What is a physician associate?
All your PA related questions answered by Nealy, a Physician Associate working in London.
What does being a physician associate entail on a day to day basis (a day in the life)?
At the moment I am locuming and therefore working in different locations, so my day to day life is very varied! The consistency of it would be that I usually work a 9-5, (if I ever get to leave work on-time!)
8am to 1:00pm: Morning clinic, I know I said 9 but sometimes I start at 8. It consists of 10-15 minute appointments, this depends on where I’m working (and how lenient they are), which will take me to around 1pm. At the moment due to Covid19, most, if not all, of my appointments have been telephone consultations or via eConsult.
1:00pm-1:30 pm: Catch up with supervisor, here I run through any questions I have with my supervisor/doctor available.
1:30pm-2:00pm: Lunch and admin. During my lunch I may action some letters on Docman and send off any referrals or look at lab results (basically admin duties).
2:00-5:00pm: Afternoon clinic and catch up with supervisor. Then I will start my PM clinic until my last patient at either 4:45pm or 4:50pm depending on my appointment times. Again, I’ll brush up any queries with my supervisor and get my timesheet signed (so I get paid!).
What type of patients do you see?
All different ages and conditions. I could have a neonate all the way up to the eldest patient I have had who was 107 years old! I see a wide range of patients too, this is one of the longer term locum positions I have had and the reception team literally book me the same patients they would a GP (not sure if that’s a good or bad thing!).
This does mean that some of the patients are complex with multiple comorbidities, however, it doesn’t always mean their consultations are out of my competency. The main point is that I can acknowledge my limitations and gaps in my knowledge and seek guidance where required/signpost or book another appointment with someone else.
For example, a patient that really resonated with me was an 80 year old gentleman who I originally thought was suffering from gastro oesophageal reflux disease, until I saw the results of his barium swallow, which diagnosed him with corkscrew oesophagus!
What kind of decisions are you able to make?
To be honest, I make all kinds of decisions and I manage patients a lot more autonomously than I anticipated! Over the last few months my supervisor and I have built trust with each other, he understands my strengths and weaknesses and we work as a team. There are times we may have slightly different management plans for a particular patient, for example, different medication, however, he won’t change my plan - as long as it’s safe!
I remember the first time I had to take over a follow up appointment concerning an acne review, I was expected to change their management plan, least to say I felt overwhelmed. I contacted my PA buddies on the whatsapp group chat with an abundance of questions. There were so many times I felt the guidelines were not enough for someone newly qualified and I quickly realised I had to learn a lot of things on the job! Having a supportive supervisor to be able to discuss these things with is definitely a huge asset to my development.
However, it’s safe to say that over time, I have noticed certain conditions I first felt intimidated by are now some of my favourites, for example the joys of gynaecology!
I have also been able to make decisions on the type of work that I carry out too! For example, I have a special interest in dermatology and genito-urinary conditions, therefore, I can have priority in seeing those patients in my clinics. I am also able to decide if I’d like to block off any slots to catch up with work, should I need it.
How do PA's and Junior doctors work together?
This is a tough question as I don’t work with any junior doctors, but from what I can imagine, working alongside a junior doctor would be VERY beneficial for a PA, as we could pick their brains and learn from them, whilst also learning WITH them. The two professions would potentially really complement each other as they both have good skills to learn from each other.
What are the pros and cons of being a PA?
Pros are that we have the freedom and choice to move freely between different specialties, without having to do any further training. We can also start working in the desired field a day after qualifying!
Cons would be that at this very moment we are not regulated, however, this is open to change very, very soon (by the GMC). This could open doors of possibilities for PAs, such as, having the ability to prescribe and order ionising radiation.
Another con is that the general public do not seem to know alot about the profession and our abilities. Since graduating, I have only experienced ONE person refuse to speak to me (and that was because she was expecting her usual GP to call her).
What is the most challenging thing about being a PA?
Hmmmmmmmmmm….probably the lack of experience and hence knowledge I have around certain things. Sometimes I wish I knew the same as my supervisor (disclaimer; he’s almost 70 - I think- and has been a GP his whole life). Realistically, I’d love to just have learnt more (even though we learnt so much during university that my brain almost gave up on me).
Actually, the most challenging thing about being a PA was probably BECOMING a PA!!! University was my biggest challenge and I’m so glad it’s over!
How did you know this was the right choice for you, why not become another healthcare professional?
If I’m honest, I didn’t want to be any other healthcare professional, I did not have the desire to be a doctor, nurse, pharmacist….I originally wanted to pursue a career involving my manual dexterity and creativity but changed my mind last minute to study pharmacology.
I just so happened to study an appropriate degree, which happened to make me eligible for the PA. At the time, I admit I didn’t fully understand the role as it was so new and we just didn’t have the social media coverage of it that we do now! Nevertheless, I took a leap and I’m just glad that I am where I am now.
I honestly feel like the profession fits me like a glove, especially now that I am able to teach and help prospective students getting into the course - this is almost as rewarding for me as my 9-5!
What gaps do PA's fill in patient care?
I don’t think PA’s are there to fill in the gaps per say, they are there to offload the pressure. When I see my fellow colleague's appointment lists, I sometimes think to myself
“I could have seen half of their patient list.”
I say this because there are only so many appointments available for each clinician and they’re almost always fully booked. I am the first PA at one of the practices and I can really see the difference I’ve made there so far. The regular GP’s now have the time to tend to their most complex and urgent patients.
Sometimes people literally just want some anusol (hemorrhoid medication) - I mean that doesn’t really require a GP appointment, does it?.
What was the training process like?
At times I felt like I was in a bootcamp. It was tough. I’m a very strong character and rarely show my emotions but I will admit there were times where I felt defeated by the course and there were tears - maybe a drop or two.
It was probably the hardest thing I could have ever imagined and that’s why it is my biggest achievement. It is do-able (I don’t mean to scare people off), it just requires a lot of time and attention (kind of like a woman). Through speaking to different students from different universities, I will say, people have very different experiences but almost all of them will tell you it’s not easy.
Would you make the same choice again?
100000% - I might have decided to take a different path to where I am, however, I’d for sure choose the same career. For the REAL answer, ask me again in ten years time hahaha.