Experience of the Irish physician associate role: PA and supervising consultant perspectives

Abstract

Background: The physician associate/assistant (PA) role was introduced into the Irish healthcare system in 2015 when four PAs from North America were recruited to work in Ireland as part of a two-year pilot program. In parallel, the Royal College Surgeons in Ireland (RCSI) began its own PA program in January of 2016 and has graduated 25 PAs. To date, there is little published on the few Irish-trained PAs. This study seeks to share initial experiences with the PA profession in Ireland.Methods: This descriptive phenomenological study explores the newly implemented PA role in Ireland through semi-structured, one-to-one interviews with five PAs and their supervising consultants in Dublin, Ireland. Questions centered on the PA scope of clinical practice, satisfaction with the role, acceptance by the medical team, and integration into the Irish healthcare system.Results: Six themes were identified from the interviews: continuity of patient care, flexible scope of practice, lack of role clarity, complementary to the medical team, regulation and prescribing challenges, and the emerging role of the PA.Conclusions: The development of the PA role is in its infancy in Ireland, but this study suggests that they fill an important role by providing continuity of care to both patients and the medical team. Currently, there are significant challenges imposed by a lack of regulation of the PA profession and the inability to prescribe. However, PAs in Ireland appear to enjoy their work and have great potential to expand throughout Irish healthcare and are valued by their team members.

A survey exploring factors affecting employment of physician associates in Ireland

“…However, when medical students were familiar with the role, they indicated a willingness to work with the PA in referring patients to them, if this would reduce wait time for patients [11]. A common reason for familiarity with the PA role included the respondent's experience of the PA during speciality training in North America [2].…”

“…They are highly sought after and excellent feedback at Management Team Meetings Improving workflow and continuity in medical teams was the most popular influencing factor chosen for recruiting a PA, chosen in this study. In previous studies [1][2][3][13][14][15][16], the quality and the continuity of care, particularly at the time of trainee doctors' change-over, improved, according to staff in the hospital, with the introduction of the PA role, allowing the PA to be a reliable point of contact for other departments, facilitating communication across the hospital. PAs generally do not rotate and can be a more stable factor in the continually changing medical workforce, and are thought to be more familiar with the routines of other individual professionals [13].…”

“…Ultimately, the rationale for undertaking this research was to explore the perceived demand for the PA role, and, as the only university in Ireland educating this group of professionals, to plan for an increase in student number if required. As with some other countries, the PA profession is not yet regulated in Ireland, something which has been reported as a barrier for potential employers because of indemnity issues [ 2 ]. Halter et al [ 3 ] sampled medical directors of all acute and mental health trusts in England, to explore employment factors there.…”

PAs in the Republic of Ireland

“…15 Many Irish surgeons carry out their specialist surgical training in North America and return to Ireland with an appetite to introduce the PA role to the Irish health system, knowing the benefi ts PAs can bring to the continuity of care for patients. 16,17 Large-scale team changeovers of residents occur in January and July each year in Ireland. In addition, the general physician shortages, with many physicians emigrating out of Ireland, have made PAs an attractive solution for the medical workforce.…”

“…While recognizing the challenges of lack of regulation and at times, role clarity, Irish PAs are optimistic about their future, especially after their skill sets were optimized during the COVID-19 pandemic. 14,16 Physician colleagues also have contributed signifi cantly to the profession, through their infl uence in medicine in the Republic of Ireland. 23 In 2021, the PA program established an external advisory board, with representation from all sectors of the healthcare occupational and regulatory landscapes.…”