RCEM – Physician Associates

7 June 2024

The following position was approved by the Council of the Royal College of Emergency Medicine by a unanimous vote on 6 June 2024.

It supersedes any previous College position on this matter, including but not limited to the 2015 documentation.

The position of the Royal College of Emergency Medicine is as follows:

The College does not currently support the expansion of the Physician Associate workforce in Emergency Medicine.

This is supported by the following considerations:

• Patient safety is paramount and the transparency and clarity of the scope of practice of Physician Associates (PAs) within Emergency Medicine (EM) is required.
• It is imperative to prioritise the training and retention of all EM doctors, credentialling and credentialed Advanced Clinical Practitioners (ACPs).
• The College has concerns about the capacity of EM Educators to train and adequately supervise PAs.

RCEM’s updated position includes the following in reference to the current EM PA workforce:

• Addressing Workforce Shortages: PAs cannot replace EM doctors or ACPs.
• Prioritising EM Training: During a time of significant workforce challenges in Emergency Medicine, funding, resources, and learning opportunities must prioritise the training and retention of all EM doctors, and credentialling and credentialed ACPs.
• Rotas: PAs should be considered a distinct workforce group and should not be used to replace EM doctors and ACPs.
• Patient Safety: The scope of practice of PAs in the EM workforce must be defined, safe and effective.
• Supervised Practice: PAs working in Emergency Departments must always operate under the safe supervision of an EM consultant, Associate Specialist or Specialist doctor according to local policy.
• Public Awareness: PAs must be clearly identifiable and identify themselves as a PA to members of the public and other clinicians.
• Tiers of Working: RCEM defines five tiers of practice and responsibility for clinicians working in emergency departments. Superseded as below.

• Tier 1: RCEM recognises that currently employed PAs are working at Tier 1.
• Tier 2: RCEM acknowledges that some currently employed PAs are working at Tier 2. PAs working at this level should have EM specific training and experience.
• RCEM does not support PAs working at Tiers 3, 4 or 5.

• Adequate Resourcing: Training, induction and supervision of PAs within Emergency Department settings must be appropriately designed, job-planned, staffed and funded.
• Undifferentiated Patients: PAs must not see undifferentiated patients within an ED without safe supervision, and within agreed entrustment levels.
• Regulation: PAs must be regulated at the earliest opportunity.

The College believes that PAs employed in an ED require specialty specific training. This is important for patient safety, the specialty, and understanding of the current PA workforce.  This currently does not exist to a national standard. Further work to address our concerns is required by the College. Any work in this area needs to be externally funded. This work will not be underwritten with membership fees.