In my third year of medical school, my mother announced she wanted to become a physician associate (PA). I always encouraged her to follow her dreams — until she told me her motivation.
Osaruese Egharevba
“It’s basically the same as being a doctor, but with less time at university,” she said.
Her words gave me pause. Despite years of medical training, even I wasn’t entirely sure where the line was drawn between doctors and PAs. And if I was confused, how could patients be expected to understand the difference?
A Workforce Turf War
Physician associates were introduced to the NHS in the early 2000s to address workforce shortages, particularly in primary care. Initially framed as a supporting role under doctor supervision, the number of PAs has grown to over 3200, with plans to double that figure in the coming years. However, as their scope of practice expands, so does anxiety among doctors.
The tension between doctors and PAs has been simmering for years, but lately, the turf war has felt more intense than ever. What started as quiet unease has become an open fracture, and medical students like me are watching the conflict unfold in real time.
For some doctors, the PA role can feel less like a collaborative partnership and more like a threat to their professional identity. The British Medical Association has accused the government of using PAs as substitutes for doctors, compromising patient safety in the process. These concerns are not hypothetical.
In one widely publicised case, a 77-year-old woman died after a PA misdiagnosed her hernia as a nosebleed. She had believed she was seeing a doctor.
Separately, managers of Lewisham Hospital admitted last year in response to a freedom of information request that 19 of its PAs erroneously authorised prescriptions in 2018 and 2019. Drugs included morphine, fentanyl, and oxycodone.
Such incidents reflect a system willing to cut corners on safety while failing to address the root causes of the NHS workforce crisis. However well-intentioned, Pas are being asked to work beyond their competencies. Ultimately, patients always pay the price.
Stethoscopes, Scrubs, and a Crisis of Professional Identity
Resident doctors, after years of gruelling medical education, find themselves supervising PAs for the same — or even less — pay. Some argue that rather than easing their workload, PAs add to it.
I remember speaking to a doctor on placement who was particularly irked by PAs wearing stethoscopes, calling it “confusing to patients.” Although a stethoscope is just a tool, it has long symbolised the expertise and authority of doctors. This goes beyond professional pride — concerns about blurred lines are valid.
At NHS Grampian, a reported row over uniforms highlighted how easily patients might mistake PAs for doctors. Both PA and medical students wear identical black uniforms, with only a small label distinguishing between their roles. One medic there commented, “There is a big difference in the knowledge of a medical student on placement and a trainee physician associate. They are not doctors and never will be. Confusing the two roles is a risk to patients.”
For medical students, the future feels precarious. We hear stories like that of the GP in the Midlands working as an Uber driver to make ends meet while the government expands roles for those who have studied less and trained for a shorter time. Some of my peers wonder whether there will even be a place for us in hospitals by the time we qualify.
I understand why doctors are frustrated. Unfortunately, many doctors run the risk of projecting these frustrations onto well-meaning PAs. I can only imagine how demoralising it must be to work in an environment where your colleagues question your legitimacy.
Many PAs entered the profession to support an overstretched NHS, not to replace doctors. However, inconsistent training and regulation leave them vulnerable, often in unsafe situations. The forthcoming Leng review hopes to address these issues. In its submission, the Royal College of Physicians has suggested renaming the role “physician assistant” to clarify distinctions in clinical roles. This aims to provide the clarity needed to protect both PAs and patient safety.
Doctors and PAs: Allies or Rivals?
The Royal College of General Practitioners has asserted that there should be no role for PAs in general practice. For many PAs, this stance might feel like a dismissal of their contributions, creating a tense atmosphere where they feel undervalued. Law firm Shakespeare Martineau has confirmed it is pursuing claims on behalf of affected PAs who have been dismissed or restricted in their roles in general practice.
The emotional toll on PAs cannot be ignored, as they continue to seek validation for their role and assurance that their contributions to patient care are recognised within a system struggling to understand how best to utilise their skills.
The real issue is not the presence of PAs, but the system that has created the conditions for this conflict. PAs have been misled about their role and are now facing the backlash. The solution is not to pit doctors and PAs against one another. Existing PAs, whatever their motives, have the potential to provide excellent patient care with appropriate training and oversight. If we are serious about patient safety, we must establish clear, enforceable boundaries for the PA role. PAs should work within a defined scope that supports, rather than substitutes, the work of doctors.
Instead of letting ourselves be divided, we must come together as a healthcare team. This includes doctors, PAs, and all roles in between. The decisions we make must always be guided by one principle: patient safety. Only by working in unity, with clear roles and mutual respect, can we ensure that the system serves the best interests of those who matter most: our patients.
Osaruese Egharevba is a fifth-year medical student at Imperial College London with a keen interest in both public health and surgery. Passionate about health equity, she is committed to addressing disparities in healthcare and improving outcomes for underserved communities.
