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PLoS One. 2016 Aug 25;11(8):e0160902. doi: 10.1371/journal.pone.0160902. eCollection 2016.

Physician Associate and General Practitioner Consultations: A Comparative Observational Video Study.

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Department of Clinical and Experimental Medicine University of Surrey, Guildford, GU2 7XH, United Kingdom.
Division of Population Health Sciences and Education St. George's University of London, London, SW17 0RE, United Kingdom.
AT Medics, St. Charles Hospital, Exmoor Street, London, W10 6DZ, United Kingdom.
Department of Population Health NYU School of Medicine, 227 East 30th Street, New York, New York, 10016, United States of America.
Faculty of Health, Social Care & Education, Kingston University & St. George's University of London, London, United Kingdom.
Social Care Workforce Research Unit King's College London, Strand, London, WC2R 2LS, United Kingdom.



Physician associates, known internationally as physician assistants, are a mid-level practitioner, well established in the United States of America but new to the United Kingdom. A small number work in primary care under the supervision of general practitioners, where they most commonly see patients requesting same day appointments for new problems. As an adjunct to larger study, we investigated the quality of the patient consultation of physician associates in comparison to that of general practitioners.


We conducted a comparative observational study using video recordings of consultations by volunteer physician associates and general practitioners with consenting patients in single surgery sessions. Recordings were assessed by experienced general practitioners, blinded to the type of the consulting practitioner, using the Leicester Assessment Package. Assessors were asked to comment on the safety of the recorded consultations and to attempt to identify the type of practitioner. Ratings were compared across practitioner type, alongside the number of presenting complaints discussed in each consultation and the number of these which were acute, minor, or regarding a chronic condition.


We assessed 62 consultations (41 general practitioner and 21 physician associates) from five general practitioners and four physician associates. All consultations were assessed as safe; but general practitioners were rated higher than PAs in all elements of consultation. The general practitioners were more likely than physician associates to see people with multiple presenting complaints (p<0.0001) and with chronic disease related complaints (p = 0.008). Assessors correctly identified general practitioner consultations but not physician associates. The Leicester Assessment Package had limited inter-rater and intra-rater reliability.


The physician associate consultations were with a less complex patient group. They were judged as competent and safe, although general practitioner consultations, unsurprisingly, were rated as more competent. Physician associates offer a complementary addition to the medical workforce in general practice.

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