MUSC pediatrics resident advocates for frontline service providers

The shortage of primary care physicians in the sixties begot a novel program for mid-level healthcare professionals: physician assistants (PA). Eugene A. Stead, Jr, M.D. recognized the need for frontline providers early enough to develop a “fast-track” curriculum for students wanting to apply combat medic training as civilians but did not have the educational backgrounds to do so. Stead, a medical educator, and physician at Duke University Medical Center, successfully graduated four military-trained Navy Hospital Corpsmen in what was the first physician assistant program in the world.

Fast-forward roughly fifty years and numerous healthcare policy deliberations later, there is still an ever-growing need for PAs and other providers of comparable training. Physicians and the healthcare delivery system largely rely on these well-trained professionals to maintain equilibrium in care, patient volume, and patient satisfaction.

Tessa Wyborny, MD, a third-year pediatrics resident, lamented on the increased importance of these providers in rural, remote settings where their presence enhances the patient experience, particularly Assistant Medical Officers (AMOs)—comparable to PAs—and nurses. While the nomenclature differs from country to country, the roles are similarly just as vital.

“I think it makes the doctor’s job so much harder when you don’t have skilled personnel to provide support for physicians,” said Wyborny. “It is even more difficult in low- and middle-income countries, where patients often present late and need specialized care—the whole system suffers.”

Wyborny recently traveled to Arusha, Tanzania to complete a pediatrics residency rotation as a 2015 MUSC Center for Global Health Trainee Travel grant recipient. She found that the Tanzanian healthcare delivery system is held together mostly by mid-level healthcare providers and professionals: nurses, midwives, birth attendants, and community health workers. AMOs also fill gaps in care that doctors cannot. Wyborny explained how common it is for an AMO to staff a medical facility, especially in the more rural areas of Tanzania. “Assistant Medical Officers sometimes serve as the sole provider in rural clinics,” Wyborny said.

Despite training deficiencies, nurses outnumber physicians and AMOs as providers of care in Tanzania. According to the World Health Organization (WHO), there are 0.1 physicians for every 10,000 patients in Tanzania; whereas, there are 2.4 nurses and midwives for every 10,000 patients. The need to fill the void between physicians and nurses is more important than ever given the disparities in the training needed to sufficiently deliver care. Wyborny pointed out that doctors are well-trained in Tanzania; however, only a small percentage of Tanzania’s population are physicians. Wyborny, a well-trained pediatric resident advocates strongly on behalf of the frontline service providers and their important contributions to delivery systems in the US and globally. She feels the need for these professionals cannot be overstated.

The 21st-century healthcare delivery system warrants better training and patient empathy. Nurse practitioners and PAs spend slightly more time, on average, with patients than doctors. Physicians, nurses and PAs spend an average of 18.6, 19, and 20 minutes with patients at community health centers in the US, respectively. This is a close comparison to the conditions that might be found in some remote areas abroad.

A prevailing message from physicians, nurses and PAs alike is that it is important to work effectively alongside one another for the good of patients. As Wyborny notes, it is of even greater importance for healthcare professionals to receive multidisciplinary, team-based training in settings that lack technological advances found in high-income countries.

“Working with healthcare professionals with different backgrounds helps everyone critically think through how best to treat rare conditions and how to provide the best care with limited resources,” Wyborny said. “This is the most effective way to educate front-line practitioners and eventually gain trust among peers and patients.”