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Opinions of Monday, 24 August 2020

Columnist: Desmond Apenteng

The plight of the Ghanaian physician assistant under the current medical and dental council

Physicians in a surgical theatre Physicians in a surgical theatre

Misleading as the name sounds, a Physician Assistant does not assist any Physician or a Doctor but practice medicine independently.

This cadre of health professionals are found all over the world including countries like the USA, Canada, UK, Australia and many African countries. To become A Physician Assistant in the USA one is required to complete a 4 year University education in a science related program before proceeding to another 4 years University Education to train as a Physician Assistant. After completing the 4 year training they are allowed to specialize in any field of medicine just like a trained medical Doctor. In that country many patients prefer to be seen by a Physician Assistant other than a Doctor.

In Kenya Physician Assistants train in accredited Universities for 3 years and are made to serve in under-served communities where they practice medicine and surgery with some leading surgical teams and perform invasive procedures like caesarean sections and hysterectomies.

In Ghana currently, the program is offered at Universities (eg. UCC, Central University, University of Allied Health, Presbyterian University, College of Health and Wellbeing etc.) across the country for a minimum of 4 years (With students paying in excess of GHC8000 annually as fees) after which the professionals are made to sit for a licensing exams supervised by the Medical and Dental Council of Ghana. All those who pass these exams are made to undergo additional 1 year of training under strict supervision in accredited Hospitals across the country. This is to ensure that the professionals are prepared to practice medicine in the country.

After 5 years of training a Physician Assistant is expected to register with the Council and must attend Medical and Dental Council accredited programs and must accrue minimum 10 credits each year in order to renew his license and be in good standing with the council in order to continue practicing medicine in the country.

It will interest readers to know that some of the accredited programs can cost as high as GHC 2000 while the retention fee is subject to annual review at the discretion of the council with last year's ration fee pegged at GHC300.

After going through the ordeal stated above, Physician Assistants practicing in the country have no prestige and recognition among health professionals in Ghana. They are treated like PUPPETS and MADE SERVANTS of Medical Doctors with the Medical and Dental Council (dominated by medical doctors) being the supervisor.

Neither the Council, the health ministry nor the Ghana Health Service treats the Physician Assistant with Any dignity (be reminded that all these institutions are headed by medical doctors who see the Physician Assistant as a threat). This partly accounts for the reason why most Physician Assistants in the country continue to hide under the shadow of a Doctor other than identifying themselves as Physician Assistants.

It is a fact that most of those in white coats who attend to patients in various hospitals and clinics across the country are Physician Assistants not doctors. These cadres of health professionals willingly accept postings to underserved communities where a Medical Doctor refuses to go.

In fact the recently posted Physician Assistants are currently working without appointment letter and remuneration from the Ghana Health Service with some even refused a befitting accommodation unlike their “Masters” who the ministry acting on the directive of the Ghana Medical Association (whose members head these institutions) ensures that a doctor is provided with a free, furnished befitting accommodation with internet service.

The Medical and Dental Council in collaboration with the National Accreditation Board over the years made frantic efforts aimed at worsening the plight of the Ghanaian Physician Assistant. These two institutions allowed proliferation of Physician Assistant Training Schools with some schools running the program on weekends. Most of the schools have no laboratories, requisite teaching materials and qualified staff hence resort to services of part-time lectures from other universities and medical schools who often do not have enough contact hours with the students. Practical in most of the schools is inadequate and sometimes non-existent for most of the subjects taught in the schools.

The Medical and Dental council over the years limited the curriculum of the schools thus limiting the lecturers from teaching most of the relevant topics that could benefit the Ghanaian. This is aimed at making products from the Physician Assistant training schools ignorant and to widen the knowledge gap between Doctors and practicing Physician Assistants in the country.

Several attempts by the training schools to improve teaching and learning in the schools by for example teaching the Physician Assistant student how to do caesarean section met resistance from members of the council with the reason that the students are not competent to undergo such training.

But the truth is training Physician Assistants to do CS will make most doctors in the country irrelevant and reduce their market value, snd the government will no longer bow to their demands when they embark on strikes.

Can you imagine Doctors going on strike and Physician Assistants holding the front in both medical and surgical fields, will the impact of their strike be felt and demands granted?

You and I know the answer. This is the reason why the Medical And Dental Council is refusing to allow and improve curriculum and specialization for the Ghanaian Physician Assistant.

Last year parliament of Ghana requested for an amendment of the health professionals regulatory act, the Medical and Dental council quickly moved to amend the act seeking to put Licensed and practicing Physician Assistants in the country under the supervision of Medical Doctors.

This move has nothing to do with protecting the public as the council wants Ghanaians to believe. It is to ensure that Physician Assistants who own private clinics mandatory employ Doctors as their practitioner in charge and to limit the number of Physician Assistants who go into private practice to saturate the market space. It is also to reduce the rate of unemployment among newly qualified and retired doctors and to keep them relevant while the Physical Assistant remains in abject poverty .

It is a fact that there are as many bad and recalcitrant Doctors just as Physician Assistants who will do all kinds of abortions and sign all kinds of medicolegal documents even with lies and errors as long as they can make some money from the act.

The council currently prohibits Physician Assistants from signing medico legal documents for patients they have attended to. The documents must be signed by a doctor even if the Doctor is not the practitioner who attended to the patient. Mind you this has nothing to do with protecting the Physician Assistants but for the money charged for signing such documents. Fees charged for signing medicolegal documents are often pocketed by the Doctor or the practitioner who signed them. This has become a cash cow for most Doctors because they will not allow the Physician Assistant to sign them.

It will interest readers to know that signing of such documents is never part of the curriculum of medical schools, but the council organizes training for newly qualified Doctors where they are taught how to endorse the documents.

Since the Medical and Dental council is regulating both the Doctors and the Physician Assistants, one wonders why only the doctor is given such training when in most cases they do not attend to the patients themselves.

I have also met several astute, diligent and good Physician Assistants in various hospitals who if not told they are Physician Assistants you wouldn’t know.

One may ask what becomes of the supervisory roles of the Medical And Dental Council and by extension medical superintendent in our hospitals if every doctor is to supervise a Licensed Physician Assistant?

Will the doctors in the years to come demand additional pay for the supervisory role being assigned them by the Medical And Dental Council?

How are the limited number of Doctors in the country going to supervise Physician Assistants in every health facility in the country?

It will interest readers to know that even before parliament could approve the yet to be amended health professionals regulatory act, the Doctors are muscling their power through the Medical and Dental Council, HeFRA, Ghana Health Service and NHIS (all headed by Doctors) to start implementing contents of the act by having Physician Assistants supervised by Doctors. This is happening at the time the likes of the USA and other countries are passing laws that grant autonomy to the Physician Assistants.

Currently there is a strong resistance against Physician Assistants establishing their own council to regulate their training and practice as Doctors in the country see this as a further threat to their existence and relevance.

Medical and Dental Council promptly submits details of newly qualified Doctors (including those trained outside Ghana) to the ministry of Health and Ghana Health service for posting but the same cannot be said of the Physician Assistants.

In fact quite recently a little over 800 Physician Assistants received clearance from the ministry of finance following several efforts by the Mother Associations (Graduate Physician Assistants of Ghana and Ghana Physician Assistants Association).

Despite the fact that the clearance came last year, only a little over 400 were posted without appointment letters. The rest didn't even know their faith. It is being rumoured that the clearance is currently on sale to the highest bidder by powers that be at the ministry of health and Ghana Health Service.

These are some of the reasons why Ghana will forever remain a developing country and continue to struggle to achieve the millennium development goals. God bless our homeland Ghana and make our nation great and strong.