Clinical Careers  -  Physician Assistant

Background

The four District Health Boards in the Northern Region of New Zealand (Auckland District Health Board (ADHB), Counties Manukau District Health Board (CMDHB), Waitemata District Health Board (WDHB) and Northland District Health Board (NDHB)), in collaboration with the University of Auckland Faculty of Medical and Health Sciences, are proposing to undertake a pilot study of the Physician Assistant (PA) role.  Physician Assistants are not currently part of the health workforce in New Zealand.

The overall purpose of the pilot will be to determine whether the PA scope of practice, as practiced by PAs trained under the USA medical model and working under the delegation of a registered medical practitioner, has a role to play in the future of health services in New Zealand (NZ).  The scope of practice for PAs in New Zealand will be different and initially narrower than that in the United States, but it is expected that it will evolve during the pilot as understanding of the opportunities of the PA  role in the New Zealand setting is clarified.

As a first step, it is proposed to start with a small pilot in surgery at CMDHB in South Auckland.  The pilot will be in the department of general surgery surgery.  The proposal is to bring two USA trained PAs to NZ to work at CMDHB for a period of twelve months, commencing in 2010.

The pilot may get expanded to other sites in the Northern Region.

 

Overview of NZ Public Health System

Health services in NZ are primarily publically funded, with a relatively small private sector covering mainly elective surgical services.

The public funded health services are delivered through organisations called District Health Boards (DHBs) which are responsible for providing health care services for the population of a specific geographical area.  There are 21 DHBs in NZ.

The statutory objectives of DHBs include improving, promoting and protecting the health of communities, promoting the integration of health services, especially primary and secondary care services, and promoting effective care or support of those in need of personal health services and disability support.

 

Counties Manukau District Health Board (CMDHB)

CMDHB covers the southern region of Auckland, New Zealand’s largest city, and looks after a population of approximately 465,000 (more than 10% of NZ’s population) a third of which are of Maaori and Pacific Island descent.  Counties Manukau enjoys an international reputation for world-class orthopaedics, burns and spinal injury rehabilitation, and it also specialises in neo-natal intensive care, renal dialysis, and reconstructive and maxillo-facial surgery.  CMDHB is unique in terms of the diverse population it serves and the medical challenges it faces, which makes it an excellent training ground for medical procedures and cultural practices alike.

Counties Manukau DHB has two major health campuses, Middlemore Hospital and the Manukau Health Park.
 

Middlemore Hospital

Middlemore Hospital is the largest hospital operated by CMDHB.  It provides predominantly acute secondary level care and a selected range of community and domiciliary services.  Middlemore also provides niche tertiary services for the region and nationally in orthopaedics and plastic surgery, burns, spinal rehabilitation, renal dialysis and neonatal intensive care.  Middlemore Hospital is one of the largest tertiary teaching hospitals in NZ. Annually, it admits more than 91,000 in-patients, and handles in excess of 354,000 day-patient and outpatient attendances.  It employs around 4,700 staff.
 

Manukau Health Park

The Manukau Health Park includes a surgery centre and the SuperClinic and is 9 km from Middlemore Hospital.

Surgery Centre

The Surgery Centre has 10 operating theatres, 2 procedure rooms and 78 inpatient beds.  The Centre provides elective surgery, including day surgery and acute arranged surgery for patients who are not expected to need access to intensive care or interventional radiology.  Surgery performed at the Centre includes orthopaedic surgery including joint replacement, general surgery, colorectal surgery, breast surgery including breast reconstruction, gynaecological procedures, plastic surgery, ORL/ ENT and ophthalmology.

Manukau SuperClinic

The Manukau SuperClinic provides specialist outpatient appointments and day procedures for orthopaedics, paediatrics, ORL and audiology, medical and medical subspecialties, women’s health, ophthalmology, general surgery, breast clinic and palliative care.

 

Surgery Department at Counties

The surgery department at Counties provides a full range of general surgical services, with particular expertise in vascular surgery, gastrointestinal, endocrine, trauma, colorectal and breast surgery.  There are also close links with the gynaecology and gastroenterology services as well as the other CMDHB surgical specialties.

There is a variety of elective and acute surgery, with a strong commitment to excellence in patient care and staff satisfaction.  Specialty services include breast, colorectal and vascular surgery.

There are currently 10 consultant surgeons, 4 vascular surgeons, 11 registrars and 12 house surgeons across three wards. The service is dedicated to teaching students and training doctors as part of the South Auckland Clinical School, and the University of Auckland School of Medicine. An Associate Professor in General Surgery is a member of the department and there is a strong research base.

The department fosters a multidisciplinary team approach.  Strong leadership has created a friendly, enthusiastic, motivated and supportive environment.