Role of physician assistants and their impact on cardiology specialty training in the United Kingdom

Background The expansion of physician assistants (PAs) in the UK has raised concerns about patient safety and the impact on resident doctor training, with a lack of clarity about PA scope of practice and supervision. The role of PAs within cardiology remains poorly defined. We aimed to describe their scope of practice and assess their impact on resident doctor training in UK cardiology.

Methods The 2024 British Junior Cardiologist’s Association (BJCA) training and BJCA Starter surveys captured resident doctors’ experience of PAs working within cardiology. Data were collected on three broad domains: scope of practice, impact on training and supervision. A combination of best match, checkboxes, Likert scale and free-text responses was used to gather responses. Analysis was performed using a mixed-methods approach.

Results Responses were received from 553 resident doctors working in cardiology, of whom 268 (46.8%) were currently or had previously worked with a PA. Of these, 255 (95.1%) reported PAs to be working in a ward-based setting and 70 (26.1%) in outpatients. 78 respondents (29.1%) reported witnessing PAs to be performing cardiology-based procedures, primarily echocardiography (n=55, 20.5%) and direct current cardioversion (n=32, 11.9%). 34 respondents (12.6%) reported working with PAs who performed actions outside of their scope of practice including prescribing (n=7, 2.6%) or ordering ionising radiation (n=14, 5.2%). When stratified by training stage, an inverse, graded relationship was observed: with those at earlier training stages reporting the most negative impact on their training, driven by increased workload and competition for training opportunities.

Conclusions Evidence from this UK-wide survey underlines the urgent need for PA national guidance within cardiology, a clear legal framework and a defined scope of practice to safeguard both patient safety and resident doctor training.