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Published in: Human Resources for Health 1/2007

Open Access 01-12-2007 | Review

New Role, New Country: introducing US physician assistants to Scotland

Authors: James Buchan, Fiona O'May, Jane Ball

Published in: Human Resources for Health | Issue 1/2007

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Abstract

This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland.
The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored.
The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland.
Literature
1.
go back to reference Hooker RS, Cawley J: Physician Assistants in American Medicine. 2003, Edinburgh: Churchill Livingstone, 3 Hooker RS, Cawley J: Physician Assistants in American Medicine. 2003, Edinburgh: Churchill Livingstone, 3
2.
go back to reference Estes EH, Carter RD: Accommodating a new medical profession: the history of physician assistant regulatory legislation in North Carolina. N C Med J. 2005, 66: 103-107.PubMed Estes EH, Carter RD: Accommodating a new medical profession: the history of physician assistant regulatory legislation in North Carolina. N C Med J. 2005, 66: 103-107.PubMed
3.
go back to reference Fenn W: NES Exploring new solutions to Scotland's Healthcare workforce pressures. Physician Assistants in the US: History, Background & Evidence Base. 23. 2006, January . Presentation given in Edinburgh: The Lister Institute Fenn W: NES Exploring new solutions to Scotland's Healthcare workforce pressures. Physician Assistants in the US: History, Background & Evidence Base. 23. 2006, January . Presentation given in Edinburgh: The Lister Institute
4.
go back to reference AAPA: Trends in the physician assistant profession 1991–2003. 2004, Alexandria, Virginia: AAPA AAPA: Trends in the physician assistant profession 1991–2003. 2004, Alexandria, Virginia: AAPA
5.
go back to reference AAPA: Competencies for the physician assistant profession. J Am Assoc Physician Assist. 2005, 18: 16-18. AAPA: Competencies for the physician assistant profession. J Am Assoc Physician Assist. 2005, 18: 16-18.
6.
go back to reference Lindsay S: The feminization of the physician assistant profession. Women Health. 2005, 41: 37-61. 10.1300/J013v41n04_03.CrossRefPubMed Lindsay S: The feminization of the physician assistant profession. Women Health. 2005, 41: 37-61. 10.1300/J013v41n04_03.CrossRefPubMed
7.
go back to reference Nenstiel R, White GL, Vetrosky DT, Covey PC: Allied health and physician assistants: a progressive partnership. J Allied Health. 1997, 26: 133-135.PubMed Nenstiel R, White GL, Vetrosky DT, Covey PC: Allied health and physician assistants: a progressive partnership. J Allied Health. 1997, 26: 133-135.PubMed
8.
go back to reference Grumbach K: Fighting Hand to Hand over Physician Workforce Policy. Health Aff. 2002, 21: 13-27. 10.1377/hlthaff.21.5.13.CrossRef Grumbach K: Fighting Hand to Hand over Physician Workforce Policy. Health Aff. 2002, 21: 13-27. 10.1377/hlthaff.21.5.13.CrossRef
9.
go back to reference Cooper B: Weighing the Evidence for Expanding Physician Supply. Ann Int Med. 2004, 14: 705-714.CrossRef Cooper B: Weighing the Evidence for Expanding Physician Supply. Ann Int Med. 2004, 14: 705-714.CrossRef
10.
go back to reference Cawley JF: Physician assistant supply and demand. J Am Assoc Physician Assist. 2005, 18: 11-12. Cawley JF: Physician assistant supply and demand. J Am Assoc Physician Assist. 2005, 18: 11-12.
11.
go back to reference LaBarbera DM: Physician assistant vocational satisfaction. J Am Assoc Physician Assist. 2004, 17: 34-40. 51 LaBarbera DM: Physician assistant vocational satisfaction. J Am Assoc Physician Assist. 2004, 17: 34-40. 51
12.
go back to reference AAPA: Issue brief: Physician Assistant Scope of Practice. 2004, Alexandria, Virginia: AAPA AAPA: Issue brief: Physician Assistant Scope of Practice. 2004, Alexandria, Virginia: AAPA
13.
go back to reference Hooker RS, Berlin LE: Trends in the supply of physician assistants and nurse practitioners in the United States. Health Aff. 2002, 21: 174-181. 10.1377/hlthaff.21.5.174.CrossRef Hooker RS, Berlin LE: Trends in the supply of physician assistants and nurse practitioners in the United States. Health Aff. 2002, 21: 174-181. 10.1377/hlthaff.21.5.174.CrossRef
14.
go back to reference AAPA: 2000–2003 Policy Manual. Alexandria, Virginia: AAPA AAPA: 2000–2003 Policy Manual. Alexandria, Virginia: AAPA
15.
go back to reference Mittman D, Cawley J, Fenn W: Physician assistants in the United States. Br Med J. 2002, 325: 485-487. 10.1136/bmj.325.7362.485.CrossRef Mittman D, Cawley J, Fenn W: Physician assistants in the United States. Br Med J. 2002, 325: 485-487. 10.1136/bmj.325.7362.485.CrossRef
16.
