Spotlight series – PAs in acute medicine

According to the Faculty of Physician Associates (FPA) annual census survey 2021, acute medicine was the second largest specialty practised by physician associates (PAs). Acute medicine specialises in assessing, diagnosing and treating patients with urgent medical needs. PA Emma Higgie qualified as a PA in 2018 and began working at Musgrove Hospital – the same hospital she was born in. Here, she shares her experience of working as a PA in acute medicine and as lead PA for the trust.  

What made you decide to become a PA?

I always had a passion for science, and I was familiar with healthcare from a young age, as both of my parents were GPs in a rural area. They were very well-integrated into the local community and had a fairly holistic approach to healthcare (often, they would bring home their patient's pets if they had a change in their circumstances), and I was always wanting to be involved. My older brother followed in their footsteps and went to study medicine. Initially, I wanted to give myself a broader exposure to what scientific career I might want to ultimately pursue.

I studied biological sciences at undergraduate level. I loved the variety and achieved first-class honours. This led to employment in a biotechnical company, where I enjoyed customer interaction, regulatory work, and applied science while working there. I then looked to apply this experience to a care setting, where I could actively use my skills to care for people in the community. My research led me to an advert for a PA role, although I hadn’t heard of the profession at that time. The more I understood, the more it seemed to suit my personality and ability to learn complex material quickly and effectively. It came across as a dynamic role, providing an extra pair of hands and being able to explore various areas of medicine, which really appealed to me. I was lucky enough to be part of the north-west pilot of the course and moved to Liverpool to study. That was a big change at first, as I grew up in a small town in the south-west, but I wouldn’t change my experience for anything.

Can you tell us more about your experience of working as a PA in acute medicine? 

Emma Higgie While studying the PA course, I had exposure to acute medicine early on and thoroughly enjoyed it. It gave me the experience of delving into undifferentiated conditions and using a combination of clinical skills to diagnose patients and plan treatment. I started working at Musgrove Hospital after attending a site visit and discussing the PA role with the clinical service lead for the Acute Medical Unit (AMU). The hospital had employed one PA previously (in gastroenterology), but I was the first to join the AMU team. At first, it was challenging not having a role model to look up to, and I was very much setting the foundation of the PA role at AMU.

I chose to pursue acute medicine as it provides a really good platform for developing a skillset as a PA, as you’re continually exposed to a range of conditions. AMU can be a busy and high-pressured environment, but from the beginning I have been well-supported by my consultants, and I feel lucky to be part of the multi-disciplinary team. We also work closely with lots of other departments and teams, including, oncology, cardiology and haematology. This really helped me to build up my knowledge base in the early stages.

What diagnostic/investigation/procedural skills have you gained?
I quickly learned how being a permanent fixture in the acute medical team was incredibly beneficial in developing my skillset and building my confidence. I became familiar with the equipment and where everything was kept on the ward. A typical day will see me support new medical admissions, either from the emergency department or primary care, taking the history of the patient, examining them, and formulating the differential diagnosis management plan. I then review that with the consultant before we implement the treatment plan. I rotate between the AMU and Same Day Emergency Care (SDEC).

I am developing my skills in performing advanced procedures such as lumber punctures, ascitic drains and pleural aspirations. Having a permanent presence allows me to support trainee doctors during their rotations too, and we work closely with them when they are being integrated into the department.

I enjoy teaching and seeing people develop in their roles, and as part of my lead PA role I deliver weekly teaching to our PAs. This integrates simulation training alongside interactive workshops and has been well-received. We have PAs joining us from so many different backgrounds and some have never worked in the NHS before. By mixing the simulation training with interactive workshops, I can meet with colleagues, share experiences and ask questions to help them feel supported in their roles. I have recently started attending attend the trust faculty meetings.
These allow me to explore how we can increase the efficiency of the PA role and how it can be integrated into other teams.

How would you describe the impact your role as a PA has had?

One of the key benefits of our role is that we’re consistent members of the team and able to provide patients with continuity of care as well as supporting colleagues. You have to be proactive as a PA – there is always something that needs to be done. It’s about recognising that and being responsive, because it’s such a busy environment.

I see my role as being more than an additional pair of hands. As PAs, we’re available to jump in and out of multiple tasks. I am involved with triaging telephone referrals from general practice or support with referring patients. I can then transfer that knowledge and referral to the correct team. I’m always on hand to support patients and their families – especially as some will have never been in hospital before, or they’ll have concerns over who will look after their farm while they are staying with us. I think some of those patients appreciate that I’m local and understand those concerns, and can help with structuring a plan for them – making it one less thing they need to worry about. I received some really nice feedback recently from a patient who sent a card that said that I ‘hospitalised’ them, writing that I showed them much care and hospitality. It means a lot knowing you’ve done enough for a patient and made them feel safe during what is a difficult and often vulnerable time.

