By Dr. Reginald Broekmann
In the USA, the function of the Physician’s Assistant has been part of the health system for several decades. This member of the health team is a highly trained individual who has completed a degree course and has been intensively trained to work under the direct supervision of a doctor – usually a specialist – who is fully responsible for the actions of the Physician’s Assistant.
In the early 1980s I visited Jacksonville, Florida, USA, where I met up with a Physician’s Assistant (PA) and was able to discuss his role within the health system. The PA was fully qualified (a three-year university degree) and was employed by a cardiologist. The role of the PA was to visit the patients under the care of his employer – who were exclusively patients who had been admitted to the Cardiac Intensive Care Unit of the local hospital. The PA would regularly examine these patients and communicate with the cardiologist. The PA was entitled to prescribe medicines for the patients and give instructions to the ICU nursing staff.
South Africa does not intend to have the Clinical Assistant programme as a post-graduate course, but candidates will be trained for three years, will have to pass an examination set by the Board of Medical Examiners and will do an ‘internship’. He/she will function under an appointed supervising doctor.
The Minister has stated “Medical assistants will be placed in district hospitals and will be part of a team in different units such as emergency, maternity, out-patient or surgical (services). In operating theatres, for instance, the assistants will work with doctors on basic procedures like incisions, drainage and evacuations.”
Given the shortage of doctors in South Africa, one can see the logic of the process. However, there are potentially negative outcomes as well.
On the positive side, hospital doctors would be able to decant some of their time-consuming tasks to the Clinical Assistant, tasks such as taking blood for laboratory testing, writing up case notes, arranging transfers and the like. This will relieve some of the stresses of clinicians, especially in rural areas.
On the negative side, however, the provision of ‘relief’ to embattled rural doctors may reduce the perception of the urgency with which our whole health system needs to be re-modelled. Failure to deal with the ‘push’ factors in rural and public health delivery may leave the Clinical Assistants providing hospital care without the supervision of medically qualified staff – effectively a ‘downgrade’ of hospital level care.
Furthermore, the system is likely to generate ‘turf wars’ between nursing staff and Clinical Assistants where their scopes of practice overlap. There may also be a clouding of the issues of legal liability regarding patient care and this will have to be addressed by the State as a matter of urgency.
In terms of the South African Qualifications Authority mandate, learning should be modular and there should be pathways to higher qualifications. The Clinical Assistants – as a health profession – are likely to insist on the establishment of such a pathway. This could open the way to becoming recognised as a medical practitioner without having to go through university training.
Modern healthcare is becoming increasingly more complex and the need for properly schooled practitioners to adequately assess research findings and clinical options is becoming ever more important.
In my view, the training of Clinical Assistants is a risky policy that may, in the longer term, aggravate the problems it was intended to solve.
