Submission on: THE USE, TRAINING AND REGULATION OF MEDICAL ASSISTANTS. Submitted by: The Royal Australasian College of Physicians

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1 Submission on: THE USE, TRAINING AND REGULATION OF MEDICAL ASSISTANTS Submitted by: The Royal Australasian College of Physicians 6 October

2 Use, training and regulation of medical assistants Thank you for the opportunity to comment on the recent paper relating to the use, training and regulation of medical assistants. The Royal Australasian College of Physicians (the College) understands that the Council is currently investigating the role of medical assistants and how such practitioners may be used, trained and regulated within the New Zealand health sector. Overseas data suggests that these practitioners have made a major contribution to health service efficiencies in the United States. 1 The College understands that physiotherapy assistants are currently employed in a range of settings in the New Zealand health sector. There are strict guidelines relating to their role and responsibilities. 2 Physiotherapy assistants have defined competencies and are expected to engage in relevant Continuing Professional Development (CPD). The assistant role is not viewed as a pathway to full registration as a physiotherapist in New Zealand. Currently these individuals are not regulated under the Health Practitioner Competence Assurance Act 2003 (HPCA Act). The College accepts that new approaches must be considered to address current workforce issues and supports the views advanced in a number of recent reports 3 that emphasise the need to examine different ways to deliver health care, including developing new health profession roles. Workforce pressures and service delivery issues may be the drivers leading to the development of new roles or scopes of practice within the health sector. However, in the College s view these initiatives must be considered within the context of patient safety issues and should pose no potential threat to the delivery of quality of care. The College supports the concept of the medical assistants, with the proviso that these new health professionals are regulated, adequately trained and supervised and have a defined scope of practice. The role of the medical assistant As indicated in their title, medical assistants should work under the supervision of a registered medical practitioner. From the College s perspective this does not require the assistant to work side-by-side with the medical practitioner. In 1 Hooker, R (2006) Physician assistants and nurse practitioners: the United States experience, Medical Journal of Australia, 185 (1) New Zealand Society of Physiotherapists The Physiotherapy Assistant May Ministerial Review Group Report Meeting the Challenge July 2009 and the Report from the Medical Training Board Foundations of Excellence August

3 primary care settings it may be appropriate for the assistant to provide community based care under the instruction of a medical practitioner. The College would want the medical assistant to have a clearly defined scope of practice. The competencies and skills required to work as an assistant should be clearly articulated. The level of delegation would need to be defined. For example, a medical assistant would most likely be able to prescribe, however there would to be parameters regulating their prescribing rights Given that physicians practise in highly specialised areas, the numbers of assistants working with physicians may not be as great as they may be within primary care 4. In the College s view medical assistants could be employed in the area of chronic disease such as diabetes - in education, prevention and care. In respiratory medicine they might be employed in a similar capacity. The College envisages medical assistants working in clearly defined areas, such as an asthma clinic, and working as part of team well supported by other suitably qualified health practitioners, such as physicians, nurses and allied health practitioners. The College strongly emphasises that the medical assistant does not provide a replacement service for a physician, but provides a complementary service to the supervising physician. Working within a well-supported team, the assistant should be able to undertake pre-specialist assessments and screening at the direction of a physician; educative roles, and help streamline those consultations which are non-complex or routine, where there is a limited risk to the patient (e.g. they might deal with the need for repeat prescriptions where there are few or no co-morbidities). Assistants could be deployed to undertake some of the administrative tasks that Registered Medical Officers (RMOs) have indicated consume a great deal of their time and impact on their own job satisfaction. 5 Possible roles for the assistant include ordering tests and X-rays. Other examples of roles for assistants are within the hospital setting where they might undertake routine ward calls in busy acute hospitals, and work in post acute ward rounds and operating theatre assistants. No doubt assistants would have a greater role to play in the primary health setting and in the rural health setting. When developing the curriculum for medical assistants it may be necessary to clarify if assistants are to be trained as generalists (so they may practise in primary care) or as specialists (so they may assist in a specific areas of medicine.) 4 Hooker, R ibid 5 Commission on Resident medical Officer Workforce (2009) Treating People Well page 16 3