go back to reference Cooper RA, Laud P, Dietrich CL: Weighing the Evidence for Expanding Physician Supply. Ann Int Med. 1998, 14: 705-714. Cooper RA, Laud P, Dietrich CL: Weighing the Evidence for Expanding Physician Supply. Ann Int Med. 1998, 14: 705-714.
17.
go back to reference Beschle JC: Role differentiation of the nurse practitioner and physician assistant, within the realization of health care reform. Nurse Pract Am J Prim Health Care. 1994, 19: 69-70. Beschle JC: Role differentiation of the nurse practitioner and physician assistant, within the realization of health care reform. Nurse Pract Am J Prim Health Care. 1994, 19: 69-70.
18.
go back to reference Dehn RW, Cawley JF: Looking into tomorrow. Health workforce issues confronting physician assistants. J Am Assoc Physician Assist. 2000, 13: 39-42. Dehn RW, Cawley JF: Looking into tomorrow. Health workforce issues confronting physician assistants. J Am Assoc Physician Assist. 2000, 13: 39-42.
19.
go back to reference Hooker RS, Cipher DJ: Physician assistant and nurse practitioner prescribing: 1997–2002. J Rural Health. 2005, 21: 355-360. 10.1111/j.1748-0361.2005.tb00107.x.CrossRefPubMed Hooker RS, Cipher DJ: Physician assistant and nurse practitioner prescribing: 1997–2002. J Rural Health. 2005, 21: 355-360. 10.1111/j.1748-0361.2005.tb00107.x.CrossRefPubMed
20.
go back to reference Cox CL: Advanced nurse practitioners and physician assistants: what is the difference? Comparing the USA and UK. Hosp Med. 2001, 62: 169-171.CrossRefPubMed Cox CL: Advanced nurse practitioners and physician assistants: what is the difference? Comparing the USA and UK. Hosp Med. 2001, 62: 169-171.CrossRefPubMed
21.
go back to reference Record J, McCally M, Schweitzer S, Blomquist R, Berger B: New Health Professionals after a decade and a half: delegation, productivity and costs in primary care, cited in Scheffler RM, Waitzman MJ, Hillman JM: The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care. J Allied Health. 1996, 25: 207-217. Record J, McCally M, Schweitzer S, Blomquist R, Berger B: New Health Professionals after a decade and a half: delegation, productivity and costs in primary care, cited in Scheffler RM, Waitzman MJ, Hillman JM: The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care. J Allied Health. 1996, 25: 207-217.
22.
go back to reference Larson E, Hart LG, Ballweg R: National Estimates of Physician Assistant Productivity. J Allied Health. 2001, 30: 146-152.PubMed Larson E, Hart LG, Ballweg R: National Estimates of Physician Assistant Productivity. J Allied Health. 2001, 30: 146-152.PubMed
23.
go back to reference Hooker RS, Cipher DJ, Sekscenski E: Patient satisfaction with physician assistant, nurse practitioner, and physician care: a national survey of Medicare beneficiaries. J Clin Outcomes Manag. 2005, 12: 88-92. Hooker RS, Cipher DJ, Sekscenski E: Patient satisfaction with physician assistant, nurse practitioner, and physician care: a national survey of Medicare beneficiaries. J Clin Outcomes Manag. 2005, 12: 88-92.
24.
go back to reference Woodin J, McLeod H, McManus R: Evaluation of US-trained PAs working in the NHS in England. Interim Report: The introduction of US-trained physician assistants to primary care in Tipton: first impressions. 2004, Health Services Management Centre, Department of Primary Care and General Practice, University of Birmingham: Birmingham Woodin J, McLeod H, McManus R: Evaluation of US-trained PAs working in the NHS in England. Interim Report: The introduction of US-trained physician assistants to primary care in Tipton: first impressions. 2004, Health Services Management Centre, Department of Primary Care and General Practice, University of Birmingham: Birmingham
25.
go back to reference Roblin DW, Becker ER, Adams K, Howard DH, Roberts MH: Patient satisfaction with primary care: does type of practitioner matter?. Med Care. 2004, 42: 579-590. 10.1097/01.mlr.0000128005.27364.72.CrossRefPubMed Roblin DW, Becker ER, Adams K, Howard DH, Roberts MH: Patient satisfaction with primary care: does type of practitioner matter?. Med Care. 2004, 42: 579-590. 10.1097/01.mlr.0000128005.27364.72.CrossRefPubMed
26.
go back to reference Miller W, Riehl E, Napier M, Barber K, Dabideen H: Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-Verified Level II Trauma Center. J Trauma. 1998, 44: 372-376.CrossRefPubMed Miller W, Riehl E, Napier M, Barber K, Dabideen H: Use of physician assistants as surgery/trauma house staff at an American College of Surgeons-Verified Level II Trauma Center. J Trauma. 1998, 44: 372-376.CrossRefPubMed
27.
go back to reference Duffy K: Physician assistants: filling the gap in patient care in academic hospitals. Perspect Physician Assist Educ. 2003, 14: 158-167.CrossRef Duffy K: Physician assistants: filling the gap in patient care in academic hospitals. Perspect Physician Assist Educ. 2003, 14: 158-167.CrossRef
