Physician associates—what do they do?

Training

The first UK trained physician associates graduated from the University of Birmingham in 2009. Health Education England announced in 2014 that it would create a further 205 posts to support emergency medicine and primary care.1 The next year, the National Physician Associate Expansion Programme (npaep.com) was launched in England, seeking to employ 200 physician associates to work in the NHS for one to two years.

Currently 27 UK universities offer postgraduate training for physician associates, with further courses in the process of development. Most require at least a 2:1 honours degree for entry into the postgraduate diploma course, as well as some prior health or social care experience.

Alison Carr is director of postgraduate studies at Plymouth University Peninsula Schools of Medicine and Dentistry. The schools have offered a two year postgraduate diploma in physician associate studies since 2015.

Carr says that because physician associates are trained through a postgraduate course, they will have studied for at least five years in total before they are qualified. “Their first degree is in either biomedical science or in a healthcare science such as nursing,” she says. “So they are coming into the programme with experience either of science applied medicine or of working in a healthcare setting.”

She adds, “That means that they have already got three years of training in a relevant specialism and then they do a 90 week, two year intensive programme where they have mandatory amounts of clinical experience. They cover general practice, paediatrics, gynaecology, surgery, medicine, and emergency medicine. Their total training is five years at least because they’ve got their three year undergraduate medical related degree and then two years of a postgraduate diploma which is at masters level qualification.”

Carr says that she would like the misconception that physician associates only train for two years “to go out the window.” She adds, “I think it’s really important that people know that there are prerequisites [to physician associate training] and the prerequisites take longer than the training programme itself.”

The medical model

Once qualified, physician associates take on similar roles to junior doctors and work alongside them to carry out procedures, see patients, and make decisions, Carr says.

“I’ve seen examples of more experienced physician associates training junior doctors in their specialty, simply because the physician associate has been there several years and the junior doctor has just arrived or not been there for very many months,” she says.

Carr says that, while junior doctors frequently move during the course of their training, physician associates can offer continuity. A junior doctor may spend four to six months in once place, but a physician associate may choose to stay there for 10 years, “so they end up with a skill set which is narrowed to the actual field that they are working in,” she says.

The physician associate role is distinct from that of a nurse, because of the way that physician associates are trained, Carr says. “The essential difference between physician associate training and the training of nurses and other healthcare professionals is that physician associates are trained to the medical model,” she says. “This means that they learn as a doctor does, to deal with people who have got symptoms and signs that don’t necessarily fit into a clear diagnosis.”

Nick Cooper, associate professor in clinical education at Plymouth University Peninsula Schools of Medicine and Dentistry, says that the fact that physician associates are trained under the medical model is particularly useful in general practice. “The majority of treatment that is done by a GP is uncertain and you haven’t got the label for and it doesn’t fit into a nice box,” he says. “You deal with uncertainty and complexity of diagnosis, and I think that’s an area where physician associates can develop.”

Collaboration

Alex Stevens graduated as a physician associate in 2009 and has been working in the NHS for six years. The nature of his role means that he becomes fully involved within a medical team, working with consultants and junior doctors to help to deliver consultant lead care of patients. “That means taking part in ward rounds, seeing patients, clerking patients in, doing jobs such as helping to facilitate discharges,” he says.

As well as seeing patients, Stevens can carry out procedures and input into the training of junior doctors in the foundation training programme. “On an average day I could take blood, cannulate, do arterial blood gas sampling—anything that’s deemed necessary for the patient,” he says. “I can also perform a lumbar puncture, plural tap, ascetic tap, and put chest drains in.”

Despite taking on similar roles to junior doctors, physician associates shouldn’t be thought of as a threat to doctors, Stevens says. “We are there to work collaboratively with doctors in practice and quite often we help to create more time for trainees, giving them increased opportunities and access to better quality education and training from consultants or anybody else,” he says. “[Our presence] can open up doors for other members of the team. But it’s quite understandable that people think of us as a threat first of all.”