Workforce issues – The registration of physician associates is a move in the right direction

Physician Associates (PA) are set to become officially registered health professionals under the HPCAA with oversight of the Medical Council of New Zealand. Arrangements for this are expected to be complete in 2026, once the Medical Council has developed its processes for assessing registration and competencies.

We know that not all doctors will welcome this group of health professionals into New Zealand's primary care space alongside doctors and nurse practitioners. The Board of Medicus has, for some years, accepted PAs for membership and through that has provided them with professional indemnity insurance. This decision was made three to four years ago after careful review of their training and experience.

PAs in New Zealand received their initial training in the UK, but more recently some have also come from the United States. In the absence of registration, all those practicing in New Zealand maintain ongoing accreditation in either the UK or the US. PAs from the UK have an initial degree in biomedical science, followed by a full-time two-year university course with a curriculum that mirrors that of medical schools. The curriculum adheres to a framework developed with the Royal College of Physicians and the Royal College of General Practitioners. This is followed by a one-year internship during which time PAs gain clinical training through rotations at medical facilities. Their intern time includes a minimum of 350 hours in general hospital medicine and 90+ hours in mental health, surgery and paediatrics. In this way, they are trained as medical generalists.

The professional healthcare workforce shortage in New Zealand and indeed throughout the developed world is very real. The solution will not simply rest with training more doctors or seeking more medical immigration, methods which we have traditionally relied upon but have failed us.

There is a real need to embrace new entry points into the professions and healthcare system. This includes advanced practice providers (APPs), such as nurse practitioners and physician associates, which we have in NZ but have not yet fully embraced.

It is worth noting that in the UK, there are currently approximately 6000 PAs working in an even split across trusts, core organisations and in GP practices and primary care networks. This compares with approximately 50 PAs working in NZ at the present time. The UK government plans to grow PA numbers to 10,000 in the next 10-12 years. Other APPs such as nurse endoscopists and nurse anaesthetists already exist in many developed countries without any evidence of lowering of professional standards or healthcare delivery. The time is now, for NZ to fully embrace PAs and to begin considering further APP options.

Dr. Richard Stubbs

Chairman of Medicus NZ Inc