Workforce: The career aspirations and expectations of student physician associates in the UK
Abstract
The NHS five year forward view1 supports the development of a flexible workforce. Expanding the traditional medical workforce using physician associates (PAs) is increasing in popularity. This study explores the career aspirations and expectations of student PAs from a large PA school in England. Thematic analysis of qualitative data from an online survey examined the personal motivations and career aspirations of student PAs. Finally, we make nine recommendations to enhancing recruitment, retention and development of PAs post qualification. Lessons learnt from this data set are generalisable.
Background
The NHS five year forward view1 supports the development of a flexible workforce. Expanding the traditional medical workforce using physician associates (PAs) is increasing in popularity. Health Education England has invested heavily in the training of student PAs and the first cohort of PAs graduated in January 2018.
Understanding the experiences and managing the expectations of the PAs is vital for recruitment, retention and development of this extended medical workforce member into the local NHS. This research examines the influences, experiences, motivations and expectations of the student PAs, in an attempt to assist with the Health Education England future investment strategy and the task of retaining and developing qualified PAs in the local healthcare economy. Lessons learnt from this project are generalisable.
The key principles in this report examine the personal motivations of student PAs:
What motivates this group to come to and remain in their location?
How ready they feel the present context of the NHS is for them and how ready they themselves feel working in the NHS?
What they see as a suitable job and how might we support their development?
Method
Perceptions were sought from PAs across the north west of England (NW) by use of Bristol online survey (BOS). The questions were designed in advance by discussion between the authors and from understanding of the present literature. The question framework was piloted with 10 respondents, no difficulties were identified from its use, and so the same question framework was thus used for all respondents. 284 training PAs were contacted via email and invited to participate in the survey. Consent for data collection was taken at time of recruitment. The 284 training PAs contacted formed cohort 1 and cohort 2 of the PA training pilot within the NW; those contacted include all those training at the three higher education institutions; University of Central Lancashire, University of Manchester and University of Liverpool. All those who were invited to complete the survey were on clinical placements at the time of completion of the survey. One email reminder was sent after 2 weeks to those who had not completed the survey at first invitation. The survey was open for 4 weeks. Of the training PAs cohorts contacted cohort 1 were expected to graduate from their programme of study in January 2018 and cohort 2 in January 2019. Qualitative thematic analysis of the data submitted in the survey responses, was carried out by the authors via an inductive approach.2
Results
The survey took place in July 2017. At the time of closure of the survey, 91 training PAs had completed the survey. A response rate of 30% of the total possible which was felt to be adequate given the volume of surveys PAs are expected to complete at this time. Analysis occurred both within and across questions, to allow identification of central themes running through the data collected. Data saturation was felt to be achieved when the authors coding the data found no new themes for coding and felt the themes identified represented the data sample.
The demographic distribution of those responding to the survey invitation is shown in Figs 1–3. Age (Fig 1), gender (Fig 2) and cohort (Fig. 3) at the time of completion of the survey are shown against the number of respondents.
The demographic data presented reflects an accurate representation of the distribution of age/gender within the two cohorts surveyed.
Thematic analysis of survey responses
Twelve open questions were asked in the survey. Questions are displayed with the dominant themes found by the thematic analysis (Tables 1⇓⇓⇓⇓⇓⇓⇓–9, Figs 4 and 5). Qualitative quotations from the survey data set support the answers. Answers’ themes to questions 11 and 12 are displayed in Table 7.
Q. Why do you want to become a PA?
Five dominant motivational themes were exhibited within the responses (Table 1).
Q. Why did you choose to train in this location?
Three dominant themes were exhibited (Table 2). The student PAs appeared to value financial support to aid their ability to study and studying in a place where they have social support networks.
Q. What will your ideal job content be as a qualified PA?
Dominant themes were displayed by the respondents (Table 3).
Q. What do you see, hear and feel about PAs working in primary and community care?
Three main themes were described (Table 4).