What do you find most enjoyable and rewarding about being a PA?

I always knew that working in medicine would be extremely rewarding; working as a PA, I am exposed to a variety of conditions and patients. Every day provides me with a platform to learn something new, and I love that. There is no 'routine' – each day brings new challenges, and that keeps it fresh and exciting.

Particularly, working in Somerset makes me realise the value I can really add to patients. A lot of patients travel up to an hour to get to the hospital, and we must deliver the appropriate care for them. Often, I’ll encounter the same patient several times: they may have come in for blood transfusions previously, and return if they become symptomatic. I can build a rapport and a relationship with them, which is special. I get to know where they like to have their cannula sited and that they like to go to Costa while waiting for their blood to be ready. I love that element of my job, and I get that because I’m a consistent member of the team on the ward.

As the first PA on the acute medical team, I feel lucky to tread a relatively new path and set the foundations for the role. I’ve been able to mould the role to a certain extent, and encourage the development of new skills including management, leadership, teaching and mentoring. I feel the lead PA role gives me a platform to influence change and progression. I have recently undertaken a mental health first aid course to support the PAs because a lot of them are joining the trust as newly qualified. Having been in their position myself 5 years ago, I want to be able to help guide them through that journey of being newly qualified and offer support – on both a clinical and personal level.

What challenges do you face as a PA working in acute medicine?

The lack of prescribing is a big hurdle that we all want to be able to jump. Working in acute medicine and not being able to request ionising radiation is frustrating, but I’m lucky to work alongside and be supported by a team of doctors who understand the limitations.

As the PA role is still fairly new, it can become tiresome to explain the role and its limitations. Still, I find it positive to speak to trainee doctors on rotation through the department, as each rotation brings a new set of people that we can educate about the PA role and how we can work together. It’s vital that we promote the role as we continue to grow as a profession. I'm not a doctor, a nurse, or a therapist, but I’ve found my fit within the multidisciplinary team, and I’m proud of the positive impact my role has on patient care. I’m also networking with other PAs in my region, and we touch base with each other often to share experiences, what is working well and how their role as a PA is being utilised. I think it’s important that we maintain that positive relationship with each other as our profession continues to grow. 

What does the future look like for you as a PA?

I'm hopeful that regulation will be coming soon. The progress we have made is positive, and when the time comes it will make our role even more flexible. I’m excited at the prospect of then being able to work a little bit more autonomously, while still maintaining my position within the MDT and those positive working relationships. The doctors I work with are supportive of my development, but I would like to continue developing my skills and become involved in more procedures. Pleural drains are my next aim, and I was supervised draining a pleural effusion recently, which was a great experience.

In my lead PA role, I’m aiming to continue extending my skills in leadership and management to help future-proof the role in our area. I’m passionate about helping us to progress and that our skills are utilised appropriately. That then leads to retention of the workforce, and I’m keen for us at Musgrove to retain our PAs by allowing them to be exposed to a range of clinical scenarios that help them to learn and grow – and to feel that they have a solid progression pathway.

What advice would you give to a PA looking to work in acute medicine?

Take every opportunity you’re presented with to shadow various members of the multidisciplinary team. It helps to expose you to the various roles and how they fit into the overall team. Medicine and being a PA is about collaboration and working together. Shadowing helps to avoid confusion when you join the wards, as you already have a knowledge base of how you will be able to integrate into the team. During placements, you move around multiple specialties that help you to discover what areas you enjoy and challenge you.

It’s important to start thinking about what specialty you’d like to enter. Acute medicine is a fantastic specialty as it will expose you to a range of conditions and is a great place to grow knowledge. It can be fast-paced and it’s an ever-changing environment, so can feel overwhelming. Embrace the experience of learning and finding your feet, because it’s so rewarding. We are a profession that is growing in numbers in the UK, so reach out to your PA network. We are here for advice, sympathy and to remind you what is great about being a PA!

We’re always looking for qualified PAs who are FPA members to share their stories. If you’re interested in sharing yours, get in touch using the contact details below. If you’re thinking of a career as a PA, you can learn more about how to begin your journey here.

Get in touch to share your PA story:

Jenna Donaldson – FPA communications officer

[email protected]