BY PATRICIA MEDEIROS
Dr Eugene Stead (the US chairman of the Department of Medicine) founded the physician associate (PA) profession in 1965. There was a prominent shortage of physicians and other medical providers, resulting in a higher demand for healthcare professionals1. As a response to this, Dr Stead initiated the PA course; a 2-year medical masters with a fast-paced curriculum, similar to the 3-year medical curriculum used to train doctors in World War II2. However, due to the knowledge required, potential candidates could only matriculate if they had previous health-related training. Following the graduation of the first PA cohort, other US universities incorporated the PA course in their medical schools. Numerous countries around the world have since developed their own versions of the course, including the UK.
The UK formally introduced the PA profession in 2003. The Faculty of Physician Associates (FPA) defines PAs as medically qualified professionals with a generalist healthcare background3. PAs are an emerging role in the NHS and an integral part of the multidisciplinary team. They are dependent practitioners, working in liaison with medical supervisors, these commonly being consultants and surgeons. However, with the appropriate training, PAs can work autonomously.
During the course, PA students attend a series of clinical placements in primary care (GPs) and secondary care (hospitals). These placements include a variety of medical specialties, such as, paediatrics, GP, general surgery, obstetrics and gynaecology, mental health and more. After qualifying, PAs can choose to reside in a single area of medicine, but they also have the option to move between specialties. As part of the multidisciplinary team, PAs have become increasingly prevalent within the world of medicine and more widely recognised in the healthcare sector. PAs are not doctors; the PA role was designed to develop generalist clinicians as opposed to a specialised healthcare professional. For example, Drs commonly train to become ‘specialists’ in one area of medicine and PAs train to become ‘generalists’ in many areas of medicine. PAs have obtained a previous health-related degree, whereby certain areas of that degree incorporate key components of medicine. Therefore, providing them with a subsequent generalist medical education, develops competent individuals with the ability to work in varying areas.
There are, approximately, 30 universities in the UK offering the physician associate course. To become a qualified PA, applicants are firstly required to achieve a 1st class (or a 2.1 honours) in a 3 to 4 year undergraduate degree. This degree has to be in a science or health-related subject. Examples of these include, biomedicine, pharmacology and medical sciences. Following this, an additional 2 years of the PA masters (MSc) or the postgraduate diploma (PGdip) is required (or alternatively, a 4 to 5 year MPAS). PAs are also required to complete a series of university exams, a national exam, assessments, OSCEs, and more in order to qualify4. After qualifying, PAs are then further trained in a specialty of their choosing, with many completing internship years or, alternatively, rotational posts. As with many other medical professionals, PAs must also sit a recertification exam every 6 years. This exam encompasses all areas of medicine, regardless of the area the PA is currently working in. This ensures that all PAs maintain a general knowledge of medicine for patient care and safety.
As physician associates study postgraduate level medicine, once they qualify, they are able to: diagnose and treat their own patients; formulate management plans; perform surgical procedures; run clinics; take medical histories; carry out physical examinations and more. Currently, PAs in the UK do not; sign off prescriptions, request ionising radiation or have licenses to work in certain countries. However, PAs in other countries, such as the US, do not have these limitations. This is mainly because the PA role in the UK is newly established and currently not regulated. However, in 2022, the General Medical Council (GMC) will become the official new statutory regulator for PAs. This means that the current limitations are being re-evaluated with plans for prescribing rights, licenses to work abroad and a clear progression pathway for the role5.
AN INSIGHT INTO THE PA PROFESSION:
PA THOMAS SMYTH IN CONVERSATION WITH PATRICIA MEDEIROS
With guest editing by Afnan Housein and Nabiha Ahmed
WHAT DID YOU DO YOUR DEGREE IN?
“I did my undergraduate degree in sports rehabilitation at the University of Salford and graduated in 2015. Then, I completed the PA course at the University of Manchester and I did the PGdip, not the MSc, so I didn’t need to do an additional thesis at the end of the course.”
DID YOU HAVE ANY WORK EXPERIENCE BEFORE APPLYING?
“I was in the very first cohort, in the northwest, back in 2016. As the course was quite new, I didn’t know what experiences were applicable, so I tried to make everything as relevant to healthcare as possible. Luckily, with my sports rehabilitation degree, I already had placements in the NHS setting, like working with orthopaedic surgeons in hospital. Unfortunately, a lot of students now won’t have as much experience due to COVID-19, so universities are being slightly more lenient. We do have a mentor scheme at Salford Royal called the PA Academy and there’s also the North West PA Forum so people can get in touch for an insight into the role. We understand that students are doing their best under the current circumstances.”
WHAT TIPS WOULD YOU GIVE ON WRITING A STRONG PERSONAL STATEMENT?
“A useful tip that I was told, was using a ‘SEE’ approach, which is a ‘skill’, then an ‘experience’ relating to that skill, then an ‘elaboration’ on that and how it applies to everyday needs. Also, always link experiences to healthcare, even if they are not directly in a healthcare setting. Try not to waffle – whoever is reading your personal statement is trying to gain an understanding of your knowledge and experiences from a short-written piece.”
WHAT WAS YOUR INTERVIEW LIKE AND WHAT ARE INTERVIEW PANELS LOOKING FOR WHEN SELECTING A PA?
