Call to prevent Medical Council regulation of physician associates ‘bizarre’ – head of PA programme

The head of Ireland’s only postgraduate programme for physician associates (PAs) has described as ‘somewhat bizarre’ a call from the Irish Medical Organisation (IMO) for the profession to not be accredited by the Medical Council.

Prof Lisa Alexander said she was surprised by a recent motion passed by the IMO for PAs not to be registered with the medical regulator.

“I found that to be a somewhat bizarre motion myself,” the director of the two-year master’s programme in physician associate studies at RCSI told IMT.

“When you think about a PA working under the supervision of a consultant, worst case scenario, something bad happens. If there’s going to be a sanction against the PA and the doctor, wouldn’t it be reasonable for the regulator to do it, so that case would be reviewed by one regulator rather than two? That would really complicate it,” she added.

Prof Lisa Alexander. Pic: RCSI

“The model of education (for PAs) is based upon the medical model, so that’s another argument – that the regulator would understand the education of the PA programme.”

At the IMO’s AGM in April, members passed a number of motions which sought clearer definitions of the role of the PA and how it is regulated. The union also called on the health service to issue instructions to all HSE-funded healthcare settings advising that PAs cannot be used to cover doctors’ shifts or rotas.

IMO president Dr Denis McCauley used the conference to raise concerns about the careful regulation of PAs to avoid any risk to patient safety.

“The Irish health service needs more doctors, but we are concerned that PAs may be recruited to mask the shortage of doctors,” he said. “The role of the PA can only be to support doctors…not to replace them.”
However, Prof Alexander dismissed claims that PAs would take over the role of doctors.

“There’s more than enough patients to go around. I don’t think the PA profession is trying to suggest that the workforce doesn’t need to grow more doctors,” she said.

“I don’t speak for consultants, but I think they have a pretty good contract right now. If the Health Department wants to augment the healthcare workforce with another cadre of health professionals that are going to actually help a consultant’s practice, I don’t see why they would be upset about it.”

Established in 2016, the RCSI masters programme in physician associate studies takes in 30 students each year. Applicants must hold a level 8 health science or science-related degree to be accepted for the 24-month full-time course.

Currently it is estimated that just 72 PAs work in the Irish healthcare service, with the majority in Dublin hospitals.

Alexandra Troy is a physician associate working in colorectal surgery in Beaumont Hospital for the past six years. She is a former president of the Irish Society of Physician Associates and was one of the first batch of graduates from the RCSI master’s degree.

“If something happens, say a lot of people are off sick, if people are on nights or if people have study leave or annual leave, there’s a place where physician associates can facilitate their role. If I was in theatre, for instance, I would be helping out in an assisting role,” she said.

She added that any covering of junior doctors’ shifts would not lead to a change in a PAs duties and responsibilities: “If we see people in clinic we check things with our consultant. We check everything so their patients are safe.”

Beaumont Hospital currently has 8.5 working-time equivalent PAs among its staff. However, a recent job advertisement for a PA in Neurosurgery on the hospital’s website drew criticism on social media for some of the language used.

In particular, some clinicians raised concerns over a line in the advertisement stating: “Physician Associates (PA) are trained and educated similarly to doctors, and therefore share similar diagnostic and therapeutic reasoning.”

On Twitter, consultant neonatologist Dr Afif El Khuffash said he was ‘very uncomfortable with this emerging narrative on how a PA is described as trained and educated similarly to doctors. They are not.’

He added: “There is no doubt a role for PAs exists, but let’s start on the right path. I certainly will not be accepting responsibility as is described in this now standard job description here in Ireland.”

In response to questions from IMT, a Beaumont Hospital spokesperson said that there are aspects of the role of PA ‘which overlap with NCHD duties and training’ but that, in light of concerns raised, ‘the hospital will review advertisement templates and make the necessary amendments to provide greater clarity to the roles and responsibilities.’

Prof Alexander said that the issue ‘does show how there is still a good deal of education that needs to be done for everyone…including HR departments. That is one of the things we are focussing on this year.’

She believes that much of the concern among Irish clinicians is coming from recent reports in the UK of PAs acting beyond their qualifications by prescribing treatments, and failing to inform patients that they are not doctors.

She also thinks that misinformation, largely driven by social media commentary of UK reports, is responsible for much of the negative reaction towards PAs from within the medical profession here.

“There’s a lot of misinformation out there. Even physicians or surgeons have said to me ‘I myself have been the victim of misinformation. I believed what somebody told me about a PA that was totally false,” she said.

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