The man's GP believed he was getting counselling for his depression. Photo: 123RF
Not every health problem needs a doctor to deal with it.
That is the diagnosis of Taranaki GP Nick Loveridge-Easther, whose practice network is one of those embracing a new multi-disciplinary way of working, including employing two overseas-trained physician associates.
Part of the health workforce in the United States since the 1960s, physician associates - or PAs - work under the supervision of a doctor, but see patients independently.
"I think there's always a bit of hesitancy with anything new, but we've only had great feedback about our PAs," Loveridge-Easther said.
"They [patients] have to get used to the fact that they can see an appropriate provider for an appropriate condition in an appropriate time, if we take all these other workforces on board."
Together with nurse practitioners, extended care paramedics, pharmacist prescribers and other health workers, physician associates had huge potential to increase New Zealanders' access to timely, quality healthcare, he said.
Chronic workforce shortages were a problem across the health sector, including primary care - 44 percent of GPs intend to retire within 10 years, according to the Royal NZ College of General Practitioners
The Ministry of Health was currently in the process of considering regulation for physician associates, who first applied to be regulated back in 2017.
Meanwhile PAs were allowed to practice in New Zealand as long as they had at least five years' experience and maintained certification in their home countries.
New Zealand Physician Associate Society president Shelly Collins said their scope of practice was the same as their supervising doctor's.
"If I have any questions or anything I'm not very comfortable with, I discuss it with my supervising doctor. Otherwise I just see patients and do my thing."
In order to qualify in the United States, physician associates complete a bachelor's degree, followed by a master's degree, which includes more than 2000 hours of hands-on patient care.
To maintain certification, they do 100 hours of continuing medical education every two years and re-sit an exam every 10 years.
Ministry of Health chief medical officer Joe Bourne said there were currently about 50 PAs practising nationwide, mostly in rural GP practices.
The first pilot of the Physician Associate (PA) role in New Zealand was at Middlemore Hospital in Counties Manukau District Health Board (CMDHB) in 2012, with further trials in 2013 and 2015.
Despite a positive evaluation, Health Workforce New Zealand decided against recommending further action at that time.
"The question of what role (if any) PAs should play in New Zealand's health workforce therefore remains an open one."
In 2017 the PA profession applied to the ministry for regulation under the Act and the ministry was still assessing that application.
"In brief, the need for regulation under the Act is based primarily on assessment of the risk of harm to the health and safety of the public or that it is otherwise in the public interest to regulate the profession under the Act."
Ensuring public safety included assigning a responsible authority (like the Medical Council) to set the scope of practice and required qualifications, and maintain a publicly accessible register of members.
"Consultation on the ministry's proposal to regulate the profession was recently conducted, and the 49 submissions received are currently being analysed," Dr Bourne said.
"The ministry will then provide further advice to the Minister of Health and will seek his instructions on whether or not the application should be progressed.
"If the application is progressed, the final decision on whether the profession should be regulated would be made by Cabinet."