Clinical supervision of physician associates (PAs) in primary care: who, what and how is it done?

Abstract

The physician associate (PA) role is gaining momentum as a healthcare professional who supports medical workload in primary care, yet there is a lack of clinical literature around how best to clinically supervise this new role. This seems especially pertinent amid the recent funding initiatives that encourage employment of PAs to aid the increasing demands in primary care, especially with the added stressors of the COVID-19 pandemic. There is a need for clinical supervisors to be aware of what their responsibilities are when employing and supervising a PA. Qualitative feedback from a cohort of primary care PAs in Sheffield alongside the authors' own expertise have been collated to produce recommendations to supplement existing documentation from the Faculty of Physician Associates. The paper seeks to rapidly initiate a starting point in clinical literature around the breadth of considerations within PA supervision. These recommendations include, but are not limited to, a discussion at the onset of PA employment of mutual needs and a specified supervisory schedule, alongside named clinicians who generally address clinical and pastoral components periodically. This accompanies an induction into the practice and general clinical support that is initially more intensive but otherwise remains available when the PA feels it is required.

Career Development Needs of Physician Associates in the United Kingdom: A Qualitative Study

“…The leap from student to practicing healthcare worker is a large jump in any profession, 13 and evidence suggests that employers who are inexperienced in supervising PAs misunderstand how to best support the newest members of their team, leading to a lack of supervision of inexperienced PAs. 24 Participants involved in primary care in this study felt strongly that PAs should receive more support. A lack of clear guidance leads to differences in clinical supervision of primary care PAs, which can result in PA job dissatisfaction.…”

“…The unique ability of PAs to move between specialties and primary and secondary care could lead to retention issues in the future if working in primary care leads to satisfaction but secondary care does not. 24 The PA profession attracts passionate and skilled science graduates and should be viewed as an important vehicle to attract talent into the NHS. 21 Participants in the current study said that without career opportunities and progression for newly qualified PAs, the profession would “lose the brightest and best” students to medicine.…”

“…A lack of clear guidance leads to differences in clinical supervision of primary care PAs, which can result in PA job dissatisfaction. 24 They described how the existence of a lead PA in secondary care translates into junior PAs being mentored and, therefore, feeling more supported. Newly qualified PAs should be supported and work in a way that is clinically safe and appropriate for their skillset while their confidence grows.…”

Physician associate prescribing: perspectives, practices and pathways

“…During the induction period, we recommend PAs and their supervisors discuss a period of close supervision during which PAs will not independently prescribe but be able to discuss and reflect on management plans. 23 This period of supervision will be dependent on the PAs' competence and the PA-supervisor relationship.…”

Remote consultations for physician associates in primary care: qualitative feedback from a regional cohort study

“…Previous research on clinical supervision of primary care PAs recommended a formal induction period to enable the PA to become embedded in the practice's ethos. 11 Following the onset of the pandemic, a further recommendation within this induction period would also be to ascertain how familiar the PA is with remote consultations, and discussion of strategies to support the PA with this, if required. Some strategies included by the practices employing PAs in this study were an observational period with a supervisor, shared telephone consultation lists allowing observation of the PA or a stepped approach to telephone consultation commencing with a few areas with which the PA felt confident and competent, and where more clinical clues were available.…”