Physician Associates in Wales
Research type
Research Study
Full title
Physician Associates in Wales: a study of their preparedness for practice, their contribution and patient perspectives on the role
IRAS ID
274639
Contact name
Alison Bullock
Contact email
Sponsor organisation
Cardiff University
Duration of Study in the UK
1 years, 9 months, 30 days
Research summary
Research Summary
The Physician Associate (PA) is a relatively new role within primary and secondary care settings in Wales and England and numbers have increased in recent years. Working under the supervision of a consultant or GP, PAs support doctors in the diagnosis and management of patients. They are trained to perform specific clinical tasks including taking a patient’s medical history, carrying out examinations, formulating and documenting a detailed differential diagnosis and analysing test results. At the moment, PAs do not have prescribing rights, nor can they order radiological investigations.
To date there has been no evaluation of the existing PAs currently working in Wales. It is opportune and timely to undertake a robust evaluation of the role. From a strategic perspective, the evidence is needed that these individuals are well prepared to join NHS organisations in Wales and contribute to service delivery and to the care of patients. Such study can support the development and implementation of the role, ensuring consistency of practice and a smoother transition into the workplace for graduates.
The academic challenge is three-fold. Firstly, there is a need to address knowledge gaps. There is no agreement on how PAs may best contribute to team-work and the impact on service provision. Secondly, very little research has been conducted that explores how well the training programme prepares the PA for the role. Thirdly, patient perspectives must not be overlooked: to be successfully embedded into the future workforce, patients need confidence in the PA role. Insight into patient expectations and confidence in their healthcare providers can inform how roles are explained and played out in practice within healthcare teams.Summary of Results
Background Physician Associates (PAs) were introduced in the USA in the 1960’s and first appeared in the UK in 2003. In the UK, PAs are defined as:
“…medically trained, generalist healthcare professionals, who work alongside doctors and provide medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners working with a dedicated medical supervisor but are able to work autonomously with appropriate support.” (FPA, 2022a) The evidence base around PAs in the UK is still developing and this study is one of the first to examine PAs in the context of Wales. The aims of the study are to explore and report:
1. the experiences of recently qualified PAs and how well prepared they feel for their role following training and/or their internship, exploring the transition from trainee to qualified PA
2. the perceptions of the impact PAs have on service delivery and provision
3. how well embedded PAs are in the multidisciplinary team, examining PAs and their colleagues’ perspectives
4. patient expectations, experiences, and sense of confidence in the PA role
5. similarities and differences in the experiences and impact of PAs between the primary and secondary care settings.Methods
The study adopted a mixed methods design split into three parts: case studies across four health boards, the ‘All-Wales PA questionnaire’ and one-off interviews. Data in the case studies and one-off interviews was collected through semi-structured interviews with PAs, their clinical team members, staff involved in the management of the role and patients. All PAs working across Wales were invited to complete the questionnaire. In total, 51 participants took part in an interview and 31 PAs responded to the questionnaire. Additionally, a questionnaire targeted at managers in the case study health boards was distributed, but only gathered four responses.Overview of findings
The findings from the study identified the barriers and facilitators for newly qualified PAs (NQPAs) in the transition from student to qualified PA. Perceptions around how well-prepared PAs felt for practice collected conflicting results. Internships were discussed. Although the internships provided support during the transition to NQPA, there were issues raised including differences in structure and ambiguity around expectations.
PAs were considered to contribute positively to teams and services in both the primary and secondary care settings, particularly for continuity. They supported their teams both clinically and non-clinically. The PA profession, as other studies have previously identified, still faces ambiguities and in some cases associated resistance. Comparisons with and references were made between doctors and PAs. The ambiguity surrounding the profession has resulted in some PAs not being utilised most effectively. Regardless of the ambiguities and occasional hesitancy, PAs were reported to be accepted in their teams. Legitimate peripheral participation, the process in which ‘newcomers’ develop their skills by learning from ‘old-timers’ (Lave and Wenger 1991), was present between PAs and team members as well as contribution to communities of practice.
Patients were overall unclear or unaware about the PA profession, often believing that they were a different professional. However, patients in the study were generally positive or indifferent towards seeing a PA in the future.
As the study took place during the Covid-19 pandemic, attitudes and experiences were discussed in that context. The PAs in the study reported challenges associated with working during the pandemic, including increased workloads and staffing shortages, as well as disruption to learning. However, perspectives were shared around how the pandemic had served to highlight the PA profession and its value and there were speculations that new opportunities had developed because of this.Conclusions
In summary, a total of 86 participants took part in this study. The findings from this study are self-reported and offer insight into the PA role in Wales from several perspectives.
The findings from the study identified that despite mechanisms in place such as internships, there are still barriers in the transition from student to qualified PA. There were also mixed views from the PAs around preparedness for practice.
PAs were overall reported to be satisfied with their job and well accepted in their teams, though ambiguities surrounding their role can hinder their integration. Patients were also found to be unclear about the PA role and although from their perspective this did not create issues, the PAs expressed a desire for patients to have a better understanding.
Role ambiguity also resulted in some PAs not being utilised in the most effective way. There was also a consensus that the lack of regulation affected the full impact of the profession. But overall PAs were considered to contribute positively to teams and services in both primary and secondary care.
Whilst the Covid-19 pandemic was extremely challenging, affecting both work and learning for PAs, the value of the PA role has been showcased and new opportunities developed for some PAs.REC name
West of Scotland REC 4
REC reference
20/WS/0084
Date of REC Opinion
23 Jul 2020
REC opinion
Further Information Favourable Opinion