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Open Access 01-12-2024 | Research

Public perception of the physician associate profession in the UK: a systematic review

Authors: Rhys Swainston, Yingxi Zhao, Eli Harriss, Attakrit Leckcivilize, Mike English, Shobhana Nagraj

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

The physician associate (PA) role within the NHS is currently under scrutiny due to recent legislative changes and concerns about their scope of practice within primary and secondary healthcare. There is currently limited knowledge of public understanding of PAs and their levels of satisfaction with PAs. This review synthesises the evidence relating to patients’ and potential patients’ understanding of and satisfaction with the PA profession in the UK.

Methods

We systematically searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCOhost CINAHL, Education Resources Information Centre (ERIC), ProQuest Dissertations and Theses Global, and Scopus databases for empirical studies of patient understanding of PAs or satisfaction with PAs. We included quantitative, qualitative, and mixed-methods studies looking at PAs in primary and/or secondary care. Quality appraisal was conducted using the CASP Critical Appraisal checklists. A reflexive thematic analysis was used to synthesise data and the GRADE-CERqual method was used to assess the certainty of the themes.

Results

A total of 18 papers involving 15 studies were included in the review. Findings revealed that patients had limited understanding of the PA role with many mistaking PAs for doctors and other healthcare professionals. Patients were confused by the lack of PA prescribing rights. There was receptivity to learn more about the PA role. The evidence suggests that patients had a largely positive view of PAs after an encounter, despite their lack of knowledge about the role. Many patients expressed a willingness to be seen by PAs in future and viewed them as a useful part of the wider healthcare system.