Q. What would attract you into a career in primary care?
Four dominant themes were exhibited (Table 5).
Q. What would attract you into secondary/tertiary care?
More free text was recorded in response to this question in comparison to that of career attractions to primary care. The narrative of attraction to ‘secondary/tertiary care’ appeared more positive. The text is highlighted below by the authors to show the themes of positivity used in the narrative for example ‘more’:
I feel there is more scope for PAs to be utilised in hospitals at present.
Exposure to more interesting cases.
Keen supervising doctors who are given time to help you with your continued learning.
Other themes that were demonstrated in response to this question are show in Table 6.
Q. Following qualification where do you see yourself working?
See Fig 4.
Q. Which specialties would interest you as a career?
Specifically within surgery the most popular career destination choice was obstetrics and gynaecology followed by general surgery. Within medicine, the most popular career destination choice was acute and general medicine followed by care of the elderly and palliative care (Fig 5).
Within ‘Other’ the most desired career choice was for PA education followed by NHS management.
Q. Considering your career what do you want now?
The words more and better were used repetitively and frequently throughout the responses.
Specific themes included in Table 7.
Q. What do you want as a qualified PA?
PAs in their responses described a desire to be supported in a positive context; specifically they recognise the need for a supportive team, clinical and educational supervision, ‘An encouraging team of people working with me and supportive staff around me.’ Table 8 provides further understanding of their forward desires.
Q. What would encourage you to stay in a locality?
There seemed to be two distinct encouragements for staying in the NW region these are seen in Table 9.
Discussion
Throughout the responses to questions dominant personality traits can be seen; early adopters to system change, valuing flexibility and work–life balance. These sentiments should not come as a surprise for PAs at the demographic age shown.
The funding support of the PA programmes appears to allow widening participation, as demonstrated by the text comments and age of the cohort. In addition student PAs valued being in their home geographical location. Much energy is shown among respondents for a desire to work in an integrated way between primary and secondary care – the motivation seems to be to develop clinical confidence and, in turn, competence. Respondents value placements in a succession of specialties to allow informed career choice and to help them consolidate programme learning. They desire direct clinical patient contact in a medical model of communication, diagnosis and management. They also yearn for flexible job plans containing continuous professional development, specifically in leadership, management and education.
Feelings of relative isolation are expressed by PAs when working in primary care. The desire for working in secondary care focus on access to clinical variety, contextual support and the ease of gaining continued professional development. Feelings of being more in a team in secondary care, surrounded by support appear to be linked to their ability to feel confident.
The PAs most commonly see themselves working in both primary and secondary care. They portray an ideal picture of work in the secondary care in the early postgraduate period in order to improve skills and confidence with clinical emergencies. They recognise the value of primary care for use of their generic skills and the sheer variety of the work.
Conclusions and recommendations
Nine specific actionable recommendations can be made from the data collected (Box 1).
From this work, recruitment of PAs onto training programmes should focus on offering opportunity to those within the local geographical location; local university graduates, school leavers, and those working in the local biomedical science industries.
Retention and development of PAs post qualification would benefit from financial investment. An early years’ post-qualification PA preceptorship model, focusing on collaboration between primary and secondary care and a rotation of specialities is needed. Capitalising on their desires to work across both primary and secondary care would help the workforce crisis in primary care settings. In addition consideration should be given to training pathways for PAs post qualification in clinical leadership, NHS management, research and medical education. Capitalise on PAs’ motivations and negotiating with them their career expectation will support their retention for the locality and the wider NHS.
It may be useful to repeat this survey at a future time to allow a higher response rate.
- © Royal College of Physicians 2019. All rights reserved.
References
- ↵
- NHS
- ↵About thematic analysis. Auckland: The University of Auckland. www.psych.auckland.ac.nz/en/about/our-research/research-groups/thematic-analysis/about-thematic-analysis.html [Accessed 06 December 2017].
- Jackson B
- Rimmer A
- Halter M
- Public Health England
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