4 What training should a medical assistant undertake? Medical assistants would require a tertiary qualification in life sciences before undertaking training as an assistant. In the College s view these individuals should undertake a training programme at one of the universities offering medical degrees. Officials in the National Health Service, in the United Kingdom 6 are considering a two-year university degree which would lead to a statutory registered qualification. New Zealand could implement a similar programme. Some type of examination would need to completed by assistants before could legally practise. Practicums would need to be included covering the areas where the assistants may practise. Developing the role of medical assistants is not a quick fix solution to the current workforce issues. Training such assistants will require investment and, in the College s view, assistants will compete for training time and teaching resources. Senior medical officers are already under pressure from their employers to train doctors, deliver clinical services and provide leadership. Training assistants may become an additional pressure for those providing training in clinical settings. Clarification of the funding arrangements are required to ensure additional funds are made available to train assistants and funds not drawn away from nursing, physician training budgets to fund this new initiative. The College recommends that relevant international curricula are examined, and assessment procedures and learning tasks are evaluated to ascertain the most effective methods of training assistants. Should the practice of medical assistants be regulated? In the College s view it is essential that medical assistants are registered and apply for an annual practising certificate so that they are subject to the same level of regulation as any other health practitioner practising in New Zealand. The appropriate body to undertake these activities is the Medical Council of New Zealand. The College understands that the assistants would not be working as independent practitioners, however they would be operating at a particular skill level requiring monitoring of fitness and competence to practise. For example, it is likely that assistants would have limited prescribing rights, therefore regulation of the profession under HPCAA would be necessary. Other Issues To Consider There are other issues that the College wishes to address in relation to utilisation of medical assistants in New Zealand. 6 Brooks,P and Ellis,N (2006) Health Workforce Innovation Conference, Medical Journal of Australia,184 (3)

5 (1) IMG Recruitment The development of a medical assistant workforce should not be viewed as a solution to the issue of unregistered IMGs. The reasons these individuals failed to gain registration may also make them unsuitable to be medical assistants e.g. inability to communicate and comprehend English (see section 16 (b) HPCAA) or a poor background in life sciences. (2) Recruitment of Assistants from The Defence Forces In the College s view recruiting medical assistants from the Defence Forces would seem to be inappropriate. Training in a military environment may not be transferable to civilian health care. Also, the training obtained by military personnel does not seem to be of sufficient standard as the entry to the programme does not require a tertiary qualification in life sciences. For the reasons cited above, the College cannot endorse a policy that suggests that a medical assistant could become a doctor with some additional training. In our view the two professions are discrete and are not on the same continuum. (3) The Impact of Assistants on the Health Sector Workforce It appears the key reason to introduce medical assistants is to increase the health workforce thereby delivering a quality health service. The College questions if this will result in the desired outcome. There may be a switching from nursing and allied health to the assistant role and therefore no net gain in the health sector workforce. Conclusion It would seem rational to the College that physicians and other health practitioners are deployed in those areas where they can be best utilised and that they devolve less technical tasks to medical assistants. The College is supportive of the proposal to make provision for medical assistants with a view to improving service delivery within the health sector. In our view assistants would assist health practitioners, particularly in primary care settings. However, in order for this initiative to move forward the College believes further work is required. The assistant role must be fully defined and evaluated, the process of regulation developed, training (including curriculum) robustly designed and funding issues addressed before this initiative can be fully implemented. 5

6 The College is available to discuss this proposal with you, if you wish. The College looks forward to receiving further information regarding this proposal as it progresses. Yours sincerely Dr Ruth Anderson New Zealand Manager The Royal Australasian College of Physicians 6