A “Physician associate” is a relatively new role that started in America several decades ago and has finally made its way to the United Kingdom.
It promises to alleviate some of the stress put on doctors, and directly address the shortage of doctors within the healthcare system.
In this article, we will explore the roles of a physician associate in-depth and determine exactly where they fit in the hierarchy of healthcare professionals.
What is a physician associate?
Physician associates are healthcare professionals that, like doctors, can take patient history, examine patients, call for tests to be done, and make diagnoses.
They however can’t prescribe medication or request for X-rays as legislation states only registered healthcare professionals are able to carry out such tasks.
This will likely change as the GMC announced that it will be the regulating body for physician associates, amending its currently unregulated status.
Physician associates are a lot like (but not the same as) general practitioners (GP’s), in that they are generalists who work alongside physicians and surgeons to provide medical care.
They are trained to follow the medical model which means they can identify disease and issues of the body in a systematic way, identifying symptoms, performing examinations and observing test results.
Within the setting of general practice, physician associates can see and treat patients presenting with acute problems the same way a GP does.
The only difference is a physician associate will essentially be working under the supervision of a senior physician who is technically responsible for the patients.
As a physician associate, you will be still practising medicine. Many of your daily tasks will be more or less identical to that of a doctor.
You, however, won’t be working with full autonomy, but most doctors and healthcare professionals will never work completely unsupervised anyways.
How to become a physician associate?
To apply for the 2-year PGDip/MSc required to qualify as a physician associate, you must be coming from a bioscience background.
This usually means you have completed a biomedical science degree with at least a 2:2 (Hons).
Most applicants will, however, be achieving a 2:1 or higher to be considered as this is the only academic requirement. A-Level grades and GCSEs aren’t considered at this level of study.
You will also need to have a work history within care. Most applicants achieve this through work as a healthcare assistant (HCA) or a support worker in a care home or hospital.
After achieving both degrees, there is a junior internship year you must complete after graduation, much like FY1 in medical school.
Since regulation is yet to be taken over by the GMC who currently regulates doctors, there is no formal registration as a healthcare professional.
You, however, need to register with the royal college of physicians, as they keep a voluntary register of physician associates. You usually can only be employed if you are on this register.
Why can’t PAs prescribe?
Due to a lack of a regulatory body, physician associates can’t prescribe medicines or order tests involving ionising radiation (x-ray).
The legislation only permits such tasks if you are a legally registered healthcare professional.
Once the GMC becomes the governing body, it is very likely PAs will have a statutory register, allowing them to be recognized officially as healthcare professionals.
Once the profession becomes regulated, we will also likely see the creation of prescribing courses to give physician associates the skills to prescribe medication.
Physician associates are required to pass a national exam every 6 years to ensure their knowledge is up to date, and they have the competency to practice medicine.
Is there any career development with becoming a physician associate?
Can physician associates progress their career like doctors? Once a medical student graduates, they complete their foundation years and undergo specialist training.
They can then progress into more senior roles such as consultants or GP’s and work without supervision. While it is possible to progress in terms of pay, most of the PA job progression seems lateral once you hit peak expertise in your speciality.
You may progress to senior PA however you won’t progress to becoming a doctor, surgeon, or consultant.
Once you become a physician associate, you stay that way, unless you decide to take on teaching and lecturing roles, in which case if you have a PhD, your students will refer to you as Doctor.
You may also choose to apply for an accelerated 4-year graduate medical degree to practice as a doctor.
This is quite a long route and there is no evidence that it will be easier to enrol on a medical degree with a PA masters.
Once you graduate as a PA, you will likely dive straight into your role and leave the dream of being a doctor behind.
If any PAs have become doctors, please contact us as we would love to hear your story!
What is the difference between a doctor and a physician associate?
Doctors must complete a medical degree, usually 5 years, and do their foundation years, then specialize to become full-fledged doctors.
PAs typically have to have a BSc in a bioscience degree and complete another 2 year MSc/PGDip in physician associate studies. this is also a total of 5 years study.
Doctors typically undergo more demanding and in-depth training and as a result, will always outrank physician associates.
The role, however, wasn’t created for ranking purposes, it was created to alleviate stress on in-demand healthcare professionals such as doctors.