Conclusion

In the UK, there is limited information about, and understanding of, the PA role. Nevertheless, patients were largely satisfied with the quality of care they receive from PAs during consultations. Our findings suggest a need for comprehensive public information regarding the roles and scope of practice of PA’s, and to provide the public and patients with clear expectations of their relative strengths and limitations. Further research might determine if these findings are specific to PAs, or reflect wider issues affecting public perception of other cadres of healthcare professionals.
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Literature
1.
go back to reference Cooksley T, Clarke S, Dean J, Hawthorne K, James A, Tzortziou-Brown V, et al. NHS crisis: rebuilding the NHS needs urgent action. BMJ. 2023;380:1.CrossRefPubMed Cooksley T, Clarke S, Dean J, Hawthorne K, James A, Tzortziou-Brown V, et al. NHS crisis: rebuilding the NHS needs urgent action. BMJ. 2023;380:1.CrossRefPubMed
4.
go back to reference Bagenal J. Physician associates in the UK and the role of the doctor. Lancet. 2024;13:102–4. Bagenal J. Physician associates in the UK and the role of the doctor. Lancet. 2024;13:102–4.
5.
go back to reference Wang H, English M, Chakma S, Namedre M, Hill E, Nagraj S. The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis. Hum Resour Health. 2022;20:69. Wang H, English M, Chakma S, Namedre M, Hill E, Nagraj S. The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis. Hum Resour Health. 2022;20:69.
9.
go back to reference Ghadiri SJ. Physician associates: an asset for physician training and a 21st-century NHS? Future Healthc J. 2020;73:e9–10.CrossRef Ghadiri SJ. Physician associates: an asset for physician training and a 21st-century NHS? Future Healthc J. 2020;73:e9–10.CrossRef
11.
go back to reference Salisbury H. Helen Salisbury: Physician associates in general practice. BMJ. 2023;382:1596. Salisbury H. Helen Salisbury: Physician associates in general practice. BMJ. 2023;382:1596.
12.
go back to reference Salisbury H. Helen Salisbury: blurring the boundaries of the medical profession. BMJ. 2024;384:q494–4. Salisbury H. Helen Salisbury: blurring the boundaries of the medical profession. BMJ. 2024;384:q494–4.
13.
go back to reference Zhao Y, Quadros W, Shobhana N, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med. 2024;22(1):286. Zhao Y, Quadros W, Shobhana N, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med. 2024;22(1):286.
18.
go back to reference University of Pittsburgh. Ovid Medline search filters: qualitative studies (revised 25 March 2024) 2024 [updated 25/03/2024]. Accessed 25 July 2024. University of Pittsburgh. Ovid Medline search filters: qualitative studies (revised 25 March 2024) 2024 [updated 25/03/2024]. Accessed 25 July 2024.
19.
go back to reference Braun V, Clarke V. Thematic analysis: a practical guide. London: SAGE; 2022. Braun V, Clarke V. Thematic analysis: a practical guide. London: SAGE; 2022.
20.
go back to reference Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the Conduct of Narrative Synthesis in systematic reviews a product from the ESRC Methods Programme. Lancaster: Lancaster University; 2006. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the Conduct of Narrative Synthesis in systematic reviews a product from the ESRC Methods Programme. Lancaster: Lancaster University; 2006.
22.
go back to reference Halter M, Drennan VM, Joly LM, Gabe J, Gage H, de Lusignan S. Patients’ experiences of consultations with physician associates in primary care in England: a qualitative study. Health Expect. 2017;205:1011–9.CrossRef Halter M, Drennan VM, Joly LM, Gabe J, Gage H, de Lusignan S. Patients’ experiences of consultations with physician associates in primary care in England: a qualitative study. Health Expect. 2017;205:1011–9.CrossRef
23.
go back to reference Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, et al. What is the contribution of physician associates in hospital care in England? A mixed-methods, multiple case study. BMJ Open. 2019;9(1):e027012. Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, et al. What is the contribution of physician associates in hospital care in England? A mixed-methods, multiple case study. BMJ Open. 2019;9(1):e027012.
24.
go back to reference Drennan VM, Halter M, Joly L, Gage H, Grant RL, Gabe J et al. Physician associates and GPs in primary care: a comparison. Br J Gen Pract. 2015;65(634):e344–50. Cited 2020 Jan 17. Drennan VM, Halter M, Joly L, Gage H, Grant RL, Gabe J et al. Physician associates and GPs in primary care: a comparison. Br J Gen Pract. 2015;65(634):e344–50. Cited 2020 Jan 17.
25.
go back to reference Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, et al. Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Serv Delivery Res. 2014;216:1–136. Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, et al. Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. Health Serv Delivery Res. 2014;216:1–136.
26.
go back to reference Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, et al. The role of Physician Associates in secondary care: the PA-SCER mixed-methods study. Health Serv Delivery Res. 2019;719:1–158. Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, et al. The role of Physician Associates in secondary care: the PA-SCER mixed-methods study. Health Serv Delivery Res. 2019;719:1–158.
27.
go back to reference Jackson B, Marshall M, Schofield S. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach. Br J Gen Pract. 2017;67(664):e785–91. Cited 2019 Dec 21. Jackson B, Marshall M, Schofield S. Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach. Br J Gen Pract. 2017;67(664):e785–91. Cited 2019 Dec 21.
28.
go back to reference Shah C, Singh P, Matin S, Farrow J, Magon R, Zia A et al. A physician associate-led clinic for people with severe mental illness in the United Kingdom. JAAPA. 2021;34(8):1–6. Cited 2022 May 2. Shah C, Singh P, Matin S, Farrow J, Magon R, Zia A et al. A physician associate-led clinic for people with severe mental illness in the United Kingdom. JAAPA. 2021;34(8):1–6. Cited 2022 May 2.
29.
go back to reference Taylor F, Ogidi J, Chauhan R, Ladva Z, Brearley S, Drennan VM. Introducing physician associates to hospital patients: development and feasibility testing of a patient experience-based intervention. Health Expect. 2020;241:77–86. Taylor F, Ogidi J, Chauhan R, Ladva Z, Brearley S, Drennan VM. Introducing physician associates to hospital patients: development and feasibility testing of a patient experience-based intervention. Health Expect. 2020;241:77–86.
