BOTA Statement to the ASiT Physician Associate survey
15th January 2024
The Association of Surgeons in Training (ASiT) Physician Associate (PA) Survey Report is a pan-specialty and pan-grade cross sectional survey on the experiences of surgical doctors who have worked with PAs. The results of the report include crucial data and information on the impacts of the PA role on surgical training and patient care. The report highlights the opportunities and challenges for surgical training and patient safety with the expansion of PAs.
BOTA welcomes the publication of the ASiT survey report and notes the findings, which resonate with the experiences of BOTA members. The report states the potential opportunities and advantages of the PA role in surgery to include: providing support with ward work efficiency; continuity of patient care on the ward; and supporting trainees to access training opportunities in theatre and outpatient settings.
The report, however, found the significant adverse impacts of the PA role in surgery to include: reduced theatre case numbers and training opportunities for surgical doctors; increased workload on wards and during on-call/emergency commitments; doctors asked to prescribe medications and order radiological investigations on behalf of PAs; clinical decisions without appropriate clinical supervision; and poor patient understanding of the roles and responsibilities of PAs.
Our priorities are the promotion of patient safety and the protection of surgical training for surgical trainees. BOTA supports multidisciplinary team working but, in conjunction with the British Orthopaedic Association, calls for a considered and regulated integration of PAs that complements surgical training and improves patient care.
BOTA calls for training opportunities to be prioritised for surgical doctors as the surgeons of tomorrow. The concerns and adverse impacts of PA expansion on surgical training must be addressed to ensure the future of the surgical workforce.
BOTA strongly supports the recommendations of the survey, which focus on four key areas of:
clearly defined scope of practice and responsibilities for PAs;
protection of surgical training for the surgeons of tomorrow;
regulation of PAs by a dedicated statutory regulatory body;
transparent and accurate representation of PAs to patients and professionals.
As shown by the ASiT survey findings, BOTA are concerned that the rapid and unregulated expansion of PAs has adversely impacted an already strained and difficult post-pandemic surgical training environment. BOTA calls for the ongoing collaborative approach of all stakeholders and the involvement of trainee representatives in shaping the role of the PA.