Doctor displacement: a political agenda or a health care imperative?

TO THE EDITOR: We read with interest the recent editorial by Van Der Weyden on the issue of doctor displacement. We agree completely that a transparent and evidencebased approach to health care roles is essential. In proposing a pilot program of physician assistants (PAs) in South Australia to examine the potential of “physician extenders”, we broadly used the model applied to the introduction of new the apies in medicine, including new drugs: • Evidence of an unmet need; • Evidence of safety and efficacy in another setting; • A monitored pilot/trial in practice; • Re-evaluation after a defined period with a defined process; and • An emphasis on any ongoing utilisation being a consistent and national process. This last point is noted in the Australian and New Zealand College of Anaesthetists’ submission to the National Health and Hospitals Reform Commission. We emphasised the need for any proposed future clinical role for PAs to be defined, followed by identification of the required knowledge base, training and education requirements, and certification. Not all new health care roles have followed such a pathway, and this provides potential challenges for ensuring quality, safety, consistency and “trademark definition” (widespread understanding of the role). In the case of PAs, it was evident at a recent International Forum for Physician Assistant Education in the United States that the definition of the term “physician assistant” varies greatly internationally, potentially confusing future debate on this topic in Australia. Hence, to develop a robust Australian model, any proposals for ongoing use and training of PAs would have to be discussed at a national level.