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Update on Royal College of Emergency Medicine’s position regarding Physician Associates in Emergency Medicine

7 June 2024

The Royal College of Emergency Medicine has agreed its position regarding Physician Associates in Emergency Medicine.

At the College’s Council meeting held on 6 June 2024 the recommendations of the Short Life Working Group on PAs in EM were put forward as well as the findings of the Membership survey.

After careful consideration and detailed discussion, the following position was agreed by a unanimous vote:

The Royal College of Emergency Medicine does not currently support the expansion of the PA workforce in Emergency Medicine (EM).

This is supported by the following considerations:

  • Patient safety is paramount and the transparency and clarity of the scope of practice of PAs within EM is required.
  • It is imperative to prioritise the training and retention of all EM doctors, credentialling and credentialed 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 Advanced Clinical Practitioners (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.
  • 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 had 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.

Recommendations were submitted for approval by RCEM’s Short Life Working Group on PAs in EM which was established in September 2023 to:

“Develop a strategy for approval by Council that outlines what the College offering for Physicians Associates could be, this to include aspects of capacity and supervision. There will be a need to also review and suggest improvements to the published material the College has in place.”

The SLWG’s membership included College Fellows, ACP, PA and Lay representatives as well as members of EMTA, EMSAS, The College Dean and members of RCEM’s Education, and External Affairs Directorates.

Meeting over the last six months, it considered the available evidence from a wide range of sources including the results of the RCEM Member survey conducted earlier this year.

The College expresses its thanks to all members who took the time to complete this survey.

The College appreciates the difficult and challenging time that Physician Associates are experiencing and the high level of animosity and hostility they have suffered.

RCEM will continue to support its existing PA members as they progress through their careers and has reached out to the directly to them following this decision. They remain a valued part of its membership.

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