PAs are therefore technically under supervision by doctors and work in conjunction with their them.
That is not to say there is a doctor watching your every move and waiting to correct your faults.
It just means you always have a council when unsure about certain things, and your work isn’t fully independent and autonomous, as you will have to report to someone.
This isn’t a bad thing as in healthcare, you are always working within a team to achieve a greater goal, and meet the need of your patients.
What is the difference between a nurse and a physician associate?
The professions receive training in accordance with different models.
PA’s receive training in accordance with the medical model, same as doctors, whilst nurses receive training in accordance with the nursing model.
Giving that they both have advanced degrees, and pre-registration work experience, the professions are somewhat equally placed.
There is some overlap in the roles performed however typically nurses are trained to provide long or short term care and support.
They work semi-autonomously and are crucial in the holistic care of a patient.
Physician associates, on the other hand, do the job of physicians which include illness diagnoses, performing examinations, taking histories, and providing a treatment plan, all be it within the approval of the senior care physician.
It’s a tricky hierarchy and since the role is relatively new, boundaries and quirks are still being established.
It’s, however, safe to say nurses and doctors won’t be looking at PAs as competition as they will likely make their jobs easier, and improve healthcare in the process.
How does a physician associate compare to a junior doctor?
A newly qualified physician associate is comparable, but not the same as a junior doctor. They must both be able to perform at the same standard and must ask for help from a consultant when required.
A junior doctor technically cannot supervise a qualified PA as they are all under the supervision of the consultant.
PAs must take responsibility for their medical actions and practice, and refer to a more qualified healthcare professional whenever appropriate.
The same goes for junior doctors, at least for the duration of their foundation years.
How does a physician associate student compare to a medical student?
As mentioned before, physician associate students must hold a bachelor’s degree in a science subject, then go on to study a 2-year masters program to become qualified. This makes it 5 years total.
Most physician associate courses are taught in medical school, and therefore final year physician associate students take the same applied medical knowledge exams with a pass mark that is the same as the pass mark for 5th-year medical students.
PA students also sit the same OSCE’s, ISCE’s, and should expect the same case-based examinations that medical students do on placement.
These are striking parallels and has been subject to many conflicts and heated discussion between the PA and med student community.
Certain medical student groups believe it is unlikely that a BSc in science and a 2-year master’s program somehow mysteriously makes PAs as qualified as junior doctors in such a restricted time frame.
They, however, fail to consider that PAs don’t go to a separate physician assistant school, they are taught in a medical school, via the medical model. The course is as rigorous as a medical degree, only lacking in the significant depth of knowledge that medical students accrue.
This, however, doesn’t make PAs less competent at practising medicine, as often their training at university lasts just under 3 years due to the lack of a summer holiday. They must also complete a full year of work experience before becoming fully qualified.
How does a physician associate introduce themselves to patients?
Physician associates introduce themselves as physician associates. Not physicians, or doctors, just physician associates. This is a legal requirement and will prevent confusion later, in case your patients assumed they were talking to a doctor.
If your patient doesn’t know what a PA is, you simply explain that you are a medical professional who is trained and certified to practice medicine.
This is usually enough to appease the patient’s concerns and provide credibility to your role.
If the patient is still concerned, you simply need to assure them that you are well qualified to see and treat your own patients, however, there is a senior consultant who may look over your charts if a second opinion is required.
Can I work abroad?
The PA role exists in many countries abroad since its conception in the 60s.
However, UK qualified physician associates are still not registered, healthcare professionals.
To work in the UK as a PA, you must be signed on the voluntary register, and this must become a compulsory register as every other healthcare profession has.
Once this happens, you may be able to find work elsewhere possibly in the EU, Canada, and Australia.
This seems imminent as the GMC has announced it will become the governing body for physician associates in the future.
At the writing of this blog, the UK left the EU a few hours ago, adding to the uncertainty of jobs in this fresh sector.
All things considered, it seems with the GMC’s backing, the profession will grow into a strong force for the NHS and for the UK as a whole.
If you are still unsure about which courses to study, consider checking out my short course where I walk you through several life sciences courses and which ones to study in the future!