COMMENTARY
Doctors and Physician Associates: As a Medical Student, I’m Trying to Figure Out Who Does What
DISCLOSURES
| April 09, 2025In my third year of medical school, my mother announced she wanted to become a physician associate (PA). I always encouraged her to follow her dreams — until she told me her motivation.
“It’s basically the same as being a doctor, but with less time at university,” she said.
Her words gave me pause. Despite years of medical training, even I wasn’t entirely sure where the line was drawn between doctors and PAs. And if I was confused, how could patients be expected to understand the difference?
A Workforce Turf War
Physician associates were introduced to the NHS in the early 2000s to address workforce shortages, particularly in primary care. Initially framed as a supporting role under doctor supervision, the number of PAs has grown to over 3200, with plans to double that figure in the coming years. However, as their scope of practice expands, so does anxiety among doctors.
The tension between doctors and PAs has been simmering for years, but lately, the turf war has felt more intense than ever. What started as quiet unease has become an open fracture, and medical students like me are watching the conflict unfold in real time.
For some doctors, the PA role can feel less like a collaborative partnership and more like a threat to their professional identity. The British Medical Association has accused the government of using PAs as substitutes for doctors, compromising patient safety in the process. These concerns are not hypothetical.
In one widely publicised case, a 77-year-old woman died after a PA misdiagnosed her hernia as a nosebleed. She had believed she was seeing a doctor.
Separately, managers of Lewisham Hospital admitted last year in response to a freedom of information request that 19 of its PAs erroneously authorised prescriptions in 2018 and 2019. Drugs included morphine, fentanyl, and oxycodone.
Such incidents reflect a system willing to cut corners on safety while failing to address the root causes of the NHS workforce crisis. However well-intentioned, Pas are being asked to work beyond their competencies. Ultimately, patients always pay the price.
Stethoscopes, Scrubs, and a Crisis of Professional Identity
Resident doctors, after years of gruelling medical education, find themselves supervising PAs for the same — or even less — pay. Some argue that rather than easing their workload, PAs add to it.
I remember speaking to a doctor on placement who was particularly irked by PAs wearing stethoscopes, calling it “confusing to patients.” Although a stethoscope is just a tool, it has long symbolised the expertise and authority of doctors. This goes beyond professional pride — concerns about blurred lines are valid.
At NHS Grampian, a reported row over uniforms highlighted how easily patients might mistake PAs for doctors. Both PA and medical students wear identical black uniforms, with only a small label distinguishing between their roles. One medic there commented, “There is a big difference in the knowledge of a medical student on placement and a trainee physician associate. They are not doctors and never will be. Confusing the two roles is a risk to patients.”
For medical students, the future feels precarious. We hear stories like that of the GP in the Midlands working as an Uber driver to make ends meet while the government expands roles for those who have studied less and trained for a shorter time. Some of my peers wonder whether there will even be a place for us in hospitals by the time we qualify.
I understand why doctors are frustrated. Unfortunately, many doctors run the risk of projecting these frustrations onto well-meaning PAs. I can only imagine how demoralising it must be to work in an environment where your colleagues question your legitimacy.
Many PAs entered the profession to support an overstretched NHS, not to replace doctors. However, inconsistent training and regulation leave them vulnerable, often in unsafe situations. The forthcoming Leng review hopes to address these issues. In its submission, the Royal College of Physicians has suggested renaming the role “physician assistant” to clarify distinctions in clinical roles. This aims to provide the clarity needed to protect both PAs and patient safety.
Doctors and PAs: Allies or Rivals?
The Royal College of General Practitioners has asserted that there should be no role for PAs in general practice. For many PAs, this stance might feel like a dismissal of their contributions, creating a tense atmosphere where they feel undervalued. Law firm Shakespeare Martineau has confirmed it is pursuing claims on behalf of affected PAs who have been dismissed or restricted in their roles in general practice.
The emotional toll on PAs cannot be ignored, as they continue to seek validation for their role and assurance that their contributions to patient care are recognised within a system struggling to understand how best to utilise their skills.
The real issue is not the presence of PAs, but the system that has created the conditions for this conflict. PAs have been misled about their role and are now facing the backlash. The solution is not to pit doctors and PAs against one another. Existing PAs, whatever their motives, have the potential to provide excellent patient care with appropriate training and oversight. If we are serious about patient safety, we must establish clear, enforceable boundaries for the PA role. PAs should work within a defined scope that supports, rather than substitutes, the work of doctors.
Instead of letting ourselves be divided, we must come together as a healthcare team. This includes doctors, PAs, and all roles in between. The decisions we make must always be guided by one principle: patient safety. Only by working in unity, with clear roles and mutual respect, can we ensure that the system serves the best interests of those who matter most: our patients.
Osaruese Egharevba is a fifth-year medical student at Imperial College London with a keen interest in both public health and surgery. Passionate about health equity, she is committed to addressing disparities in healthcare and improving outcomes for underserved communities.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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