The man's GP believed he was getting counselling for his depression. Photo: 123RF
Overseas-trained "physician associates" are being recruited to plug the gaps left by chronic doctor shortages, despite being unregulated here.
That is set to change - but some are questioning whether the health system is equipped to give them the supervision they need to work safely.
Physician assistants - also known as physician associates or PAs - have been part of the health workforce in North America since the 1960s, and in Britain for the last 20 years.
They must be supervised by a doctor, but the supervising clinician does not have to be in the same room or even the same town.
Jane - not her real name - said her husband thought he was seeing a doctor when he had a consultation with a physician assistant late last year for pain and muscle weakness.
It was only after the second round of blood tests that they realised there was another doctor's name on the results.
They asked to see that GP, who immediately diagnosed her husband with a serious health condition.
"If we'd let it go, he could have gone blind. It's as simple as that."
PAs complete a bachelor's degree followed by a master's degree, which includes more than 2000 hours of hands-on patient care.
However, as an unregulated profession in New Zealand, PAs do not have a governing body or codified professional standards.
Jane feared that could put patients at risk.
"Phyisician assistants are coming here to fill the gaps, particularly in rural or hard to fill areas. And these are areas where there may not be any doctors. So who is going to monitor the physician assistants? That's my concern."
Since a pilot in 2010, PAs have been allowed to practice here, as long as they have at least five years' experience and maintain certification in their home countries.
Taranaki GP Nick Loveridge-Easther said his network employed their first physician associate about 18 months ago, after taking on a practice with 8000 patients but just one doctor.
They have since employed another PA, and are advertising for more.
"They're absolutely incredible physicians and I would happily have my family seen by the physician associates who we've got working for us."
Missed diagnoses did happen from time to time - and neither GPs, hospital specialists nor physician associates were immune to mistakes, he said.
In his view, the real problem with lack of regulation was it meant PAs could not prescribe medications or order tests, so they required far more support and supervision to ensure safe and effective care.
"The funding model for primary care as everyone knows is completely defunct and it just doesn't allow GPs to have funded time to provide supervision for any of that extended care team in reality."
New Zealand Physician Associate Society president Shelly Collins said they want to work at their full scope of practice, which is why they applied for regulation in 2017.
"Safety-wise, it's not a huge worry, although I will be relieved when we do get regulated because it's scary to practice without a medical license.
"This is the first time in my 19 years of practice that I haven't technically had a medical license."
Regulation would also allow the establishment of training programmes in this country, she said.
"We definitely do not want this to be just foreign PAs coming over and then going back.
"We want home-grown Kiwis who are passionate about this, who come from their rural areas and go to PA school, then move back to their rural areas and take care of their family and friends."
Targeted consultation with doctors and others in the health sector closed in December - but regulation was likely to be years away.
It cannot come soon enough for Dr Loveridge-Easther and his colleagues, as pressure continues to build on primary care services.
"Until we do get regulation, they're going to be a really untapped resource in terms of healthcare in New Zealand."
NZPAS said it had not been made aware of a patient complaint involving a PA in New Zealand prior to the publication of this article, but was seeking more information from its members.
President Shelly Collins said the organisation took patients’ safety very seriously and urged anyone with specific concerns to get in touch.
