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Doctor Vs Physician Associate: 5 Key Differences

Doctor Vs Physician Associate: 5 Key Differences

Updated on: December 17, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Doctors and physician associates can both work in hospitals, GP practices and the community, seeing and treating patients.

Considering this, what actually are the differences between doctors and physician associates?

The key differences between doctors and physician associates (PAs) are that doctors have graduated from medical school whereas PAs have generally completed a 2-year postgraduate MSc. Doctors can prescribe medications and work independently, whereas PAs work alongside doctors and can’t currently prescribe.

In their day-to-day work, junior doctors and physician associates can be quite hard for patients to distinguish.

As a doctor who’s worked with a number of different PAs, I’m going to explore the most important differences between the two professions- which will be especially helpful to you if you’re trying to decide which career path to follow.

What’s The Difference Between A Doctor And A Physician Associate?

The theory behind physician associates is that they can relieve pressure on already overworked doctors by sharing some of the workload both in hospitals and GP practices.

Broadly, they can tackle a lot of the jobs that keep junior doctors so busy on the wards: assessing patients, analysing test results and developing management plans.

However, what makes them so appealing to healthcare providers is that they’re quicker to train, cheaper to employ and easier to recruit.

It’s because of these factors that I think we’re only going to see increasing numbers of them working in clinical environments.

However, there are three main areas that doctors and physician associates diverge:

  1. Their training
  2. Their competencies
  3. Their career progression
Doctor Vs Physician Associate Pixel Infographic

Although on the surface PAs and junior doctors might seem to be interchangeable, depending on the demands of the job, one or the other may be far better suited to the role.

Doctor Vs Physician Associate Training

One of the biggest differences between the two professions is how you qualify.

To become a doctor, you need to complete 4-6 years of medical school before qualifying as a junior doctor.

To become a physician associate, you generally need to complete a 2-year postgraduate qualification.

Although physician associate applicants are generally required to have a science-based undergraduate degree, it’s still very hard for a 2-year MSc to pack in the equivalent knowledge of 5 years of medical school.

Physician associate training focusses more on the practical and clinically relevant aspects of healthcare.

For example, how to take a history from a patient, how to examine them and what treatment plan may be appropriate.

A physician associate student on placement in a hospital

Medical school, however, arguably because of the luxury of time, delves far deeper into the scientific theory behind clinical presentations.

This means doctors are more likely to understand the reasons why patients have particular symptoms or need particular treatments, not just what they have and what they need to be given.

Although both pathways can produce clinically competent healthcare practitioners, doctors have more in-depth knowledge that can guide their judgement in more complex cases.

Doctor Vs Physician Associate Competencies

The next key area where doctors and physician associates differ is in what they actually do.

When I worked in the orthopaedics department at Derriford hospital, there were 3 physician associates on the team with me.

Working alongside us junior doctors on the wards, there really wasn’t a huge amount that separated us.

We all went on ward rounds with the senior doctors, ordered and checked tests for the patients, evaluated unwell patients and wrote discharge summaries for when patients left hospital.

However, due to the fact that physician associates are relatively new in the UK, there isn’t the regulation in place to professionally support them for certain things. For example:

  • Physician associates can’t prescribe. This means they had to get a doctor if they wanted to give medication to a patient.
  • Physician associates can’t sign off discharge summaries. This meant they needed a doctor to give the final signature on the form before a patient could be sent home.
  • Physician associates couldn’t order scans. If a patient needed a scan that involved ionising radiation (x-rays), a doctor had to order it.

If a patient was particularly unwell, the less confident of my physician associate colleagues might also ask me to come and evaluate the patient too.

Over the course of medical school and the first few years of being a doctor, I’d seen more patients than a less experienced PA so could offer helpful clinical advice.

Doctor Vs Physician Associate Career Progression

A key point to note is that a lot of the similarities and experiences I’ve talked about with physician associates has been comparing them to junior doctors.

And by ‘junior doctors’ I’m using the more colloquial meaning i.e. a doctor in their first few years of work.

Physician associates currently just do not have the career progression opportunities that doctors do.

As a doctor, as soon as you graduate you essentially start up a 5-10 year training ladder that will take you from being newly qualified to a GP or consultant.

Having been in place for decades, these training pathways are incredibly robust and well defined.

As a PA however, because of the profession’s relative infancy, there just aren’t those set next steps.

A diagram explaining the different titles doctors use
The medical training ladder for doctors

Presently, there’s a bit of a glass ceiling for where PAs can get to in hospitals or GP practices.

They’ll never be able to become a plastic surgeon, a respiratory consultant or a fully-qualified GP.

Over years they’ll gain considerable experience and seniority, but will top-out at about a mid-level doctor grade.

Having said this, things may change in the future as PAs become more widely integrated into the NHS and new training pathways are formed, but as it stands a PA will never be able to progress to a senior doctor level.

Doctor Vs Physician Associate Salary

To become an FY1, which is a doctor in their first year of work, takes roughly 5 years of medical school.

To become a new-qualified physician associate will also take you 5 years- 3 years for an undergraduate degree and 2 years for the postgraduate physician associate MSc.

