Position Statement on Physician Associates in the UK

Position Statement on Physician Associates in the UK

Colleagues will be aware of the significant ongoing concerns surrounding the development and deployment of the Medical Associate Professions (MAPs) in the UK. This statement outlines the Royal College of Physicians of Edinburgh's ("the College") position on the specific role of the physician associate.

The College recognises the invaluable contributions of all members of the multiprofessional healthcare team in providing high quality and safe patient care, and we believe that with appropriate education, training, regulation and support, physician associates can contribute to such care.

However, clinical medicine is increasingly complex and the unique role of the doctor as the clinician - with the breadth and depth of knowledge and skills to allow highly skilled clinical reasoning, complex decision making and the management of uncertainty - must be preserved and strengthened.

There are clear differences in the education and training of doctors and physician associates:

• The award of a full licence to practice as a doctor in the UK requires the completion of an undergraduate medical school degree (of four to six years, with two to three years of clinical experience and in-depth knowledge based biomedical education and assessment) and one year as a Foundation Doctor, working full time in an accredited NHS post.
• Progression to consultant in internal medicine or its specialties requires a further seven to ten years of training, which is primarily experiential, but also includes completion of ongoing workplace-based assessments and high-stakes postgraduate examinations of knowledge, clinical reasoning and clinical skills.
• The training pathway for physician associates is substantially different and much shorter – a physician associate can practice clinically following completion of a prior undergraduate degree, not necessarily in the biosciences, and only two years of clinically based experiential training.

The College further notes the following specific points:

• Physician associates are not doctors and must not be regarded as substitutes for doctors, but as supplementary members of the multiprofessional team.
• Statutory and meaningful regulation of physician associates is essential to enable the quality management, training and career framework and possible future career progression for this group to be more clearly defined. This regulation must include standards of practice and formal mechanisms to investigate and sanction malpractice.
• If the GMC becomes the regulator, the register they hold must clearly and simply differentiate doctors from physician associates.
• Supervision of the clinical practice of physician associates is vital if standards of patient care and patient safety are to be assured. We recommend that physician associates always have direct in-person medical supervision available to them.
• Patients and families should know the capability of those who meet and treat them. We recommend the renaming of the profession to the internationally recognised term "physician assistant" to avoid confusion for the public with existing medical roles such as Associate Specialist.
• Clear guidance regarding the scope and limits of the clinical practice of physician associates is essential. We are deeply concerned that “scope creep” in clinical practice will rapidly develop if this does not occur, with significant potential concerns for standards of patient care and patient safety. 
• The teaching and training of our future medical staff is crucial. Doctors responsible for providing teaching and training must have sufficient time in their job plans to acquire the skills and expertise to become competent teachers; have sufficient time in their job plans to deliver teaching and training and; prioritise the teaching and training of medical students and postgraduate doctors in training to allow them to meet their curricular requirements and develop their own capabilities and roles. The training of physician associates should not compromise, in any way, the training of future or current doctors.
• Guidance on the scope and limits of physician associates must also extend to their role in the teaching and training of doctors. Physician associates should not be substitutes for doctors as teachers but they should supplement and support the medical teaching and training that is delivered. 
• Physician associates should recognise that their work should assist and support all members of the medical team, from foundation doctor to consultant. Specifically, their roles should not be confined to the support of aspects of the work of a consultant or “senior” trainee. They should provide as much support to other members of the medical team, such as foundation doctors and specialty trainees in internal medicine, and share the burden of work that is regarded as rote, such as phlebotomy, performing simple procedures such as ECG recording, test ordering, and results checking.

The Royal College of Physicians of Edinburgh is a registered charity, which helps qualified doctors to pursue their careers in specialist (internal) medicine through medical examinations, education and training. We also provide resources and information to support and facilitate professional development for doctors throughout their careers. The College has a strong UK and international presence with over 14,000 Fellows and Members in over 100 countries – including in every part of the UK - covering 54 medical specialties and interests.