Physician associates provide safe care for diagnosed patients when directly supervised by a doctor

Physician associates provide safe and effective care when they work under the direct supervision of doctors and care for patients who have already been diagnosed, or when they undertake procedures for which they have been highly trained, finds a rapid review published in The BMJ.

However, the rapid review on the safety and effectiveness of physician associates found insufficient evidence to support them assessing undiagnosed patients under indirect supervision—when seeing undiagnosed patients in primary care, for example.

Patient satisfaction levels for care provided by physician associates were similar to those provided by doctors, but there was limited evidence on the cost-effectiveness of physician associates.

The rapid review, which was prompted by concerns about the impact of the physician assistant role in the UK, also found that they increased access to care. But this may reflect the benefits of increased staffing rather than the unique contribution of the role, it suggests. In the UK, most have been deployed in socio-economically deprived areas.

Physician associates are known as physician assistants in most other countries, and were first introduced in the US in the 1960s to tackle resident doctor shortages in rural areas. They have since been adopted by many other countries facing medical workforce difficulties and/or cost pressures in their health systems.

In the UK, physician associates require a bachelor’s degree in a science or a health-related discipline plus a diploma or master’s degree in physician assistant studies focusing on the clinical skills necessary to assist doctors in patient care.

The Academy of Medical Royal Colleges called for a rapid review of the safety, cost-effectiveness, and efficiency of physician associates after concerns were raised about the implementation of the role in the UK in six broad areas. These were: scope of practice; patient safety; informed consent; preferential employment conditions; additional workload of physicians supervising physician associates; and impact on medical training.

In November 2024, the Secretary of State for Health and Social Care commissioned an independent review of the impact of physician and anesthesia associates on quality of care by Professor Gillian Leng. The rapid review included 40 studies comparing the quality of care delivered by physician associates and doctors in economically developed countries (North America and Europe, plus Israel, Japan, South Korea, Australia, and Aotearoa/New Zealand) using outcomes on safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Although focused on the UK, the rapid review’s findings would be relevant to the physician associate role in other high-income countries, say the authors.

They acknowledge several limitations to the findings, most notably that only four of the studies included were carried out in the UK. Most were carried out in the US and were of weak quality, using retrospective analyses of routinely collected data that did not always take confounding factors into account. Few assessed cost-effectiveness, and none were conducted in the post-COVID health care environment.

The authors conclude, “There is a legitimate role for [physician associates] working alongside physicians in well-defined roles under supervision. However, indirect or unsupervised management by [physician associates] of undifferentiated symptoms and disease may risk patient safety.”

They add, “National guidance on the supervision and scope of practice for physician [associates] can ensure that physician [associates] practice safely and effectively.”

Physician associates provide safe and effective care when they work under the direct supervision of doctors and care for patients who have already been diagnosed, or when they undertake procedures for which they have been highly trained, finds a rapid review published in The BMJ.

However, the rapid review on the safety and effectiveness of physician associates found insufficient evidence to support them assessing undiagnosed patients under indirect supervision—when seeing undiagnosed patients in primary care, for example.

Patient satisfaction levels for care provided by physician associates were similar to those provided by doctors, but there was limited evidence on the cost-effectiveness of physician associates.

The rapid review, which was prompted by concerns about the impact of the physician assistant role in the UK, also found that they increased access to care. But this may reflect the benefits of increased staffing rather than the unique contribution of the role, it suggests. In the UK, most have been deployed in socio-economically deprived areas.

Physician associates are known as physician assistants in most other countries, and were first introduced in the US in the 1960s to tackle resident doctor shortages in rural areas. They have since been adopted by many other countries facing medical workforce difficulties and/or cost pressures in their health systems.

In the UK, physician associates require a bachelor’s degree in a science or a health-related discipline plus a diploma or master’s degree in physician assistant studies focusing on the clinical skills necessary to assist doctors in patient care.

The Academy of Medical Royal Colleges called for a rapid review of the safety, cost-effectiveness, and efficiency of physician associates after concerns were raised about the implementation of the role in the UK in six broad areas. These were: scope of practice; patient safety; informed consent; preferential employment conditions; additional workload of physicians supervising physician associates; and impact on medical training.

In November 2024, the Secretary of State for Health and Social Care commissioned an independent review of the impact of physician and anesthesia associates on quality of care by Professor Gillian Leng. The rapid review included 40 studies comparing the quality of care delivered by physician associates and doctors in economically developed countries (North America and Europe, plus Israel, Japan, South Korea, Australia, and Aotearoa/New Zealand) using outcomes on safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Although focused on the UK, the rapid review’s findings would be relevant to the physician associate role in other high-income countries, say the authors.

They acknowledge several limitations to the findings, most notably that only four of the studies included were carried out in the UK. Most were carried out in the US and were of weak quality, using retrospective analyses of routinely collected data that did not always take confounding factors into account. Few assessed cost-effectiveness, and none were conducted in the post-COVID health care environment.

The authors conclude, “There is a legitimate role for [physician associates] working alongside physicians in well-defined roles under supervision. However, indirect or unsupervised management by [physician associates] of undifferentiated symptoms and disease may risk patient safety.”

They add, “National guidance on the supervision and scope of practice for physician [associates] can ensure that physician [associates] practice safely and effectively.”