29 July 2019

In our latest Meet the Member feature, we are turning our focus on the Physician Associate role as we spoke with Jamie Saunders – Physician Associate in Clinical Haematology at Guy’s and St Thomas’ NHS Foundation Trust. He is also a current member of the BSH Communications Committee.

Jamie told us all about the PA role, its importance in the delivery of excellent patient care as well as his career so far in haematology.

Can you tell us how a little about your career so far, and how you came to specialise in haematology?

I graduated as a Physician Associate in 2017 and was lucky enough to gain my first job as a PA in haematology and I haven’t looked back since. When I was looking for a job as a student PA I wanted to work in a speciality which had it all; academically challenging, complex, highly specialised but also contained a lot of general medicine (a very important part of being a PA). Haematology ticked all of those boxes for me.

I joined Guy’s Hospital in November 2017 as part of a three-year training programme in haematology, developed by my consultants. I spent the first year working as part of the inpatient haemato-oncology team, looking after patients with leukaemia, lymphoma, myeloma and amyloid. I am now in my second year and work in outpatients, covering our haematology day unit and conducting outpatient general haematology clinics alongside my consultants. Next year I start my third year and will work as part of the inpatient sickle cell/general haematology ward team and start outpatient clinics for patients with haemoglobinopathies.

I work closely alongside our core medical trainee doctors and haematology registrars day-to-day, reviewing and managing patients and discussing cases with my consultant where I need. Over the last year and a half I have grown enormously, in both my general medical skills as well as in my haematology knowledge. It’s nice to be the stability in the department, supporting our CMT doctors in learning haematology at the ward level as well as being able to support our haematology trainees in allowing them to attend training days as well as increased access to morphology, as I can cover the ward/outpatient day unit and review patients.

Can you tell us a little about the Physician Associate role?

Physician Associates complete a two-year, intensive, masters level postgraduate degree leading to the award of PGDip or MSc in Physician Associate studies. Prior to this PAs need to have completed an undergraduate degree in life science or healthcare for entry to a PA course. Upon graduation they are then expected to sit the PA National Certification Examination at the Faculty of Physician Associates, Royal College of Physicians, to be deemed safe to practice. 

PAs are generalist medical healthcare professionals who work alongside doctors in the diagnosis and management of patients. They are termed dependent practitioners, which means they work under the delegated supervision of a named medical or surgical consultant. In practice PAs work autonomously, diagnosing and treating patients with appropriate support from senior doctors where needed.

PAs are eternal medical generalists, meaning that we do not specialise. We work as part of the speciality team but must maintain our general medical skills and knowledge. To ensure we remain generalists we have to re-sit our exams every 6-years, called the PA National Recertification Examination. Of course, after time spent in a speciality, we gain the knowledge and skillset of that speciality and take on greater responsibility and autonomy for patient care within the speciality we work.

Why is this role so important in the delivery of excellent patient care?

For me I chose to study to become a physician associate due to the flexibility and general medical nature of the role. As we are eternal medical generalists, we get to work within the speciality team and still be involved in general medicine. I often find that patients are admitted under the haematology team with general medical issues which need managing alongside their haematological diagnosis.

I often conduct asthma/COPD reviews for our patients attending the haematology day unit and liaise with the relevant speciality/GP for advice and update them where needed. When patients are admitted to the haematology ward, I am not only able to assist in the management of their primary haematological diagnosis, but also advise on optimising and managing their general medical issues without the need for routine consultation of other specialities.

PAs also provide continuity of medical care. Unlike doctors in training, who change specialties every 4 months to every year, PAs stay in the same department and do not rotate. This means that I get to know my patients very well, from both medical and social/psychological aspects. Additionally, because PAs typically form part of the “SHO level” team, we often the first point of call for acute deterioration reviews or clerking. Patients, as well as their families, have fed back to our department that they appreciate a familiar, trusting face every time they are admitted to the ward and knowing the patient for the entirety of their care makes caring for them more streamlined.

What are the main rewards and challenges of the role?

As a PA the learning curve was very, very steep. Haematology is a complex and an ever evolving and advancing speciality. There are multiple sub-specialities and on the whole, we are working with patients with rare conditions and in some cases with a relatively limited evidence base. Working within haematology requires constant reading, investigating and discussion with my supervising consultants and senior registrars around the fundamentals, evolving diagnostics and management strategies.

But getting to see my patients come in very unwell, explain to them their diagnosis and then continue to support them during their journey through treatment and watch them come out the other side is so very rewarding. The relationships we make with our patients in haematology is truly lifelong, and I feel privileged to be able support them in every way I can during their time of greatest need and beyond.

Explain how you think the role will develop in the future?

The PA role is now well established in the UK (with the profession being more than 60 years old in the USA), and with the recent announcement of the introduction of statutory regulation of PAs by the General Medical Council (GMC) in the future we will be able to work to our full potential. This will include ordering investigations that involve ionising radiation, authorising blood products and prescribing medications.

There is a lot of scope for the development of the PA role, particularly within haematology. We follow a similar training/development pathway to doctors post-graduation. For example, since starting in my job I have learned to perform procedures such as bone marrow biopsies and femoral line insertions, to running outpatient clinics alongside my consultants and in the future potentially providing evening out of hours support for acute referrals from other specialities.

I strongly believe that PAs are well suited to practice within the haematology team. With an ageing population and increasing scope to treat patients previously deemed unfit for treatment, a joint specialist and general medical approach to patient care is vital, particularly in haematology. The value of a general medic PA within the haematology team will not only benefit patients, but also the haematology team and other specialities.

How has BSH Membership supported you in your work?

BSH is one of the first societies to recognise the important role that PAs will play in the future of modern medical care with a distinct membership category that welcomes and encourages PAs (I believe that BSH is the only society in UK to do this). The online resources are useful for my learning and enable me to develop as an individual. Access to BSH courses and the ASM is also fantastic, allowing me to network with current and future haematologists across the country as well as share my research nationally.

There is also scope to become involved in BSH activities, for example, I am member of the communications and education committees at BSH, representing PAs in haematology and providing advice and support to the BSH from a PA/junior medical team perspective.

Follow Jamie on Twitter: @jasaunders90