The role of a doctor often overlaps with other healthcare professions and so when considering a job in medicine, it is important to think about other vocations that can spark the same enthusiasm and reflect on whether they are of greater interest compared to a career in medicine. The most similar roles to a doctor include that of a physician associate (PA) and an advanced nurse practitioner (ANP). This blog explores the differences between a doctor and an PA so that you can make a more informed decision as to which, if any, suits you most. We will shortly be releasing a blog on the differences between a doctor and an ANP.
A physician associate (PA) is not the same as a doctor, though their roles are similar and they are often confused with each other. A PA is a relatively new profession that was introduced from 2003 following decades of precedent in the USA. PAs are medically trained and work alongside doctors and nurses to provide medical care as part of the healthcare team. They perform similar tasks to a doctor but don’t have the same medical training that a doctor goes through and so are not direct substitutes. They practice the ‘medical model’ as a doctor does and so will assess patients, make referrals, order certain tests and start a treatment plan. They can work in a variety of settlings such as GP surgeries, A&E and hospital wards like a doctor. They also can also get involved in leadership, teaching and research just as a doctor can.
There are a few key differences between doctors and PAs. With regards to career progression, doctors usually specialise in a particular field of medicine / surgery however physician associates remain generalists throughout their career as there is no formal training ladder. This means that doctors often rotate through different specialties as they train to become a senior doctor whereas physician associates usually work in the same place for long periods of time. This stability is one of the reasons the NHS introduced physician associates as it helps hospitals / GPs provide a continuous stable level of care whereas rotating doctors can take time to get used to the environment which can affect quality of care.
An important difference between doctors and PAs is that PAs are currently not allowed to prescribe medication or order imaging scans involving radiation (e.g X ray or CT scans). This is because PAs do not have statutory regulation in the same way nurses and doctors do. They are also not part of any legally required register in the same way other healthcare professionals are and have no protected title. This means they do not have the same legal and professional accountability that doctors do, hence they have less responsibility in clinical practice. This is largely down to the recent nature of the vocation being introduced and it is predicted that when physician associates become regulated by an organisation, they will have prescribing rights.
Once a doctor becomes a consultant or GP is fully qualified (Consultant or GP) they are allowed to practice independently, however PAs will always work under the supervision of a senior doctor.
To become a physician associate you must undertake an undergraduate degree in a relevant medical subject e.g. biomedicine. This makes you eligible to then apply for a postgraduate Physician Associate masters degree which is a two year accelerated program that focuses on clinical training (similar to the last few years of a medical degree). The PA course is offered at multiple medical schools and although is less competitive than medical school as of now, more and more students are choosing it and therefore it is becoming increasingly competitive to get in.
Therefore, the overall time taken to become a PA is 5-6 years, which is conveniently the same as undergraduate medical school. However many PAs who qualify are older than doctors as they don't necessarily complete the 5-6 years of training in one go as medical students do. Once qualified, PAs have an internship year following which they can work as a fully qualified PA subject to re-certification every 6 years through a formal examination.
Physician associates are paid on the Agenda for Change system like nurses. Following an internship year where they will earn around £30,000, they work at band 7 where they earn between £41,659 and £47,672. After around five years of experience and a further masters degree, ‘Higher level’ physician associates are banded at 8a, earning over £48,000. For comparison, a foundation level doctor (FY1 and FY2) earns between £28,000-£34,000.
The salary can be a bit of a debate point as PA’s will earn more than a foundation level doctor. The questionable justification for this goes beyond this blog’s reach but if you look at junior doctor salaries you will notice that a doctor will earn more than a PA after around four years of post-graduate training (see https://medmentor.co.uk/blog/what-happens-after-medical-school-in-the-uk).
There are several reasons people choose to become a PA instead of a doctor. Typically, it is a fantastic option for those people who are passionate about clinical medicine but prioritise a good work-life balance and are okay with fewer career progression opportunities. If however, you want to specialise in a particular field and ultimately practice independently, and you're okay with the sacrifices that come with this, then you may be better suited to applying for medicine.
Here are a few common reasons people opt for becoming a PA over a doctor:
As mentioned, to become a PA you need to do an undergraduate degree in a science-related subject, followed by the 2 year PA masters. This means you don’t need to power through 5-6 years in medical school at once, and often don’t need to go through the intense medical school application process (though PA courses are slowly becoming more competitive).
A fully qualified PA will be earning more than a fully qualified FY1, though doctors ultimately have better salary progression.
PA’s often have a standard 9-5 shift with few weekends and nights, unlike doctors who have a great mix of everything (especially when they are junior).
PAs have more control over where they work whereas doctors are at the mercy of regular competitive application processes which could place you somewhere you don’t really want to be, potentially anywhere across the entire UK.
Whilst there are currently more opportunities for career progression for doctors, PAs are still a relatively new addition to the healthcare team which means there will quite possibly be plenty of new opportunities in training, teaching and research for PAs in the future.
It’s important to be aware of similar careers to medicine to see if they align with your interests more than doctoring. Since they were introduced, the career of a physician associate has been commonly thought of as a ‘back-up’ to medical school. However, this is a belittling and rather short-sighted view because as mentioned earlier they have several differences in training pathways, independent practice, prescribing and salaries. Therefore, before undertaking any career path, do not make assumptions and try and do as much research as possible to make sure it’s the right one for you.
if this was useful for you, keep an eye out for our post on the differences between doctors and advanced nurse practitioners, who like PAs, can act in a similar capacity to doctors.
Author: Dhillon Hirani
Editor: Dr Latifa Haque
