COMMENTARY
Physician assistants in New Zealand Elisabeth Gammelin, PA-C, MS
N
ew Zealand is a two-island nation in the South Pacific with a population of about 4.5 million and 27.4 doctors per 10,000 people. One of the challenges of New Zealand medicine is retention, as many doctors migrate to Australia and other countries. This has led to medical practitioner shortages, particularly in rural general practice. In addition to shortages, general practices have had to contend with high turnover of practitioners, leading to inconsistent healthcare for the 25% of New Zealanders who live in rural areas. New Zealand provides universal healthcare to all citizens for free or a nominal fee depending on services. In addition, the Accident Compensation Corp. provides free medical care to all citizens and visitors who have suffered an accident, providing a no-fault accident structure. Both systems are funded by the New Zealand government through taxation. The country is divided into 20 district health boards, with the number of hospitals in each district based on population. Primary health organizations are funded by the district health boards to provide funding to individual general practices. New Zealand’s healthcare strategy, set by the Ministry of Health in Wellington, is to identify health priority areas and direct health services toward interventions with high benefit, including an emphasis on resolving healthcare inequalities. A commitment to healthcare for all citizens combined with difficulties in finding medical practitioners has made New Zealand a fertile ground for physician assistants (PAs). Interest in using PAs in New Zealand started in 2000 when US visitors to New Zealand and Australia discussed PAs, and physicians from New Zealand who visited the United States observed the development of PAs there. In 2009, the New Zealand Ministry of Health started to look seriously into the PA role and tasked its Clinical
Elisabeth (Lis) Gammelin practices in the ED at Gore Hospital in Gore, New Zealand (South Island). Before moving to New Zealand in December 2012, she practiced at Teton Valley Hospital in Driggs, Idaho, and at Lake Clinic in Yellowstone National Park. Read more about her work in New Zealand at www.pasconnect.org/greetings-from-new-zealanda-pa-goes-down-under. The author has disclosed no potential conflicts of interest, financial or otherwise. DOI: 10.1097/01.JAA.0000455651.96800.6a Copyright © 2014 American Academy of Physician Assistants
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www.JAAPA.com
Training Agency (now known as Health Workforce NZ, http://www.healthworkforce.govt.nz/new-roles-andscopes) to negotiate with the Counties Manakau District Health Board to inaugurate a demonstration project. Des Gorman, a member of the Health Workforce NZ board, was an early supporter of PAs and has been instrumental in investigating and implementing PA pilot projects. Health Workforce NZ was assisted by Ruth M. Ballweg, the former director of the MEDEX PA program in Washington State, and a leader in international PA promotion. Ballweg visited New Zealand in 2009 and met with government organizations, educational institutions, and district health boards to educate and organize a formal PA pilot project.
The biggest question facing the PA profession in New Zealand has been how to translate a successful pilot project into a regulated profession. She has led the recruitment and selection of PAs for the demonstration projects in New Zealand and continues to work with the Ministry of Health and advocate for PAs becoming a regulated medical profession in New Zealand. Assistance also came from Tiffany Hodgson, PA. After marrying a New Zealander and moving to the country, Hodgson was able to leverage a family practice position by starting out doing administrative work and gradually proving her worth as a clinician. She also consulted for Health Workforce NZ, working to educate hospitals and clinics so that they would hire PAs as part of a pilot project. The first two PAs who came to work in New Zealand in 2010 were part of the “pilot of pilots” project at Counties Manakau District Health Board’s Middlemore Hospital near Auckland. These were qualified surgical PAs who worked for 1 year with the acute surgical teams. Their work and communication skills made the first-year pilot a success, paving the way for the current pilot project (New Zealand PA Pilot Project).1 The current PA pilot project was started in late 2012 and was initially structured and administered by Dr. Priyesh Volume 27 • Number 11 • November 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Physician assistants in New Zealand
