Case Studies

Physician Associates in Emergency Medicine


Physician associates (PA) have been working in a busy London Emergency Department (ED) since 2013. Initially, two PAs were employed to cover the Observation Ward which had historically been staffed by locum SHOs. It was quickly realised that the PAs could be utilised elsewhere in the department though and they began seeing pre-selected patients in majors.

After a few months of building working relationships with the consultant body, they began seeing unselected patients. They would clerk and examine patients and then organise any relevant investigations. They would then present the case to a registrar or consultant and develop a management plan together. After two years, the team expanded to three PAs which provide 8 am to 8 pm cover in the Observation Ward, 7 days a week. By this time, the PAs were able to see patients in all areas of the ED including resus and UCC. They had become more autonomous over time but still discussed all of their cases with a senior doctor.

The department was experiencing difficulty in recruiting doctors so the money was used to recruit a team of PAs who would work across both hospital sites. A Lead PA was employed to line manage the team which released a significant amount of consultant time. By 2018, the PAs had become an integral part of the ED team. The PAs provide continuity. Having a team who know the processes of the department and wider hospital enables the doctors to work more efficiently, especially around the changeover period. The PAs also provide cover when the doctors have their weekly training. The PAs, after 12 months of experience, tend to see equivalent numbers of patients as SHOs. The team is expanding into the paediatric ED to add extra cover after the doctor contracts changed and rotas needed to be adjusted accordingly.

Key Facts

  • See patients in all areas of the ED
  • Provide continuity
  • 12 PAs provide 8 am to midnight cover 7 days a week over two sites
  • Close working relationship with consultants
  • Low turnover of staff, easy to recruit

Consultant Perspective

"PAs show enthusiasm and are motivated to work in the ED as it provides valuable clinical experience for them in a supervised environment. The PAs have also been trained to the medical model so their educational needs can be met readily without excessive additional training for consultants. We have always found it easy to recruit PAs and many of them have stayed in post for many years providing stability and strong base knowledge. The PAs offer resilience for the department at periods of stress (surges in demand or staff shortages) and are trusted to work relatively independently."

Dr Amir Hassan, Clinical Director for Emergency Medicine.

Nursing Perspective

"I have always found the PAs to be valuable team members, their knowledge of both medicine and the processes of the department are excellent. They show great compassion when caring for patients. They also provide a link between the nursing team and doctors which improves communication and thus patient experience."

Sophie Helyer, Emergency Medicine and Children's Safeguarding Nurse.