The case for the physician assistant
Editor – During more than 20 years working as a physician in the United States, I have interacted with physician assistants in a wide range of clinical settings. Accordingly, I read with great interest Ross and colleagues’ excellent discussion regarding the potential future role of the physician assistant in the NHS (Clin Med June 2012 pp 200–6).
For many years I had the privilege of training and then supervising a number of physician assistants on an interventional cardiology team. These physician assistants provided the long-term stability and organisational skills needed to support the smooth running of an often frantic service. In addition, they were key in teaching junior cardiology residents the basics of pre- and post-procedural care of patients undergoing invasive cardiac testing. I have observed a similar clinical utility of physician assistants in other specialist services, such as cardiac surgery and urology.
I would, however, like to offer a word of caution regarding the considerable potential for the misuse (and abuse) of physician assistants by individual physicians. In the fee-for-service model prevalent in the United States, physicians may charge, at physician rates, for services provided by the physician assistant, as long as the physician supervises that service. Unfortunately, in my experience, this supervision is often scanty and superficial, or even non-existent. This is particularly seen in the private practice setting, where physicians employ multiple physician assistants to work directly for them. While such practices may considerably increase the earnings of the physician, they frequently cause distress to the physician assistants who are trained to look for consistent and meaningful direction from their physician.
Consequently, I would urge those educators, physicians and administrators who will be responsible for expanding the number of physician assistants in the NHS, to be very clear in defining the extent and depth of physician supervision. Vigilant and thoughtful supervision of the supervisors themselves is strongly recommended.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2012 Royal College of Physicians
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