What is a physician associate (PA)?
Physician associates are collaborative healthcare professionals with a generalist medical education, who work alongside doctors, GPs and surgeons providing medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners working with a dedicated supervisor, but are able to work independently with appropriate support.
What do physician associates do?
Physician associates work within a defined scope of practice and limits of competence. They:
- take medical histories from patients
- carry out physical examinations
- see patients with undifferentiated diagnoses
- see patients with long-term chronic conditions
- formulate differential diagnoses and management plans
- perform diagnostic and therapeutic procedures
- develop and deliver appropriate treatment and management plans
- request and interpret diagnostic studies
- provide health promotion and disease prevention advice for patients.
Currently, physician associates are not able to:
- request ionising radiation (eg chest x-ray or CT scan).
How do physician associates fit into the NHS workforce?
Although physician associates are dependent practitioners, they can also practise independently and make independent decisions. This is enabled by collaboration and supportive working relationships with their clinical supervisors, meaning that there is always someone who can discuss cases, give advice, and review patients if necessary.
Physician associates can be found working in GP surgeries, Accident and Emergency departments, and inpatient medical and surgical wards throughout England and Scotland. See below for examples as to how physician associates can be used;
In a GP surgery, physician associates see patients of all ages for acute and chronic medical care. Physician associates can refer patients to consultants, the EAU or to A & E when clinically appropriate. Other duties include home visits, prescription reauthorisation, review of incoming post and laboratory results. Physician associates are an additional health care team member to help the practice reach Quality Outcome Framework targets.
In Accident & Emergency departments, physician associates are able see whatever comes in the door. They see patients in minors and majors as well as resuscitation and post resuscitation. They are also able to see medical, trauma, mental health, paediatric, obstetrics and gynaecology cases. Physician associates obtain the history, conduct the physical exam, request investigations. They are able to make referrals both to in-house specialities as well as arrange for outpatient appointments or GP reviews. Physician associates are able to discharge or admit patients and can arrange for intermediate care or community services as well. Some experienced physician associates help with teaching for the physician associate and medical students as well as foundation year one and year two doctors.
Where in the UK can I train?
Visit our UK physician associate programmes page to view the current and upcoming courses.
Why is physician associate not a registered or protected title?
As a new role in the UK, physician associates are still seeking statutory registration, therefore the title ‘physician associate’ is not a protected title. The faculty of physician associates at the RCP, along with the universities involved in training physician associates, continues to work toward registration of the profession in order to protect the title.
What does PA-R mean?
Physician associates that are registered on the physician associate managed voluntary register (MVR) may add to their name 'PA-R' to demonstrate that they are currently on the MVR and have signed up to maintaining high standards of practice. You can find out more about the physician associate MVR here.
Why are other health care roles described as physician associate/assistant?
In certain areas of the UK, there are organisations which employ people to do technical tasks in the hospital such as phlebotomy, ECGs, arterial blood gases, and administrative duties. While they are also called 'physician associates' or ‘physician assistants’, they do not have the training of NCCPA certified American physician associates or the UK physician associates being trained at the universities listed above.
There is also a separate profession called physician assistants (anaesthesia). This is a separate profession with a different set of competencies that enable them to work under the supervision of anaesthetists within the operating theatre environment.
There is a clear distinction in the level of medical training, and for this reason, the faculty of physician associates along with the universities involved in training physician associates continue to work toward registration of the profession in order to protect the title.
How are trained physician associates able to practice medicine in the UK?
Physician associates are able to practice in the UK as a result of a clause within the British General Medical Council's guidance on Good Medical Practice.
Delegation is discussed within paragraph 54 as follows:
Delegation involves asking a colleague to provide treatment or care on your behalf. Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate. When you delegate care or treatment you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved. You must always pass on enough information about the patient and the treatment they need.
What is meant by "physician supervision"?
Physician associates will require a certain amount of supervision in their medical practice. This will vary somewhat from individual to individual and is dependent on a number of factors including, but not limited to, their past health care experience and years of experience as a physician associate. A new graduate will require much more intensive supervision compared to an experienced physician associate.
