In Practice: Reflections from NPs and PAs

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

Autumn is in full swing here in the U.K., and having lived in beautiful but season-less south Florida for the past several years, I am mildly obsessed. Even in the city, the fall colors are breathtaking. Personally, I have been really enjoying boots, hot tea, and weekend hikes in the countryside (and in the U.K. fashion, always ending in a cozy country pub). With all of these seasonal changes around, I’ve been thinking about some of the changes I’ve made to how I practice since arriving to the U.K., and about the differences between practicing as a PA in the U.K. and in the U.S.

Leave Your White Coat at Home

You won’t see any white coats walking around the floors of U.K. hospitals. This is not a PA vs. physician division: no healthcare providers in the U.K. wear white coats, docs included. I asked around about what patients might think if you walked into an exam room while wearing a white coat. The answers usually fell along the lines of patients wondering why a scientist was seeing them at their doctor’s office, or why they were being seen by an actor who plays a doctor on an American television show. Not only are white coats not worn as a general practice, they are actually not allowed. More specifically, you are not allowed to wear anything long-sleeved. The National Health Service has a policy of “bare below the elbows” when providing patient care. The purpose of this is to decrease the rate of infection and contamination between patients. Thinking back about all of the things my white coat saw between washings, it’s probably a really good idea. Though I do sometimes wistfully long for all those pockets…

Assistant vs. Associate

As I’ve mentioned in previous posts, PAs here in the U.K. are called physician associates as opposed to physician assistants. Interestingly, they were previously called physician assistants here as well, but the U.K. Department of Health actually recommended they change the name to avoid confusion with other professions  — for example, personal assistants, which are administrative personnel in the U.K. This is a sentiment I’m sure many of my colleagues, British and American, could appreciate. Just like the old song, “You like to-may-to and I like to-mah-to,” I say assistant and they say associate. Personally, I rather like the term physician associate, but that’s a larger conversation for perhaps another day.

Prescribing in the U.K.

Finally, currently in the U.K., physician associates cannot prescribe medication (including ordering medications for inpatients as well as for outpatients) or order ionizing radiation (which includes x-rays and CT scans). I had debated whether to include this, but I ultimately did because (a) it highlights a big difference in how PAs currently practice in the U.K. versus the U.S. and (b) I have received several questions about it. In order for PAs in the U.K. to have that authority, physician associate must first become a regulated profession and then be added to the list of healthcare providers that are allowed to prescribe. Both of these actions require parliamentary acts. It’s a top priority of the Faculty of Physician Associates (the U.K. counterpart to the American Academy of PAs) to become a regulated profession, and this is something they have been working very hard to achieve. So while yes, right now, PAs cannot write prescriptions or order CT scans, it is my belief that it is not a question of whether PAs will ever be allowed to do these tasks, but rather when. I have never heard anything but complete support from doctors and other healthcare providers here that PAs should be allowed to do both.

So, that’s an intro course on delineating the differences between PAs on either side of the Atlantic. Now if you’ll excuse me, there are some country pubs and fall foliage to be seen. Also, it is becoming starkly apparent that this Florida girl does not actually own a winter coat.