History of the Profession
Since 2016, the Physician Associate profession in Ireland has been growing. Launched in 2016 as part of a pilot project supported by the Department of Health, it evaluated experienced US and Canadian trained PAs (Joyce et al., 2019) and found that PAs introduced in one Dublin hospital were accepted by patients and staff. A later study in this hospital (Hix et al., 2020) found that Irish trained PAs provide continuity of care to patients and the medical team and were valued by their physician colleagues. Since the initial pilot project, PAs have experienced a strong employment market and wide acceptance across the Irish health system. Presently, there are only 76 Irish trained PAs working in the health system, with most of these working in hospitals (Joyce et al., 2023). The growth of the profession has been cautious while the government and public health service slowly progress their engagement to recognise the profession at a national level.
Education
The MSc in Physician Associate (PA) Studies programme is a Level 9 twenty-four-month graduate course that comprises an 8-month pre-clinical phase and 15 months of clinical training. Data analysed recently, via university records indicated that while 51% of students and alumni were raised in the Dublin area, 63% currently reside in Dublin County. The programme’s commitment to increasing the geographic representation of PAs across the country prompted a review of the traditional on-campus experience and graduate employment that was overwhelmingly focused in Dublin County. Therefore, approval was given to pilot a hybrid/remote programme for the 8th cohort enrolled in 2023, which consisted of students who lived outside of Dublin County, along with traditional on-campus students. Employment opportunities are increasing in areas such as the south and west of Ireland, due to an understanding of the benefits of the PA role from consultants who have worked with PAs in North America, or who have previously worked at Beaumont Hospital, and have been introduced to the role there. There were six students on the 2023 hybrid model, taking all their lectures and small group teaching online, coming to RCSI twice a month for anatomy and clinical teaching. There are eight students attending full-time in the classroom. One year later, the growth in the hybrid/remote programme has been impressive, with 53% of the 30-student cohort, living outside of Dublin. The use of online tutorials throughout clinical training and advanced on-campus skill building courses, ensures continuity of learning that is equivalent for all students, no matter where they live.
Entry Criteria
Applicants must hold a level 8 Health Science or science-related degree with a minimum classification 2.2 award or equivalent qualification.
The MSc in Physician Associate Studies is a postgraduate qualification that includes extensive clinical placement. Since the PA Programme trains individuals for the domestic market, eligibility for acceptance to and continuation on the programme, must hold either a current valid EU/UK* passport or a current valid visa which entitles individuals to work in Ireland.
The PA curriculum has been accredited by RCSI University of Medicine and Health Sciences, along with National University of Ireland. It is modeled after the UK and USA frameworks. Ongoing programme evaluation is completed via faculty reports, University data from student evaluations, and ongoing input by student representatives.
Professional Certification
Once students have successfully completed the requirements of their programme, they must pass the Irish PA National Assessment (IPANE) to be able to work as a qualified PA in Ireland. This examination is a safety and competency-based assessment comprised of 200 single best answer questions. Clinical competency is verified by the training programme, through summative OSCEs, Clinical Reasoning, and Long Case assessments. To date, 100% of RCSI graduates have passed the national exam. PAs who pass the IPANE are placed on the Managed Voluntary Register (MVR) which certifies the basic graduate competencies and requires continuous professional development and membership in the Irish Society of Physician Associates to be retained on the MVR.
Scope of Practice
Physician associates work within a defined scope of practice and limits of competence. They:
- take medical histories from patients
- carry out physical examinations
- see patients with undifferentiated diagnoses
- see patients with long-term chronic conditions
- formulate differential diagnoses and management plans
- perform diagnostic and therapeutic procedures
- develop and deliver appropriate treatment and management plans
- request and interpret diagnostic studies
- provide health promotion and disease prevention advice for patients.
Currently, due to lack of legislation, physician associates are not able to:
- prescribe
- request ionising radiation (e.g. chest x-ray or CT scan).
Financing Education
Students are self-funded, with a small number of scholarships available from private hospital systems. No bursaries are provided to students during their clinical training.
Job Opportunities
In Ireland, there is a high demand for qualified PAs. Employment is across primary and secondary care in more than 20 specialties. Irish PAs are unable to work outside of Ireland, however this may change in the next decade as the profession grows.
Maintaining Role / Continuing Practice
PAs are required to maintain their continuing professional development (CPD) and must achieve 50 hours of CPD each year. This is a requirement for the PA Managed Voluntary register. Every 6 years, PAs are required to pass a re-certification exam.
Governing Bodies
Professional body : Irish Society of Physician Associates
Presently, the RCSI is the only University in Ireland that hosts a PA programme. The programme is a member of the following bodies that support PA education.
- UK Physician Associate Schools Council (PASC)
- US PA Education Association (PAEA)
- European Network of PA Educators
Future Perspectives
PA Numbers
Currently there are 76 qualified PAs in Ireland, with another 41 in training. Continued growth is expected once the PA role is officially recognised by the government.
Prescribing Authority
Across different health professions in Ireland, a number have been provided the opportunity to receive additional training that allows them to have limited prescriptive privileges. Once the PA profession is regulated, further consultation will take place that promotes extending these privileges to the PA workforce.
Scope of Practice, Supervision, and Career Pathways
Once the government establishes the professional grade for PAs in the Health Service Executive, scope of practice documents that outline supervision and career pathways for PAs, are anticipated.
Contact person in Ireland : Prof. Lisa Alexander, EdD, MPH, PA-C