Can physician associates prescribe in the UK?
Physician associates are currently unable to prescribe medications in the UK.
Close work with supervising physicians and arrangements developed individually allow for flexible ways of working and continuation and expansion of quality patient care. For instance, many physician associates working in general practice have the ability to quickly interrupt their supervising physician for a signature and then continue their work. If further advice on a case is required, the GP and physician associate take time out to discuss it and/or see the patient together to come to a decision on further treatment.
It is thought that prescribing rights for PAs may change, but it will probably be a number of years before registration is achieved. At that time, decisions will be made regarding physician associates prescriptive rights. As physician associates are not yet licensed nor regulated, this limitation also applies to requests for x-rays and other ionising radiation requests.
Do physician associates require professional indemnity (malpractice) insurance to practice in the UK?
Yes, physician associates require professional indemnity coverage. The cost of this coverage is typically paid for by the employer. Currently, the Medical Protection Society (MPS), Medical Defence Union (MDU) and Medical and Dental Defence Union of Scotland (MDDUS) will provide professional indemnity for those physician associates working in general practice. Physician associates and other hospital staff employed by a secondary care trust may typically have some form of indemnity provided through their employing trust, however this should be discussed with the employer. Additional coverage through the Medical Defence Union or other provider may be advisable depending on the physician associates roles and duties.
How much do physician associates earn?
The newly qualified physician associate post has been evaluated under Agenda for Change at Band 7. Higher level physician associates (usually requiring a minimum of five years experience and a relevant Masters Degree) have been banded at 8a.
Do physician associates get paid study leave?
Medicine is forever changing and physician associates have a responsibility to keep up to date. Continuing medical education (CME) or continuing professional development (CPD) is key to a physician associates on-going clinical practice, thus the majority of physician associates are provided with some form of study leave. This is to be determined through discussions with the physician associate and their supervising physician as well as their employer.
What clinical experience do physician associates have before training?
All physician associates hold at least bachelor's degree, usually in a life science field. Most physician associate programmes require at least a 2:1 honours degree for entry into the postgraduate diploma course along with some prior health or social care experience. The prior experience of physician associates is diverse. The most commonly reported previous occupations include nursing, health care assistant and paramedic. Other backgrounds include:
- Athletic Trainer
- Cardiac physiologist / Technician
- Care Home / Nursing Home Assistant / Home Health Assistant
- Clinical Laboratory Technician
- Counsellor / Psychologist
- Health Care Administrator
- Health Educator
- Laboratory Worker / Technician
- Occupational Therapist
- Operating Theatre Assistant
- Radiotherapy Technician
- Respiratory Therapist
- Scientific Researcher
Ritsema TS, Paterson KE. "Results of the Third Annual UKAPA Census" London, England, United Kingdom, August 2013.
In which specialties are physician associates practicing?
Physician associates are working in a wide variety of specialties and settings. Most physician associates only work in one specialty; however in the census approximately 10% of respondents indicated that they work in more than one specialty at a time.
- Emergency medicine
- General practice
- Community medicine
- Public health
Adult medical specialties:
- Acute Medicine
- Care of the elderly / geriatrics
- General internal medicine
- Genitourinary medicine / sexual health
- Infectious diseases
- Rehabilitation medicine
- Respiratory medicine
- Critical care
- General paediatrics
- Breast surgery
- Maxillofacial surgery
- Colorectal surgery
- Orthopaedic surgery
- Paediatric surgery
- Plastic surgery
- Spinal surgery
- Trauma and orthopaedics
- Vascular surgery
Ritsema TS. Results of the Fourth Annual UKAPA Census. London, England, United Kingdom, October 2014
In which clinical settings do physician associates practice?
Physician associates work in a wide variety of practice settings, including:
- GP surgery
- Inpatient ward of hospital
- Geriatrics ward
- Acute medical unit
- Medical assessment unit
- Accident and emergency
- Intensive care unit
- Outpatient department of hospital
- Walk in centre / out of hours care
- Specialty outpatient surgery
- Psychiatry clinic
- Community mental health services
- Operating theatre
Ritsema TS, Paterson KE. Results of the Third Annual UKAPA Census. London, England, United Kingdom, August 2013.
