2010 Paulatim Magazine - RAAMC Association

The Next Step for Australian Army Medics
A Physician Assistant (PA) is defined as a “midlevel health care
practitioner working under the delegated authority of a medical
practitioner”. 1 The PA profession has developed over several decades
in the US and proven to be successful in augmenting the medical
workforce and addressing geographical inequities in the provision of
health services. Such outcomes have been mirrored more recently in
Canada and the UK. 2,3 No framework currently exists for Medics
however to upskill.
The wheels are starting to turn in regards to the acceptance and
integration of PA into the Australian health system. Australian health
policy makers have looked to emulate the success of PA overseas by
developing our own PA profession. The South Australian and
Queensland health departments have conducted recent trials on the use
of overseas trained PA in their public hospitals. 4,5 A review of these
trials is underway with the prospect of PA professional recognition and
employment in these states a genuine possibility.
PA could play a valuable role in the Army’s health system, providing
accreditation for medics in their own right, upskill medics for key
functions in the fighting echelons, replace MO and providing the ability
for medics to clinically up-skill. A review of the current training
continuum for Australian Army medics and opportunities for ongoing
professional development is in order. In early 2009, a new structure for
training medics to the level of Advanced Medical Technician (AMT) was
instituted. A medics formal training is complete after the Advanced
Medical Assistant Course. AMTs are then posted to units to begin their
career as medics. 6
Once a medic has completed AMAC and become an AMT, further
medical training options for medics are very limited. Few positions are
available for medics to up-skill. Opportunities include ADF courses such
as Rotary Wing Aeromedical Evacuation (RWAME) training, Fixed Wing
Aeromedical Evacuation Training, Underwater Medicine and Aviation
Medicine, placements in public hospitals through ‘strategic alliance’
agreements. Once a medic moves into senior positions as a SGT or WO,
they take on a management and training role, with little need to either
utilise or develop their clinical skills. It is at this point that many senior
medics, some of the Corps’ most experienced and capable members,
feel they need to make a decision regarding their future prospects –
stay in the Army to mentor and manage junior medics as a WO or
ASWOC, or leave the army to pursue professional development in the
civilian healthcare sector.
This latter option generally involves further formal studies and with
their associated sacrifices. Popular study choices for medics leaving the
army include nursing, paramedical science or medicine. Others who
choose not to go on to other studies may find work as medics on a
contract basis with mining companies or on oil rigs. Employment in
public health organisations, medical administration, medical training
providers and consultancy are other options, but generally do not
involve practising clinical medicine.
Medics, particularly senior medics, must be offered a pathway within
the Army for the ongoing development of their clinical skills. This will
give those medics that do not wish to pursue a career in training and
management an incentive to remain in the ARA. The Corps’ investment
in these members’ years of training will continue to pay dividends and
not be lost as it is when medics discharge. The Corps will also retain its
most seasoned NCOs, maximising the effectiveness of our presence both
on operations and at home.
In July 2009, the University of Queensland (UQ) welcomed the first
intake of students into its new Master of Physician Assistant Studies
(MPhysAsstSt). The first program of its kind in Australia, it is open to
students who possess a bachelor’s degree in a health related discipline,
a Grade Point Average (GPA) of 4.0 and one year of experience in
direct patient contact. Students study four Part A courses dealing with
PA theory and clinical skills on a part-time basis over one year, followed
by eight Part B courses on a full-time basis over another year that
involve rotations in general practice, internal medicine, aged care,
surgery and emergency medicine, as well as two elective rotations.
The Part A courses are taught externally, with a two residential teaching
periods each semester (two weeks at the start of the semester and one
week towards the end). The Part B courses can be untaken in clinics,
aged care facilities and hospitals as discussed with, and approved by,
the Program Director. Students can choose to exit the program after
completing the Part A courses with a Graduate Certificate in Physician
Assistant Studies (GCPhysAsstSt). 1,3
Many RAAMC medics do not have a bachelor’s degree, making them
ineligible for direct entry into the MPhysAsstSt. However, an alternative
pathway to the MPhysAsstSt is through the GCPhysAsstSt. The
prerequisites for the GCPhysAsstSt are a post-secondary health
qualification and a minimum of five years full-time recent experience in
direct patient care. GCPhysAsstSt students complete the four Part A
courses, with those achieving a GPA of 5.0 being guaranteed entry to
the MPhysAsstSt. Students then only need to complete the remaining
eight Part B courses. 1 Karen Mulitalo, Program Director at UQ for both
the Masters and Grad Cert programs, has confirmed that the Army’s
medic training continuum (BMAC, Cert IV Nursing, OJT, AMAC)
as outlined above is considered to be a ‘post-secondary health
qualification’ for the purposes of entry to the GCPhysAsstSt
(oral communication, May 2010). Once in the MPhysAsstSt, there is
even the option for a medic’s work in primary health care in the Army
to be accredited as part of their general practice and elective terms. 6
6 2 P A U L AT I M – M A GAZINE O F T HE R OYA L A U S T R A L I A N A R M Y M E DICAL C O R P S – 2 0 1 0