Will physician associates be replacing doctors?
Authors: Abi Rimmer
Publication date: 10 Sep 2014
The number of physician associates working in the NHS is set to increase by more than 100 in the next few years. Abi Rimmer examines what physician associates do and how their roles are expanding
Currently 200 physician associates are working across the United Kingdom. Most of these are based in Bristol, Edinburgh, Glasgow, Weston-super-Mare, the East and West Midlands, and parts of London.
The health department has said that between September 2014 and January 2015 the existing 105 available training places will increase to 225, as a further three courses open at Plymouth, Wolverhampton, and Worcester universities and Birmingham’s course expands. Four further courses are planned by autumn 2015. Physician associate training is currently offered at three institutions—the University of Aberdeen, the University of Birmingham, and St George’s University of London.
A total of 119 physician associates have qualified in the UK since the Birmingham and St George’s courses opened in 2008 and Aberdeen’s course opened in 2011. Year on year the number of students entering courses has increased. The Aberdeen course began with 11 students and took 15 in 2013, Birmingham began with 15 students and this year had 30, and St George’s started with 12 students on its course but recently filled 19 places.
Physician associates undergo a two year postgraduate training programme, and students are usually required to have taken a science degree before starting the course. The role was formerly known as a physician assistant, and many physician associates will already be trained health professionals, such as nurses, paramedics, and physiotherapists.
Most qualified physician associates work in the NHS, in areas such as acute adult general medicine, general practice, accident and emergency, and surgery. St George’s University says that some of the graduates from its courses are the only physician associates in the UK working in their chosen specialty, such as plastic surgery and oncology. The university also says that nearly half of their outgoing students already have job offers even though they do not qualify until late September this year.
Duties of physician associates
Physician associates are trained to perform a number of duties, including taking medical histories, performing examinations, diagnosing illnesses, analysing test results, and developing management plans. The health department says that physician associates cannot do “anything” without being supervised by a doctor and the Royal College of Physicians (RCP) describes them as “dependent practitioners” who “work within their sphere of competence.”
Following the health department’s announcement that there would be more physician associate training places, the BMA has called on the government to clearly define their role. The association insists that physician associates should not replace doctors.
Mark Porter, chair of BMA Council, believes that physician associates could be “a valued part of the NHS,” but that the scope of their work needs to be clear so that they can best provide an intermediate level of care and reduce workload pressures. “It is important that all healthcare professionals—including doctors—are clear about the limits on the care they are able to provide, and work within them,” he said. “Only doctors can provide certain types of care so the government needs to ensure that standards will not be affected by these changes and the quality of patient care will be protected and maintained.”
Porter said it was important that new training places do not erode training opportunities for junior doctors or medical students, or undermine the vital role these groups play in delivering care. “Crucially, these new posts cannot replace doctors,” he says.
A health department spokeswoman said that physician associates would support doctors, rather than replace them. “They can carry out clearly defined duties, but have to be under strict supervision of a doctor at all times. Many physician associates will already be trained physiotherapists, nurses, or paramedics and will have two years of intensive training on top of that,” she said.
Currently, physician associates are not nationally licensed but they can join the Managed Voluntary Register administered by the UK Association of Physician Associates (UKAPA). The Royal College of Physicians says that the number of physician associates in the UK has so far been limited owing to lack of regulation for those taking on these roles. The college has been pushing for regulation of physician associates since 2005.
In a joint statement, the royal college and the UK Association of Physician Associates said that statutory regulation would allow physician associates to make a “more effective contribution to the health service and the health economy as well as offering better protection to the public.” The statement said: “The RCP and the UKAPA are currently setting up a new Faculty of Physician Associates, which would support and develop the role, including revalidation of PA courses, expanding the current programme of continuing professional development and managing recertification.”
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.