What are the demographics of physician associates?
According to the 2014 Census, approximately 70% of physician associates and physician associate students are women and 30% are men. Physician associates and physician associates students are drawn from diverse ethnic backgrounds. In fact, physician associates and physician associate students are more diverse than UK doctors and medical students!
Ritsema TS. Results of the Fourth Annual UK Physician Associate Census. London, England, United Kingdom, October 2014.
Which tasks and procedures do physician associates perform?
Results of the 2014 PA census survey show physician associates perform the following medical tasks or procedures. Tasks / procedures are listed in order of frequency (most frequently performed at the top of the list)
Task / procedure
- Take medical history
- Perform physical examination
- Patient education
- Interpret/obtain ECG
- Psychiatric assessment
- IV cannulation
- Arterial blood gas
- Urinary catheterisation
- NG tube placement
- Joint aspiration / injection
- Nerve blocks
- Cervical smear
- Incision and drainage of abscess
- Dislocation Reduction
- Fracture reduction
- Casting / splinting
- Mole removal
- Skin biopsy
- Surgical first assisting
- Lipoma removal
- Chest tube insertion
- Foetal heart tones
- Contraceptive implant placement and removal
- General new-born examination
- IUD removal
- FAST ultrasound for trauma
- Lumbar puncture
- Haematoma blocks
- Fitting of diaphragm
- IUD placement
- Pulmonary lung function tests
- Central line insertion
- Arterial line insertion
- Bier blocks
- Port placement
- Participate in cardiac catheterisation
- Cardiac stress testing
- Perinatal care
- Antenatal ultrasound
- Skin cancer removal
- DEXA scanning
Ritsema TS. Results of the Fourth Annual UK Physician Associate Census. London, England, United Kingdom, October 2014.
Do I need a license to work in the UK?
No, however typically American trained physician associates are required by their employer to have and maintain their NCCPA certification to work in the UK. In the future, US trained PAs may be 'grandfathered' into the UK system, have to take a UK certification exam or another route may be decided. This has yet to be determined.
Where can I look for jobs in the UK?
Job postings can typically be found on the Faculty website, in AAPA publications, the PA Job Link and at NHS Jobs. In the past, some employers have had a booth at the AAPA annual conference trying to recruit to their areas. You can also check directly with the various PA programmes.
What kind of experience are employers looking for?
Employers are usually looking for physician associates with a number of years of experience. Now that there are UK universities educating physician associates, there will be many home-grown physician associates looking for jobs so it will be necessary to recruit locally
What areas of the country are using US-trained physician associates?
Because there is no registration, there is no way to find out how many US-trained physician associates are working in the UK. There are some working here who have not joined the Faculty, or previously UKAPA, therefore we do not know exactly how many are here and where they are working. We do know that there are physician associates working in the Birmingham area, the London area, the Bedfordshire area, the South East and in Weston Super Mare.
I’m a doctor who trained abroad and would like to work in the UK as a physician associate
Anyone wishing to become a physician associate must complete the entire physician associate programme, as well as pass the examinations. This is an intensive two-year post-graduate programme, which is academically challenging.
It would be very important to recognise that physician associates are dependent clinicians, and we do not have full independence or autonomy of practice. This would be an adjustment for physicians.
If you would like more information about the programmes in the UK, please see the above for connection to each university.
I’m a physician associate who trained outside the UK or the US and I would like to work in the UK
At this time we have three categories of membership:
• Physician associate member: A graduate from a recognised UK physician associate programme or from an accredited US physician associate programme
• Student physician associate member: A student enrolled on an accredited UK or US physician associate programme
• Friend of the faculty: Individuals who are interested in joining the faculty as a non-physician associate member
As a new organisation, we are not yet in a position to allow non UK or non US physician associates to join as student or physician associate members. Presently we are looking at other existing European physician associate programmes to determine how to include them and how to evaluate the equivalency of these programmes. Until that happens we can only allow these individuals to join as a friend of the faculty.
If you have any further queries or would like more information about the physician associate profession, please contact us.