5 Genuine Downsides to Becoming a Physician Associate

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It’s not all sunshine and rainbows for PAs. There are some legitimate downsides to choosing this career path as it stands right now.

These are things that may change in the future, or possibly already in the process of changing now.  

It still remains that at some point, a practising physician associate has had grievances with these points at one time or another. 

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5 Genuine Downsides to Becoming a Physician Associate

Downsides to becoming a Physician Associate

Limited job progression

Physician associates have limited job progression.

In an optimistic world, physician associates may have the opportunity to transition into teaching, research, public health, and mental health.

In reality, few PAs manage to specialise in other fields as it stands. 

This is because for every post a PA engages in, there must be a reasonable amount of supervision.

In many ways, job availability is bottlenecked by available supervisors. 

Physician associates are also not trained in specialised fields by default, and as such training opportunities will need to be made available.

This is likely to change in the future.

Limited autonomy

Physician associates have limited autonomy. In theory, PAs are able to work autonomously with appropriate support. 

In practice, newly qualified PAs will have varying levels of confidence as a result of differences in their background, and how much supervision is already provided.

The truth of the matter is PAs are not doctors, and as such will benefit greatly from physician nurturing, formal discussions, or adopting a “buddy” approach with physicians.

Some may see this as not having the room or freedom to put into practice what you went to school for. 

The steep learning curve that PAs go through when transitioning from postgraduate students to clinicians however warrants this closer nurturing from physicians, especially in the early and often seminal years.

Conflict with physicians

Physician associates may encounter conflicts with their fellow healthcare workers, most notably doctors.

Conflict and professional disagreements are not novel occurrences in the workplace. 

In reality, developing a positive working relationship with colleagues despite having disagreements is an important part of any job.

Unfortunately, there have been reports of senior physicians giving more attention and mentorship to trainee doctors. 

This can be difficult to deal with in practice, but there are usually rules against these severe forms of favouritism in every organisation. 

Any student is well within their rights to escalate the matter to the relevant HR department.

Limited ability to practice abroad

Physician associates who have qualified in one country have a hard time relocating and practising in another.

As it stands, there are less than 20 countries that have adopted the PA role in their respective healthcare systems. 

Most notable countries adopting the PA role include the Netherlands, Australia, UK, Ireland, Canada, Germany, South Africa, and Israel. 

Most of them adopt the name ‘physician assistant’ except in the UK which uses the term ‘Physician Associate’ and in South Africa which refers to their professional as ‘Clinical Associates’.

Low public perception and trust

The physician associate role is a new one. 

As much as lecturers, doctors, And PA admission officers like to talk about the massive potential the PA role has and its widespread adoption and acceptance into the healthcare ecosystem, PAs still remain largely unknown to the public.

This isn’t to say this won’t change in the future, however as it stands, physician associates often find they have to explain exactly who they are on their first encounter with patients.

They subsequently have to justify their professional qualifications and credibility despite their non-doctor status and do so without disparaging their profession or that of the physician.

This can be a hard pill to swallow especially for new PAs who work very hard to get their job, let alone the fact that they are doing largely the same job as a junior doctor.


In summary, one may choose medicine over physician associate studies in order to have more job autonomy, better career progression, and more respect from the public.

Author’s note

This article outlines some of the potential cons of becoming a physician associate that past cohorts and current PAs may have voiced at one point. This is not an exhaustive, list, nor is it definitive. Your experience may be different and indeed there is certainly progress made on things like public perception, autonomy, and physician conflict. 

Rest assured the role is still in its infancy in the UK, and current cohorts may be a necessary force to supplement the positive progression of the PA role!

To read about the pros of becoming a physician associate, check out the article titled “why you should become a physician associate instead of becoming a doctor”.

Read more about how to become a PA on the NHS website and an article on the satisfaction of doctors with PAs.

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