So is my skills lacking or the doctors? I think we assign titles based on what school you attended and not necessarily skill level. If a physician is willing to sign off and say you have the skills to do a certain job shouldn't that be good enough?

Just a few thoughts

Dan Stalnaker August 25, 2011 7:53 PM

I am a Physician Assistant specializing in Emergency Medicine.  We always fear what we don't understand, but the PA role has been a smashing success in the U.S.

Why?   Because our training is in the medical school model, our clinical rotations are in almost every specialty, and our roles are constantly expanded based on the trust the MD's place in us, and as our skill set increases.  I'll put my suture skills up against ANY doctor, with few exceptions.  I've also been able to introduce some MD's to newer treatment modalities they weren't aware of!  Patient safety is not an issue, since we consult with a doctor on difficult cases, or simply defer the patient to the MD.

As for PA's verses Nurse Practitioners, my opinion is this; it depends on the specialty.

They are trained under a nursing model of care, whereas PA's are trained under a medical school model.

In my experience, many patients prefer to see a PA over a doctor, because of our ability to take a little extra time to educate.

Relax Australia, we expand healthcare to the masses, not water it down.

And I'd love the opportunity to live and work in your country.  D'day!

Keith Rouleau January 4, 2010 2:22 PM
Medford OR

PingBack from

March 26, 2009 2:35 PM

First of all I should say that I am a Physician Assistant. My current job is with Central Minnesota Neurosciences in Central Minnesota, USA. I have 12 years experience working in Family medicine and Neuro surgery. Before that I worked as a Registered Nurse in a large Cardiac Care Unit for over 15 years.

 It seems that much of the complaining or reservations are from MDs who have not worked along side one of us. The research has been done and the facts again and again show that PA-Cs do high quality work and not only augment every kind of practice from Family Medicine to Neuro Surgery, we enable the MD to see more patients. We can help extend the MD so that he or she can concentrate on sicker patients, see more new patient consults , and give relief from on call duties.  We also help you make more money. Last year we averaged almost 20 neuro procedures a week. This is almost 2x the amount of cases than the average surgeon. We have a 3 person team. I am 80% clinic based with exception of hospital rounds. My PA partner assists the surgeon. Here she can bill 15% of what DR. does on each case as first assist. We typically do 6-7 cases 3 days a week. This is a lot of revenue. Last year Ann billed for almost $500,000!! Considering she makes 1/5th of that, the practice makes out very well on her first assist work.

 This attitude was common 15 years ago here. Many patients prefer seeing a Physician assistant over an MD because we are not typically expected to see as many patients as the MD. This allows more time for teaching, answering  questions, and getting a more accurate history.

 I also want to comment on Nurse Practioners. We have them here and many are excellent. I believe that if you talk to 100 MDs who have worked with either NPs or PAs the majority will prefer working with a PA. This is because we are schooled in the way Physicians are trained. NPs here are taught by nurses and from what I have seen, they just think a bit different than what a MD/PA.

  I can reference a bunch of articles if need be. Do a Med Line search and you will see what I say is true. We typically cost less and the patient outcomes are the same as compared to an MD, some studies say better. This has also been studied and is fact.  

The PA profession is spreading world wide. We can fill the gap and not compete with MDs, but compliment their practice with professional, compassionate care, and we can help your practice make a lot more money. A smart PA know his limitations and with daily review of our work by the supervising MD, we learn even more. I would say that here in Minnesota, 90% + practices have at least one mid level provider or more.

Feel free to e-mail me. I am on Central Standard time here.

                       Dan Truax PA-C

Dan Truax, Neuro surgery and Urgent care - PA-C, Central Minnesota Neurosciences August 31, 2008 12:14 AM
ST. Cloud MN

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