What is a Physician Associate (PA)?

A PA is a medical professional with generalist training who works as part of a multi-disciplinary team alongside doctors, nurses and other allied health professionals to provide high quality medical care to patients. A PA is a dependant practitioner, meaning that they work with a dedicated supervisor, but a PA is able to work autonomously when there is an appropriate level of support available.

A physician associate could work in any speciality within medicine or surgery and currently there are PA’s working in General Practice, Accident and Emergency and inpatient medical and surgical wards. As part of their role a PA would be expected to take histories, perform examinations, formulate differential diagnoses and management plans. A PA may also be expected to perform therapeutic procedures, request and interpret diagnostic tests and manage long term conditions.

Why Become a PA?

The PA role is still a new and innovative profession within the NHS and these are exciting times to become a PA, you would have the ability to pioneer this new role and promote the flexibility the role provides for you.

A PA in the workforce will increase the capacity of the medical team and increase access to quality healthcare for patients by enabling and supporting other members of the team. A PA is a stable member of a ward, often being able to provide continuity of care when junior doctors rotate around specialities.

By maintaining a certain level of your generalist medical training you will also have the flexibility to move specialities and explore working in different areas of medicine at any point in your PA career.

Testimonials about the PA role include:

"I am a PA because it really is the best job in the world, I feel I am contributing and making a positive impact on the health of our patients. Alongside my colleagues I feel a valued and respected member of the team who can provide continuity to a patient in their hour of need."
– Physician Associate

"I support the PA role because they provide general medical care in some highly specialised clinical teams."
– Consultant Geriatrician

"You should become a PA because you would be a great addition to the medical team supporting the doctors in the diagnosis and management of patients."
– Acute Medical Team

Personal profile

Ruth Berry BSc (Hons), PGDip, PGCert, PA-R

Lecturer

Ruth has been working clinically as a PA for the past eight years and has been a member of the teaching team at the University of Birmingham since January 2019. Ruth is presently the lead academic for Paediatric teaching and the interim assessment lead for the programme. Ruth also works part time in General Practice providing care to the population of East Birmingham and oversees a team of junior PA’s working in the surgery.

Learning and teaching

Teaching timetable - term one example

This is a very intensive programme, as you can expect to be studying 50+ hours per week, which includes evenings and weekends, especially when on placement. Students are expected to be available for both placement and University-based teaching 8-6pm Monday to Friday, 48 weeks a year.

Clinical placements involve supervised practice in hospitals and GP surgeries to encourage learning by observation, practice and reflection and are an integral part of the course.

Each week will be different, but a typical Term 1 week may include the following scheduled sessions:

Monday – GP Placement day.
Tuesday – Clinical Sciences session / self-directed or group work on weekly problem.
Wednesday – Anatomy and Applied Theory / more work on weekly problem.
Thursday – History Taking / Examination Theory session / more work on weekly problem.
Friday – Understanding Problem Conclusion and following Problem launch (morning) / Skills session with simulated patients (afternoon)

The week will also normally include significant time for self-directed or group work on the weekly problem along with a schedule of facilitated sessions. The above schedule is indicative, with students given occasional non-recalled dates and other sessions as required.

Timetables will vary week-to-week and term-to-term depending on learning requirements and forthcoming placements.

Problem based learning

We believe in very close integration between the theory learning (‘the hip is a ball and socket joints and the femur anatomy is as follows’ and clinical learning (‘when people fracture their hips it happens like this, they present like this, and your understanding of the hip anatomy enables you to understand why and how hips fracture’). You will also link theory and practice by learning, say, how to examine a hip on each other, on a simulated patient and (often) on a real patient before you see such a patient in a clinical environment.

Sample problem

Problem Based Learning (also known as Case Based Learning) is the main way in which you will learn the anatomy, physiology, biochemistry, behavioural science, ethics, law and pharmacology you will need to understand what is happening in the clinical environment. Each week your small teaching group will be given a problem or case to work with. This is not a diagnostic problem but an understanding problem.

A case might be:

“A 55 year-old single obese man of Irish background who works as a bus driver has poorly controlled diabetes and seems unable to give up smoking. His vision has deteriorated significantly due to the diabetes.”

The group's task would be to identify the key learning issues:

What is diabetes? Including for example the anatomy and physiology of pancreas (endocrine system), pathophysiology etc.
How does it develop?
How is it managed?
Why is smoking important?
How does the man’s gender, age, occupation, family situation and ethnic background fit in, it if at all?
Are there any legal issues?

These cases/problems are supported by the following:

Traditional lectures, to provide some background (eg on the basic principles of pharmacology)
Clinical skills sessions with simulation (eg working with role players on mental illness scenarios; Inter-professional learning scenarios with nursing and medical students on a cardiac arrest)
Anatomy seminars using each other and life models for surface anatomy
Up to five days will be spent in General Practices (in term 1) specially selected for teaching, where you will see patients with relevant histories and physical signs (eg patients with asthma when studying respiratory medicine)

Working with Associate Clinical Educators

One of the highlights of the Birmingham programme is the regular session with simulated patients. Associate Clinical Educators (ACEs) are specially trained simulated patients to mimic signs, so students can practice examination skills on ‘naive’ patients without risking causing unnecessary pain.

Physician Associate: Working with ACEs

Placement based learning

Through placements, you will have access to a diverse regional population of over five million, including one million children. This means you will see a vast range of illness in people from diverse ethnic backgrounds, genders, sexualities, socio-economic statuses, and ages, helping you to relate, empathize and identify with these people on a professional and personal level.

You will further develop your basic clinical skills in taking a good clinical history and examining patients, as well as studying the communication skills needed to deliver effective consultations. You’ll also learn about common medical and surgical diseases and how to diagnose and manage them as well as continuing your theoretical work.