A new BMJ article has found no convincing evidence that PAs add value to UK primary care, renewing support to do away with recurring whispers of expanding their role in Australia.
Physicians’ assistants are a “poor policy being imported from the UK” with “no coherent strategy”, says RACGP Queensland chair Dr Cath Hester.
Last week, The BMJ published a piece authored by Professor Trisha Greenhalgh and Professor Martin McKee which found no convincing evidence that physicians’ associates added value in UK primary care or anesthetics.
Of the 29 papers which met the inclusion criteria for the review, some preliminary support was found for ward-based work by PAs when appropriately supervised.
But studies reported that PAs struggled in primary care in the more autonomous roles where decisions were more uncertain and support was limited.
“Very few UK studies have assessed the clinical competence and safety of physician associates or anaesthetic associates,” wrote the authors.
“Findings of apparent non-inferiority in non-randomised studies may obscure important unmeasured differences in quality of care.”
In October last year, Queensland Health closed a statewide consultation on the role of physician assistants in the state’s workforce, after a proposal to expand PAs at some Queensland hospitals attracted outrage online.
The results of the consultation remain under wraps.
Dr Hester told The Medical Republic that expanding the role of PAs in the Australian health system was a “zombie policy” that resurrected when things were looking dire.
“It just keeps bubbling up every few years when our health system seems desperate enough for workforce solutions, but there’s really no coherent strategy that I’ve seen so far,” she said.
“It seems to be a reaction to workforce challenges that many health systems, including Queensland Health, are facing.”
Dr Hester said the findings from the recent BMJ paper were not surprising.
“The PA model is not a particularly wise or a particularly efficient one … it’s actually a little bit reckless and I think at this point it’s probably clutching at straws.
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“PAs [are] not registered as healthcare practitioners … In Australia there’s no current established training model for PAs, nor is there any established clinical governance around the use of PAs, either in hospitals or in the wider health system.
“We’ve also seen episodes where PAs have demonstrated profound unconscious incompetence, particularly those alarming reports that have been reviewed by the coroner in the UK, around some very tragic deaths of people who otherwise could have been safely managed.”
PAs have had an ever-expanding role in the UK health system since 2003.
Dr Hester said that there was little use for PAs in Australia and that they were an “all around bad deal for the health system”.
“[The PA model] is another example of very poor policy being imported from the UK,” she said.
“[PAs] have clearly not solved the workforce issues in the UK. I would be of the opinion that their health system is not the better for their use, I’d be very unhappy to see that dilution of the quality of our healthcare system in Australia.
“The answer is really basic, but really clear: we need to train, support and retain high-quality health professionals.”
Dr Hester said that there was a concerning potential for PAs to “cannibalise” some of the work of other health professionals like nurse practitioners, allied health and clinical pharmacists.
“The PA role has been very poorly defined and it’s got very poor boundaries.
“We do see encroachment or scope expansion, which is quite dangerous, but I would say in our healthcare system, especially given the fact that they’re not registered as healthcare practitioners … their utility is very, very low.”
AMA Queensland president Dr Nick Yim told TMR that the BMJ paper showed that research into PAs was “minimal, outdated and inconsistent in quality, providing inadequate evidence of their safety”.
“Physician’s assistants and other health workers are not a substitute for medical officers.
“AMA Queensland has opposed Queensland Health’s proposal until we can access the workforce data and clinical evidence that supports expanded use of the role.
“Such proposals risk patient safety and essential training opportunities for junior doctors who are our future medical leaders.
“We are also concerned that there is no current training system within Australia to produce physician’s assistants and we would be recruiting an unknown skill set that is not registered nor regulated by AHPRA.
Dr Yim said ongoing consultation with AMAQ, ASMOFQ and other stakeholders was necessary if PAs were to be implemented to ensure their scope of practice was clear.
“Any expansion of physician’s assistants must be considered as part of a future evidence, data and needs-based holistic workforce plan and not rolled out as another ad-hoc, band aid solution to our medical workforce crisis.
“The LNP has committed to a health workforce strategy, but we need to see the details.”
A spokesperson for Queensland Health told TMR that they were looking at workforce models to support service sustainability that included roles for PAs.
“Physician assistants provide valuable support to doctors and other clinicians, working within their approved scope of practice,” they said.
“To ensure the highest standards of patient care, Queensland Health has consulted with key stakeholders, including relevant associations, on the Physician Assistant Clinical Governance Framework.
“Queensland Health’s next step is to consider the feedback in the context of developing a new systemwide health workforce plan, as part of the Queensland Government’s Easier Access to Health Services Plan.
“Consultation on the systemwide health workforce plan is expected to commence soon.”
This article was updated at 4pm on 11 March 2025 to include comments from Queensland Health.
