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Professor Phil Begg is an international leader in his clinical field, with his main interest in audiological and vestibular medicine. Professor Begg is a lifelong clinical educator, and has held a variety of academic appointments including past Associate Dean at the University of Wolverhampton, where, with his team, he developed and launched one of the first PA programmes in the UK. In 2008, he advised the South African Government in the development of education programmes for the Clinical Associates and he has assisted a number of international developments of new PA programmes. Phil has been part of the small group of dedicated educators and practitioners that started the development of the Physician Associate in the UK over 20 years ago.

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.

From Professor Phil Begg…

Twenty years feels like a real landmark, but in many ways, if you succumb to reading social media you may feel that we have not made that much progress. Let’s just remind ourselves that in just two short decades we have made enormous strides and achieved huge things.

“You want to do what ?”, my Dean asked me as I stood in her office in September of 2003.

“I want to run a Physician Assistant Programme, here in Wolverhampton.”

She asked: “Do you know what you are letting yourself in for?”

I replied, “No, but it will be interesting I am sure”.

We had great mentorship from David Fahringer from the University of Kentucky, who helped us shape the outline of a master’s Programme, if I remember we actually called it MSc Specialist Practice (Physician Associate), bizarrely later changed to Assistant to come in line with other countries, mainly the USA. We launched with five students in January of 2004. Back then there were so few of us, Jim Parle, Nick Ross, Hilary Paniagua, Ingrid Callwood, Di Jackson, Maureen Brennan, Guy Dean, Barry Hunt, Olwyn Westwood, Rob Stansfield, and Cheryl Wright.

This small band of warriors,travelled the length and breadth of the UK, knocked on doors, stood in uncomfortable spaces and championed an untested role that many wanted to fail; all of this in their own personal time. It would also be remiss to leave out those US Physician Assistants who were working here, Rachel (Catanzaro) Ditoro, Lynn Wright, Helen and David Serbousek, and of course Kirsten Gipson. The Department of Health helped in the beginning and ran a set of trial programmes at three universities including Wolverhampton, Kingston/St. Georges and Hertfordshire. Rob and Cheryl offered support and the various players at the HEIs set up what became the UK & Ireland Universities Board for PA Education.

Other programmes followed at Birmingham and Aberdeen. We had huge ups and huge lows. HEE stopped supporting some programmes, which led to a break in their running, but most started up again. 2006 was another landmark year, with several us, led by Nick Ross from Birmingham, participating, alongside the Royal Colleges, to develop the Competency and Curriculum Framework and the Matrix of Core Conditions, which finally gave a definition and guidance of what PAs could do. The UK Association of Physician Associates (UKAPA) was another massive landmark, and truly put the profession on the map, with an organisation led by PAs for PAs and was the pathway to the development of the Faculty within the Royal College of Physicians, and the professionalising of the National Examination, which until then, although strict, benchmarked and professionally run buy the HEIs, needed this lift.

Since then, the growth has been breath-taking, the pace exhilarating and the impact beyond words. Today we have 6,000 PAs on the MVR, these PAs work in almost every branch of medicine, and 41 Universities running programmes in the UK. Registration and regulation from the GMC in 2024, unprecedented that another profession other than doctors should be part of the Council. The NHS has formally and clearly recognised the profession as key to meeting the audacious goals of the new NHS Workforce Plan. Yet, there are still questions and hostility, and the lack of understanding, that there is more than enough work in medicine and healthcare generally to go around.

As we reach 20 years together, I want to stop and applaud those who undertook this journey, who gave selflessly of their time, health, and energy, many of whom are not PAs but believed in a dream. As time has passed, many of the newly graduated PAs will not know the names I have mentioned in this article. Worse still, I may have missed other key names – there are simply too many to list – but please take time today to think of those names, and thank them for their hard work, as without these pioneers, the physician associate profession would not exist.

Finally, I want to stand and applaud, loudly, each and every physician associate and student PA in training in the UK. All of you are brave, you are tenacious, you are my heroes, each and every one of you. You made huge sacrifices and face the constant challenges. Don’t ever give up, you make a difference each and everyday. When the background noise quietens, the voice you will hear, is a grateful patient and their loved ones. Enjoy the journey – the destination is worth it, and here’s to another 20 years.

You can listen to Prof Phil Begg’s podcast episode titled ‘The History of Physician Associates’ here.

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