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UK HCPs rally online in the debate on Physician Associates

01.11.2024 | Insight

UK HCPs rally online in the debate on Physician Associates

In 2024, the title ‘physician associate’ (PA) has come to attract more and more interest amongst healthcare professionals (HCPs) in the UK. New guidelines from the general medical council (GMC) coupled with pressure from a government trying to support a struggling NHS, have led to an increasing number of PAs and other medical associate professionals (MAPs) into more patient-facing roles. 

Typically, PAs would work under the supervision of a doctor or medical specialist, assisting them wherever necessary; they formally fall into the group of professionals known as ‘dependent practitioners’ . The overall objective of PAs is to reduce the workload of an increasingly stretched medical profession.

Earlier in the year, however, it was revealed that some NHS trusts were using PAs on doctors’ shifts, which has led to outrage amongst medical and patient communities. Some of these have presented worries about patient safety and the blurring of the line between medical professionals and MAPs. This has led to events such as the British Medical Association (BMA) taking legal action against an NHS campaign educating the public about the new professionals they may be seeing at the front line.

 

This is a particularly nuanced, controversial, and high-profile issue, especially considering there are also concerns over pay rates of PAs being initially superior to that of junior doctors – doctors’ pay being an already controversial issue in the recent past. As such, CREATION has tracked the HCP voice from social media on this issue and in this article will present unprompted HCP standpoints. 

An Overview

Between January 2023 and September 2024, we tracked more than 76,000 HCP posts on X about physician associates and this issue, by more than 4,000 UK HCPs. As seen in the chart below, the uptick in conversation started to gather momentum in late 2023, with the biggest peak being in March 2024, when media coverage drove the majority of activity. This peak was a result of two main events: Firstly, the Royal College of Physicians released survey data on their members’ views of PAs – a study which was vehemently criticised by the online HCP community. Secondly, The Telegraph newspaper published an article revealing the extent of PA ‘infiltration’ onto doctors’ rotas in over 30 NHS hospitals, prompting widespread concern from HCPs online.

Weekly HCP X conservation about PAs since Jan 2023

What are HCPs saying?

Frustration and criticism at governing bodies

It is immediately apparent that HCPs are concerned, and some even angry, about this issue. Several high-profile HCP commentators have shared posts with strong negative sentiment. For example, Dr Rachel Clarke, a palliative care physician and author with more than 280,000 followers on X, expressed “disbelief” at the range of degrees that are allowed as prerequisites for a PA course, expressing a concern that patient safety is being compromised.

As seen in Clarke’s post, this frustration is often angled towards governing bodies and organisations, including the UK government itself, as they have ultimate control over how NHS funding is used. From January 2023 – September 2024 UK HCPs shared more than 4,000 times on X concerning the government and governmental decisions on this matter. Of these posts, just over one percent (n=63) were of positive sentiment – mostly concerning Baroness Natalie Bennett fielding a motion attempting to stop PA legislation going through. Posts of neutral sentiment (n=2,792, 63%) mostly contained discussions of various topics, including the sharing of news about the issue and educational threads. It is worth noting that many of these posts, while not explicitly negative in sentiment, implied a latent negativity towards the Government’s actions. A good example of such sentiment is a post from Dr Ronald Macdonald, a physician in Edinburgh.

 

Posts of explicit negative or critical sentiment (n=1,618, 36%) often called out the UK Government directly for their part in this issue. Dr Trisha Greenhalgh, a primary care professor and retired GP in Oxford, highlighted a common complaint of HCPs to the Government handling of PAs: the limited number of GP training places. Her post was shared by 127 other UK HCPs and was shared over 2,300 times by the international public, garnering 5,189,047 total impressions.

 

HCP sentiment of governmental approach to PA issue

As well as in the healthcare space, HCPs have also targeted criticism towards medical governing bodies. The management of the integration of PAs into the NHS workforce has come under heavy criticism. The Royal College of Physicians was also criticised for its management of a survey investigating its member’s views on PAs. These are reflected in the most-reshared posts by UK HCPs, seen below. The three posts had reached combined impressions total of 9,647,636.

HCP posts relating to the physician associate debate most reshared by HCPs

Call for justice over Pay Issues

The issue of pay rates for NHS doctors (especially junior doctors) has frequently been front-page news in recent years, as the government and junior doctor organisations continue to look to settle this issue. It appears any bitterness about junior doctor pay also spills into the HCP debate around physician associates. From January 2023 – September 2024 more than 5,000 posts from UK HCPs on X were found discussing the pay rates of PAs (this includes discussion about the salaries of junior doctors compared to PAs).

