Explainer: What are physician associates, and how might they change health care?

"Physician associate" is now a registered profession in New Zealand, after gaining popularity as a career in the US and UK. Groups such as the Resident Doctors' Association have voiced concern about its introduction, saying money would be better spent on doctors and nurses.

But what does a physician associate actually do? And how can they help a health system in crisis? Health correspondent Kate Green reports.

Explainer - Working in urgent care, you never know what's going to walk through the door.

Andie Cook has been working as a physician associate in New Zealand for the past decade, and is currently based at an urgent care centre in Hawke's Bay.

Coughs, colds, chest pains and respiratory illnesses are common, she says, as are injuries - especially fractures - and abdominal pain.

But it is not just urgent care where you can find a physician associate. They work in all areas of health, from general practice to hospitals.

As of 1 October, the role is now officially recognised and regulated as a profession in New Zealand.

Formerly known as physician assistants, and more colloquially as PAs, these healthcare workers are more common overseas, particularly in places like the US, UK and Canada.

Despite currently lacking the ability to legally prescribe medication in New Zealand, they see patients, form diagnoses and treatment plans, and then if medication is needed they review the case with a supervising doctor, who can prescribe.

Overseas, PAs do have the ability to prescribe, and Cook hopes that will be the next step for the profession in New Zealand.

When the news of the role's regulation was announced, Health Minister Simeon Brown said it demonstrated the Government's commitment to patient safety and providing high quality care. Many hope creating more pathways for people to work in healthcare will increase the number of appointments available for patients.

It also provides the approximately 50 PAs already working in New Zealand some comfort. Until that point, Cook explains, there had been no authority in place to back PAs in complaints or wrongful dismissals, and nothing to stop people claiming to be PAs without adequate training or qualifications.

"It means safety, not just for the patient, but for us as a profession."

What training do PAs have?

Cook has a bachelor's degree, and spent eight years in the US military as a medic before going on to train as a physician associate at the University of Utah.

"My master's degree took 27 months of training of full-time study - book work [and] didactic [work] for half, and medical rotations the other half."

Next came the national board certifying examination, a five-hour test students must pass to be able to practice, followed by a six-year stint as a PA in the Air National Guard as an officer before moving to New Zealand.

The job is aligned with the medical model followed by doctors, Cook says - diagnosticians, rather than nurses - and the training is"very nitty-gritty, condensed, know what you need to know to get the job done, but not knowing it at that higher level that doctors know".

"Even though we are not a doctor, we can still see a wide breadth and depth of patients to help open and ease the pressures on the doctor."

Physician assistants are generally paid less than doctors. Cook says one advantage for clinics is being able to add another clinician to the team at a lower cost than employing another doctor.

What qualifications do PAs need to be registered?

The Medical Council offers four pathways to registration - the first three, by holding an accredited PA qualification already in Canada, the United States or the United Kingdom.

The fourth is for PAs already practising in NZ.

Medical Council chairman Dr Kenneth Clark says to register, someone must have three years of clinical practice experience within the past five years, working at least half-time, "in the same or a similar area of clinical practice to their proposed New Zealand position".

"The New Zealand experiential pathway also requires at least 24 months of practice in New Zealand immediately before applying."

The council assesses each application, including the applicant's qualifications, work history, references and fitness to practise. Physician associates initially enter a provisional scope of practice, with council approval required for their position, primary supervisor and supervision plan.

"Physician associates must continue to work under a doctor's supervision throughout their practice. Their primary supervisor must be a vocationally registered doctor. They may only work in settings where onsite supervision is available and must not be rostered to practise solo."

How did PAs get jobs in NZ before the profession was regulated?

Whether or not a GP practice chooses to employ a physician associate is at its own discretion.

Cook says she wanted to move to New Zealand, but knew it might be harder to find a job here - until one day she spotted a post on social media about an NZ-based clinic which employed a PA off the back of a trial, some years before.

"And they had such good success with her that they were reaching out to find another PA."

What concerns does the sector have?

Some groups are worried about the potential for confusion among patients about whether they are seeing a doctor, or someone with a different qualification.

Clark says clear identification is an essential part of patient safety and informed consent.

"[The Medical Council's] standards require physician associates to identify their profession clearly and tell patients they are not medical doctors. They must explain their role in a way patients can understand, including how it differs from other health practitioners' roles."

Cook says as a PA, she is used to explaining her role and her scope of practice. Role confusion is nothing new, and it isn't limited to PAs.

"Public education is key to fix this."

The Royal Australasian College of Physicians (RACP) is one group concerned about PAs becoming more common.

"We have concerns about safety, cultural competency when working with Māori patients, and precious resources being diverted away from existing training programs and the supervision of the next generation of doctors," wrote its president, Dr Hamish McCay, in April last year when the prospect of regulating the profession was first raised.

Proponents of the role say regulation will hopefully lead to the creation of local training courses - but for now, the only physician associates working here have been trained overseas.

RACP Māori health committee chair Dr Matt Wheeler says health workers without local qualifications will lack cultural awareness, particularly when it comes to Māori health, and he is concerned this will increase health inequity between Māori and non-Māori.

Other groups, such as the Resident Doctors Association, have called it a cost-cutting exercise, and many have questioned whether doctors have time to supervise other staff on top of their own workloads.

But Cook says: "Once you make that relationship with your supervising doctors, you'll find that most every doctor that you interview who has worked with a PA says it is not a burden whatsoever."

For patients, she says the important thing is freeing up appointments.

"Patients want to get seen and treated in timely fashion."