The Scope Of A Profession-The Physician Asssitant’s Account

Globally, the Physician Assistant training started somewhere in the 1960s, as result of a shortage of physicians in the US. This was after the Vietnam War in the 1960's where many were injured and the shortage of physicians created a need. The first Physician Assistants to be trained were ex-corpesmen who had had some minimal training to cure and heal during the war. Dr. Eugene Anson Stead was one of the founding physicians who started this training. In 1967, the first class of Physician Assistants graduated from the University of Duke. As time went on, this new discipline was picked and adopted by several other countries including Ghana.

In Ghana, one of the problems faced in health care had always been the inadequate number of physicians. This was especially the case when one considered the situation in rural communities. The shortage of physicians, more popularly known simply as “doctors” to the local folks was common in health centres in rural areas where indigenes go for treatment and have no doctor present. If one asked why the doctor was absent, the responses would range from: “there are not enough doctors available” to “only a few are willing to be posted to this place”. The Physician assistant programme thus offered a solution to this. Through it, it could be possible to have health providers who could supplement the work of the physician and offer care.

Physician Assistant Studies started in Ghana at Kintampo College of Health in 1969 on an ad hoc basis. It began first as a diploma program called Medical Assistantship. This course was taken then only by the Senior Nurses to address the shortage and misdistribution of Physicians. Over time, the physician assistant (PA) profession grew rapidly-especially from the 1970s. As acceptance of Physician Assistants in the health care system increased, roles for PAs in primary health care took shape and the scope of the physician assistant practice became more clearly defined. Physician Assistant education moved to a degree-based system in the 1990s. Currently, some of the institutions that offer the degree programme include the University of Cape Coast, the University of Health and Allied Sciences and Central University College.

So one may ask who is a Physician assistant and what do they do? A “Physician Assistant" (PAs) is an academically prepared and highly skilled healthcare professional educated in the medical model to practice medicine within a physician-directed and patient-centered healthcare team. They are recognized as “accelerated medically trained clinicians” who practice as semi-autonomous health care providers in collaboration with Physicians. They are part of the active driving force that provides primary healthcare in our motherland. Though they are not much recognized in Ghana, Physician Assistants are widely involved in preventive and curative medicine by providing a plethora of health services.

Why should you choose a Physician Assistant over a 'Doctor' when it comes to primary health care? There are many instances where individuals look down on Physician Assistants. Some people, out of ignorance or mere disregard, refer to them as "Senior Nurses” or “Junior doctors". What people do not know is that there are certain advantages of the Physician Assistants. Firstly, their duration of training is shorter. While Physicians spend about seven years in training only to come and specialise, Physician Assistant take a shorter time to be trained, making them “readily available” to offer immediate primary health care. This makes them a more flexible but yet equally capable option when one requires primary health care.

Physicians Assistants are trained under a medical module, like Physicians, to deliver high quality medical care in both primary and secondary care settings. Also, studies have shown that, with majority of Physicians going into specializations, it is Physician Assistants who will remain the backbone of primary health in years to come. Other advantages of Physician Assistants over Medical doctors include continuity of care, family medicine, palliative care, routine care, treating acute and chronic illnesses, managing hospital inpatients, performing minor surgeries, and assisting during major surgeries. Physician Assistants have also drastically reduced the doctor-patient ratio hence relieving the pressure on Physicians.

Physician Assistants in Ghana are trained to be skilful and competent health care providers. They undergo rigorous training that prepares them for practice. In Ghana, for instance, Physician Assistance Studies lasts four-years. This is in direct contrast to the duration in other parts of the world where Physician Assistants are actually respected and fully utilised in primary health care. In Canada’s University of Manitoba, for instance, training is for 25 months-barely over two years. For a Ghanaian student, the 4-year period of intense classroom and clinical training is just the beginning. He or she must also take the licential exams mandated by the Medical and Dental Council - a replica of the American Association of Physician Associates (AAPA), which is the regulatory and accreditation body for Physician Assistants in the Western countries - under the authority of the Ministry of Health. It is only after passing this exam that the graduate can practice in the country.

Challenges of being a physician assistant are numerous. First, the exorbitant cost incurred during the training is a huge non-incentive. The course is offered in most tertiary institutions on a fee-paying scheme. In the University of Cape Coast, for instance, Physician Assistant students pay not less than GH₵ 6,000 as fees annually. Then, when graduated and practising, they will not even get to enjoy full autonomy. They have to be supervised by the Medical doctor at the health facility or a distant one and this limits their freedom to practice. In some Western states, the Physician Assistant is limited in the prescriptions of some controlled substances- a situation that the American Academy of Physician Assistants (AAPA) argues impedes the Physician Asssistant’s flexibility to manage their workload. The situation is no different here in Ghana where Physician Assistants are sometimes queried for some prescriptions and incidents that require the P.A to wait for the approval of the “almighty doctors” to render some services. Also, there are not enough incentives for the PA despite the extra hours these Physician Assistants put in at health facilities, especially in the absence of the Physician during the night shifts. There is also the case of the non-inclusion of fields of specialization after the degree programmes. Currently for the PA students, there are no other avenues for specialization aside dermatology and mental health in Ghana.

Looking into the future, for improved primary health care and the accomplishment of United Nations' Millennium Development Goals on health, I recommend that there should be abolishment of the fee paying structure of physician assistant programme, to make it more affordable. There also should be more specialization fields to boost productivity in overall healthcare. In addition, those laws that limit the flexibility of Physician Assistants should be revised and amended so that Ghana can finally achieve universal health coverage.

Thank you
ACKNOWLEDGEMENT
Dr. Kingsley Pereko
By Senaya Ethel Enam Yawo,
Physician Assistant Student,
University of Cape Coast.