Brace Yourselves – Physician Associates Are Coming.
The impending explosion of physician associates (PAs) into the NHS will likely see the profession become more quickly established than any other group of new healthcare professionals in the history of the health service. To put that into perspective, the 2016 census of UK PAs, carried out by the Faculty of Physician Associates, revealed there were less than 300 currently practicing in the UK . By 2020, there will be over 3000 . So who are PAs, and why are they suddenly so in demand?
Physician associates are healthcare professionals that work to the medical model, under defined levels of supervision, but can work independently with appropriate support. Whilst not doctors, they carry out many tasks traditionally performed by doctors such as history taking, forming diagnoses, ordering/interpreting tests and formulating treatment and management plans.
The role originated in the US, where they’re known as physician assistants, in 1965 . Born out of the need to quickly train more medical professionals in particular cities, it provided an equivalent civilian role for medics returning from the Vietnam war. PAs first started practicing in the UK in the early 2000s, but the role has only recently gained more attention and interest . Some 50 years after their introduction in the US, across the pond the UK faces the reality of a population that is ever-growing and ever-ageing  – a major challenge for the NHS. Physician associates are part of the solution.
When talking about PAs in the UK, it’s important to remember two things. First, they are not doctors. They cannot be used to replace doctors, nor as an answer to the shortage of NHS doctors. They are a supplement to the medical workforce that work alongside doctors, not an alternative to replace them – suggesting anything else is a disservice to both professions at a crucial time for the public recognition and understanding of PAs. Second, PAs need statutory regulation to reach their full potential. Protection of the title, public trust in the role and the ability to prescribe are all key to the development of the profession – but these are regulation dependent.
As the numbers of PAs in the UK begin to significantly increase over the next couple of years, their positive externalities will be felt throughout GPs surgeries and hospitals across the country. But, if they carry out many similar tasks to doctors, why not just train more doctors?
There are a number of differences between PAs and doctors that highlight the value PAs add to the medical workforce. Firstly, whilst junior doctors in training posts rotate every few months for a number of years after finishing medical school, PAs are employed permanently in one area. This allows them to provide a continuity of care, and also to establish rapport and relationships with other healthcare professionals, crucially nurses, that will improve the way the multidisciplinary team collaborates to provide holistic care. Further to this, a PA who has worked with in one speciality for an extended period of time will be able to provide an extra level of support to newly qualified foundation year doctors, as well as improving the patient experience by reducing the time it takes for patients to see a medical professional in key frontline services such as GPs surgeries and A&E – which will bear the brunt of the increasing and ageing population. Finally, whilst doctors specialise, PAs are generalists. This provides a level of flexibility to the NHS medical workforce that it doesn’t currently have and will be crucial in the coming years as demand for particular services and expectations on the health service itself continue to change.
So there’s a case for increasing the number of PAs, though the government must not lose sight of the fact that the NHS is short of doctors and introducing more PAs won’t solve this problem.
But what does the future hold for PAs? Statutory regulation is the next step for the profession and the NHS can’t use PAs to their full potential until this is introduced. It will pave the way for prescribing rights and ordering diagnostic tests that use ionising radiation (such as X-rays) – many PA courses already include this in their training on the expectation regulation will come in the near future. Aside from this, nobody truly knows what the future holds for PAs, though further speciality training, research and teaching roles have all emerged in the development of other healthcare professions.
One thing is for certain though – physician associates are coming. And they’re here to stay.
Author: Dru Lawson, 4th Year Pharmacology
Editor: Luke Smith
 – Faculty of Physician Associates. 2016. Census Results. [Online]. [Accessed 19 March 2017]. Available from: http://www.fparcp.co.uk/censusresults/
 – Jeannie Watkins. 2016. Developing the Role of the Physician Associate. [Online]. [Accessed 19 March 2017]. Available from: https://www.healthcareconferencesuk.co.uk/news/developing-the-role-of-the-physician-associate-2
- Yale School of Medicine. 2013. The PA Profession: History of the Profession. [Online]. [Accessed 19 March 2017]. Available from: http://paprogram.yale.edu/profession/history_profession.aspx
 – Faculty of Physician Associates. 2017. Background to Physician Associates in the UK. [Online]. [Accessed 19 March 2017]. Available from: http://www.fparcp.co.uk/background/
 – Office for National Statistics. 2017. Overview of the Uk Population: March 2017. [Online]. [ Accessed 19 March 2017]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/mar2017