Ministry recognizes physician's assistants after nixing idea for years

Move stands in stark contrast to ministry’s lack of interest in the proposal; PAs less expensive, possess practical experience.

July 22, 2013 22:02
Transplant surgery [illustrative photo]

Organ transplant surgery doctor medical dr. 370 (R). (photo credit: Keith Bedford / Reuters)

The Health Ministry has in principle decided to accept physician’s assistants (PAs) as a fully fledged medical profession.

The move, aimed at addressing a shortage of doctors in Israel, stands in stark contrast to the ministry’s lack of interest in the proposal three years ago.

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PAs – recognized in the US since 1960 – are less expensive than doctors but possess practical experience treating patients under an MDs supervision.

A committee of nine experts, appointed last summer by ministry director-general Prof. Ronni Gamzu and headed by Israel Medical Administration (IMA) head Prof. Arnon Afek and Tel Aviv Sourasky Medical Center’s Dr. Gil Fier, presented its report a week ago. It was released to the press late on Monday afternoon.

Afek told The Jerusalem Post that the ministry will also recognize nurse practitioners (NPs) – an advanced practice registered nurse who has completed additional training beyond that of a registered nurse – and is launching a course for a group of such nurses in geriatrics.

Three years ago, when the Post conducted interviews with immigrants from the US who were licensed there in the two professions, both the ministry and the IMA were opposed to recognizing them. They thought recognition would “cheapen” the MD degree.

Immigrants coming with such accreditation had no choice but to work in other professions, hoping the ministry would come around to recognizing the professions.

Following the nine-member committee’s decision to recommend recognition for PAs, a smaller “implementation committee” will set down the details on what training PAs would require and formulate legal criteria, as well as attempt to persuade the IMA to go along with the move.

The committee stated in their report that they expect that a large number of paramedics – either those already working in emergency care role for Magen David Adom or United Hatzalah, or graduates of Ben-Gurion University’s program for paramedics who are not physicians – will become PAs.

There was no mention in their report of recognizing immigrants who came to the country with PA licenses from abroad.

Afek said that he would pursue in the implementation committee a suggestion by the Post that instead of training paramedics, the ministry should recognize olim with foreign PA licenses and launch a joint campaign with the Jewish Agency or Nefesh B’Nefesh to encourage the aliya of PAs. He conceded that the nine-member committee had not considered making use of licensed olim or encouraging the aliya of PAs living abroad.

Prior to the decision, PAs have been persona non grata in Israel, despite the growing doctor shortage as physicians from the former Soviet Union retire.

In the mid-1960s, when US doctors and medical educators realized that the nation was suffering from a lack of primary-care physicians, and an uneven distribution of those that they had, they decided to take action.

Dr. Eugene Stead of Duke University Medical Center in North Carolina established the first class of PAs, basing the curriculum partly on his knowledge of the fast-track training of doctors during World War II. The class consisted of Navy veterans who had considerable medical training during the war in Vietnam but couldn’t put that knowledge and experience to use in a civilian job.

Today, the PA profession based on Stead’s model has grown and thrived, and nearly 100,000 PAs are currently working for impressive salaries in hospitals and clinics under the supervision of MDs. PA training is usually two to three years of fulltime post-secondary education.

David, one PA who declined to give his full name, told the Post that a considerable number of PAs in the US are Jewish and that those interested in aliya would be happy to earn lower salaries working here if they were recognized.

According to the American Academy of Physician Assistants (AAPA), more than 43 percent of PAs work in group practices or solo physician offices, and over a third in hospitals. The rest are employed in rural clinics, community health centers, surgical facilities, nursing homes, school- or collegebased facilities, industrial settings and correctional systems.

According to the committee, the PAs will start by working in hospitals, especially in fields in which there is a severe shortage of physicians – anesthesiology, urgent care medicine, surgery, internal medicine and pathology.

Extra training and lab work will be required for pathologists and other similar fields.

Israel annually grants licenses to about four new physicians per 100,000 Israelis, compared to an average of nine in other OECD countries. It takes a minimum of 12 years to become a doctor in Israel.

“Many Israeli doctors who have experience studying and working in US hospitals are familiar with the PA profession, and tell me that they’d love to hire PAs, but the ministry and the IMA won’t allow it,” said David, a 49-year-old California-born, New York-trained PA with over 10 years of experience in emergency medicine who made aliya a few years ago.

“I can’t work here even as a consultant. I have gone to meet heads of emergency departments in Jerusalem hospitals; they know what PAs are and told me they’d hire me in a minute if PAs were recognized here.”

David said the only way he could get a medical job in Israel would be to take a paramedic course and then be hired by MDA, even though he already has experience in emergency care. He said he earned $120,000 a year in his West Coast hospital but would be willing to earn considerably less here “out of Zionistic reasons.”

Dr. Nahum Kovaski, the deputy director of the TEREM chain of private urgent care clinics, said that PAs “can provide high-quality medical care that would free physicians from many sometimesmundane tasks. These professionals could provide the time to patients.”

“At the same time, the simple reality is that these professionals are generally paid less than physicians and thus can help reduce costs in Israel. Top emergency rooms around the world make heavy use of these professionals. There are many such professionals who would happily move to Israel if they could. In TEREM, we definitely could use such professionals to further speed care and provide high quality across the board,” Kovalski said.

“We have not yet spoken to the IMA,” Afek told the Post.

“But I am optimistic. I can’t say now how many PAs there will be here. But we recognize now that this paramedic profession is important.”

He added that the ministry’s chief of nursing, Dr. Shosh Riba, will soon introduce the first course of nurse practitioners in geriatrics.

“I am very much in favor of it. It’s the first stage. We can’t run too fast, but now we have to be practical because of the manpower shortage,” he said.

Nurse practitioners treat both physical and mental conditions through comprehensive history-taking, physical exams and ordering tests for interpretation.

Nurse practitioners in the US can provide a diagnosis and recommendations for a wide range of acute and chronic diseases within their scope of practice and provide appropriate treatment for patients, including simple anesthesia, prescribing medications, serve as patient’s primary health care provider and see patients of all ages depending on their specialty.

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