Geert van den Brink (training coordinator for the Master’s programme for physician assistants at the Arnhem and Nijmegen Universities of Applied Sciences) recently completed his PhD research into the use of physician assistants (PAs) and specialist nurses (USs) in Dutch healthcare. He concludes that both functions are indispensable. And they themselves play an important role in further strengthening their position.
Van den Brink was the source of PA training. “At that time, 23 years ago, the profession still did not exist in our country,” he says. “In the United States it did exist, but it was still called a nurse practitioner at that time. The Ministry of Health, Welfare and Sport created the PA and VS platform to access the compensation system for these jobs. My presidency provided me with a good basis to conduct research on how the two professions have developed. This research eventually led to a thesis because I wanted to pass on my knowledge.
His research focused on the PA and the US. Are the features similar enough to justify this combination? “There are more similarities than differences,” he says. “If you look at the issues facing healthcare today – the availability of medical specialists, general practitioners, and geriatric care specialists, increasing treatment options, increasing patient empowerment – both groups play a huge role in access to and quality of care. Both have completed dual master’s degrees in higher education. But of course you can’t lump them together. In practice, the PA is more medically oriented and the US is not only medical but also nursing. The US has a nursing background. That’s the case for 50% of medical assistants, but the rest have a different paramedical background. Furthermore, there has already been more research done on the US, so I didn’t have to repeat that. That’s why my dissertation has two articles specifically on the PA and two articles on combining the PA and VS.
Expected growth
The share of PA and VS is still limited in relation to the number of specialist doctors in the Dutch hospital case. “I see this changing,” says van den Brink. “Their numbers will increase. They do a good job, the patient outcomes are just as good as the work done by doctors and in many cases better. Moreover, they are not more expensive and seem to have a positive impact on the job satisfaction of those who work with them. This is an important point in the context of sustainable employment of healthcare workers.”
PA and VS relieve doctors of many administrative tasks. “The workload is also high for them, so this is an important aspect of the efforts of these two groups,” says van den Brink. “It gives doctors more time for patients with complex conditions.”
Value Added
Van den Brink finds it difficult to say where the PA and the US have the greatest added value in healthcare. “Hospitals are in dire need of PAs,” says Van den Brink. “This has to do with the fact that many hospitals can no longer attract trainees. Then, shifts can’t be completed, and doctors have to start working on the front shifts again, which puts pressure on production. The US also finds a lot of work in hospitals. But that certainly doesn’t make the hospital the only place where both groups can have added value. Look at GP care now that many people no longer have their own GP. They can also play a role there. Also in elderly care, as well as in acute care. In mental health care, the US can be deployed as a coordinating practitioner, and the personal assistant can also be deployed based on his general medical knowledge. Occupational medicine is still an unexplored area. Given the huge shortage of company doctors, we are now seeing the first initiatives for deployment by the PA and the US. Even sporadically in clinics, but both professionals are better in their own place where they feel most comfortable.
Healthcare providers do not fully understand the value of PA and VS in all situations. “The best quality, cost-effectiveness and sustainable deployment can only be achieved with the right deployment of PA or US,” says van den Brink. “So this has to be carefully considered. If the work is very simple, it is best done by a physician assistant. If it is very complex, it should be handled by a physician. You also see it used for management tasks. You may wonder if this is the right level.”
stereotyping
He did not investigate whether either professional group was fully utilizing its strengths. “My experience is that both are doing exceptionally well,” he says. “Their professional associations NAPA and V&VN VS have also put the professions well on the map, but PAs and VSs need to stand out in their roles. It is also the job of the training courses to include them in this. Both professions are not yet known everywhere. When general practice starts working with the first PA or VS, the GP really has something to explain to the team and patients. In the hospital, sometimes the board and HR have to explain the added value of both professions. PAs and US should not shout about themselves, but rather demand a real position. Research plays a role in this. But also indicate at an institutional level what they can and cannot do. In the US for example you see them uniting in advisory groups, which is a great initiative that can achieve a lot. Furthermore, both PAs and VSs as a group can act as peers for students. They can be role models for the nursing profession. It is an attractive career path if you have ambition.
Increasing request
There is no shortage of interest in both courses. “There are far more registrations for both than there is space available,” says van den Brink. “These courses are expensive, so the government is checking whether the money is being spent efficiently. In the Capacity Authority working group I work for, we have seen an increasing demand for PAs and VSes over the past year and a half. I expect that after the current policy period – which runs until 2026 – a recommendation will be made to expand capacity. Both professions have become indispensable. You now see PAs and VSes in most institutions. Many patients have to deal with them. The initial resistance among doctors has also disappeared. I was recently in Düsseldorf, where the main PA programme is now being offered. There you can now see what happened here 10 to 15 years ago.
source:
Geert van den Brink received his PhD from Radboud University Nijmegen on 1 November 2023 with his thesis “Physician assistants and nurse practitioners in the Netherlands: a solution for healthcare”. www.geertvandenbrink.nl The thesis can be downloaded.
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