Ad hominem; Author information or conflict of interest

The Journal received five emails recently about the recent editorial “Regulation of physician associates in Aotearoa New Zealand mitigates a medical practitioner workforce crisis and leads to stronger, diversified healthcare teams,” all expressing concern about an alleged undeclared conflict of interest of the authors. The emails are below:

I read with interest your recent editorial on the regulation of physician associates in Volume 137, No. 1599, DOI: 10.26635/6965.6616. However, I was concerned to note the absence of declared conflicts of interest, particularly given that one of the authors, Shelly Collins, is the current President of the New Zealand Physician Associate Society (NZPAS). According to the NZPAS website, their mission is to "promote the profession and advocate for the regulation of Physician Associates." This editorial, written by their president, appears to be doing just that.

Could you please provide clarification on this matter?

Yours sincerely,

Dr Ben Lawrence

In relation to the recent published editorial about the use of physician associates in New Zealand, it has been drawn to my attention that the 2 authors are the previous and current presidents of NZPAS. However, no conflict of interest is noted in the article. Regardless of the content of the article, I think most would agree that this is a very clear COI.

Many thanks,

Dr Simon Gordon

Kia ora,

I am writing to express my sincere concerns about the Physician Assistant editorial in your July issue.

Both authors have heavy conflicts of interest as current and previous presidents of PA organisations. In my opinion. this should have precluded this article from being published in the first place. It is highly concerning that the COI is not disclosed.

It is disappointing to have this kind of editorial published in NZ Medical Journal when there is a mounting body of data regarding how unsafe non-medical “practitioners” are. As a medical registrar, I see missed diagnoses and mismanagement by NPs and PAs on a daily basis and constantly worry about how expansion of these roles would potentially impact the population of Aotearoa.

PAs/NPs are NOT the answer to the doctor shortage problem. It should be addressed by training, employing and retaining more actual doctors, rather than using undertrained and unsafe replacements.

We urge you to listen to your physician readers and retract the piece.

Regards,

Dr E Rakhmanova

I am writing with concern that the article you have chosen to publish entitled “Regulation of physician associates in Aotearoa New Zealand mitigates a medical practitioner workforce crisis and leads to stronger, diversified healthcare teams” lacks transparency regarding the authors’ conflicts of interests.

It is no secret that the New Zealand Physician Assistant Society is lobbying wholeheartedly for regulation of physician assistants in Aotearoa. This article, published by a current and former president of this society, quite clearly intends to advance this narrative. While these roles are clearly listed in the author information, I would argue that these positions undoubtedly introduce a bias into the article that must be explicitly made reference to in the “competing interests” section of this letter—which is currently blank.

I welcome discussion in the literature regarding the role of this profession in Aotearoa. However, it must be done with transparency and reputability. Additionally, I must point out that the decision to publish this letter as an editorial does seem to imply the Journal is in agreement with the authors’ stance, whether intentional or not.

Regards,

Dr William Park

I am writing to express my concerns regarding the editorial in the subject heading, titled “Regulation of physician associates in Aoteroa New Zealand mitigates a medical practitioner workforce crisis and leads to stronger, diversified healthcare teams”.

This editorial has been published and declared to be free of conflict of interest. The primary author, Lisa deWolfe, is the current president of the New Zealand Physician Associate Society. As such, I strongly believe this constitutes a conflict of interest and request this be made abundantly clear in the article itself.

Kind Regards,

Dr Johnathan Reynecke MBChB

Editor’s reply

Thank you all for taking the time to email your concerns about the recent NZMJ editorial on the regulation of physician associates. Given we have had five “letters to the editor” about this topic it is likely to be of concern to many more.

The COI was well documented by the authors of the editorial and the information that appears to have concerned those who contacted the Journal is found in Authors’ information (which is directly under COI in the manuscript)—see below. The authors also declared this information on their COI form.

Authors can put information about their roles under Authors’ information that might be considered COI or might be considered the “why they know something” about what they are writing on.

If authors choose not to put in the Authors’ information slot such information and it is listed on their COI form (in which this was declared), or if the Journal know about it from an internet search, then we put it in the COI space. In this case, however, as it is clearly documented in the Authors’ information, it would be unnecessary repetition, as stating it under Authors’ information declared this interest.

This is what was published at end of the manuscript before the references:

Competing interests

Nil.

Author information

Lisa deWolfe: Physician Associate, Emeritus, Past President, New Zealand Physician Associate Society.

Shelly Collins: Physician Associate, President, New Zealand Physician Associate Society.

Corresponding author

Lisa deWolfe: Physician Associate, Emeritus, Past President, New Zealand Physician Associate Society.

Some journals are now putting the authors’ submitted COI form as a “click through” on the webpage of the article as well. As yet, we have not been doing this; however, given the concerns of readers we will see what we can do, as that might increase transparency further.

Frank Frizelle

Editor NZMJ