Mon. Jul 22nd, 2024

The Royal College of Emergency Medicine (RCEM) has announced its official position on Physician Associates (PAs) working in Emergency Departments (EDs). In a unanimous vote at a recent council meeting, the RCEM stated it does not currently support the expansion of PAs in Emergency Medicine.

This decision comes after careful consideration of a working group’s recommendations and a membership survey. The RCEM prioritizes patient safety and emphasizes the need for clear guidelines regarding a PA’s scope of practice within the Emergency Department.

The College additionally highlights the importance of focusing on training and retaining existing emergency medicine doctors, as well as credentialed Advanced Clinical Practitioners (ACPs). They also expressed concerns regarding the capacity of current emergency medicine educators to properly train and supervise an expanded PA workforce.

Following a six-month review by a Short Life Working Group (SLWG), the College Council voted unanimously to not support the expansion of PAs in EM at this time.

The SLWG, comprised of College Fellows, Physician Associates, and lay representatives, was established in September 2023 to develop a strategy for PA integration within the College. Their review considered a wide range of evidence, including a recent member survey.

“The College appreciates the hard work and dedication of our existing PA members,” said an RCEM spokesperson. “We acknowledge the challenges they have faced and want to assure them of our continued support as they progress in their careers. They are valued members of our College.”

The RCEM did not elaborate on the reasons behind their decision or the specific concerns raised in the member survey. However, they did acknowledge the “animosity and hostility” faced by some PAs.

The RCEM did acknowledge its existing PA members and expressed its appreciation for their contributions. They will continue to support these members as they progress in their careers.

The statement emphasizes patient safety and calls for a clear definition of the PA role within the emergency medicine workforce.

Key points from the RCEM update:

  • PAs are not replacements for doctors: RCEM stresses that PAs should not be seen as a solution to staffing shortages in emergency medicine. The focus should be on training and retaining qualified doctors and Advanced Clinical Practitioners (ACPs).
  • Prioritizing EM training: Resources and opportunities should be directed towards ensuring a robust workforce of emergency medicine specialists.
  • Distinct workforce group: PAs should be recognized as a separate group within the ED team, working collaboratively with doctors and ACPs.
  • Safe and effective practice: The scope of practice for PAs in emergency medicine needs clear definition to ensure patient safety and optimal care.
  • Supervision is essential: All PAs in EDs must work under the direct supervision of a qualified emergency medicine consultant, associate specialist, or specialist doctor, following established local protocols.
  • Transparency for patients: The RCEM highlights the importance of clear identification for PAs. Patients should be informed about the qualifications and experience of the healthcare professional treating them.
  • The RCEM’s updated position comes amidst ongoing discussions about the role of PAs in emergency medicine. While PAs can play a valuable role in supporting patient care, the College emphasizes the need for a well-defined and safe working environment for all members of the emergency medicine team.

RCEM use a five-tier system defines the levels of responsibility and competency from clinicans in emergency medicine. Tier 1 reflects the current role of many PAs in EDs. Tier 2 designates PAs with additional emergency medicine (EM) training and experience. The RCEM discourages PAs from working at Tiers 3, 4, or 5, which likely involve more complex patient cases and procedures.

The guidelines also emphasize the importance of adequate resources for PA training, induction, and supervision within EDs. This ensures PAs receive proper support to perform their duties effectively.

RCEM stresses that PAs should not see undifferentiated patients – those with unknown medical conditions – without qualified supervision. The level of supervision should be determined by an agreed-upon entrustment process.

Finally, the RCEM calls for the earliest possible regulation of PAs. This would establish a formal framework for their qualifications and practice, further ensuring patient safety and optimizing their contributions to emergency care.

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