Jeannie Watkins, President of the Faculty of Physician Associates at the Royal College of Physicians, debunks some myths about the growing profession.
Sometimes facts are skewed for the sake of an attention grabbing headline. Physician associates have fallen foul of this on numerous occasions, with sensationalism often obscuring the real benefits physician associates bring to medical teams and to patients. Physician associates can’t replace doctors – but they can help them. In recent years they’ve become an integral part of hundreds of multidisciplinary teams. I’d like to quash some common misconceptions, and discuss the value they add to our health system.
Who are physician associates?
Physician associates are new healthcare professionals, specifically trained in medicine to deliver medical care to patients, under the supervision of, and in partnership with, doctors. PAs work across a range of specialties in the NHS in both hospitals and general practice; taking histories, examining, diagnosing, managing and treating patients. Their training is intensive and covers all body systems, with emphasis on common and important conditions. Patient safety is paramount, and PAs must be safe and competent in the care they deliver when they qualify.
What does PA training involve?
All PAs must have a first degree in a biomedical or healthcare science before undertaking their two-year PA programme. This means they’ve already completed three years of study before starting their course. The intensive programme requires a minimum of 3200 hours (over a minimum of 90 weeks). It is expected that universities deliver 30-40 hours per week of education and in addition students are expected to spend an additional 30 plus hours per week in self-directed study. The same is expected when the students are in clinical placement. On successful completion of their university programme PAs must sit a national qualifying examination to enter into professional practice regardless of where they have studied.
What is their scope of practice?
The competence and curriculum framework for the physician assistant* clearly states what a PA should be able to do once qualified. The framework for graduates is deliberately non-prescriptive and flexible so employers can shape the role for local needs. While there is a need for a little more clarity around scope, we do not want to end up being so directive that we lose the essence of what a PA is, their flexibility in the workforce and the potential for innovation. We don’t want to put clinicians in a rigid box.
Don’t believe the headlines: PAs are not ‘doctors on the cheap’
Although sensationalist headlines have stirred up negative perceptions about physician associates, it is hard to find any clinician who has experience working with physician associates without a positive opinion of the role. Physician associates are categorically not doctors, instead supporting them and adding value to the teams in which they work. PAs salaries are set in line with agenda for change which was decided following a consultation with over 300 bodies. Currently, when qualified, many start on band six or seven, dependent on the employer. The average salary for a PA in the UK (according to the PA annual census 2017) is around £37,364.
Is there any career progression or development?
PAs are trained in a general way, which allows them to move around within a particular specialty to provide a service or to move between specialities. This is career progression, but not in the typical hierarchical way that is currently recognised in healthcare. When they work in a specialist area, their knowledge and skills increase. This means the types of patients they see and the procedures that they can do, can, with time, also increase in complexity. PAs also can be very flexible as they take the recertification knowledge based exam every six years. This means they essentially have to retake their certifying examination that enabled them to enter into professional practice, helping them to update their generalist knowledge.
The idea of bringing a new healthcare professional into the system was not to take away from opportunities that currently exist for junior doctors in training or anyone else. We know heavy workloads sometimes affect junior doctors’ availability to participate in training. We need to work with employers, consultants and GPs to ensure that everyone who requires training is able to access it appropriately and that those providing it have the recognised and protected time to do so. What is encouraging and reassuring is that junior doctors who work with PAs say they have seen an improvement in their ability to attend training, while the jobs that need to be done get done.
PAs help redistribute the workload
PAs are not there to fill rota gaps or to replace existing healthcare professionals. They can’t as they are not trained as anything other than PAs. What they can do, however, is help with the redistribution of the medical workload which helps to ease the pressure on the medical team providing the care required for patients.
What positive impact could PAs have on our health system?
As an additional member of the workforce, PAs should increase access to care.
PAs once qualified do not tend to rotate, although some trusts offer internships which are rotational in the first year. Not rotating, we believe, helps to provide better continuity of care for the patients and team stability.
Currently there is no evidence to suggest that PAs offered reduced consultation times, in fact, they could be slightly longer. I think in most cases we should be offering longer consultation times, particularly in general practice, to enable clinicians to manage the patient and their problems. This may reduce the number of consultations that a patient has overall.
Why should this profession be regulated?
It is vital for the profession to be regulated. It’s something we, as a group, have lobbied for over 10 years. The number one reason is for public protection. Despite having lots of standards and quality assurance measures, we currently have no legal authority to enforce these if they are flouted. A perfect example of this is when organisations employ people who are not recognised or qualified to work as a PA in the UK. We need regulation to protect the title and drive forward standards for education and training. It would ensure PAs could reach their full professional potential by allowing them to request ionising radiation (eg. x-rays). Regulation would also pave the way for PAs to be able to prescribe within the agreed scope of their practice.
Although physician associates aren’t always portrayed as they should be, the national headlines have helped to spark interest in the profession, inspiring prospective trainees and employers. It has also empowered PAs to take the stage, and carry out their own myth busting while raising the profile of this exciting new profession.
Though the role is still relatively new, physician associates have already assisted valuable change in multidisciplinary teams throughout the UK’s four countries and I’m excited to see what further growth could bring.
* Physician associates were known as physician assistants until 2013.