Study Questions Effectiveness of Physician Associates in Primary Care and Anesthesia Roles

Study Questions Effectiveness of Physician Associates in Primary Care and Anesthesia Roles

Researchers say they cannot find convincing evidence that medical associations add value to UK primary care or that anesthetics add value to anesthesia, and some evidence suggests this is not the case.

In a special paper published byThe BMJToday, professors Trisha Greenhalgh and Martin McKee say the lack of safety incidents in a handful of small studies "should not be taken as evidence that the use of physicians and anesthesiologists is safe."

New research is urgently needed “to examine staff concerns, review safety incidents and inform a national scope of practice for these relatively new and controversial staff roles,” they add.

In Great Britain, collaboration with doctors and nurses is presented. They are graduates - usually with a health or life sciences degree - who complete two years of additional training, but there has been much debate about the effectiveness and safety of these new roles.

As a result, the UK Government has commissioned an independent review into the scope and safety of these roles in the NHS and their place in the care of patients.

To inform this review, researchers maintained three electronic research databases (PubMed, Cinahl, Cochrane Library) for all studies of physician associates and anesthesia providers in the UK healthcare system published between 2015 and January 2025.

A total of 52 newspapers were eligible (48 for medical board members, 4 for anesthesia staff), of which 29 (all from England) met their inclusion criteria for trustworthiness, generalizability and relevance to current UK policy.

They found that the total number of physicians studied, particularly in primary care, was very small, and no studies reported direct assessment of anesthesia masses.

Only one study of four physicians was an assessment by a physician of their clinical competence through direct observation, and no studies examined safety events.

Some studies among the 29 suggested that physician staff could support the work of teams on pieces and work in emergency departments when deployed and supervised in clinical settings, but the numbers of people and settings studied were small, so these results should be considered preliminary.

However, studies reported that primary care physicians appeared to struggle because the role was more autonomous, the case mix was more diverse, decisions were uncertain, institutional support was more limited, and monitoring arrangements were more difficult.

Patients' views of physicians were largely positive or neutral, while staff were concerned about the competence of physicians and anesthesia providers to treat undifferentiated, clinically complex, or highly dependent patients; job scans; or prescribe. Doctors Associates reported a range of experiences and wanted a clear role within the team.

Overall, researchers found no evidence that physician associations add value in primary care or that anesthetics add value in anesthesia, and some evidence suggests that this is not the case.

They acknowledge some limitations, e.g. B. find no evidence of similar roles in other countries, and emphasize that their findings should be interpreted in the context of the broader international evidence base. Assuming their focus on UK-based research, detailed search and analysis of the most influential articles, and identification of gaps in existing research provide robust conclusions to inform this policy review.

“Very few UK studies have assessed the clinical competence and safety of medical or anesthesia staff,” they write. “The results of apparent non-infidelity in non-randomized trials may obscure important, unmeasured differences in quality of care.”

In a linked editorial, Professor Kieran Walshe at the University of Manchester asks how we ended up in this mess and what should we do about it?

He points to a massive under-investment in research into the healthcare workforce, the ambiguous and largely inappropriate future plans for workforce expansion, and legal arrangements regulating healthcare professionals that are inadequate.

“It is likely that a messy compromise will be found that will resolve the debacle over physician assistants and anesthesia workers,” he writes. But says: “We need to do these types of workforce reforms much better in the future for patient safety and staff wellbeing.”

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