THE PHYSICIAN ASSISTANT EXPERIENCE IN INDIA

Anitha Chandrasekhar PA-C

Cardiac Surgical Associate - Fortis Malar Hospital, Chennai, India

Senior Vice-President – Indian Association of Physician Assistants

Taskforce member – National Curriculum Standardization of

Physician Assistant Education in India

Associate member - APACVS

April 5, 2018

USA

INDIA

OUTLINE

• Overview of Indian healthcare delivery system

• Evolution of PA profession in India

• PA Education

• Practice areas

• Work profile

• Regulation of PA practice

• Best knowledge statistics

• Diversification of PA roles

• IAPA initiatives

• PA activities

• The Global PA movement

• International collaboration

• The Future

• Summary

DISCLOSURE

• All photos of PAs have been reproduced with permission

• The videos have been shot with permission from the patient

• Trip is being jointly funded by APACVS, Fortis Malar Hospital and Self

HEALTH CARE IN INDIA

HEALTHCARE DELIVERY SYSTEM IN INDIA

ISSUES IN INDIAN SCENARIO

• India lags behind in key healthcare indicators

• Growing burden of disease and disease mix

• Inadequate and poor healthcare planning (Top down)

• Inequitable distribution of resources

• Shortfall of physical infrastructure

• Shortfall of trained manpower

• Miniscule healthcare budget by government

• High cost advanced treatments

• Low insurance penetration

• Unregulated private sector

DOCTOR – PATIENT RATIO

PA

???

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DR. K. M . CHERIAN PROF. C. V. RAMAKRISHNAN

Need + Opportunity + Vision = Birth of PA profession

First Postgraduate Diploma PA program 1992

Birla Institute of Technology and Science-

2 years Master’s degree

1994

4 years B.S Physician Assistant graduate

program1996

EVOLUTION OF PAs

PA PROGRAMS OFFERED IN INDIA

University Duration of course Degree

Birla Institute of Technology and Science, Rajasthan

4 yrs (3 yrs + 1 yr internship) Bachelor

Amrita Institute of Medical Sciences, Kochi 3 ½ yrs+ 6 months internship Bachelor

Dr. MGR medical University, Chennai 3 years Bachelor

Avinashilingan University 4 yrs (3 yrs + 1 yr internship) Bachelor

Bharathiar University 4 yrs (3 yrs + 1 yr internship) Bachelor

Netaji Subas Open University 3 years Bachelor

Osmania University, Hyderabad 2 years (1 year + 1 year) Post graduate Diploma

West Bengal University 4 yrs (3 yrs + 1 yr internship) Bachelor

Bundelkhand University 3 years Bachelor

Shivarathreshwara University 4 years Bachelor

PATTERN OF EDUCATION

• Didactic coursework + Internship

• Infrastructure is the same required for MBBS programme

• Teaching faculty:

– Non-clinical subjects : Medical post graduates

– Clinical subjects : Physicians, Surgeons and Senior PAs

– Faculty for ancillary subjects : Subject matter experts

– Biomedical instrumentation : Biomedical expert, physician/senior PA.

PATTERN OF EDUCATION : REVIEW OF LITERATURE

PA’s ROLE IN INDIAN HEALTHCARE

• The PA model - tested and validated in the private health care institutions in tertiary health care centres

• Especially in speciality medicine such as cardiology, cardiac surgery, gastroenterology, orthopaedics etc.

• The role of PAs in primary care is yet to be explored!

JOB PROFILE OF PAs

OUT PATIENT SETTING

• Take medical histories

• Examine patients

• Prepare case summaries

• Order investigations

• Interpret laboratory tests like X-rays, ECGs, ultrasonogram

• Perform and Interpret Echocardiogram, Treadmill tests, pulmonary function tests etc.

