Research focus

Physician associates

Three recent studies have looked at the use of physician associates, which have been used for many years in the United States, but are still relatively unknown in the UK

Physician associates (PAs) have been used for many years in the US, but are still relatively unknown in the UK. Here are three recent articles about PAs.

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Analysis of the level of general clinical skills of physician associate students using an objective structured clinical examination

This study aimed to describe the level of clinical skills of student physician associates (PAs) in the Netherlands. Comparison was made with those of newly qualified doctors.

Five Objective Structured Clinical Examinations (OSCEs) with a range of scenarios were undertaken by 139 PA students and 91 doctors. They were assessed out of ten on history taking, physical examination, consultation skills and report writing using assessment forms developed by the authors.

Total mean scores were 6.2 for PAs and 6.7 for doctors. PAs and doctors scored the same for history taking (5.8 and 5.7). PAs scored 4.8 for physical examination versus doctors' 5.6, and 8.2 against 8.6 for communication. For the report writing quality, PA students scored 6.0 and doctors 6.8.

The authors concluded that PA skills were comparable to junior doctors, but suggested that further attention needed to be paid to ensuring development of clinical reasoning skills across the full scope of medicine, beyond the PAs’ practice specialty. They also suggested further research was needed on the level of general clinical skills in experienced PAs.

van Vught AJAH, Hettinga AM, Denessen EJPG et al (2015) Journal of Evaluation in Clinical Practice. 21, 971-975. doi: 10.1111/jep.12418


Physician associates and GPs in primary care: a comparison

Outcomes and costs of same-day consultations by PAs and GPs were compared in this study. The authors undertook a comparative observational study of 2,086 patient consultation records (932 with PAs and 1,154 with GPs) across 12 practices in England, and of 539 linked patient satisfaction surveys. The primary outcome measure was number of patients re-presenting with the same or linked issue within 14 days. Secondary outcomes included processes of care, patient satisfaction, length and cost of consultation.

There were no significant differences in re-consultation rates between PAs and GPs, either planned or unplanned. After adjusting for confounding variables, there were no differences between processes of care. Average consultation length for PAs was 17.03 minutes compared with GPs (11.23 minutes) but the lower cost of PAs meant that cost per consultation was only £28.41 compared with £34.36. There was no significant difference in recorded patient satisfaction between the two groups. Additionally, the PAs' clinical documentation was considered more appropriate than the GPs' (81.6% vs. 50.8%). PA consultations were with younger and less medically complex patients.

The authors concluded that PAs offer potentially cost-effective alternatives for straightforward same-day patient consultations, freeing up GPs for more complex cases. They noted that data on GP time spent on PA supervision and professional development were not available so this may affect the overall cost-effectiveness, and further research is needed.

Drennan VM, Halter M, Joly L et al (2015) British Journal of General Practice. doi: 10.3399/bjgp15X684877

Physician associate and general practitioner consultations: a comparative observational video study

The quality of PA consultations was compared with those of GPs in this study. The researchers filmed 62 consultations (21 PA and 42 GP) from 12 practices in England and, using a comparative observational study design, the recordings were analysed by four GP assessors using the Leicester Assessment Package. This assessed various components of the consultation using a rating scale from A (highest) to E (lowest). The researchers attempted to identify which type of clinician was undertaking each consultation, and there was analysis of case mix for each professional group.

All consultations were considered safe by the assessors, but GPs consistently scored higher than PAs across all assessed domains with overall scores of C for PAs and C+ for GPs. PAs were only correctly identified in 56% of cases. Patients seeing a GP were more likely to have more than one presenting complaint, and to have presenting complaints related to a chronic condition.

The authors concluded that PAs provide safe care to non-complex cases and complement GPs' role in primary care. They noted that GPs had substantially more years post-training experience than PAs in this study, which may influence results. Further research is needed in this area.

de Lusignan S, McGovern AP, Tahir MA et al (2016) PLoSONE. doi: 10.1371/journal.pone.0160902

Kat Millward is a lecturer at City, University of London. 

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