If you book an appointment at a GP clinic or urgent care centre, the person who sees you may not be a doctor or a nurse. They could be a physician associate, a role that became a regulated health profession in New Zealand on 1 October.
The Medical Council of New Zealand, which also regulates doctors, now registers physician associates. RNZ reports there are about 50 working here, all trained overseas.
What is a physician associate?
The Medical Council describes physician associates as trained and qualified health professionals who always work under the supervision of a medical doctor. The role started in the United States in the mid-1960s and is also regulated in Canada and the United Kingdom.
They used to be called physician assistants, and are often known as PAs. The Minister of Health confirmed "physician associate" as the official title in New Zealand.
RNZ spoke to Andie Cook, who has worked as a physician associate here for about a decade and is now at an urgent care centre in Hawke's Bay. Coughs, colds, chest pains, breathing problems, injuries such as fractures, and abdominal pain are all common in her work, she said. Physician associates also work in general practice and hospitals.
What can they do, and what can't they?
According to RNZ, physician associates see patients, form diagnoses and make treatment plans.
The key limit is medicine. Physician associates cannot legally prescribe in New Zealand, even though they can in some other countries. If you need a prescription, they review your case with their supervising doctor, who writes it.
The Medical Council has also set supervision rules. Its chair, Dr Kenneth Clark, told RNZ that physician associates must work under a doctor's supervision for their whole career. The primary supervisor must be a vocationally registered doctor, and physician associates "may only work in settings where onsite supervision is available and must not be rostered to practise solo."
Will they tell me they are not a doctor?
They should. Clark said the council's standards require physician associates "to identify their profession clearly and tell patients they are not medical doctors." They must also explain their role in a way patients can understand.
If you are not sure who you are seeing, ask. That matters more if English is not your first language and job titles are unfamiliar. You can ask what their role is, who their supervising doctor is, and how a prescription or referral will be handled.
Who can register?
The Medical Council has four ways in, RNZ reports. Three are for people with an accredited physician associate qualification from Canada, the United States or the United Kingdom. The fourth is for people already working as physician associates in New Zealand.
Clark said applicants need three years of clinical experience in the past five years, working at least half-time, in a similar area to the job they are applying for. The New Zealand pathway also requires at least 24 months of practice here immediately before applying.
New registrants start in a provisional scope of practice. The council has to approve their position, their main supervisor and the supervision plan.
There is no local training course yet. Supporters hope regulation will lead to one, RNZ says.
Why some doctors are worried
Not everyone welcomes the role. RNZ reports the Resident Doctors' Association has called it a cost-cutting exercise and said the money would be better spent on doctors and nurses. Some people also question whether doctors have time to supervise.
The Royal Australasian College of Physicians has raised concerns about safety, cultural competency with Māori patients, and resources being taken away from training the next generation of doctors. Its Māori health committee chair, Dr Matt Wheeler, told RNZ he was concerned overseas-trained staff would increase inequity between Māori and non-Māori.
Those in favour say the main benefit is more appointments. Health Minister Simeon Brown said regulation showed the Government's commitment to patient safety and high-quality care. Cook said doctors who have worked with physician associates usually find supervision is "not a burden whatsoever", and that patients "want to get seen and treated in timely fashion."
For the people already doing the job, regulation also brings protection. Before 1 October, Cook said, there was no authority to back physician associates in complaints, and nothing stopped untrained people calling themselves one.
If you are new to New Zealand and still sorting out primary care, our guide on how to enrol with a GP explains how enrolment works. We have also looked at what Southern Cross covers for Mohs skin cancer surgery.