• Make provisional diagnosis

• Counsel patients

Clinical history taking Physicial examination

Review investigations Counsel patients

PRE & POST OPERATIVE WARDS/INTENSIVE CARE UNITS

• Take rounds

• Record progress notes

• Order or carry out therapy under the supervision of a specialist

• Recognize and manage emergency situations until the arrival of the specialist

• Order or carry out therapy under the supervision of a specialist

• Patient intubation and extubation

• Insertion and removal of chest tubes

• Prepare discharge summaries

CVP line insertion Wound dressing

Radial artery line insertion

ICU rounds Pleural fluid aspiration

SURGERY

• Work as first or second assistant

• Harvesting conduits for CABG:– Saphenous vein

– Radial artery

– Internal Mammary artery

• Chest opening / Chest closure

• Harvest and prepare homograft

• Handle emergency crisis in OR

• Prepare operation notes

• Involve in postoperative management of the patients

• Involve in wound management

Cannulation

Cannulation, Assist main procedure, Weaning off CPB,Decannulation, Chest closure

Bovine pericardial conduit

Chest opening

Endoscopic vein HarvestingTraining for EVH

Endoscopic radial artery harvesting

Internal mammary artery harvesting

CURRENT CLINICAL WORK SETTINGS

• Internal Medicine

• Surgery

• Obstetrics and Gynecology

• ENT

• Pulmonology

• Medical oncology

• Radiation oncology

• Surgical oncology

• Nephrology

• Head and neck surgery

• Plastic surgery

• Transplant medicine

• Neurology and Neurosurgery

• Cardiology and cardiac surgery

• Endocrinology

• Anesthesiology

• Robotic surgery

• Intensive care unit

• Community outreach programs

BEST KNOWLEDGE STATISTICS

IAPA estimate based on survey

Total number of graduated PAs 2000

Clinically active PAs 450

IAPA members 445

CT Surgery PAs 150

ISSUES AND CONCERNS IN PA PROFESSION

IDENTITY CRISIS……

ISSUES AND CONCERNS IN PA PROFESSION

• Unregulated courses

• Designation / Protection of title

• No regulatory body

• No Government recognition

• Attrition of Clinical PAs

• Lack of job opportunities in public health sectors

• No academic growth

REGULATION OF PA PRACTICE

• No regulations in place

• Universities evaluate the program annually

• Quality of program depends on the training institute

DIVERSIFY INTO MYRIAD ROLES

• Ultrasound technology

• Respiratory therapy

• Speech therapy

• Cardiovascular sonography

• Echocardiographer

• Cardiac physiologist

• Cardiac rehabilitation : vO2 max

DIVERSIFY INTO MYRIAD ROLES…

• Pharmaceutical industry

• Medical device companies

• Hospital Administration

• Quality control

• Medical tourism

• Medical insurance

• Health Informatics

• Public Health care

• Organ transplant Coordination

DIVERSIFY INTO MYRIAD ROLES!

• Research PhD

• Clinical coordinators for clinical trials

• Study coordinators

• PA educators

• JCI, NABH coordinators

• WHO, UNICEF workers

• Certified Diabetic educators

• Medical writing

DIVERSIFY….

• Homograft banks

• Health care BPO

• Marketing Hospitals, Medical schools

• Advertising Pharma companies

IAPA INITIATIVES

INDIAN ASSOCIATION OF CARDIOTHORRACIC SURGEON’S CERTIFICATE FOR CT SURGERY PAs

IACTS CERTIFIED CTVS PAs

• 2015 – 21 PAs• 2016 – 3 PAS• 2017- 7 PAs

NATIONAL INITIATIVE FOR ALLIED & HEALTH SCIENCES

• The National Initiative for Allied & Health Sciences (NIAHS) Skills and competencies- based approach to curricula redesign: National Expert Taskforce Meet - 26th June, 2015

CONTENTS OF CURRICULUM HANDBOOK

• Introduction of PA profession

• Definition of PA

• PA Education and profession – The Global scenario

• PA Education and profession in India

• Scope of practice

• B S curriculum

• Job description

• Career pathway

Definition developed by the NIAHS PA Taskforce

“Physician Associates are health care professionals trained

in a medical model who practice medicine as part of the

healthcare team. They are qualified and competent to

perform preventive, diagnostic, and therapeutic services

with physician supervision”

NIAHS TASKFORCE

ANNUAL CONFERENCES - IAPACON11th IAPACON 2014

COIMBATORE

12th IAPACON 2015

KOCHI

13th IAPACON 2016

KOLKATA14th IAPACON 2017

HYDERABAD

PRE-CONFERENCE BRAIN-STORMING SESSION ON PA EDUCATION AND CURRICULUM WITH KEY STAKE HOLDERS, 2017

SYNOPSIS OF THE PROCEEDINGS

The discussions revolved over three broad areas:

• Curriculum

• Recognition/Licensing of PAs and

• Spreading the awareness of the PA profession

PA ACTIVITIES

PA MAGAZINES

PAPER PRESENTATIONS

PUBLICATIONS

PA DAY CELEBRATIONS

NEED OF THE HOUR!!

• Standardization of course curriculum

• Recognition from the government

• Creating posts in government hospitals

• Effective utilization of PAs as part of medical team

THE WORLD IS TRANSPARENT

GLOBALIZATION OF PA WORKFORCE

WHO Global healthcare workforce statistics, 2013

Hooker RS, Cawley JF 2015

Global health education consortium

India

Australia

New Zealand

South Africa

Canada

USA

Liberia

Ghana

Saudi Arabia

Nicaragua

Kenya

UK

NetherlandsIreland

BulgariaChina

Taiwan

Thailand

GLOBALIZATION OF PA WORKFORCE

• Improve access to health care

• Address doctor shortages

• Expand delivery systems

• Each country defines the role and level of autonomy that the PA has or will have

• Modifications and improvisation of the original version

COST EXPLOSION

IRRATIONAL TECHNOLOGY USE

CONSUMER DISSATISFACTION

ACCESS TO CARE

QUALITY OF SERVICES

UNREGULATED PRIVATE SECTOR

INTERNATIONAL COLLABORATION

• Exchange of experiences around common problems

• Evidence on alternatives

• Health has consistently remained one of the few truly universal aspirations

• Opportunity to reconcile national self-interest with international mutual interest

THE PA MOVEMENT

• New models of care coupled with new technologies requires unique training for the needs of each country.

• International experience must be shared in developing services which comply with local needs.

• The physician assistant represents a highly adaptable type of provider that can adjust to many changes in the healthcare environment.

THE FUTURE

• Government recognition

• National Licensing examination

• State licensing – TN as pioneers

• Centers of Excellence

• International collaboration

SUMMARY

• Third decade of PA existence in India

• Very useful and efficient cadre of professionals

• Expanding the frontiers of practice with increased experience

• Awareness poor- India/Internationally

• Need international support for stabilization of profession

ACKNOWLEDGEMENT

• IAPA

• Professor Roderick Hooker

• Mr. Shivakumar

• Mrs. Gomathi Sundar

ani.sach@gmail.com

anitha_sach@yahoo.com

seniorvicepresident@iapaonline.com

QUESTIONS????CLARIFICATIONS????