Physician Associates (PAs) were introduced in the UK in 2003. The UK Association of Physician Associates (UKAPA) was established, acting as a professional body for physician associates in 2005, becoming the Faculty of Physician Associates at the Royal College of Physicians (RCP) in 2015. The Competence and Curriculum Framework (developed by the Department of Health, Royal College of General Practitioners and RCP) for PAs was released in 2006 and updated in 2018. In 2011 a voluntary register was adopted, and the Faculty was launched in 2015 by the UKAPA and the RCP.
PAs are medically trained, generalist healthcare professionals (from science, social care, or medical backgrounds), who work alongside doctors providing medical care as an integral part of the multidisciplinary team. PAs can work with a degree of autonomy with appropriate support. [1]
PAs can undertake many of the tasks undertaken by trainee doctors (FY1 (Junior House Officer) to IMT2 and ST1 (Junior Registrar)) except ordering ionising radiation investigations (eg X-ray and CT scans). This is expected to change when PAs come under the remit and regulation of the GMC. [2]
How I became a PA: Colina Archie-Pearce
My story is unique from start to finish, but one that is to the glory of God. I had not planned to be a PA; in fact, I was initially completely opposed to the idea. From a child, I had always said 'I will become a doctor', such that I studied Science and Maths at A-Level and was a member of the Bexley Grammar School Medicine Society. The God who knows the end from the beginning has a funny way of reminding us that he has not only ordered our steps, [3] but the future is all in the past tense to a God who sits outside of time. [4]Scripture is clear that the Lord speaks to us in various ways, including dreams and visions. [5] I experienced this strange phenomenon during the transitioning period of my final year of Biomedical Sciences in 2015. I was reaching the point where I had to decide what to do after completing my degree. I was attending a conference, when I had a vision in which I saw myself walking down a hospital corridor with a stethoscope around my neck. I took this as a clear sign from God to apply for medicine; I completed the UCAT (University Clinical Aptitude Test), [6] and sent my applications off with the confidence that this was God's direction for me.
I was wrong. I received four rejections and was devastated. A few months later, I discovered that PAs dressed like medical doctors and everything finally made sense; this is where God was leading me. I applied for the programme at the University of Sheffield, a scholarship and travel expenses were paid and to the Glory of God, I received an offer.
The third year of Biomedical Science was probably the hardest period of my life. It was in this period I finally understood the character of God. He is a loving, yet relentless Father who, if he promises something, is faithful to complete it. [7]
During my third year of University, I had to endure a few hardships not limited to, but including, my parents' divorce, depression and subsequently struggling in my degree. This meant I was unable to commence the PA course at the University of Sheffield. Subsequently, I was offered a non-scholarship place at the University of Birmingham, which required a deposit of £500 the following week.
The vision and direction I had from God now all seemed to be a product of my imagination. The funny thing is, God, the Alpha and Omega, may show us the future ahead of time, [8] but may not reveal the details of the journey to get there! I remember telling God how much I trusted him and his plans for me. I knew what he had promised me, and I believed that if it were truly the Lord who had detailed this career path, it would happen.
I will never forget the following Friday afternoon (a few days before Birmingham University required their deposit). I received a call from the University of Sheffield asking if I would like to study there. Someone had dropped out. Thrilled, I accepted and immediately realised that I was now moving back to Sheffield in a few weeks but had nowhere to live. During the final year of my Biomedical Science degree, I had worked as a residential mentor, which entitled me to free accommodation. However, the applications for the upcoming school year had closed months earlier. In faith, I called the residential mentoring team, explaining my situation and was wondering if, there were any vacancies for a residential mentor. They told me that someone had quite literally dropped out that day and so they had an unexpected vacancy that they could offer me.
Like a dream, I completed PA studies at Sheffield University. The month after passing my national qualifying exams in 2018, I commenced at the Queen Elizabeth Hospital, and I have not looked back.
I understand why God directed me to become a PA, and I am still learning how to express the nature of Christ in how I relate to my colleagues and patients. Looking back on everything, I would never trade my experience, though difficult, because it allowed me to see different sides to God from what I thought I knew; I learned the sustenance of God and the depths of his grace and mercy.
Life as a Physician Associate: Twinelle Baidoo
As a child, I was fascinated by Bible stories of Jesus helping and healing people. Jesus taught us through his Word that joy was to be found in serving, not in self-centredness. [9] Jesus further emphasised that we should be stewards to our neighbours and this world. Throughout my life, I was challenged by the healing accounts in the Scriptures about how I could best serve others, particularly the vulnerable. I could have done this in many ways, including working for the justice system and social services.Aged five, my brother was diagnosed with leukaemia and had a significantly poor prognosis. This was a distressing time for us all; we learnt to rely completely on God when medicine did not have all the answers (Psalm 23:1-6). After this encounter, I developed an interest in life sciences and how diseases were treated. I also had a newfound admiration for healthcare professionals and their dedication towards families like mine. As a result, I applied to study medicine in sixth-form.
However, I received multiple rejections. This was challenging to deal with after being convinced that becoming a clinician was my calling. Yet even in rejection, I had to recognise that 'he guides me along right paths, bringing honour to his name'. [10] I decided to undertake a degree in biomedical sciences, committed to obtaining a significant amount of work experience in healthcare to support an application for graduate medicine, convinced that this would make me a stronger candidate. I was not successful in my application.
Then the MSc PA Studies course was advertised to me, complete with a full scholarship. Following extensive research, I decided to embark on the MSc PA Studies course. Although this journey would not be the same as being accepted into medical school or becoming a doctor, it allowed me to obtain knowledge and skills that could improve lives and serve vulnerable people, which remained in line with my career goals. It was an immensely steep learning curve picking up the principles of medicine and clinical reasoning within two years.
Starting clinical placements in the first few days of the course without prior clinical knowledge or reasoning skills and having to undertake objectively structured clinical examinations (OSCEs) in the first few months of the course are examples of how tough the course was. The growth and expectations over just two years were overwhelming yet equally rewarding.
I started my first job as an acute medicine and geriatrics PA approximately one year ago. Helping to optimise people's health has certainly been as rewarding as I had anticipated.
Many colleagues do not understand a PA's role, either expecting too much or too little of us, which can be stressful. Despite working in a clinical team, there can be a feeling of isolation. There can be a lack of the identifiable peer-to-peer support and community that other professionals have. While doctors are responsible for the clinical and educational supervision of PAs, there can be a feeling of disconnect due to differences in our academic and career trajectories. [11]
My future as a PA remains somewhat unclear, but God knows the beginning and end and his plans concerning my life. [12] Wherever my journey leads, I want to ensure that I am always of service and impacting lives around the world. The Christian Medical Fellowship was a reminder from God that he would always provide me with community, irrespective of where I find myself.
Colina Archie-Pearce and Twinelle Baidoo both work as Physician Associates at the Queen Elizabeth Hospital, Woolwich
