Physician assistants are a quick fix

Editor -Vittal Katikireddi's article about the use of physician assistants in the United Kingdom was informative.¹ There are, however, numerous foreseeable problems associated with the use of physician assistants.

The pilot training programme hopes to attract graduates with upper second class degrees.² And given that such applicants are capable of getting graduate entry places to read medicine at UK universities, justifying how the physician assistant pathway will be in their best interests is difficult. Surely the reduced social status, pay, and career prospects compared with doctors are serious considerations? These capable graduates also risk being perpetually trapped within a house officer style job (where a large amount of time will be spent on mundane tasks), which will eventually lead to job dissatisfaction.

It is envisaged that physician assistants will not have powers to prescribe drugs.³ How many doctors will be willing to sign prescriptions for patients they themselves have not assessed especially considering medicolegal ramifications?

For physician assistants working in primary care, who will decide whether a patient sees an assistant or a doctor? Will patients be pressured into seeing assistants? How easily will a patient be able to see a doctor if he or she remains unsatisfied after consulting an assistant?

A severe shortage of doctors exists within hospital medicine and general practice. This needs to be tackled to maintain optimal patient care, but we must tread carefully and choose thoroughly researched strategies, not just "quick fix" solutions. The last thing we want to do is to create another group of disillusioned healthcare professionals.

Medical students must be aware of the issues surrounding physician assistants and other frontline healthcare staff because on becoming house officers they will be the ones working most closely with them.

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1. Katikireddi V. UK universities to train physician assistants. studentBMJ2004;12:96.(March.)
2. Katikireddi V, Rushworth S. Using physician assistants in the United Kingdom.BMJ 2004;328(suppl):S69. (14 February.)
3. Henry J. Medical degrees lasting two years created to fill shortage of GPs.Sunday Telegraph 2004 Feb 1. www.telegraph.co.uk/news(accessed 16 Mar2004).