Intended for healthcare professionals


Medical associates: junior doctors oppose professional equivalency

BMJ 2019; 365 doi: (Published 20 May 2019) Cite this as: BMJ 2019;365:l2265
  1. Elisabeth Mahase
  1. The BMJ

Junior doctors have voted to “actively oppose” medical associate professionals (MAPs) being treated equally to them when it comes to medical staffing.1 MAPs include physician associates and advanced critical care practitioners.

After a heated debate at the BMA’s junior doctors conference on Saturday 18 May, delegates also voted to oppose MAPs being able to sit postgraduate medical exams and to become senior decision makers in healthcare teams.

Several other motions concerning the growing role of MAPs were passed. These included a call for the BMA to be involved in the further development of the role of physician associates and that it should lobby the government to ensure that physician associates were regulated not by the GMC but a different body.

The Physician Associates (Regulation) Bill 2017-19, currently in the House of Commons, states that physician associates will be regulated by the GMC.2

Speaking for a clear distinction between medical associate professionals and junior doctors, James Warwick, from Mersey Junior Doctors Committee, said, “MAPs are undoubtedly incredible valuable resources to both the NHS as a whole and to doctors. However, this does not mean I believe them to be equivalent to doctors. They fill a valuable role, and there may be many situations where they can complete work which is currently completed by junior doctors, either independently or alongside them. But that still does not mean that they are doctors.”

He went on to say that physician associates needed “separate rotas with separate roles” and that allowing them to take the same postgraduate medical exams as doctors would “undermine the value of the medical degrees we worked so hard to get.” He added that MAPs’ training “must not be at the expense of doctors’ training.”

However, other delegates said that some of parts of the motions were “rude” and “quite arrogant.”

Ellen McCourt, from Yorkshire Junior Doctors Committee and a former chair of the BMA Junior Doctors Committee, said, “The motion refers to senior decision makers, but there is no definition of what a senior decision maker is. I know that when I worked in ICU, there were advanced critical care practitioners that had been there for 20 or more years. There is a great argument that they were more senior than me as an ST3, and I relied on their advice.

“There is an argument that, at a lower level, the senior decision makers can be MAPs. I just don’t think they should be consultants or clinical directors. This motion does not protect our training or our profession, and it’s quite arrogant even to suggest that we might try and convince another professional group that we know more about their role and that we can dictate to them what they do.”

Concerns about how MAPs fitted into healthcare teams were also raised at the BMA’s annual representative meeting last year, where delegates voted for a motion warning that these associate professionals were making decisions “they are not qualified to make.”3