30.
go back to reference Taylor F, Halter M, Drennan VM. Understanding patients’ satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England. BMC Health Serv Res. 2019;19(1):603. Taylor F, Halter M, Drennan VM. Understanding patients’ satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England. BMC Health Serv Res. 2019;19(1):603.
31.
go back to reference McDermott I, Spooner S, Goff M, Gibson J, Dalgarno E, Francetic I, et al. Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study. Health Social Care Delivery Res. 2022;109:1–148.CrossRef McDermott I, Spooner S, Goff M, Gibson J, Dalgarno E, Francetic I, et al. Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study. Health Social Care Delivery Res. 2022;109:1–148.CrossRef
32.
go back to reference Farmer J, Currie M, Hyman J, West C, Arnott N. Evaluation of physician assistants in National Health Service Scotland. Scot Med J. 2011;563:130–4.CrossRef Farmer J, Currie M, Hyman J, West C, Arnott N. Evaluation of physician assistants in National Health Service Scotland. Scot Med J. 2011;563:130–4.CrossRef
33.
go back to reference Williams LE, Ritsema TS. Satisfaction of doctors with the role of physician associates. Clin Med. 2014;142:113–6.CrossRef Williams LE, Ritsema TS. Satisfaction of doctors with the role of physician associates. Clin Med. 2014;142:113–6.CrossRef
34.
go back to reference Halter M, Drennan V, Wang C, Wheeler C, Gage H, Nice L et al. Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes. BMJ Open. 2020;10(9):e037557. Halter M, Drennan V, Wang C, Wheeler C, Gage H, Nice L et al. Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes. BMJ Open. 2020;10(9):e037557.
35.
go back to reference Cheang PP, et al. What is in a name–patients’ view of the involvement of ‘care practitioners’ in their operations. J Royal Colleges Surg Edinb Irel. 2009;7(6):340–4. Cheang PP, et al. What is in a name–patients’ view of the involvement of ‘care practitioners’ in their operations. J Royal Colleges Surg Edinb Irel. 2009;7(6):340–4.
36.
go back to reference Zaman Q, Yogamoorthy S, Zaman M, Fouda RMFR. Patients’ perspective of physician associates in an acute medical unit within an English district general teaching hospital – a pilot survey study. Future Healthcare J. 2018;5(3):213–7. Cited 2020 Apr 13. Zaman Q, Yogamoorthy S, Zaman M, Fouda RMFR. Patients’ perspective of physician associates in an acute medical unit within an English district general teaching hospital – a pilot survey study. Future Healthcare J. 2018;5(3):213–7. Cited 2020 Apr 13.
37.
go back to reference Drennan VM, Calestani M, Taylor F, Halter M, Levenson R. Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study. JRSM Open. 2020;11(10):205427042096957.CrossRef Drennan VM, Calestani M, Taylor F, Halter M, Levenson R. Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study. JRSM Open. 2020;11(10):205427042096957.CrossRef
39.
go back to reference Wilsher SH, Gibbs A, Reed J, Baker R, Lindqvist S. Patient care, integration and collaboration of physician associates in multiprofessional teams: a mixed methods study. Nurs Open. 2023;10(6):3962–72. Wilsher SH, Gibbs A, Reed J, Baker R, Lindqvist S. Patient care, integration and collaboration of physician associates in multiprofessional teams: a mixed methods study. Nurs Open. 2023;10(6):3962–72.
42.
go back to reference King NMA, Helps S, Ong YG, Walker S. Doctors’, patients’ and Physician associates’ perceptions of the Physician Associate Role in the Emergency Department. Health Expectations: Int J Public Participation Health Care Health Policy. 2024;27(4):e14135.CrossRef King NMA, Helps S, Ong YG, Walker S. Doctors’, patients’ and Physician associates’ perceptions of the Physician Associate Role in the Emergency Department. Health Expectations: Int J Public Participation Health Care Health Policy. 2024;27(4):e14135.CrossRef
44.
go back to reference ‌Berwick S, Calev H, Matthews A, Mukhopadhyay A, Poole B, Talan J, et al. Mistaken identity: frequency and effects of gender-based Professional Misidentification of Resident Physicians. Acad Med. 2021;966:869–75.CrossRef ‌Berwick S, Calev H, Matthews A, Mukhopadhyay A, Poole B, Talan J, et al. Mistaken identity: frequency and effects of gender-based Professional Misidentification of Resident Physicians. Acad Med. 2021;966:869–75.CrossRef
45.
go back to reference Ahmad SR, Ahmad TR, Balasubramanian V, Facente S, Kin C, Girod S. Are you really the doctor? Physician experiences with gendered microaggressions from patients. J Women’s Health. 2022;31(4):521–32.CrossRef Ahmad SR, Ahmad TR, Balasubramanian V, Facente S, Kin C, Girod S. Are you really the doctor? Physician experiences with gendered microaggressions from patients. J Women’s Health. 2022;31(4):521–32.CrossRef
46.
go back to reference Jefferson L, Bloor K, Spilsbury K. Exploring gender differences in the working lives of UK Hospital consultants. J R Soc Med. 2015;1085:184–91.CrossRef Jefferson L, Bloor K, Spilsbury K. Exploring gender differences in the working lives of UK Hospital consultants. J R Soc Med. 2015;1085:184–91.CrossRef
47.
go back to reference Roberts K, Drennan VM, Watkins J. Physician associate graduates in England: a cross-sectional survey of work careers. Future Healthc J. 2022;9(1):5–10.CrossRefPubMedPubMedCentral Roberts K, Drennan VM, Watkins J. Physician associate graduates in England: a cross-sectional survey of work careers. Future Healthc J. 2022;9(1):5–10.CrossRefPubMedPubMedCentral
48.
go back to reference Windish DM, Olson DP. Association of Patient Recognition of Inpatient Physicians with knowledge and satisfaction. J Healthc Qual. 2011;333:44–9.CrossRef Windish DM, Olson DP. Association of Patient Recognition of Inpatient Physicians with knowledge and satisfaction. J Healthc Qual. 2011;333:44–9.CrossRef
49.
go back to reference Merriel SWD, Salisbury C, Metcalfe C, Ridd M. Depth of the patient–doctor relationship and content of general practice consultations: cross-sectional study. Br J Gen Pract. 2015;65637:e545–51.CrossRef Merriel SWD, Salisbury C, Metcalfe C, Ridd M. Depth of the patient–doctor relationship and content of general practice consultations: cross-sectional study. Br J Gen Pract. 2015;65637:e545–51.CrossRef
Metadata
Title
Public perception of the physician associate profession in the UK: a systematic review
Authors
Rhys Swainston
Yingxi Zhao
Eli Harriss
Attakrit Leckcivilize
Mike English
Shobhana Nagraj
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-11965-2