In Practice: Reflections from NPs and PAs

Megan Tetlow, PA-C, practices gynecologic oncology in Sheffield, England, as part of the National Physician Associate Expansion Program. She is from Fort Myers, Florida, and will be a guest blogger for In Practice in the coming year.

“Couch” not exam table, “theatre” not operating room, “obs” not vital signs: my first 2 weeks as a physician assistant practicing in England as part of the National Physician Associate Expansion Programme (NPAEP) have been exhilarating, enlightening, and more than a little disorienting. While I haven’t been in the UK long enough to speak with authority on the differences between our two healthcare systems, I have had a little time to reflect on the events that led a girl from sunny south Florida across an ocean to the heart of Yorkshire, England.

I first heard about the NPAEP last year on a Facebook post shared by the American Academy of Physician Assistants. It fortunately came at a time when I had been thinking a lot about what I wanted out of life, figuring out how to achieve it, and then just going for it. What I wanted was adventure … while continuing to work as a PA. The difficulty was that while the physician assistant model continues to expand, it remains a largely American profession. There are some opportunities for American PAs to practice internationally, but I found myself more limited as a PA that has always practiced in a specialty, specifically in gynecologic oncology.

Meanwhile, across the Big Pond, Dr. Nick Jenkins and the UK National Health Service (NHS) had developed a program to expand the role of physician assistants (here called physician associates) in England. The aim was to bring a group of American PAs to England for 2 years and place them in regions where there is a lack of practicing physician associates, in an effort to demonstrate to patients and providers alike the benefits that PAs could bring to the health system. The program wanted to recruit across different areas of medicine to demonstrate the breadth of midlevel provider abilities. As a result, and luckily for yours truly, they were recruiting among both generalist and specialty care providers.

I felt like I had stumbled upon my big chance. This was a rare opportunity to be able to live and work in another country, while continuing to work as a physician assistant. As an added bonus, and even beyond my original goals, I would be able to help foster the PA profession on a global scale and serve as a diplomat for a profession that I care so deeply about.

After applying and interviewing, to my surprise and delight, I was accepted into the program. Additionally, to my even greater delight, I found that I was to be placed with a physician group within my same subspecialty of gynecologic oncology. I knew it was just where I was supposed to be.

The time between then and our move in June has been a flurry of paperwork, visas, fingerprinting (four different times!), selling our worldly possessions, buying one-way plane tickets, more paperwork, and then suddenly and literally overnight becoming full-time foreigners.

Everyday, I learn a little more about our new home and new medical system. I look forward to sharing more about my experiences in the UK, to both highlight the differences and similarities between our two systems and how PAs fit into the NHS. Hopefully some of these insights will help us improve our own practice on either side of the pond. No matter what, one thing I know for certain is that these next 2 years are bound to be quite the adventure.