Tiwari, who passed the project to its current administrator, Tony Crane, at Health Workforce New Zealand. Four PAs, including Hodgson, arrived in late 2012 with three additional PAs arriving in late 2013. The project serves several sites on the North Island and one site on the South Island. As of 2014, six PAs work in family practice settings on the North Island; four in the Hamilton area; and two in the rural town of Tokorua. A seventh PA works in the ED at Gore Hospital, a rural hospital near the southern tip of the South Island. Instrumental to the placement of these PAs has been the support and progressive thinking of Drs. Navan Rojan and Leo Revell of Radius Healthcare in Hamilton, and Karl Metzler, CEO of Gore Hospital. Although the results of a formal evaluation will not be available until the project is finished, communications from the sites and the participating PAs are encouraging. A steady stream of positive interest has come from the medical community, as well as positive reporting in the media. The biggest question facing the PA profession in New Zealand has been how to translate a successful pilot project into a regulated profession that will have a lasting, positive effect on the New Zealand healthcare system. Although
JAAPA Journal of the American Academy of Physician Assistants
the New Zealand government appears supportive of the PA profession, Health Workforce New Zealand, a regulatory body not yet chosen, and the workforce itself will have to advise the minister of health to approve PAs as a regulated profession. The newly conceived New Zealand PA Society (NZPAS) will help facilitate this progression. Challenges to establishing the PA profession in New Zealand include becoming a regulated profession, gaining prescribing rights, and developing a domestic PA training program. The NZPAS is a brand new organization, and is working on the basics such as incorporation and setting up a communication. In addition to helping PAs adapt to a different healthcare system, NZPAS is working passionately to bring the PA profession to New Zealand permanently, and to inform interested PAs in the United States about the current status in New Zealand. JAAPA REFERENCE 1. Health Workforce New Zealand. Evaluation of the Physician Assistant Trial. Final Evaluation Report of the Counties Manukau District Health Board Demonstration Pilot. http://www.nzma.org.nz/sites/all/files/PAevaluationreport.pdf. Accessed August 1, 2014.
www.JAAPA.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
11
Physician assistants in New Zealand Elisabeth Gammelin, PA-C, MS
N
ew Zealand is a two-island nation in the South Pacific with a population of about 4.5 million and 27.4 doctors per 10,000 people. One of the challenges of New Zealand medicine is retention, as many doctors migrate to Australia and other countries. This has led to medical practitioner shortages, particularly in rural general practice. In addition to shortages, general practices have had to contend with high turnover of practitioners, leading to inconsistent healthcare for the 25% of New Zealanders who live in rural areas. New Zealand provides universal healthcare to all citizens for free or a nominal fee depending on services. In addition, the Accident Compensation Corp. provides free medical care to all citizens and visitors who have suffered an accident, providing a no-fault accident structure. Both systems are funded by the New Zealand government through taxation. The country is divided into 20 district health boards, with the number of hospitals in each district based on population. Primary health organizations are funded by the district health boards to provide funding to individual general practices. New Zealand’s healthcare strategy, set by the Ministry of Health in Wellington, is to identify health priority areas and direct health services toward interventions with high benefit, including an emphasis on resolving healthcare inequalities. A commitment to healthcare for all citizens combined with difficulties in finding medical practitioners has made New Zealand a fertile ground for physician assistants (PAs). Interest in using PAs in New Zealand started in 2000 when US visitors to New Zealand and Australia discussed PAs, and physicians from New Zealand who visited the United States observed the development of PAs there. In 2009, the New Zealand Ministry of Health started to look seriously into the PA role and tasked its Clinical
Elisabeth (Lis) Gammelin practices in the ED at Gore Hospital in Gore, New Zealand (South Island). Before moving to New Zealand in December 2012, she practiced at Teton Valley Hospital in Driggs, Idaho, and at Lake Clinic in Yellowstone National Park. Read more about her work in New Zealand at www.pasconnect.org/greetings-from-new-zealanda-pa-goes-down-under. The author has disclosed no potential conflicts of interest, financial or otherwise. DOI: 10.1097/01.JAA.0000455651.96800.6a Copyright © 2014 American Academy of Physician Assistants
10
www.JAAPA.com
Training Agency (now known as Health Workforce NZ, http://www.healthworkforce.govt.nz/new-roles-andscopes) to negotiate with the Counties Manakau District Health Board to inaugurate a demonstration project. Des Gorman, a member of the Health Workforce NZ board, was an early supporter of PAs and has been instrumental in investigating and implementing PA pilot projects. Health Workforce NZ was assisted by Ruth M. Ballweg, the former director of the MEDEX PA program in Washington State, and a leader in international PA promotion. Ballweg visited New Zealand in 2009 and met with government organizations, educational institutions, and district health boards to educate and organize a formal PA pilot project.
