Sammy Chan is very proud of being a physician assistant, despite the controversies. “I find it especially rewarding because I get to build relationships with patients,” she said.
Chan works in respiratory medicine, mainly on an outpatient basis. In addition to routine patient monitoring and booking scans, she is trained in performing chest drains and inserting pleural catheters. “Although it is quite challenging emotionally, it is nice to be a constant presence in their journey,” she said.
Chan is one of forty medical staff working at the Royal Berkshire Foundation Trust in Reading. Introduced nearly two decades ago, physician assistants have some medical training but are not physicians. They can take a medical history, perform a physical examination and help develop treatment plans, but cannot prescribe medications or order X-rays.
The NHS aims to increase the number of physician associates working in England from around 4,000 to 10,000 to help close widespread gaps in the workforce.
The proposals have sparked strong criticism, with the British Medical Association (BMA) calling for a moratorium on further expansion amid patient safety fears and confusion following the death in 2022 of Emily Chesterton. And a recent survey by the BMA found that many people wrongly believed that physician assistants were doctors.
But Dr. Janet Lippett, the chief medical officer at Royal Berkshire NHS Foundation Trust, says they are essential to the smooth running of the hospital. “Physician employees are an essential part of our workforce. When properly supervised, they play an invaluable role in freeing up our consultants and junior doctors to treat more patients. Without them we would be much less prepared for winter.”
Royal Berks hired its first physician assistants in 2015 and now employs 40 employees in 16 departments. They have separate lanyards or badges, clearly marked as “physician employee,” and must always tell patients and families that they are not doctors.
“I always explain and introduce myself to everyone,” Chan says. “I say, ‘I’m a physician assistant. Although I work with doctors and nurses, I am not a doctor, but I am medically trained to do certain things. And I can help provide some care. ”
To become a physician assistant, students must have a bachelor’s degree in a health or science discipline and complete a two-year postgraduate degree. Royal Berks is also insisting that all its employees are included in the voluntary register of junior doctors declared fit to practice, which will be replaced from the end of next year when they are regulated by the General Medical Council.
Dr. Tahir Akbar, regional medical director of the South East School of Physician Associates, which trains around 120 a year, said: “No safety concerns have been raised with me about doctors in the south east of England.” But it is essential that GPs or consultants have full control over what junior doctors do. “If you find yourself in a situation where those controls are not there, then that is risky,” he says.
Ruhel Miah, a physician associate in elderly care who helps doctors run two clinics, says he has constant supervision. “There is always a consultant present, so we always discuss the plan and what we think the diagnosis is, and then they also see the patient with us.”
Apu Chatterjee, consultant geriatrician at Royal Berks, said staff like Miah have improved patient care. “Since the establishment of the physician assistants, I have noticed that there is much more continuity in care for our complex patients. I can’t imagine how we could work without them.
“I’ve never had a junior doctor come to me and say, ‘but I can’t learn because (the junior doctors) are doing all the tasks that don’t come to me.’”
Rachel (not her real name), a junior doctor in ENT services, agrees. She says the physician assistant in her department has helped, not hindered, her training. “I have not had the feeling at all that my educational opportunities have been jeopardized. In fact, the opposite.” she says. “She has given me the freedom to do more of the things I wanted to do, instead of taking opportunities away from me.”
Dr. Edward McKeown, a consultant in respiratory medicine, said: “I don’t think a junior doctor would claim to be a replacement for junior doctors. What they offer right now is to help us diagnose and manage patients.
“I think doctors in training have very valid reasons to be frustrated about their fate right now. But I don’t think this is entirely up to the doctors.”
Physician assistants can help ease the workload and pressure, he says. “Unfortunately we don’t have junior doctors who grow on trees and so on and so on. We need an answer to keep these patients safe and the processes running smoothly.”
Akbar agrees. “The truth is that no matter how much money you spend on recruitment, you won’t get a junior doctor overnight.” Even then, he says that work colleagues won’t appeal to most doctors. Running a department with very little clinical career progression but staying at the same level all the time “is not a role that many doctors would choose”.
“With the government’s stricter migration laws putting us under enormous pressure again, what should we do if more departments open and we cannot staff them? You have to think about something else.”
Mary (not her real name), a physician associate also at ENT, says it was disturbing to see all the hate. “It’s become so toxic. I think people forget about the patients in all of this. Ultimately, everyone here at the NHS is here to help.”