Clearing the confusion over ‘physician assistants’
Published: 25 Jun. 2023, 19:37
Yoon Seok-jun
The author is the dean of Korea University Graduate School of Public Health.
Physician assistants (PA) has been getting frequent mentions these days. PAs began working in hospitals from the late 2000s to compensate for the shortage of doctors following the rapid surge in hospital beds at the time. There are an estimated 7,000 to 10,000 active PAs in Korea.
PAs have gotten attention because they are not ensured of their legal status and protection, though they often provide health care as medical professionals typically expected of doctors. I had surveyed their status quo at the request of the government.
I have discovered that they act much of the past roles of resident doctors or attending physicians in hospitals. In Korea, more than 90 percent of the PAs are nurses. The rest of them medical assistants having license and qualifications for emergency practices and other treatments.
But the problem is that in many cases, patients — the consumers of medical services — are not aware whether the services they receive at hospitals are those from doctors or PAs. The standards of PAs differ by hospitals and departments due to the lack of systematic training programs. What’s more worrisome is that medical practices by PAs are not kept record.
Unlike in Korea, PAs are raised in a legitimate way in countries like the United States, the UK, and Canada. They typically must go through a three-year post-graduate PA course and take a state exam to certify for the role and work in hospitals and clinics. PAs can work well in the U.S. thanks to the horizontal relationship common in organizations.
But medical settings in Korea are still running on the vertical mechanism, where hierarchy is important. If Korea adopts the PA system in the U.S., a greater conflict may arise in hospitals or clinics due to a lack of clear standards required of their professions and roles.
A revision to the Nursing Act, which was railroaded by the majority Democratic Party in the National Assembly to help expand the role of nurses, was vetoed by President Yoon Suk Yeol on the grounds that the revision could stoke confusion and conflict in medical fields.
The Korean Nurses Association (KNA) has launched a unique strike — only doing the job required of them while refusing to do other medical services they have so far carried out on behalf of doctors. (If they are instructed to do such extra jobs by doctors, they must report it to the KNA.) As a result, medical fields are brewing with tensions these days.
I believe that the PA issue should be rationally addressed in the context of Korea’s medical reality. What can be done? First, hospitals must establish an effective system to manage and supervise PAs and provide systematic training programs to help nurture top-caliber medical assistants. All medical practices by Pas should be kept on record. In other words, the common-sense norms that had been ignored in our medical fields must be fixed first.
The duties and roles of different medical professionals also must be defined by public authorities. The government must clearly outline what medical roles can be played by PAs — and nurses — after thorough discussions.
For instance, advanced nurses or other PAs place casts on patients on behalf of orthopedic doctors in many clinics in Korea. Specialists warn that if casts are wrongly placed, skin maceration and other issues can arise. Some insist that the practice of casting must be carried out by doctors while others think the role can be assigned to medical assistants. Duties previously taken up by resident doctors now can be done by others due to the advance in medical technology.
The Korean society is infamous for being volatile. When a conflict brims, it is often unclear who must — and can —mediate. The medical field is no exception. If a conflict goes untended for long, the damage could to patients and their families. The confusion over PAs, a hot-button issue for our medical field, must be addressed in an orderly fashion. If we can find a reasonable solution to the issue, I am sure the medical community will establish an order in a few years later.
Translation by the Korea JoongAng Daily staff.
with the Korea JoongAng Daily
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