Evidence
Alert

Physician associates need support to establish their place within the healthcare workforce

The role of physician associate was recently introduced in the UK as a response to staff shortages, growing demand for services and rising costs in the NHS. Physician associates support multidisciplinary healthcare teams in the diagnosis and management of patients. They are supervised by doctors and they take medical histories, carry out physical examinations and see people with long term conditions. But there is a lack of awareness about their role – and the needs of trainees – among those teaching and working with them.

Physician associates are not qualified as doctors. They typically have a first degree in biomedical sciences, and then take a two-year course in which they develop medical skills. Initial training programmes for small numbers of physician associates were set up in 2004. There are now 36 programmes across the UK, and more than 1000 students graduate every year.

Researchers surveyed the first year of physician associate students in the Yorkshire and Humber region. Almost half said their placement supervisors did not know enough about the new role and were unclear about what clinical work physician associates should do.

The students were older than traditional medical students and more likely to have caring responsibilities. They reported more mental health problems. The study found that physician associates face distinct challenges and may need more support, compared with traditional medical students. In addition, doctors and other supervisors in the NHS need to be fully informed about this new role.

What’s the issue?

The role of physician associate has been an integral part of the US healthcare workforce since the 1960s but is new in the UK. Around 1600 physician associates had qualified in the UK in 2019, but that number is expected to rise quickly as students in the system qualify and join their ranks. There has been little research as yet into their experiences of training and work, and how they will be integrated into the health system.

This research was carried out to better understand the experiences of physician associates in training. It is part of an ongoing ten-year project that will follow this group, and subsequent students over time. This paper reported on the first year of results.

What’s new?

Researchers sent questionnaires to all 120 first year physician associate students in the Yorkshire and Humber region in 2017-18. They received 89 responses. The physician associates were aged 25 on average at the start of their course, but they ranged in age from 19 to 49 years. The majority (71%) were female.

Many of the questions about student experience explored student work placements. The study found that:

  • most students on work placements (79%) felt they had a member of staff they could approach for support
  • however, almost half (45%) felt that staff on placement did not know enough about the physician associate role, and three in five (61%) felt that staff did not know what clinical work they should undertake
  • almost half of students (49%) reported symptoms that could suggest mild depression or anxiety. This is higher than reported rates of these symptoms among medical students (25-37% in other studies)
  • student’s wellbeing was linked to their levels of engagement with the course. The one in six (16%) who had caring responsibilities were less likely than others to be highly engaged with the course.

Why is this important?

Understanding the early experiences of physician associate students is important if this new profession is to receive adequate support. The finding that supervisors and other staff were unsure about appropriate work for physician associates on work placements suggests a need for better information and training of those in the healthcare workforce expected to work alongside them.

Existing research has suggested that a lack of awareness of the new role will slow down the integration of physician associates into the workforce. Interestingly, because the role is new, supervisors will come from a different discipline. At best, this could help break down barriers between disciplines. But there is also a danger that this will be problematic, given the lack of knowledge about the scope of work physician associates should be learning to do.

Many physician associate courses in the UK are set up within medical schools, and they share resources. The finding that physician associate students had higher levels of anxiety and depression suggests they may need more – or different – support than is normally provided to medical students. This may continue to be the case once they have qualified.

However, this data comes from the first year of the study and could develop or change over time.

What’s next?

The research will continue, following the next four cohorts of physician associate students for five years each. The researchers hope that longitudinal data will inform them more about the effect of the course and employment on wellbeing and vice versa. They will be able to monitor changes in the experiences of physician associates as students and once they are employed.

You may be interested to read

The full paper: Howarth SD, and others. The early experiences of Physician Associate students in the UK: A regional cross-sectional study investigating factors associated with engagement. PLoS ONE. 2020;15:e0232515

A paper giving further context about physician associates: Drennan VM, and others. Building the evidence base-10 years of PA research in England. JAAPA. 2020;33:1-4

Funding

This research was supported by the NIHR Yorkshire & Humber Patient Safety Translational Research Centre, the NIHR CLAHRC Yorkshire and Humber, and Health Education Yorkshire and Humber.

Commentaries

Study author

It was interesting to note that caring responsibilities were associated with lower engagement. We were involved in developing a postgraduate physician associate studies programme and found that the early focus was directed at creating a curriculum based on the medical model to train safe, competent practitioners in just two years. Student support is integral to any new curriculum and it is clear from these findings that the support mechanisms need to be developed specifically for this programme.

We need to find out more about how we can appropriately support physician associate students and clarify how they differ from other student groups. We need to know more long term about their wellbeing, support and training in order to better understand how we can retain and promote a new profession that is rapidly growing in numbers every year. There were an estimated 600 PAs qualified in 2018 and this rose to 1600 in 2019.

Sarah Howarth, Research Assistant in Applied Health, Leeds Institute of Medical Education, University of Leeds

Director of PA training

This report from the Yorkshire and Humber area of the UK investigates the experience of new physician associate students and interrogates the factors facilitating and blocking their engagement. It is already known that introducing physician associates improves flexibility within healthcare systems and offers an additional recruitment route for clinicians working in the medical space, with minimal negative impact on existing health professions. The lack of knowledge of the role can cause initial resentment and confusion, largely related to fear of the unknown among other professions, but familiarity ameliorates this.

Institutions training and/or recruiting physician associates need to prepare the ground. They need to recognise that the physician associate student body is older and more ethnically diverse than the medical student body. They may need different approaches to placement orientation and support, as they are generally older than other healthcare students and often have personal responsibilities.

Jim Parle, Emeritus Professor of Primary Care and former Course Director for the Physician Associate PGDip programme, University of Birmingham

Conflicts of Interest

None declared.