This is a milestone year for physician associates in the UK, with our profession now celebrating 20 years in the NHS.
The PA role as we know it started back in 1967 in the USA. The development of PAs was triggered by a shortage of doctors in underserved areas of America. PAs started to work alongside their doctor colleagues to provide care for patients. Almost six decades of PA practice has demonstrated the safety and competency inherent in the role.
Decades later, PAs and other similar non-doctor roles exist and contribute to healthcare across the globe. Adding a clinician trained in the medical model to a team can significantly increase patients’ access to care.
In such a litigious society as the US, the PA profession would not have survived and flourished for 56 years if PAs were not safe and competent clinicians. Over 200,0001 PAs have qualified in the US and PAs are increasingly in demand. According to a U.S. News and World Reports 2023 article, the job growth for US PAs is currently forecast at 28% for 2021-2031.
“Becoming a PA has been one of the best decisions of my life. It was not taken lightly and I knew how challenging the path would be,” Karen Roberts told The PA+PER. Karen wasn’t a fresh-faced university graduate with a life science degree like many PA applicants. She was in her mid-30s with a 1st class German degree and a variety of work experience, including almost a decade of high-level administrative roles. But Karen made the brave decision to quit her job and returned to university full time to gain the life sciences required to apply to a PA programme.
‘Jubilant’ is how Karen remembers feeling when she was accepted onto the Child Health Associate/PA (CHA/PA) programme at the University of Colorado Health Sciences Center. It is one of the few three-year PA programmes in the US, with a curriculum that covers the breadth of medicine across all age groups, but had a strong focus on paediatrics.
As Karen was beginning her journey as a PA student in the USA, the PA role was making its first tentative steps here in the UK. A few experienced American trained PAs paved the way as part of trial study in 2003. They began working in the Midlands, mainly in GP and A&E settings. You can learn more about what it was like as one of the first PAs in the NHS from Rachel Ditoro’s podcast episode. Shortly after the pilot study concluded, homegrown UK PA training started at three pilot training sites from 2004‐2006, with pilot graduates taking the first National Exam in 2007.
By 2004, Karen was now a newly qualified PA with extended paediatric training. She told me: “I loved seeing children, but I wanted the entire range of patients so working in GP was always the right choice for me. My first GP surgery in North Denver had never employed a PA before. In my first few weeks on the job, I clearly remember asking for guidance or a patient review on half to two-thirds of my patients. I could always take a thorough history and perform a relevant exam but what needed development at the point of graduation was my management plans. This could be a quick 30-second question or a GP review with the patient if I had safety concerns.”
Over the next few months, Karen explained how her GP colleagues always patiently answered any questions she had as she found her feet. Karen said: “By adding me to the team they were able to offer approximately 100 additional patient appointments per week. After I diagnosed my first MI in a patient presenting only with epigastric pain, they removed my sole restriction of “no patients with chest pain”.
I guess they figured if I didn’t miss the MI in a patient without chest pain, I would be safe with patients experiencing chest pain!”
By 2007, Karen had moved to West Sussex in the UK and remembers being amazed by the NHS. “The service was fantastic, wait times were reasonable and the culture was supportive. Strikingly, for a US PA, there were no patient co‑payments. As a US PA student, I had teaching sessions dedicated solely to medical billing. Free healthcare for all – what a concept!”
Karen really loved her role as a PA in General Practice. “In my experience, what patients really value is having someone who will listen to them and help with their problems. There is almost nothing as rewarding as providing this service. It is truly a privilege to positively impact patients’ lives.”
But Karen recognises that it isn’t always easy being a PA. “As with all clinicians, especially post‑COVID, PAs can experience stress and burnout. At that point, you start to consider your options. It would be a pity to give up years of education and training to throw in the towel. Sometimes it just takes a change to renew one’s love for our chosen profession.”
Karen offers this advice for PAs when evaluating their careers or experiencing burnout. “Why not consider changing specialities (a benefit of our role) or consider a role in PA education? Delivering a one‑off session at your local PA programme is a great way to share your knowledge and find out if teaching is right for you. Choose a topic you know a lot about, develop your session and ensure that your management follows NICE/SIGN guidelines.
“Another key to avoiding burnout is to broaden your role. What is your special interest? I love dermatology, hence my weekly minor surgery clinic. For me, this added some much‑needed variety to my week. Think what you can do to add value to your team and discuss this with your seniors. Developing a clear and structured plan for your role progression is important.”
Karen’s career path continued to evolve over time. Karen has served as programme director for PA courses for over a decade and been on boards of national UK PA organisations from 2010‑2018. Karen was chair of the PA National Exams for four years.
Talking about her role in PA education, Karen’s enthusiasm shines through clearly. “It has been one of the greatest pleasures of my life to work in the NHS and to be involved in our profession’s growth as a PA educator. Developing a life science graduate into a safe and competent PA in two years is extremely rewarding!”
Many of the PAs who are now working across the UK will have been toddlers 20 years ago. Just as when infants learn to walk, the PA profession was also taking its first steps 20 years ago. There have been a few stumbles and set backs along the way, but it does feel like we are gathering pace and mastering our stride together.
We all owe a debt of gratitude to Karen’s work over the last 20 years. And other names too – such as Professor Phil Begg and Professor Jim Parle, PA Rachel Ditoro and countless others – who have all contributed to establishing the PA profession over the last 20 years.
What does the future hold for physician associates? By Karen Roberts
As we approach regulation, we are experiencing a challenging time. The social media environment has become very negative. We might need to think of different ways to cope. One option is to disengage from the platforms. My best advice is not to respond and ignore the chatter. But if asked, be prepared to sit down and discuss the facts with those who really want to understand our profession. Use evidence to back up your statements, not relying on anecdotal stories or rumours.
We know how much we contribute. Our teams know how much we contribute. We demonstrate our worth by providing excellent care for our patients and by supporting our colleagues in delivering the service. Remember that every encounter with every person matters – whether that is a patient, a colleague or an anonymous stranger on the internet. Remain professional at all times. Remember your limitations and never exceed them. Healthcare is not about ego. It is about our patients.