The Physician Assistant: An Unrecognized Gem

The PHYSICAIN ASSITANT (PA) profession is a young medical profession that is quickly moving into global health care in response to the overwhelming needs in the health care workforce created by multiple issues affecting health and health disparity. The practice of medicine is not the birth right of the Medical Officer / medical doctor. This might sound strange and controversial as doctors the world over are seen to be the ‘owners’ of medical practice. However, in many places of which Ghana is no exception, this birth right is fast fading away. There are other well qualified orthodox medical practitioners aside the doctors who see to clients on daily basis, some especially PAs see more clients in the health centers, polyclinics and district and regional hospital more than the doctors.

WHY THE INEPTION OF THE PHYICIAN ASSISTANT PROGRAM?

The main goal for the inception of this noble profession was the issue of primary care physicians shortage worldwide leading to a skewed doctor to patient ratio including Ghana. This led to the inception of this profession in the 1960s in the US and later its dissemination to other countries including Ghana to help bring the patient-doctor ratio to level. The trained physician assistants were primarily posted to the remote areas in their respective countries equipped with competencies and skills help deliver basic primary health care. This remains the main goal for the training of Physician Assistants in Ghana. It therefore can be concluded that the physician assistant is the main custodian of primary health care in Ghana but it is rather sad and disheartening to see that such a noble and vital profession is not being given the necessary attention and devotion from the government and also the necessary respect by the health system (in Ghana) as a whole.

THE PHYSICIAN ASSISTANT (DEFINITION AND SCOPE OF PRACTICE)

Physician Assistants, by definition, are health care professionals licensed to practice medicine with physician supervision (which is not the case in Ghana as PAs are not supervised by doctors here) and educated on the medical model designed to complement physician training.

Within the Physician-PA relationship, PAs exercise autonomy in medical decision-making and provide a broad range of diagnostic and therapeutic services.

Physician assistants are also involved in education, research, and administrative services in Ghana. Most of the health data in the country is generated with the help of PAs since they mostly are the sub- district in charges, where a bulk of health data is generated.

PAs are educated in the medical model and work as members of the total health team being autonomous in practice or in the physician-directed teams.

PA scope of practice is determined by: Education and experience of the PAs, the Country/State law, policy of the health care facility (government and private or quasi-governmental), delegatory decisions made by the supervising physician (this is usually not the case in Ghana as PAs practice independent of medical officers).

Determinants of the scope of practice is also based on what necessitated the birth of the PA profession in that country, that is, the need that was to be met by the PA professionals.

It is however worthy of note that the PA concept is easily adaptable to the to the specific health needs of other nations and that Category of “physician assistant” globally lacks standardization and has differing academic competencies, skills, and functions.

THE ROLES
In Ghana, the purpose of the PA provides comprehensive primary health services in support of the total effort of the health care delivery system and also to achieve equity in coverage and quality care especially in the Health Centers in rural areas and Polyclinics/Hospitals in the urban setting.

THE STRUGGLE
Trained Physician Assistants are posted mainly to the health centers in the rural areas with lesser equipment and also sometimes lesser or inadequate team support from the other members of the healthcare team to work tirelessly to deliver healthcare. Sometimes physician assistants are met with hostility with the other healthcare professionals especially the doctors on the issue of competence. Doctors feel that they are the superiors when it comes to healthcare delivery and most of the cases which I know have been coming out lately, doctors disregard the medical decisions of physician assistants and treat them as people who lack skills to practice making patients and other healthcare workers (especially nurses) doubt the skills of Physician assistants. Meanwhile, these doctors will not accept posting to the rural areas to work. I DON’T UNDERSTAND THIS!!!

The most disheartening issue is that of the government and the health regulatory bodies in Ghana (Ghana Health Services, Ghana Medical and Dental Council and Ministry Of Health). The government of Ghana has decided to turn a deaf ear to the cry and plea of physician assistants about their poor salary conditions in relation to their tedious and heavy work load. The health regulatory bodies also have decided to remain insensitive in hearing our cry to help solve this issue despite the numerous strike actions, demonstrations and boycotts made over the years by physician assistants. It does not surprise me though since the heads of these health regulatory bodies are doctors. THEY HATE PHYSICIAN ASSISTANTS FOR NO TANGIBLE REASONS!!!

I am forced to conclude my article because I fear I may lose control and say something inappropriate. As a concern citizen and a Physician assistant in the making, I along with my fellow practicing physician assistants and physician assistant students will tirelessly continue to urge and remind the government and the health regulatory bodies to recognize a gem when they see one and treat it with the utmost honour and care. The role of a physician assistant is very vital in the practice of medicine, especially in a developing country like our own. Let all who may read this article be touched and help make this noble profession a worthy profession.

LORD OWUSU BIO.
A Level 200 Physician Assistant Student
University Of Cape Coast