Introducing the physician associate role in Ireland: Evaluation of a hospital based pilot project

Abstract

Objective: Ireland has medical workforce challenges and a growing demand for services. One strategy is to include Physician Associates (PAs) in healthcare settings. A pilot study was undertaken with PAs recruited from North America and the United Kingdom to work in a large Dublin teaching hospital.Methods: Four PAs were deployed on surgical services. Communication with the hospital staff preceded their employment. A series of interviews were undertaken at the beginning [2015] and end [2017] of the project. Data collection included surveys and interviews with staff and PAs.Results: Despite a series of communications about the employment of PAs a lack of awareness among hospital staff prevailed. This presented a challenge for the PAs to assume their role and for staff to bring them on board. Once on board those staff who worked with the PAs found their role beneficial in terms of continuity of care and skillset. Recommendations for inclusion of PAs in any new employment should include a more robust stakeholder engagement and promulgation throughout the wider healthcare system.Conclusion: Attitudes about the adoption of the PA have come slowly when first introduced in a country and Ireland seems no exception. At the same time communication lessons were learned about introducing a new health provider role in Irish society.

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

“…The PA role was introduced into the Irish healthcare system in 2015 when four PAs from North America were recruited to work in one hospital in Ireland as part of the two-year pilot project with the Irish Department of Health. [13] Numerous factors are driving the implementation of PAs in Ireland, including workforce shortages, a need for improved continuity of care for patients, and the European Working Time Directive. [13] Compared to other countries, Ireland's medical teams rely more heavily on "non-consultant hospital doctors," commonly referred to as "junior doctors," for the delivery of care.…”

“…[13] Numerous factors are driving the implementation of PAs in Ireland, including workforce shortages, a need for improved continuity of care for patients, and the European Working Time Directive. [13] Compared to other countries, Ireland's medical teams rely more heavily on "non-consultant hospital doctors," commonly referred to as "junior doctors," for the delivery of care. [13] Junior doctors include all physicians in training, from interns to senior residents, whose training is characterized by rotating to hospitals throughout the country every 3, 6, or 12 months.…”

“…[13] Compared to other countries, Ireland's medical teams rely more heavily on "non-consultant hospital doctors," commonly referred to as "junior doctors," for the delivery of care. [13] Junior doctors include all physicians in training, from interns to senior residents, whose training is characterized by rotating to hospitals throughout the country every 3, 6, or 12 months. [14] Large-scale team changeovers of junior doctors occur in January and July, which can be disruptive to continuity of patient care.…”

“…[14] Large-scale team changeovers of junior doctors occur in January and July, which can be disruptive to continuity of patient care. [13] This is aggravated by general workforce shortages, with fewer junior doctors entering postgraduate training programs and more doctors emigrating out of Ireland. [15] Additionally, PAs are seen as a way to improve compliance with the European Working Time Directive, which since 2004 has limited doctors' working hours to an average of 48 hours per week.…”

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“…Alongside these challenges and developments, a pilot project was set up with the Department of Health, in Ireland, to introduce the role of the PA in 4 surgical services in one large urban teaching hospital in Dublin. As part of an evaluation of a two-year pilot project (Joyce et al, 2019), the team undertook a study on patient willingness to be seen by a PA with surrogate patients who were not yet familiar with the role in Ireland (Joyce et al, 2018). The findings of the latter study suggest that patients are willing to see a PA, if they can be seen quicker than any other clinician.…”