Physician associates (PAs), often known as physician assistants in other countries, can safely offer patient care when they work closely under the supervision of a doctor and within certain boundaries, according to a recent quick review published in The BMJ. However, the data is insufficient to support them in treating undiagnosed patients on their own. 

The assessment comes at a time when there is rising concern in the UK over PAs' expanding position in the healthcare system. PAs were first developed in the United States in the 1960s to address rural doctor shortages, and they are now a part of many healthcare systems dealing with manpower shortages and rising expenses. 

PAs in the United Kingdom must first earn an undergraduate scientific degree before pursuing a diploma or master's degree in physician associate courses. Their training focuses on developing clinical skills to help doctors provide patient care. 

The Academy of Medical Royal Colleges commissioned the evaluation, which looked at 40 studies from industrialised countries, such as the United States, Canada, Australia, and the United Kingdom. It compared physician associates' care to that of doctors, evaluating safety, patient satisfaction, efficiency, and access to resources. 

Only when doctors properly monitor their work can Physician Associates (PAs) play a significant role in healthcare teams. A comprehensive assessment of global studies indicated that PAs are capable of providing safe and effective care, particularly when performing jobs for which they have received specific training. This position involves treating individuals who have already been diagnosed and assisting with normal procedures. The researchers stated, "There is a legitimate role for [PAs] working alongside physicians in well-defined roles under supervision." 

However, the picture becomes less clear when PAs are required to work independently. The assessment raised major concerns regarding cases in which PAs treat unexplained symptoms or new health issues without doctor supervision. Such behaviour is especially dangerous in primary care, because patients frequently approach with ambiguous or early indicators of illness. In such circumstances, mistakes could jeopardise patient safety unless a precise diagnosis is available or a clinician provides direct assistance. The authors warned that "unsupervised management by [PAs] of undifferentiated symptoms and disease may risk patient safety." 

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Beyond safety, the topic of cost-effectiveness remains unresolved. While patient satisfaction with PA-led care appears to be comparable to that of doctors, little research has examined whether hiring PAs saves money for the health system. Even among the studies that did look at expenses, several had methodological flaws—they were based on obsolete or indirect data, especially from the United States. This makes it challenging to draw strong conclusions about whether PAs save costs or improve outcomes in a financially significant way. 

There is some evidence, however, that including PAs on health teams may enhance access to care, particularly in underserved or rural areas. However, this improvement may not be due to the PAs' special skills. Instead, it could simply reflect the benefits of having more personnel available. The review stated that "more staff—including PAs"—can assist relieve the workload and reduce patient wait times. However, the finding does not necessarily highlight the PA role's distinctive contribution; rather, it indicates that personnel numbers are more important than professional designations. 

Together, these studies emphasise a crucial message: PAs can improve healthcare services, but only in well-defined roles with strict control. Giving people additional autonomy without appropriate proof may pose unnecessary dangers, particularly when patient situations are complex or confusing. At the same time, presuming that PAs will lower costs or provide distinct benefits may be premature, unless supported by robust, context-specific research. 

In November 2024, the UK Secretary of State for Health and Social Care invited Professor Gillian Leng to head a larger evaluation of the effects of PAs and anaesthesia associates on patient care. This study arose from concerns about six critical areas: patient safety, informed consent, training, job preference over doctors, workload on supervising physicians, and the overall scope of the PA role. 

It is worth noting that just four of the 40 research projects included in the fast evaluation were conducted in the UK. None addressed the new realities of post-COVID healthcare. The authors stressed the importance of clear national guidelines to establish boundaries for supervision and tasks: "National guidance on the supervision and scope of practice for physicians [associates] can ensure that they practice safely and effectively."