Physician associates Tiffany Hodgson (left) and Jackie Sartorius. Photo / Dean Taylor
When Kiwis talk about healthcare a favourite topic is the shortage of general practitioners at grassroots level — from sole operators in small towns to busy clinics in towns the size of Cambridge and Te Awamutu.
One solution that is getting traction is a system of physician assistants developed out of need in America following World War II.
And here in New Zealand Te Awamutu Medical Centre is leading the charge to have these practitioners recognised and integrated into the medical system.
In New Zealand they are known as a physician associate (PA). There are just seven in the country and two are working in Te Awamutu.
Alaskan Tiffany Hodgson is a pioneer of the role in New Zealand.
She married Russell Hodgson, who was born and raised in Te Awamutu, and they live in Cambridge with their two Kiwi-born daughters.
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Tiffany has been in New Zealand nine years and was part of the second PA trial in 2013, working in Hamilton. The trial went for 16 months.
After the nationwide trial finished in 2015, and her second daughter was born, Tiffany joined Te Awamutu Medical Centre as a part-time PA.
Tiffany explains that the concept was developed in the USA when servicemen and women returned home from war to a country desperately short of medical professionals.
Doctors at Duke University realised many returning service personnel had medical experience through necessity or training, so the physician assistant programme was developed to fast-track those medics through medical school.
Today, people with the required educational qualifications and medical experience can apply to undertake a further two years study to become a physician assistant.
In the United States it is a nationally recognised qualification that allows the graduate to work in the medical profession — under the supervision of a doctor.
In America there are 130,000 PAs working in all fields of medicine.
They are able see patients alone, be partners in clinics, assist in theatre and can prescribe medication.
To qualify applicants need a bachelor degree, a minimum of 2000 hours patient care experience and pre-med pre-requisite papers.
New Zealand PAs are not regulated at this stage, but they have formed the New Zealand Physician Assistants Society and are lobbying the Ministry of Health for greater recognition and authority.
Tiffany served as vice-president of the society for two terms and is now an adviser.
Her colleague in Te Awamutu, Jackie Sartorius, is treasurer.
Tiffany's background is in mental health, specifically addiction disorders such as eating, drugs and alcohol.
She says she always had an ambition to continue on to PA school and says it is a move she has never regretted.
"It is less stressful than being a doctor, but I still get to help people," she says.
"Being a PA is also good for work/life balance."
Tiffany completed her medical training at Loma Linda University in California. She holds a Bachelor degree in Health Science and Masters degree in PA Studies.
She has special interests in wilderness medicine, children's health, dermatology and whole-person care.
Jackie is from South Lake Tahoe in California and moved to New Zealand for the job about 10 months ago after she and her husband Ben met Tiffany while on holiday here.
They are also living in Cambridge and Ben has been able to use his skills and qualifications to win a job with Waipa District Council's parks and reserves team.
Jackie has a background in education and healthcare.
She says her goal was to be involved in a profession where she could help people.
She was a science teacher for four years and gained her patient care hours volunteering at a hospital part-time for a year.
Jackie holds a Bachelor of Science (Honours) in Biology and a Masters degree in Education and completed her medical studies at Idaho State University, gaining a Masters degree in PA Studies.
Tiffany says interest is growing in New Zealand and other clinics are looking to employ PAs.
She says she is fully invested in making it work in New Zealand and making it viable for US trained PAs to help out here until eventually Kiwis can be trained as PAs in one or both of our medical schools.
"I'm a citizen now and committed to my community. I love it here," she says.
Tiffany has also partnered with Te Awamutu Medical Centre colleague Dr Hannah Shaw to form and operate a PA recruitment company.
She says they look to the US for suitable recruits as, although there are similar programmes around the world, she believes the US training system is the most robust.
Te Awamutu Medical Centre general manager Wayne Lim says that although the clinic did not participate in the original national pilot, staff were enthusiastic in 2015 about having PAs in the clinical mix.
"We were one of the earliest clinics in New Zealand to take on PAs as part of our permanent provider mix, and we have been their vocal champions ever since," he says.
"Out of the seven PAs currently working in New Zealand, three have worked, or are currently working, for us."
He says PAs are highly skilled and come with a wide range of experience, including family medicine and time with the military as a couple of examples.
"From my view PAs are highly capable, readily available and already used to working under supervision of a GP.
"They represent value from a business perspective, and it makes total sense to utilise their skills to serve our patients," says Wayne.
Tiffany says the shortage of GPs is a national problem that will not be solved quickly just through recruitment and training of more doctors.
"PAs and nurse practitioners both have a part to play in helping us meet the health needs of Kiwis," says Wayne.
"More nurse practitioners are being trained these days, and their scope has widened, so that will help in future.
"But more urgently, PAs are an untapped group of already trained medical experts who can help us combat our GP shortage starting right now.
"We anticipate that formal registration and a quality framework will be put in place for them in New Zealand before too long and they could be a great solution for health provision, especially in provincial areas, once they are allowed to prescribe."
Tiffany and Jackie say their reception in Te Awamutu has been warm, from both colleagues and patients.
They believe there are even advantages to them working here because, by the nature of the role, patients get the benefit of a team-based approach.
Wayne agrees.
"I believe we need both physician associates and nurse practitioners to complement our GPs," he says.
"Here at Te Awamutu Medical Centre we are working towards having both in our mix in future."
‘This is about a bigger sort of commitment that we have to te reo Māori.’