In answer to Olumide Elegbe’s question ‘is there a role for physician assistants (PAs) in routine care?’1 my answer, currently, would be no. I would much prefer an experienced nurse or even, dare I suggest it, another doctor. Mr Elegbe obviously has confidence in the evidence he has referenced, however, the majority of this is from the US and given the differences between our two healthcare systems and respective primary care, I would not rush to apply the same conclusions from the data collected there, to here.
A pilot of PAs has already been undertaken in Scotland2 and this highlighted some important points. The PAs involved felt that they were unable to demonstrate their full capacity within primary care and this was attributed to the fact that there was no identifiable gap in the care of patients for them to fill, presumably this was because the pre-existing primary care team was already sufficient and as the PAs put it ‘family medicine/general practice differed from the US to Scotland’.
Any issue regarding the cost-effectiveness of PAs was also underlined by the study, reporting that within the primary care setting, an individual PA would cost approximately £15 000 more to employ than a practice nurse (PA salary defined as Agenda for Change Band 7, £29 091–£38 353).
I remain unconvinced that a science graduate with 2 years training would complement the current primary care team, at least not for that price.
- © British Journal of General Practice, 2010.
