Education And Debate

The physician assistant: would the US model meet the needs of the NHS?

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7323.1244 (Published 24 November 2001) Cite this as: BMJ 2001;323:1244
  1. Linda Hutchinson, lecturer in medical education (linda.hutchinson@uhl.nhs.uk)a,
  2. Tom Marks, program director, physician assistant studiesc,
  3. Mike Pittilo, deanb
  1. a Department of Medical and Health Care Education, St George's Hospital Medical School (University of London), London SW17 0RE
  2. b Faculty of Health and Social Care Sciences, Kingston University and St George's Hospital Medical School (University of London)
  3. c Grand Valley State University, Grand Rapids, MI, USA
  1. Correspondence to: L Hutchinson, Director of Education and Workforce Development, University Hospital Lewisham, Lewisham High Street, London SE13 6LH
  • Accepted 19 July 2001

The public and the government have both identified “more staff” as a way of improving the NHS.1 Problems with recruitment and retention in nursing and allied health professions and falling numbers of applicants to primary care are potential constraints on the meeting of targets. One option is to introduce a new group of staff (box 1). 2 3 Practitioners who perform “mid-level” duties in the United States include doctors in training, nurse practitioners (including advanced practice nurses and other titles), and physician assistants. These three groups perform similar duties and, at the level of the patient, act interchangeably. The American term “physician” encompasses all doctors, and physician assistants work in all branches of medicine and surgery. Physician assistants in the United States are fully trained professionals who take on a role equivalent to that of a junior doctor for their entire career. They pride themselves on their “dependent” status, have the ability to move to and from various clinical settings, have their own recertification processes, and do not compete for senior medical posts. Higher education institutions in the United Kingdom are starting to look into the education needs of such a profession. But is the US physician assistant model the right solution for the NHS?

Summary points

Physician assistants make a major contribution to provision of health care in the United States

They function as “mid-level” practitioners, along with doctors in training and nurse practitioners

They train and work in a biomedical model and do not perform “nursing” tasks or tasks of other therapists

Introduction of US-style physician assistants in the United Kingdom would reduce medical staffing difficulties but would not help to remove professional boundaries or barriers to expanding scope of practice

It is not known whether introduction of another healthcare career pathway would attract into the health service people …

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