Shouldn’t The Physician Assistant Be Looked At With More Importance And Value In Ghana?

The Physician Assistant; the Village Physician; the physician in the absence of the physician. Physician Assistants (PAs) are academically prepared and highly skilled healthcare professionals educated in the medical model and licensed by the Ghana Medical and Dental Council to practise medicine within a physician-directed and patient-centered healthcare team. They are recognized as “accelerated medically trained clinicians", who practise as semi-autonomous providers in collaboration with physicians. PAs deliver medical and surgical care in teams with physicians, who provide medical supervision and delegate tasks to the PAs.

The Physician Assistant in Ghana plays a lot of roles in healthcare service delivery that result in the ease of burden on the rest of the service deliverers and increase patient satisfaction. Some of such roles include: understanding etiologies, risk factors, underlying pathological processes and epidemiology for medical conditions. They also identify signs and symptoms of medical conditions, select and interpret appropriate diagnostic or lab studies, manage general medical and surgical conditions, including understanding the indications, contraindications, side effects, interactions and adverse reactions of pharmacological agents and other relevant treatment modalities. Similarly, they identify the appropriate site of care for presenting conditions, including identifying emergent cases and those requiring referral or admission. They identify appropriate interventions for prevention of conditions. Additionally, PAs identify the appropriate methods to detect conditions in an asymptomatic individual, differentiate between the normal and the abnormal in anatomic, physiological, laboratory findings and other diagnostic data. Last but not least, PAs appropriately use history and physical findings and diagnostic studies to formulate a differential diagnosis and provide appropriate care to patients with chronic conditions.

The resultant effects of the roles played by Physician Assistants can’t just be overlooked as they bring numerous direct and indirect benefits to the patient, the Physician and the nation as a whole.

Physician assistants ensure the continuity of medical care in the absence of the Physician. The Physician assistant, in the absence of the Physician, ensures the continuity of medical care especially in the rural Polyclinics and District Hospitals where you can have just one and two physicians respectively. This prevents the pain and agony patients go through in the absence of the physician. Similarly, Physician Assistants who are the sole medical service providers in health centers and clinics are able to prevent majority of the preventable diseases and complications of patients' conditions which altogether reduces the amount of patient congestion at the District, Regional, Municipal and Teaching hospitals. The use of PAs in hospital settings has also increased in response to restrictions in resident duty hours, as more hospitals integrate PAs into their services to perform tasks previously completed by physician residents.

The Physician assistant, by performing his roles, reduces the amount of work stress on physicians. Physicians experience expanded practice, greater efficiency and greater access to care for their patients in the presence of the Physician Assistant. Physician Assistants working in District Hospitals and Polyclinics, especially those in the rural areas, carry out minor procedures as instructed by physicians, and in the absence of the physician assistant, the physician has to carry out such procedures by himself including the major ones. Physician assistants, during ward rounds, help carry out procedures such as - passing of an intravenous line, passing of naso-gastric tubes, catheterization, among others, which facilitates a speedy rate of ward rounds and easing Physicians of hectic ward rounds stress as well as patients of the stress involved in waiting for Physician review of their conditions. This, in short, reduces work load on physicians in such deprived areas hence reducing their work stress.

Physician Assistants also reduce the waiting period of patients at OPD for consultation in health facilities. PAs are proving to be particularly useful as they help with Out-Patient Department consultations by seeing patients with minor conditions and allowing the physician to manage more complex cases. A supervising physician may also delegate a PA to perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, prescribe medications, manage patients with chronic conditions, perform minor surgical procedures, provide patient education, among others, while he sees to patients with more complex conditions. When PAs assist with patients with lower acuity, the Physician is able to see more patients faster, reducing wait times and increasing patient satisfaction.

Physician Assistants, with such amazing results through the playing of their roles, have a good number of challenges which are being overlooked, bringing their capabilities to a crawling stage. A few among the challenges PAs face include the struggle to find the appropriate balance of autonomy and supervision in their practice, high cost involved in the PA's training and the feeling among most physicians that the responsibility of supervising and delegating to a PA is too burdensome.

In my submission, I suggest the PA's training cost be subsidized especially in the Ghanaian universities to increase the number of PAs in the health system since they are needed in clinics, health centers, polyclinics, district hospitals, regional hospitals and the teaching hospitals. As of now, we have only 7% of PAs in the rural clinics and health centers in Ghana, which, in my opinion, is not good enough to improve upon healthcare service delivery at the grassroot level. Also, PAs, if allowed to operate as an autonomous body with a well-defined job description, will improve upon their work output and allow the Physician to have less or no responsibility in supervising the PA at work. To lift my pen of submission, I put to my readers that, if the Physician Assistants' challenges are given better attention and their demands met in terms of their number and better conditions of service, morbidity and mortality rates in Ghana will reduce drastically since PAs mainly tackle diseases in primary prevention and secondary prevention which, if very effective, tertiary prevention, where most mortalities occur, will be of the least in healthcare service delivery.

WRITTEN BY- NUHU BERIME OSMAN, A LEVEL 200 STUDENT OF PHYSICIAN ASSISTANT STUDIES-UNIVERSITY OF CAPE COAST.