So, it only seems fair to compare their initial salaries:

In my first year of work as a doctor I earned roughly £29,000. A starting salary for a PA is approximately £40,000.

Not bad right!

Although £40,000 is the starting salary, this can easily rise to £45,000 based on your skills and growing experience.

Higher-level physician associates may earn between £47,000 and £53,000 in the NHS, but to get to this level you’ll usually need at least 5 years’ experience and a relevant Masters degree.

Now, over £50,000 is admittedly nothing to sniff at, but much like the career progression of PAs, their salaries hit a bit of a wall much sooner than doctors.

Although junior doctors start at a lower pay grade, they quickly progress as they climb the training ladder.

After 5 years of work, a doctor may be earning roughly £51,000 and as a consultant your pay immediately jumps to £88,000.

Due to the fact they can work independently, doctors also have a far larger scope for private practice.

This is where the big bucks are made for a lot of the top-earning doctors and surgeons, and just isn’t possible as a PA without a supervising doctor.

Can Physician Associates Specialise?

Physician associates don’t specialise the same way as doctors do.

Over the course of their training, doctors often become specialists in just one particular area of medicine- such as respiratory medicine.

They only see respiratory patients and are experts in all conditions that affect the lungs.

Physician associates on the other can become very established in a particular specialty, but they do also have to maintain their general medical knowledge.

This is because they have to recertify every 6 years by passing an exam that can touch on any area of medicine.

A doctor and physician associate working together

I worked with a PA once who was an expert in stroke medicine. He’d completed a PhD in the field and roughly operated at the level of a registrar (mid to high-level doctor).

However, because of this recertification exam, he would have had to maintain his general medical knowledge in order to pass every 6 years.

His medical colleagues, who would be neurology registrars, were allowed to let their broader knowledge drop off in favour of becoming increasingly specialised just in their chosen field.

Although PAs can gain considerable knowledge and expertise in an area, they won’t ever become true ‘specialists’ (or ‘consultants’) in the medical sense of the word.

Can A Physician Associate Become A Doctor?

At present, there is no set pathway for physician associates to transfer to become doctors.

However, I wouldn’t be too surprised if that changes in the future.

At the end of the day, a physician associate does acquire a lot of clinically relevant experience and knowledge over time.

Proponents of the pathway would argue that it seems logical if a PA could take an exam, or series of theoretical and practical exams after a couple of years of working on the wards, they could transfer onto the doctor pipeline.

This arguably only seems more likely now that doctor degree apprenticeships are being brought in.

These apprenticeships will really start to blur the lines between pre-clinical medical school learning and practical learning done on the wards through work.

All that being said, I think there will always be significant resistance to anything like this being brought in.

It is incredibly competitive to get into medical school, with only the top students being accepted, so it would have to be a very high bar for PAs to enter the cohort and for people not to feel like they were diluting the highly selected pool of medical graduates.

A PA can always go away and study medicine as a graduate student at university, but I think a lateral transfer could be an appealing way for the government to recruit more doctors who will already have a degree of clinical competence.

What Do Doctors Think Of Physician Associates?

It’s fair to say there can be some animosity between doctors and physician associates.

It doesn’t take long to find comments like this on medical subreddits:

“Why are PAs paid more than junior doctors when they can’t even prescribe?”

As a doctor myself, with friends who are both doctors and physician associates, I feel that I’ve got a good picture of both sides of the coin.

A lot of the friction does come from the differences in pay.

Junior doctors, rightly so, feel that they’re underpaid for the hours they work and the responsibility they shoulder.

This fact is only rubbed in their face when they see newly qualified PAs earning over £10,000 more than them for an objectively easier job role.

Doctors also have to take responsibility for prescribing for PAs, signing off their discharge summaries and ordering x-rays for them.

If anything goes wrong with any of these things, the doctor takes the blame.

This can make doctors feel like they’re taking on their colleagues’ risk while they get all the benefits.

While all the above is true, I personally feel that PAs are valuable members of the multidisciplinary team.

There are a few kinks that need to be ironed out, such as exactly what they can and can’t do and how they’ll progress, but broadly I think they’re a net positive for an overstretched and understaffed NHS.

I think PAs will likely be allowed to prescribe in the future, which will remove one of the biggest friction points between doctors and physician associates.

No one wants to have to put their signature on the dotted line for a drug they’re not choosing to prescribe.

Negotiations between the British Medical Association and the government should hopefully raise doctors’ pay in the future, so this initial disparity should also hopefully be reduced.

In its current state, the NHS needs clinical personnel so badly that I don’t think we can afford to turn our noses up at dedicated, hard-working and intelligent professionals just because they didn’t graduate from medical school.

Final Thoughts

As it stands, there are a lot of similarities between doctors and physician associates.

However, as time passes, the doctor is able to benefit from a clearly marked training pathway while the PA remains relatively static in their job role.

It’s as the doctor progresses and the PA remains stationary that the gaps in their professional competencies really start to widen.

As a doctor myself, I’m always going to recommend medicine to you if you’re on the fence between the two paths. I just don’t think there’s any better profession.

However, I will admit that all of my PA colleagues in Plymouth absolutely loved their jobs and got good money for reasonable hours.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.