The Australasian College for Emergency Medicine (ACEM; the College) warns that long-term deficits in health workforce planning and resourcing cannot be resolved simply by extending the scope of the existing healthcare workforce and introducing non-medical health practitioner roles, such as Physicians Associates and Extended Scope Paramedics, as has been observed in the United Kingdom.
While Emergency Departments (EDs) have long embraced a strong, highly collaborative and multi-disciplinary approach to patient care, ACEM is calling on health system stakeholders to undertake purposeful and meaningful consultation with emergency medicine clinicians, and to exercise greater caution by taking a more carefully graded approach to establishing new roles and healthcare settings.
Extending the roles of health practitioners has been shown to work in EDs with appropriate clinical autonomy. However, the effectiveness of these roles is contingent upon having a clearly defined and agreed scope of practice, within a framework of ongoing education, training, credentialling, audit and quality improvement.
The rate at which several newly-created roles are being operationalised – particularly within or at the interface of EDs, and with limited or no input from emergency medicine specialists – is subjecting emergency physicians to an unacceptable level of clinical risk and raises significant concerns about patient safety.
ACEM is concerned that these new roles are being presented to the public as the solution to health care workforce shortages – particularly in regional and rural locations – and strongly disagrees with the notion that health care services that typically are provided by medically qualified practitioners can safely be provided by these newly-created roles.
Workforce shortages in regional and rural settings have been a long-standing issue that impacts upon the availability of health care services. The State of Emergency 2024: Regional, Rural and Remote report showed that at least one third of presentations in regional and rural hospitals in Australia were a category 1-3 on the Australasian Triage Scale, highlighting that the need for emergency medicine specialists in rural and regional hospitals is vital.
It is imperative that everyone presenting to an ED has timely access to emergency care, otherwise we run the risk of setting up a two-tiered health system that disadvantages those living outside metropolitan areas. All communities deserve to be treated by highly-qualified, medically-trained physicians, not non-medical practitioners who lack the depth of training undertaken by doctors.
ACEM stands ready to work collaboratively with governments, health system leaders and regulatory agencies to implement safe and sustainable solutions to the health workforce crisis, to ensure the highest standards of emergency healthcare services are provided for all communities across Australia and Aotearoa New Zealand.