Sammy Chan is very proud to be a physician associate, despite the controversies. “I find it particularly rewarding because I get to build relationships with patients,” she said.
Chan works in respiratory medicine, mainly in outpatients. As well as more routine monitoring of patients and booking scans, she has been trained to perform chest drains and to insert pleural catheters. “While it’s quite emotionally challenging, it’s nice to be a constant presence on their journey,” she said.
Chan is one of 40 physician associates employed at the Royal Berkshire foundation trust in Reading. Introduced nearly two decades ago, physician associates have some medical training but are not doctors. They can take medical histories, carry out physical examinations and help develop treatment plans – but cannot prescribe medicine or order X-rays.
The NHS aims to increase the number of physician associates working in England from about 4,000 to 10,000 to help plug widespread gaps in the workforce.
The proposals have provoked strong criticism, with the British Medical Association (BMA) calling for a moratorium on any further expansion amid fears over patient safety and confusion following the death in 2022 of Emily Chesterton. And a recent survey by the BMA found that many people erroneously thought physician associates were doctors.
But Dr Janet Lippett, the chief medical officer of the Royal Berkshire NHS foundation trust, says they are essential to the smooth running of the hospital. “Physician associates are a vital part of our workforce. Supervised properly, they play an invaluable role in freeing up our consultants and junior doctors to treat more patients. We’d have been a lot less prepared for winter without them.”
Royal Berks hired its first physician associates in 2015 and now employs 40 in 16 departments. They have separate lanyards or badges, clearly marked “physician associate” and always have to tell patients and families that they are not doctors.
“I always explain and introduce myself to everyone,” says Chan. “I say, ‘I’m a physician associate. While I work alongside doctors and nurses, I’m not a doctor, but I am medically trained to do certain things. And I can help provide some care.’”
To become a physician associate, students must have an undergraduate degree in a health or science discipline and complete a two-year postgraduate degree. Royal Berks also insists that all its associates are on the voluntary register of physician associates declared fit to practise, which will be superseded from the end of next year, when they become 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 to me about physician associates in the south-east of England.” But it is essential that GPs or consultants have full control over what the physician associates are doing. “When you get a situation where those controls are not there, then it’s risky,” he says.
Ruhel Miah, a physician associate in elderly care, who helps doctors run two clinics, said he has constant supervision. “There’s always a consultant there, so that we’re always discussing the plan and what we think the diagnosis is, and then they will also see the patient with us.”
Apu Chatterjee, consultant geriatrician at Royal Berks, said associates such as Miah have improved patient care. “Since the physician associates started, I’ve found there is a lot more continuity of care in our complex patients. I can’t imagine how we would be able to work without them.
“I’ve never seen any junior doctor come up to me to say: ‘but I can’t learn because [the physician associates] are doing all the jobs that haven’t come to me.’”
Rachel (not her real name), a junior doctor in ear, nose and throat (ENT) services, agrees. She says the physician associate in her department has helped her training not hindered it. “I haven’t felt that my training opportunities have been threatened at all. In fact, quite the opposite.” she says. “She has actually freed me up to do more of the things I wanted to do rather than taking opportunities from me.”
Dr Edward McKeown, a consultant in respiratory medicine, said: “I don’t think any physician associate would claim to be a replacement for junior doctors. What they are providing at the moment is to both help us diagnose and manage patients.
“I think that junior doctors at the moment have got very valid reasons to be frustrated with their lot at the moment. But I don’t think that’s down to physician associates at all.”
Physician associates can help ease the workload and pressure, he says. “Unfortunately we do not have junior doctors growing on trees and so and so we’ve got to have an answer to keep these patients safe, keep pathways running smoothly.”
Akbar agrees. “The truth is, no matter how much money you chuck at recruitment, you’re not going to get a junior doctor [overnight].” Even then, he says the work associates do wouldn’t appeal to most doctors. Running a ward with very little clinical career development, but staying at the same level throughout “is not a role that many doctors would go for”.
“Now the government’s tighter migration laws put us under a lot of pressure again, what do we do when we’ve got more wards opening and we can’t staff them? You have to think elsewhere.”
Mary (not her real name), a physician associate also in ENT, says it has been upsetting to see all the hate. “It’s become so toxic. I think people are forgetting about the patients in all of this. At the end of the day, everyone here in the NHS is here to help.”