“I actually interview applicants at Manchester and the process now is different from when I applied. Back then, we had to go to Hayfield Racecourse because I think there were 500 of us and only 140 places, spread between 3 universities. We had MMI (multiple mini interview) stations and if you got through, then you got a place at one of the 3 universities based on what you scored. It was very intense, but I think interviewers are looking for students that can understand and distinguish the PA role from other allied professions. It is also good to be knowledgeable on the NHS and its core values, data protection and more.”
WHAT MADE YOU CHOOSE THE PA ROLE, AND DID YOU EVER CONSIDER MEDICINE?
“Yes, I always wanted to study medicine and I did a lot of research into it and found the PA course which, honestly, really resonated with me. I did a sports rehabilitation degree, so I already knew a lot about the human body and how it functions, but I wanted to know more. I think that a key factor in studying medicine to be a Dr. and studying medicine to be a PA, is that the course itself is 2 years, but it’s a postgraduate masters, so you need knowledge from another 3-4 year degree. After that, you can then still go into any specialty whilst maintaining a generalist approach. So because we are generalists, we can transition between specialties, without restarting our training, so I really liked that flexibility.”
WHAT SPECIALTY ARE YOU CURRENTLY WORKING IN AND WHAT WAS YOUR MOST INTERESTING CASE ?
“The apple didn’t fall too far from the tree; I went back and did trauma and orthopaedics and I just fell in love with the role at Salford Royal hospital, especially the surgical element to it. So, I think the most interesting case I’ve had was a bone transportation surgery. Unfortunately, a patient had a high trauma road-traffic accident and a large portion of the bone in their leg was missing. We have a phenomenal team of specialist surgeons called the limb recon team. So, we did a bone transportation where we physically cut a segment of the bone and transported it millimetre by millimetre each day, and you could actually see the bone regrowing, it was amazing.”
WHAT IS YOUR FAVOURITE PART OF BEING A PA AND ONE THING THAT YOU WOULD POTENTIALLY IMPROVE?
“For me personally, it would have to be the flexibility and the work-life balance. I’m in many different places throughout the week. I’m a PA ambassador and a guest lecturer too. I’m also in theatre for surgery a lot and I run my own clinics, so I enjoy that. But I think if I was to improve anything, it would be the recognition of PAs. There are a few misconceptions about the role and it’s undervalued at the moment because it’s quite new in the UK and people don’t always know what we can do.”
WHAT DO OTHER HEALTH CARE PROFESSIONALS THINK OF YOUR ROLE AS A PA?
“When I first started, they weren’t quite sure on what the role was, so I was often having to explain. I was also trying to fit in this huge, already well-established, medical team. But as soon as I got past that, there was a huge gap to be filled. Me and the other PAs don’t really rotate around; we’re there to offer patient continuity so we know the system. Since we’ve been there for 3 years, we’re able to teach the junior doctors that come in and get them into the system very quickly. We can free up the ward time for the juniors, so that they can go into theatre and into clinics and get all these extra experiences, so actually, we do work very well together.”
WHAT DO YOU THINK THE GMC REGULATION MEANS FOR PAs?
“GMC doesn’t really change my role, but it would make it slightly easier. I work in a profession where I need both ionising imaging and to prescribe, but the doctors are there for support and vice versa. But equally, I am a bit sceptical because with the GMC regulation, PAs may become more prevalent on the wards without much support from the doctors. But overall, I think it’s a great thing because PAs can expand their scope of practice.”
WHAT ADVICE WOULD YOU GIVE TO PROSPECTIVE STUDENTS?
“Personally, I had a great experience, so choosing to be a PA was a success story in itself, I definitely recommend it. I would say though, students need a clear distinction as to which medical model they want to study, whether that’s a PA medical model or a Dr. medical model. Any aspiring PAs are welcome to look at our mentor scheme or contact me on social media with any other questions!”
Find Thomas on Instagram:
@ThomasthePA
To find out more about the mentor scheme, visit thepaacademy.co.uk
Students at the University of Salford can join the Graduate Entry Medicine, Dentistry and Physician Associate Mentoring Scheme for guidance and mentoring with PA applications. For more information on this, please contact S.Namvar@salford.ac.uk.
References
1. Longmire D. The Use of Physician Assistants for Health and Wellness in Aging Population.; 2020. Accessed February 18, 2021. https://scholarscompass.vcu.edu/uresposters/325/
2. Brady MI. A Survey Assessing Patient Satisfaction with Physician Assistant Care at the Maple Street Clinic.; 2004. Accessed February 18, 2021. https://core.ac.uk/download/pdf/48843937.pdf
3. Reynard K, Brown R. A clinical analysis of the emergency medicine workforce crisis. Br J Hosp Med. 2014;75(11):612-616. doi:10.12968/hmed.2014.75.11.612
4. Murphy DC, Harvey A. Jeannine Watkins is a physician associate. BMJ. 2020;371:m3858. doi:10.1136/bmj.m3858
5. Ghadiri SJ. Physician associates: an asset for physician training and a 21st-century NHS? Futur Healthc J. 2020;7(3):e9-e10. doi:10.7861/fhj.teale-7-3
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