This issue is highlighted in a YouTube video from Kenji Tomita, a physician in London who makes YouTube content for aspiring or young medical professionals. In the video he discusses the matter as a whole, delving into complaints around doctors’ funding, the unclear guidance on MAP roles, as well as patient safety concerns. He also presents a visual showing pay rates of junior doctors and PAs. He illustrates that only in their fifth year of earning will a doctor start to out-earn a PA, and that it takes over seven years of earning for these doctors to have brought home more money overall. Tomita claims the injustice of these figures is clearer when considering the longer years of study doctors undergo compared to PAs. Other online HCPs from the UK and worldwide commented on this video, agreeing with his comments and prompting further discussion. 

Why doctors HATE physicians associates.

Such sentiment is echoed on X too, with HCPs commenting on the unjustness of pay rates of PAs given their job requirements and descriptions. One NHS doctor called it “a weird alternate reality” that PAs earn so much; others went as far as to remark that one “[shouldn’t] bother being a doc” if PAs get similar pay.

It is worth noting that the doctor salaries in Tomita’s video are, at time of writing, about to be outdated following BMA members’ acceptance of the government’s 22% pay rise offer in September 2024.

A call to stop the “witch hunt”

It is evident that many HCPs have strong, critical opinions on this matter. However, it’s necessary to investigate whether any HCPs share contrasting views to the negativity discussed above. There are a handful of HCPs who do oppose this potentially harmful rhetoric towards PAs, despite the apparent injustices and incompetencies that make such discourse understandable.

One example is Dr Suzanne Fletcher, a GP in the North West of England. In a reply to one post, she states that the narrative around PAs is, in her opinion, a “witch hunt”, and that all medical professionals, especially junior doctors, are prone to errors. This post was shared by one other HCP, and garnered 88,103 impressions – significantly lower than the numbers for highly critical posts seen above. Frank Coffey, an emergency medicine consultant in Nottingham, also used the phrase “witch hunt” to describe this situation, having previously called the issue “divisive and toxic”.

Similar sentiment was also shared by Dr Farhad Peerally, a gastroenterologist in Kettering, who stated he was “appalled” at the hate PAs have received online, especially considering his experiences of working with PAs have been very positive.

What do the PAs online think?

When considering this topic, it is also important to analyse the voice of the online PAs. Of the more than 1,800 HCPs who posted original content in the study period, CREATION.co found 19 former or current physician associates posting original content about the ongoing debate. While this is a small fraction of the HCPs active, they were significantly vocal, contributing 338 original posts. Their views on the matter varied: one ex-PA, Adam Skeen, now studying medicine full time, expressed frustration around the pay-cut a PA would face when they graduate to a junior doctor. Active PAs seemed to share this sentiment around pay issues. Heather Reid, a PA working in Scotland, also expressed this view, but shared her own experiences of mistreatment by doctors who she feels “undermine” her role; a role she believes to be important given the current state of the NHS.

Despite the worries some PAs have expressed online, most seem to be in favour of improving the guidance on their roles. Ruth Berry, a PA in the Birmingham area, had stated that her “pride in her professional identity” was being eroded by the narratives around PAs in some medical circles, and mentioned a “campaign of hatred” she feels is brought against PAs. She later went on to express her positivity about new orders which allow for GMC regulation of MAP courses and their roles.

Summary:

In summary, the large volume of HCP conversation around the PA debate demonstrates the need to reach a resolution. Finding such a resolution is, however, no simple task. While it seems clear that doctors want more stringent PA regulation from an independent body separate from the GMC (GMC regulation od PAs will commence in December 2024), the requirement for PAs to assume their original intended purpose remains apparent.

This intended purpose is demonstrated in the United States, where PAs (called ‘physician assistants’ in the US) are more widely spread across health systems. Notwithstanding the obvious differences between UK and US healthcare, the value PAs are bringing across the Atlantic is nonetheless recognised by UK HCPs. This success can give UK HCPs hope when looking towards solutions to the debates raised in this article, and may help guide and inform government and medical regulators with decision making on the road ahead.

If you would like to hear more about tracking the HCP online conversation, and for more issue-specific insights like these, get in touch.

 

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Meet the Author

Ben Stott

Ben, a recent physics graduate, brings a strong foundation in analytical and technical skills honed during his academic journey. Armed with this knowledge, he uncovers valuable data insights to present to the pharmaceutical industry.

In his spare time, Ben loves to play hockey and spend time with friends and family. You’ll often catch him watching sport, or attempting a new geography quiz.