Comparing physician associates and foundation year 1 doctors-in-training undertaking emergency medicine consultations in England: a quantitative study of outcomes

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Objectives: To compare the contribution of physician associates (PAs) to the outcomes of emergency medicine consultations with that of foundation year 1 doctors-in- training (FY1s).

Design: A quantitative study using retrospective chart review of adult patients seen by PAs or FY1s from August 2018 to January 2020 using 16 months of anonymised clinical record data.

Setting: One emergency department (ED) in England. Participants The outcomes of 7405 patients seen by 11 PAs and 7 FY1s were recorded, with n=4580 PAs and n=2825 FY1s having complete records.

Outcome measures: The study aimed to evaluate wait times to consultation as the primary outcome. Secondary outcomes included length of stay (LOS), patients leaving without being seen (LWBS) and unplanned returns to the ED within 72 hours with the same complaint.

Results: PAs working in an ED in England treated patients mainly in Majors and Resus and saw more patients out of hours compared with FY1s. Following adjustments for confounding factors, there was no significant difference in wait times to consultation between those PAs or FY1s patients (116 min vs 109 min, respectively, p=0.84). Patients seen by PAs versus FY1s had a significantly longer LOS (52 min); 237 min vs 185 min, p<0.001 (95% CI 45.03 to 59.67). LWBS rates (n=89; 1.94% for PAs vs n=34; 1.2% for FY1s) showed no significant difference (p=0.073). Unplanned reattendance rates patients within 72 hours with the same presenting complaint showed no difference between PAs and FY1s (n=261 (5.70%) vs n=128 (4.58%), respectively, p=0.167).

Conclusion: PAs working in an ED in England managed patients with a range of conditions with a similar level of impact on three emergency medicine outcome measures as FY1s (wait times to consultation, numbers of patients LWBS or returning within 72 hours with the same presenting complaint). However, patients seen by PAs had a longer LOS.
Original languageEnglish
Article numbere078511
Number of pages9
JournalBMJ Open
Publication statusPublished - 6 Jan 2024

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