Editor’s Note: This post was previously published in Insights on Residency Training, which is hosted by the New England Journal of Medicine and NEJM Journal Watch.
Autumn is in full swing here in the U.K., and having lived in beautiful but season-less south Florida for the past several years, I am mildly obsessed. Even in the city, the fall colors are breathtaking. Personally, I have been really enjoying boots, hot tea, and weekend hikes in the countryside (and in the U.K. fashion, always ending in a cozy country pub). With all of these seasonal changes around, I’ve been thinking about some of the changes I’ve made to how I practice since arriving to the U.K., and about the differences between practicing as a PA in the U.K. and in the U.S.
Leave Your White Coat at Home
You won’t see any white coats walking around the floors of U.K. hospitals. This is not a PA vs. physician division: no healthcare providers in the U.K. wear white coats, docs included. I asked around about what patients might think if you walked into an exam room while wearing a white coat. The answers usually fell along the lines of patients wondering why a scientist was seeing them at their doctor’s office, or why they were being seen by an actor who plays a doctor on an American television show. Not only are white coats not worn as a general practice, they are actually not allowed. More specifically, you are not allowed to wear anything long-sleeved. The National Health Service has a policy of “bare below the elbows” when providing patient care. The purpose of this is to decrease the rate of infection and contamination between patients. Thinking back about all of the things my white coat saw between washings, it’s probably a really good idea. Though I do sometimes wistfully long for all those pockets…
Assistant vs. Associate
As I’ve mentioned in previous posts, PAs here in the U.K. are called physician associates as opposed to physician assistants. Interestingly, they were previously called physician assistants here as well, but the U.K. Department of Health actually recommended they change the name to avoid confusion with other professions — for example, personal assistants, which are administrative personnel in the U.K. This is a sentiment I’m sure many of my colleagues, British and American, could appreciate. Just like the old song, “You like to-may-to and I like to-mah-to,” I say assistant and they say associate. Personally, I rather like the term physician associate, but that’s a larger conversation for perhaps another day.
Prescribing in the U.K.
Finally, currently in the U.K., physician associates cannot prescribe medication (including ordering medications for inpatients as well as for outpatients) or order ionizing radiation (which includes x-rays and CT scans). I had debated whether to include this, but I ultimately did because (a) it highlights a big difference in how PAs currently practice in the U.K. versus the U.S. and (b) I have received several questions about it. In order for PAs in the U.K. to have that authority, physician associate must first become a regulated profession and then be added to the list of healthcare providers that are allowed to prescribe. Both of these actions require parliamentary acts. It’s a top priority of the Faculty of Physician Associates (the U.K. counterpart to the American Academy of PAs) to become a regulated profession, and this is something they have been working very hard to achieve. So while yes, right now, PAs cannot write prescriptions or order CT scans, it is my belief that it is not a question of whether PAs will ever be allowed to do these tasks, but rather when. I have never heard anything but complete support from doctors and other healthcare providers here that PAs should be allowed to do both.
So, that’s an intro course on delineating the differences between PAs on either side of the Atlantic. Now if you’ll excuse me, there are some country pubs and fall foliage to be seen. Also, it is becoming starkly apparent that this Florida girl does not actually own a winter coat.
After my having visited The U.K. (twice) I can and do well appreciate this writing re: PAs in England.
Please share my e-mail who might be interested in my Mentoring/my Tutoring.
Respectfully submitted….Doctor Josh {students, colleagues, editor, mid levels know me as Doctor Josh}
Josh Grossman, Colonel {r} U.S. Army Medical corps, M.D., F.A.C.P.
FMR. Chief of Medicine 121st Evac Hosp APO SF 96220
FMR. Commanding Officer 548th Gen Disp APO SF 96301
Best wishes for the Holidays….
Like Physician and Professor of Internal Medicine and Knowing very clear, since my many years of being a Dr, , that between all Treatments that a Dr must Give and Teach to a patient, behind those indications and prescriptions, there are a lot and deeper knowledge of how is and how works the Human Body in Health and Disease, so, I think that never PA can start giving Prescriptions of Medicines. Being a Physician, require not only complete totally Medical School, but also, to have Residency and after that=CME during all Life,
Weel if physios are wellcome to order X rays and prescribe MSK drugs why not PAs?
They were changed to Physician Associate, not so they weren’t confused with Personal Assistant but because ‘Physician Assistant’ is already a role in the UK – they are ODPs (operating department practitioners) who undertake further training in anaesthetics. So to lobby for regulation, the title was changed to Physician Associate to give a more independent basis for regulation.
Medical schools attract and admit the brightest of the bright. Most incoming students have a track record of earning impressive grades and performing well on exams, as demonstrated in their stellar academic backgrounds. But even the most intelligent students who graduated with ease may find medical school to be an entirely different level of rigor.