The IMO has cautiously welcomed the HSE’s publication of an independent review of the role of physician assistant (PA) in the Irish public health system. However, it warned that concerns around regulation and resourcing need to be addressed for the grade to integrate effectively.
The IMO said it welcomed the review’s “clear distinction between doctor and PA” and its recommendation to refer to the grade as ‘physician assistant’ rather than ‘physician associate’, to minimise the risk of patients confusing the grade with that of a doctor. It also welcomed the review outlining limitations to the scope of practice.
However, it said that no clear regulatory obligations have been outlined, and it is unclear how consultants would be in a position to supervise, train and monitor PAs given their “existing onerous workload”.
Prof Matthew Sadlier, President of the IMO and Consultant Psychiatrist, said: “While the IMO cautiously welcomes this review, significant work remains. The physician assistant role must remain a support to the clinical team, not a substitute for a doctor. The HSE’s review categorically states that the role of physician assistant must not be employed in such a manner. It is also our position that the implementation of the position into a clinical team should only happen where consultants have been engaged with directly.
“There remain notable concerns amongst doctors around the lack of clear regulatory obligations in relation to the role. Moreover, expecting already overstretched consultants to supervise and train PAs without a substantial increase in consultant numbers is simply not realistic. Resourcing and regulation will determine whether this new initiative succeeds or fails.”
He added that the work of PAs must not negatively impact on the training of NCHDs and that NCHDs should not be expected to undertake any training or supervision role in respect of PAs.
The IMO said it expects the HSE to engage in discussions regarding a national framework around the introduction of the PA position into the health system.
According to the HSE-commissioned review: “Although the number of PAs employed in publicly funded services is small (38 across the system), feedback from clinical teams where the role is already in place is positive.”
The review said PAs are consistently described as providing valuable continuity, coordination and organisational support within consultant-led teams, particularly in environments characterised by high NCHD rotation, fragmented pathways, and operational complexity. “Their permanent presence contributes to safer care through consistent documentation, reliable follow-up processes, and support for multidisciplinary communication, while freeing NCHDs to focus on training and clinical decision-making.”
However, the review also found that the PA role in Ireland has evolved without a clear, nationally agreed definition of its purpose, scope of practice, or governance framework. This has resulted in considerable variability across sites, uncertainty for clinicians and PAs, and avoidable risk. In the absence of such clarity, the future development or expansion of the PA role cannot be safely supported.
Based on evidence gathered, the review concludes that the primary purpose of the PA role in Ireland is to assist the medical team in its provision of care to patients, by supporting the organisation, coordination and continuity of medical care, and by carrying out defined clinical tasks and procedures under a medical practitioner’s supervision or oversight.
To support safe and consistent role deployment, the review recommends the establishment of a core PA scope of practice and extended scope of practice. It also recommends the exclusion of certain activities from the PA scope of practice.
“These are activities that cannot be delegated to a PA and largely fall into the category of responsibilities that require a full medical qualification and registration in the relevant Division of the Register of Medical Practitioners; carry very significant risk to the patient; or that are legally restricted areas of activity.”
Given that the role is not regulated and relatively new to the Irish healthcare system, it is “essential” that governance controls are clear, robust and fully embedded. This is necessary to protect patients, PAs, doctors working with and delegating duties to PAs, and the overall institution. It is the responsibility of the relevant institution to ensure that these controls are in place, according to the review. Each PA must also have a designated consultant supervisor, to whom they report on all professional and performance matters.
The review did not consider the question as to whether the role of PA should be regulated.
“This is a matter for the DoH, as the decision to regulate a role, or even to consider a role as a candidate for regulation, falls within its remit. The process followed by the DoH is detailed and transparent, and addresses multiple aspects, including matters relating to EU directives on regulation of professions,” it outlined.
The review is available here: https://about.hse.ie/api/v2/download-file/file_based_publications/Report_of_the_Independent_Review_of_the_PA_Role_in_the_Irish_Pub_mTb6wA5.pdf/
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