The biggest question facing the PA profession in New Zealand has been how to translate a successful pilot project into a regulated profession. She has led the recruitment and selection of PAs for the demonstration projects in New Zealand and continues to work with the Ministry of Health and advocate for PAs becoming a regulated medical profession in New Zealand. Assistance also came from Tiffany Hodgson, PA. After marrying a New Zealander and moving to the country, Hodgson was able to leverage a family practice position by starting out doing administrative work and gradually proving her worth as a clinician. She also consulted for Health Workforce NZ, working to educate hospitals and clinics so that they would hire PAs as part of a pilot project. The first two PAs who came to work in New Zealand in 2010 were part of the “pilot of pilots” project at Counties Manakau District Health Board’s Middlemore Hospital near Auckland. These were qualified surgical PAs who worked for 1 year with the acute surgical teams. Their work and communication skills made the first-year pilot a success, paving the way for the current pilot project (New Zealand PA Pilot Project).1 The current PA pilot project was started in late 2012 and was initially structured and administered by Dr. Priyesh Volume 27 • Number 11 • November 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Physician assistants in New Zealand
Tiwari, who passed the project to its current administrator, Tony Crane, at Health Workforce New Zealand. Four PAs, including Hodgson, arrived in late 2012 with three additional PAs arriving in late 2013. The project serves several sites on the North Island and one site on the South Island. As of 2014, six PAs work in family practice settings on the North Island; four in the Hamilton area; and two in the rural town of Tokorua. A seventh PA works in the ED at Gore Hospital, a rural hospital near the southern tip of the South Island. Instrumental to the placement of these PAs has been the support and progressive thinking of Drs. Navan Rojan and Leo Revell of Radius Healthcare in Hamilton, and Karl Metzler, CEO of Gore Hospital. Although the results of a formal evaluation will not be available until the project is finished, communications from the sites and the participating PAs are encouraging. A steady stream of positive interest has come from the medical community, as well as positive reporting in the media. The biggest question facing the PA profession in New Zealand has been how to translate a successful pilot project into a regulated profession that will have a lasting, positive effect on the New Zealand healthcare system. Although
JAAPA Journal of the American Academy of Physician Assistants
the New Zealand government appears supportive of the PA profession, Health Workforce New Zealand, a regulatory body not yet chosen, and the workforce itself will have to advise the minister of health to approve PAs as a regulated profession. The newly conceived New Zealand PA Society (NZPAS) will help facilitate this progression. Challenges to establishing the PA profession in New Zealand include becoming a regulated profession, gaining prescribing rights, and developing a domestic PA training program. The NZPAS is a brand new organization, and is working on the basics such as incorporation and setting up a communication. In addition to helping PAs adapt to a different healthcare system, NZPAS is working passionately to bring the PA profession to New Zealand permanently, and to inform interested PAs in the United States about the current status in New Zealand. JAAPA REFERENCE 1. Health Workforce New Zealand. Evaluation of the Physician Assistant Trial. Final Evaluation Report of the Counties Manukau District Health Board Demonstration Pilot. http://www.nzma.org.nz/sites/all/files/PAevaluationreport.pdf. Accessed August 1, 2014.
www.JAAPA.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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