Physician Assistant - profession with perspective

Interview with Dr. Karl Blum, Head of Research Division - Deutsches Krankenhausinstitut e.V. (German Hospital Institute)


The doctor's profession is exhausting and involves many different activities. For a long time, there have been discussions about how doctors can be supported by other specialists. One solution: help from so-called physician assistants. The profession, which exist much longer, for example, in the USA, involves various activities normally carried out by doctors. Doctors are thus relieved, patients can be better looked after. The German Medical Assembly (Deutscher Ärztetag) has now approved this concept in Germany.

Image: Smiling man with dark hair, red tie and suit - Karl Blum; Copyright: private

Dr. Karl Blum; © private

Dr. Blum, what does it presently entail to become a physician assistant?

Dr. Karl Blum: There are currently eight universities in Germany that offer this type of education and professional development. Some universities have several campus locations. Generally, this professional qualification is offered as continuing education courses, meaning as an additional qualification. That is to say, admission requirements entail a completed training in a health care profession. In some instances, it even specifies that qualification must be obtained in the "health care" field. There are two universities that also offer direct entry programs, meaning you don’t require any prior completed training qualification. However, this alternative was recently rejected by the German Medical Assembly (Deutscher Ärztetag). It remains to be seen how things will progress in this case.

What impact does this decision have on graduates of these particular universities?

Blum: Initially there is no impact. If they are good in their field, graduates of these degree programs are likely to have similar chances on the labor market than continuing medical education graduates. Should there be a model regulation on continuing medical education or government regulations on continuing medical education for physician assistants in the future, it could potentially curtail the career opportunities of graduates of direct entry physician assistant programs. But for now, that is still up in the air. Currently, the qualifications of graduates are the most important factor. Since direct entry physician assistant graduates also have developed great relations and garnered extensive practical experience during their academic studies, they will in all likelihood also find a position in these places or be hired after completing their studies.

What are the duties and responsibilities of this profession?

Blum: Generally – and this will likely remain so for the time being- physician assistants work based on a delegation of services agreement. That means, physician assistants are only allowed to perform selected activities as directed and supervised by a physician and for which they are professionally qualified. This doesn’t mean constant supervision of the physician assistant by a doctor but only the frequent random review of his/her work and final inspection. The assistants must not make any autonomous diagnostic or therapeutic decisions or perform tasks on their own.

Other countries allow for certain activities to be carried out independently. Why isn’t this the case in Germany?

Blum: Other countries have models where assistants are permitted to work as part of a substitution agreement. However, this always takes place in collaboration with a medical team and physicians, respectively. The job title is partially different and in this case, the person is considered less of a "physician assistant" and more of a "nurse practitioner". The latter is allowed to independently carry out medical activities, as is the case in the U.S. for example. However, this is not permitted in Germany and was also rejected by various professional organizations and committees.

Image: A young woman takes another young woman's blood sample; Copyright: Trautmann

At present, more women than men are trained as physician assistants; & Copy Trautmann

Do you know what the basis was for this decision?

Blum:  The respective organizations cite professional and liability concerns and reasons. Ultimately, the attending physician is responsible for the patient, also from a legal perspective. This is why it certainly stands to reason that physicians want to remain in control of the treatment. In addition, there might also be professional reservations and concerns when certain medical services are substituted and performed by physician assistants with non-comparable qualifications.

Which brings me to my next question: how is this new job profile received by physicians?

Blum: Overall, the physician assistants are very well received. We conducted a study several years ago where we asked surgical and physician assistants how satisfied they think physicians are with their performance. The assistants alleged that doctors are very satisfied and that their profession is highly accepted and appreciated. In a more recent study pertaining to the "Physician Assistant" degree program at the Baden-Wuertemberg Cooperative State University (Duale Hochschule Baden-Württemberg, DHBW) in Karlsruhe, we surveyed over 100 physicians who collaborate with graduates and students. The finding was that the perceived work quality was great and rated positively. Another interesting aspect was that the physicians also rated the acceptance of physician assistants by patients as very high.

Are the physician assistants also satisfied or is there still room for improvement?

Blum: The findings of various graduate surveys show that the overall level of satisfaction is very high. It is apparent that physician assistants are assigned duties and responsibilities commensurate with their professional abilities. The graduates indicate an excellent collaboration with the physicians as well as other team members. Overall, it is evident that the use of physician assistants supports the medical service, both in terms of administrative and organizational tasks. To that effect, it’s fair to say that physician assistants allow physicians to focus more on their core competencies.

What is the current gender distribution in this profession? Are there more female or male physician assistants?

Blum: There are presently exceedingly more women in this profession since most degree programs –as I have already mentioned- require professional training in the field of health care. However, even other professions, for which this degree program is of interest, such as medical assistant technicians, for example, still tend to appeal more to women.
Foto: Simone Ernst; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Simone Ernst and translated by Elena O'Meara.