Physician Associates are currently undergoing intense scrutiny as a review by Professor Gillian Leng draws to a close, with the report due out soon. As part of our ARRS frontline professionals series a physician associate explains how this has impacted her and her colleagues. She wished to remain anonymous due to backlash she and her colleagues have received.
Physician associates are a relatively new addition to the NHS, starting in 2002 after the success of PAs in North America, Australia and parts of Africa.
As healthcare practitioners trained and working to the medical model in both primary and secondary care, we are autonomous but work under the supervision of a consultant. We cannot prescribe medication or order tests that require ionising radiation.
The big question that has come up over the past few years, as expected, is our scope of practice. As previously stated, we are a relatively new group of healthcare professionals treating the public. Therefore, clarity as to where we fit into the team and the expectations and limitations should have been given before the role was launched.
My scope is guided by what my practice needs from me, similarly to most PAs working in GP Land. Some will be more confident in skills such as taking blood samples and minor surgery, while others excel at managing long term conditions. No two PAs in General Practice will have the same working day.
I work together with the multidisciplinary team to help to manage patients with both acute and long-term conditions. Over the years, I’ve had the opportunity to upskill and spend a lot of time working with patients who have specific long-term conditions, alongside dealing with the day-to-day acute patients. Over time, I have become more confident about the types of patients that I see, however the time that I have allocated in which to see them has decreased.
One thing that hasn’t changed however, is the level of supervision. PAs not rotating affords us the opportunity to build a good rapport with our supervisors. This allows us to gradually broaden our skillset and improve our confidence levels while still benefiting from the guidance and knowledge afforded by supervision.
In my opinion, the recent backlash and uncertainty is due to the role initially not being well defined and fully explained to other HCPs before the recruitment and training of PAs. More pressingly, I do not feel that the role was clearly explained to the public, making them unaware of our role.
‘Hello, my name is…and I am a Physician Associate’ is how I and my colleagues introduce ourselves to each patient. The number of times that I’ve been questioned ‘What’s that?’ ‘Are you a doctor?’ is illuminating.
The public and other HCPs are very used to the structure of the healthcare system as it was- doctor nurse etc and they expect to see those clinicians in their respective locations. With the advent of newer roles, it’s hard for patients and other healthcare workers to place us. Saying that, the number of PA’s currently working and the work that they do shows that there is a need for the role. As society grows and changes, so must the healthcare system.
It’s draining as a clinician, to constantly have to explain your role during consultations, especially in the limited time that we have in general practice. This, compounded by the hate that PAs have received online from individuals and larger organisations has had a huge impact on myself and the PAs that I work with.
We are more anxious about patient interactions. We over analyse and sometimes over investigate diagnoses that we are confident about due to the fear of making a mistake that ends up on the news or online. We triple check notes to make sure that everything possible is written down and spend extra time with supervisors discussing cases that aren’t very complex, just to reassure ourselves that we have made the right decisions.
Some would say that’s good, and to some extent, it is. However, the impact of doing this every day with the normal pressures of working in the NHS is enormous. It depletes energy levels, destroys self-confidence, fuels anxiety and leads to burnout.
Additionally, the lack of jobs leaves people feeling stuck, and the fear that you may lose yours because your practice or PCN may decide that they don’t want a PA anymore because of the recommendations and guidelines released is a real worry and has made many reconsider whether this is the right career path. This is a huge shame because I really do believe that PAs bring something great to the primary care team, but perhaps that was the goal? To make it so uncomfortable and impractical to be and have a PA that people doubt the role.
Thankfully, the PCN that I work for has maintained its PA numbers and the PAs that I have worked with as a lead have been fantastic additions to their clinical teams.
As a PA, I want people to remember that behind the clinician is a person trying their best for their patients and that we all have the same goal. Perhaps, instead of trying to bring each other down, we should be working to make things better for all.