The role of a PA
Role of a Physician Associate
The role of a Physician Associate (PA) often creates a question that demands the definition of PAs since the introduction of PAs in the 1950s (Braun et al., 1973). Physician associates are medically trained professionals who are generalists within the healthcare industry. A PA's role is to work alongside doctors and provide patient care as an integral part of the multidisciplinary team. Physician associates are practitioners who work with a dedicated medical supervisor but are cable of working autonomously with appropriate support. Faculty of Physician Associates (31052021) Who are physician associates?, Available at https:www.fparcp.co.ukabout-fpaWho-are-physician-associates (Accessed: 31052021).
The United State of America introduced the first formal program of Physician associates at Duke University, from which 68 PAs graduated in the year 1965 (Braun et al., 1973). According to the Department of Health, the official definition of the role of a PA is (2012): ''A new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical andor general practice team under defined levels of supervision. (RCP: FPA, 2012). The main aim of the roles of a PA is to reduce the pressures experienced by doctors and to offer a continuity of care to patients (Joyce et al., 2018; NHS, 2017b). By 2020 there have been approximately 1,000 PAs practicing in the UK with many more in training (NHS, 2020a; RCP: FPA, 2017; Ritsema et al., 2019).
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Physician associates have an important role to play in primary and secondary care as part of a multi-skilled team, working alongside pharmacists, advanced nurse practitioners, doctors, and consultants. They provide a continuity of care for patients especially those who have long-term conditions, which patients value as there is a decreased need to repeat medical histories.
PAs were initially introduced to the US as a response to a shortage of workforce within the primary and secondary healthcare service. However, PAs have faced negative scrutiny within the public domain. PAs were seen as an inexpensive substitute for Doctors. This negative image made it extremely difficult to allow the effective integration of PAs into the NHS. These concerns were mainly down to questioning the effectiveness of PAs, in comparison to junior Doctors. As a PA student, I have also experienced impediments throughout various clinical placements. However, the integration within the team was assuaged with the support of staff and patients. Integration and acceptance of PAs have always been difficult, but with time both staff and patients have observed the benefits of PAs. These benefits have been illustrated by PAs in both primary and secondary care through reduction of frontline pressure, decreased waiting time, depletion in shortage of staff, and building a trustworthy rapport with the patients. This has eased the integration and acceptance of PAs within the NHS and public domain. In summary, PAs are referred to as the helping hand that expedites access to healthcare services.
In the UK the profession of physician associate is considered a new role that was initially introduced in the country in 2003.
The role of physician associate first developed in the US in the 1960s, known as a physician assistant, and similar roles under different names exist in many healthcare systems around the world. There has been an increase in patient satisfaction in response to the role of PA. In 2004, the Department of Health evaluated the impact of introducing the role of physician associate, where a higher level of clinical satisfaction was noted. In 2005, the UK Association of Physician Associates (UKAPA) was established which now acts as a professional body for physician associates. Following this, in 2006 the Department of Health
The profession has gained great success and popularity in the UK with the addition of the voluntary register for physician associates in 2011, and the launch of the Faculty of Physician Associates through collaboration with UKAPA and the RCP in 2015.
Faculty of Physician Associates (31052021) Who are physician associates?, Available at https:www.fparcp.co.ukabout-fpaWho-are-physician-associates (Accessed: 31052021).
PAs are to assist in providing a robust NHS workforce, a broad and inclusive practice of care, a sufficient work-based learning environment, and supervision. However, Reid (2008) highlights that introduction of new roles may not be a swift and complete solution to the increasing demand and pressure of the current NHS climate but instead, an in-depth assessment of patient's medical needs should be the priority. A key barrier that has been highlighted in myriad studies is the integration, acceptance, and recognition of such roles, especially PAs in the NHS workforce and public view (Adamson, 1971; Aiello, 2017; Brown et al., 2019; Drennan et al., 2019).
'They function as mid-level practitioners, along with doctors in training and nurse practitioners
Physician assistants were first employed in the United Kingdom in 2003, working in primary care in the West Midlands
Stewart A, Catanzaro R. Can physician assistants are effective in the UK? Clin Med2005;5:344-8
n the UK they now work mainly in hospitals in a wide range of specialties, predominantly general medicine and the emergency department but also in surgery and in smaller specialties such as pediatrics and oncology
Ross N, Parle J, Begg P, Kuhns D. The case for physician assistants. Clin Med2012;12:200-6.
The scheme was evaluated qualitatively through a retrospective questionnaire. This incorporated open questions on the role of physician assistants in psychiatry, the advantages of employing physician assistants, and any issues that had arisen. These were distributed to the physician assistants, their respective consultants, a non-medical team member, and any attached junior doctor.
Before physician assistants were employed, the clinician's initial concerns were that:
The team would have a limited understanding of the role of the physician assistant
Physician assistants would not have enough psychiatric knowledge
Physician assistants would be unable to prescribe.
All those approached replied to the questionnaire: five responses were from physician assistants, six from consultants, five from non-medical team members, and four from junior doctors (ranging from foundation year 1 to core training year 3).
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