28.
go back to reference McKibbin RC: Cost effectiveness of physician assistants: a review of recent evidence. PA J. 1978, 8: 110-115.PubMed McKibbin RC: Cost effectiveness of physician assistants: a review of recent evidence. PA J. 1978, 8: 110-115.PubMed
29.
go back to reference Hooker RS: The economic basis of physician assistant practice. Physician Assist. 2000, 24: 51-54. 57–60, 63–66 Hooker RS: The economic basis of physician assistant practice. Physician Assist. 2000, 24: 51-54. 57–60, 63–66
30.
go back to reference Gryzbicki DM, Sullivan PJ, Oppy JM, Bethke A-M, Raab SS: The economic benefit for family/general medicine practices employing physician assistants. Am J Manag Care. 2002, 8: 613-620. Gryzbicki DM, Sullivan PJ, Oppy JM, Bethke A-M, Raab SS: The economic benefit for family/general medicine practices employing physician assistants. Am J Manag Care. 2002, 8: 613-620.
31.
go back to reference Hooker RS: A cost analysis of physician assistants in primary care. J Am Assoc Physician Assist. 2002, 15: 39-42. 45, 48 Hooker RS: A cost analysis of physician assistants in primary care. J Am Assoc Physician Assist. 2002, 15: 39-42. 45, 48
32.
go back to reference Hooker RS: Physician assistants in occupational medicine: how do they compare to occupational physicians?. Occup Med. 2004, 54: 153-158. 10.1093/occmed/kqg126.CrossRef Hooker RS: Physician assistants in occupational medicine: how do they compare to occupational physicians?. Occup Med. 2004, 54: 153-158. 10.1093/occmed/kqg126.CrossRef
33.
go back to reference Roblin DW, Howard DH, Becker ER, Adams EK, Roberts MH: Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO. Health Serv Res. 2004, 39: 607-625. 10.1111/j.1475-6773.2004.00247.x.CrossRefPubMedPubMedCentral Roblin DW, Howard DH, Becker ER, Adams EK, Roberts MH: Use of midlevel practitioners to achieve labor cost savings in the primary care practice of an MCO. Health Serv Res. 2004, 39: 607-625. 10.1111/j.1475-6773.2004.00247.x.CrossRefPubMedPubMedCentral
35.
go back to reference Scottish Executive Health Department: Future Practice: Proposals of an Advisory Group. 2002, Commissioned by the Scottish Executive to Review the Scottish Medical Workforce. Edinburgh: Scottish Executive Scottish Executive Health Department: Future Practice: Proposals of an Advisory Group. 2002, Commissioned by the Scottish Executive to Review the Scottish Medical Workforce. Edinburgh: Scottish Executive
37.
go back to reference Scott S: Doctors' assistants or a Trojan horse?. Nurs Stand. 1996, 10: 17-PubMed Scott S: Doctors' assistants or a Trojan horse?. Nurs Stand. 1996, 10: 17-PubMed
38.
go back to reference Hutchinson L, Marks T, Pittilo M: The physician assistant: would the US model meet the needs of the NHS?. Br Med J. 2001, 323: 1244-1247. 10.1136/bmj.323.7323.1244.CrossRef Hutchinson L, Marks T, Pittilo M: The physician assistant: would the US model meet the needs of the NHS?. Br Med J. 2001, 323: 1244-1247. 10.1136/bmj.323.7323.1244.CrossRef
39.
go back to reference Bashford S: Physician assistants: opportunity or duplication?. Indepen Nurse. 2005, 9: 22-23. Bashford S: Physician assistants: opportunity or duplication?. Indepen Nurse. 2005, 9: 22-23.
40.
go back to reference Gavin M, Esmail A: Solving the recruitment crisis in UK general practice: time to consider physician assistants?. Soc Pol Admin. 2002, 36: 76-89. 10.1111/1467-9515.00271.CrossRef Gavin M, Esmail A: Solving the recruitment crisis in UK general practice: time to consider physician assistants?. Soc Pol Admin. 2002, 36: 76-89. 10.1111/1467-9515.00271.CrossRef
41.
go back to reference Stewart A, Cantanzaro R: Can physician assistants be effective in the UK?. Clin Med. 2005, 5: 344-348.CrossRef Stewart A, Cantanzaro R: Can physician assistants be effective in the UK?. Clin Med. 2005, 5: 344-348.CrossRef
42.
go back to reference Woodin J, McLeod H, McManus R, Jelphs K: Evaluation of US-trained PAs working in the NHS in England. Final Report. 2005, Health Services Management Centre, Department of Primary Care and General Practice, University of Birmingham: Birmingham Woodin J, McLeod H, McManus R, Jelphs K: Evaluation of US-trained PAs working in the NHS in England. Final Report. 2005, Health Services Management Centre, Department of Primary Care and General Practice, University of Birmingham: Birmingham
Metadata
Title
New Role, New Country: introducing US physician assistants to Scotland
Authors
James Buchan
Fiona O'May
Jane Ball
Publication date
01-12-2007
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2007
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/1478-4491-5-13

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