Singapore’s rapidly aging population presents a critical challenge for its healthcare system. By 2026, more than one-fifth of Singapore’s residents will be 65 or older, placing significant pressure on both primary and specialist care.

To ensure high-quality, accessible healthcare in the face of these demographic shifts, it is timely to consider innovative approaches—one of which is the introduction of Physician Associates (PAs), also known as physician assistants, into the healthcare workforce.

The PA role has been successfully integrated into healthcare systems across at least eighteen countries, including the United Kingdom (UK), the United States (US), the Netherlands, India, and Australia. Each country’s experience underscores PAs’ ability to fill clinical gaps, enhance patient access, and alleviate burden on physicians.

PAs have demonstrated their value in various healthcare systems worldwide. In the United Kingdom, studies have shown that PAs, also known as Physician Associates, can handle a significant portion of routine primary care consultations, with one study indicating they manage up to 70% of such cases.

This has led to a substantial reduction in doctors’ workloads and improved patient throughput. Additionally, research has found that PAs safely support the workloads of clinical teams, provide team continuity, and positively contribute to patient experience and patient journey, benefiting medical and surgical teams and their patients across a wide range of specialties.

This is backed by a 2021 review of the literature on physician assistant/associate (PA) cost-effectiveness compared to physicians found that PAs delivered similar or better care outcomes at the same or lower cost. The review assessed cost-effectiveness in terms of quality, accessibility, and cost of care.

Key findings include:

• PAs provided comparable or superior care outcomes to physicians.
• PAs often achieved these outcomes at the same or lower cost.
• The efficiency of PAs was attributed to two main factors:
  • Greater effectiveness in producing care and activity.

Overall, the review suggests that the employment of PAs can contribute to more efficient healthcare, addressing the growing demands of demographic changes, new developments in healthcare, and physician shortages.

The PA model has been successfully implemented in various countries, demonstrating its scalability and adaptability. In the US, over 150,000 PAs are employed across multiple specialties, showcasing the model’s potential for broader responsibilities. Additionally, PAs are often employed in the private healthcare alongside nurse practitioners to manage higher workloads.

Other countries have also recognized the value of PAs, granting them increased autonomy and responsibilities. For example, the Netherlands has granted PAs prescriptive authority, highlighting confidence in their training and the model’s adaptability.

In Australia, physician assistants (PAs) have been successfully integrated into rural healthcare systems, enhancing accessibility and showcasing the model’s flexibility. However, the experience highlights the importance of clear regulatory frameworks. Pilot programs have demonstrated PAs’ effectiveness in managing post-operative care and chronic disease follow-ups, improving clinic efficiency and continuity of care.

Despite initial successes in the states of Queensland and South Australia, where pilot programs improved patient access and reduced wait times, nationwide implementation faced challenges in professional integration. This experience underscores the need for early stakeholder engagement and well-defined PA roles to ensure a smooth transition.

In India, PAs play critical roles in high-pressure environments, particularly in cardiology, emergency medicine, and surgical assistance. They provide critical care and support in cardiology, assist in emergency departments, and support surgeons and anesthesiologists in operating rooms. By effectively filling healthcare gaps in corporate hospitals and specialty care, PAs contribute to efficient and high-quality care.

In Singapore’s context, PAs can also make a significant impact. In polyclinics, they can manage routine cases, allowing doctors to focus on complex conditions, reducing wait times, and enhancing patient satisfaction. In specialist clinics, they can conduct follow-up consultations, coordinate care, and perform routine procedures, improving clinic efficiency and ensuring continuity of care.

Furthermore, as Singapore’s ageing demographics reconfigure its growing healthcare infrastructure stresses, PAs can play a key role in community-based care, managing chronic conditions and coordinating with specialists as needed, delivering consistent, quality care through their comprehensive training and detailed patient interactions.

To meet the intensifying demand for healthcare services in Singapore, the country’s healthcare system must expand its capacity. This requires building a robust workforce capable of delivering quality care efficiently. By leveraging the skills and expertise of PAs, Singapore can enhance its healthcare infrastructure and provide better care for its ageing population. Integrating PAs can:

1. Bolster Primary Care: In polyclinics, PAs can manage routine consultations and stable chronic diseases, reserving physicians’ time for complex conditions.
2. Enhance Specialist Clinics: By overseeing regular follow-ups, conducting procedures, and coordinating care, PAs can increase productivity and reduce wait times.
3. Strengthen Community Care: PAs, working alongside Advanced Practice Nurses (APNs) and physicians, can expand chronic disease management and elderly care coordination in community settings.

Singapore already has Advanced Practice Nurses (APNs). However, these roles complement each other. APNs bring advanced nursing expertise, patient education, and specialised care. Meanwhile PAs, trained under a medical model, focus on diagnostic, treatment, and procedural responsibilities.

Factoring the compelling economic case to optimise healthcare outcomes with appropriate financial allocations, when deployed together, these professionals can optimise clinical workflows and improve patient outcomes—especially critical for managing complex geriatric cases.

PA training is a cost-effective way to deliver competent routine medical care, requiring fewer resources than physician education. PAs can substitute for doctors in approximately 85% of primary care tasks; generate significant revenue; and are at least as productive as doctors in outpatient visits.

The opportunity cost of producing a PA is also lower, at around 20% of the cost of producing a doctor. Additionally, PAs can provide six years of healthcare services to society before a doctor is fully trained and functioning independently, making them a valuable addition to the healthcare workforce.

Implementing a PA profession in Singapore requires careful planning, appraisal, and deployment. Establishing regulatory frameworks, developing training programs, and ensuring smooth integration into the healthcare system are essential steps. However, the potential benefits of improved access to care, reduced wait times, better care coordination, and efficient resource use justify this investment.

A measured approach to introducing PAs in Singapore could involve:

1. Pilot programs in high-need areas like primary care and geriatrics to evaluate impact on waiting times, care coordination, and cost-effectiveness.
2. Developing accredited PA programs through partnerships with medical schools, ensuring rigorous, Singapore-specific competencies.
3. Establishing clear guidelines that define PAs’ scope of practice and supervision, maintaining public trust and integrating seamlessly into existing teams.
4. Ongoing evaluation using pilot data to refine regulations, training, and deployment, ultimately allowing for broader expansion if results prove favorable.

By adopting a phased and evidence-based approach, Singapore can successfully adapt and localise the PA model to meet its unique needs, ultimately leading to more accessible, efficient, and comprehensive healthcare delivery.

As the city-state grapples with the challenges of caring for an ageing population, expanding its healthcare workforce is crucial to maintaining its high standard of care. The global success of PAs offers a promising solution for improving patient access, optimizing physician workloads, and sustaining cost-effective service delivery. With careful implementation, the PA model can become a vital component of Singapore’s healthcare system, ensuring its resilience, innovation, and readiness to meet the challenges of the future.