Comparing physician associates and foundation year 1 doctors-in-training undertaking emergency medicine consultations in England: a quantitative study of outcomes

King, Nicole Marjorie Andrea; Helps, Suzannah

doi:10.1136/bmjopen-2023-078511

Cited by 2 publications

(3 citation statements)

References 22 publications

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“…According to our study, some patients mistakenly believed that they were being treated by a doctor. The misconception of PAs as doctors has also been noted in other UK studies [ 38 , 39 , 40 , 41 ]. Despite the PA role being present in the United States for over 60 years, a survey conducted in 2021 showed that the PA role confusion is longstanding with 25% of patients wrongly believing PAs to be doctors [ 43 ].…”

Section: Discussionsupporting

confidence: 56%

“…Other studies have also found PAs' documentation to be thorough [ 21 , 37 , 38 ] and there was a suggestion that the ED metrics may be affected because of the level of PA documentation [ 39 ]. Our study could have been enhanced if combined with impact metrics [ 40 ] and or included observations of case notes [ 39 ] to better experience the level of PA patient documentation and its effects on the department throughput.…”

Section: Discussionmentioning

confidence: 99%

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Doctors', Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department

King,

Helps,

Ong

et al. 2024

Health Expectations

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IntroductionThe Emergency Department (ED) has seen increased patient attendance and difficulty meeting demands. New healthcare professions such as Physician Associates (PAs) are being utilised to complement the existing medical workforce. Despite the growth of their professions in the United Kingdom, little evidence is available about the perceptions of their roles.ObjectiveThis study aims to provide evidence of doctors', PAs' and patients' perceptions of the PA role in the UK ED.MethodsA mixed methods approach consisted of the following: An online exploratory survey of ED doctors at one English ED over 1 month (February–March 2022). Post consultation semi‐structured patient questionnaires over 2 weeks (April 2022). Semi‐structured virtual interviews with ED consultants across the four regions of the United Kingdom (3 months in 2022). Semi‐structured virtual interviews with ED PAs across the four regions of the United Kingdom (3 months in 2022).The analysis methods that were used included frequency counts and percentages from closed questions, and hybrid thematic analysis of free text and interview transcripts.ResultsFour ED consultants and four ED PAs across the United Kingdom were interviewed. Twenty‐eight ED doctors participated in the online survey. Fifty‐seven patients completed the post consultation questionnaire. Four main themes (PAs being fit for purpose; patient recognition of PAs, PAs providing continuity of care, and future PAs and regulation) were deduced as per the General Medical Council, Good Medical Practice domains (knowledge, skills and development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism). Other subthemes were induced via hybrid thematic analysis. In this study, doctors and patients had mixed comments about the role of PAs. Most of them were positive as doctor participants perceived PAs to be knowledgeable, highly skilled, with mostly good communication skills, team players, providing continuity of care and overall being fit for purpose. However, some doctor participants commented negatively about PAs for providing little quality healthcare and being inexperienced. There was a desire for career progression among the PA participants and a need to work to their full potential. Although the clinicians of this study displayed a clear understanding of the PA role in the ED, a high frequency of surveyed patients mistook PAs for doctors. It was suggested that future PAs could complete a postqualification programme in emergency medicine, combine roles, be paid on an alternative scale and be formally regulated.ConclusionIn this study, mixed views were expressed by ED consultants, ED junior doctors and patients regarding the role of the PA in the ED. Stakeholders can use the information presented to develop a better understanding of the perceptions of the PA role within the UK ED.Patient or Public ContributionThe Patient and Public Involvement and Engagement (PPIE) group, led by Healthwatch, made significant contributions to the study's design by providing valuable feedback on the information sheets and consent forms utilised. The patients' responses helped guide the study's direction and shape its future work. As part of the dissemination activities, the study findings was shared with both the PPIE team and Healthwatch media production team.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Doctors', Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department

King,

Helps,

Ong

et al. 2024

Health Expectations

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“…The positive impact of MAPs is particularly important during times of doctor shortages and rota gaps 14,15,16 . In UK emergency departments, MAPs have been shown to work at an equivalent level to foundation year one and two doctors, with similar outcomes, and provide safety and continuity to the team 17,18,19 . Generally, patients report good levels of satisfaction with MAPs.…”

Section: Sushruta Journal Of Health Policymentioning

confidence: 99%

Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS

Chakravorty,

Parekh,

Sharma

et al. 2024

Sus

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Background: With the global scarcity of the healthcare workforce, innovations in healthcare professional (HCP) roles include the model introduced in the 1960s in the USA of medical associate professionals (MAPs). Since 2003 in the UK, MAPs had a scope of practice defined by local employers. In 2024, the UK Parliament passed a resolution to bring the MAPs under regulation by the General Medical Council. However, multidisciplinary team and public awareness of MAPs have come under scrutiny, due to uncertainties around roles, unmonitored expansion of scope of practice, patient safety concerns, and competition for jobs and training with doctors. There is a need for rigour in exploring the opinions of the whole spectrum of HCPs, especially locally employed doctors (LEDs), Specialty and Associate Specialities (SAS) and international medical graduates (IMGs) who not only make up a large cohort of doctors in the UK but work closely with MAPs and support their prescribing and ordering investigations functions. Aim: Designed by a multi-professional working group, an online survey of HCPs was conducted to explore the role of MAPs in patient care, and how workforce plans around the roles align with the roles, responsibilities, and training of doctors. Findings: A total of 583 responses were collected which included consultants (43%), postgraduate doctors in training, General Practitioners, LEDs, IMGs (75%), nurses, and allied health professionals. Role: 53% of respondents were uncertain of the specific role of MAPs within the team; 43% agreed primary roles of MAPs involved delivering specific, well-defined skill-based services, reducing workload (20%), and providing continuity (19%). 89% emphasised the importance of a clear distinction between the roles of doctors and MAPs. Patient Safety: 77% agreed that MAPs currently may pose a risk to patient safety. 89% recognised the risk associated with MAPs working beyond their scope. 69% agreed with the need for a competency framework for MAPs. Supervision: 75% expressed concerns about the increased clinical risk and burden faced by doctors in supervisory roles. Impact on Doctors: 69% reported reduced job prospects and 67% reduced training opportunities. Regulation: 74% agreed with regulation by an independent regulator, not the GMC. Free text: The analysis of free-text comments revealed a predominantly negative sentiment regarding the role of MAPs. Concerns about patient safety, lack of proper training, additional workload implications for doctors, the potential for misrepresentation, the erosion of training opportunities for doctors, the risk of scope creep, and confusion among patients. Conclusion: Innovation in healthcare professional roles and functions is key to supporting the human resource shortage in health systems. The results of this survey from Multiprofessional respondents including IMGs, suggest that caution is required in how roles are positioned to the public, to avoid blurred lines of responsibility or interchange between professional roles, and to avoid confusion and consequent risk to the public. MAPs need a robust national framework of competencies, an independent regulator for licensing, and support doctors but not compete for resources, jobs, and training opportunities.

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Comparing physician associates and foundation year 1 doctors-in-training undertaking emergency medicine consultations in England: a quantitative study of outcomes

Cited by 2 publications

References 22 publications

Doctors', Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department

Doctors', Patients' and Physician Associates' Perceptions of the Physician Associate Role in the Emergency Department

Multiprofessional Survey on the Role and Impact of Medical Associate Professions in the NHS

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