Willingness of medical students to refer patients to a physician associate or a doctor based on clinical scenarios when time is a trade-off

Abstract

Background: The Physician Associate (PA) role was introduced in Ireland in 2015 in an effort to bolster medical services. From the perspective of the patient and staff they have been well received. However, the attitude of medical students about PAs is not known.

Objective: To investigate the willingness of medical students to refer patients to a PA or a doctor.

Methods: A quantitative study was undertaken using an online survey with a sample of 1,909 undergraduate and graduate entry medical students. Based on three outpatient scenarios, they were asked, in their role as future intern (PGY1), to choose a referral to a PA or a doctor, with six time trade-off options offered. Year of study, country of residence and working or treatment experience with PAs and Nurse Practitioners were recorded. Descriptive statistics, and logistic regression models were used.

Results: In 2019, in Dublin, 177 medical students took part in the survey. Those surveyed were international and domestic nationals. Overall the PA option was chosen where the patient’s wait time was shorter and the clinical condition was perceived more serious. The doctor option was selected more readily when the wait time difference was less significant. Respondents from countries with established PA roles may have had experience to choose PAs than naïve ones.

Conclusion: This study confirms that medical students’ willingness to refer a patient is influenced by familiarity with the PA role and severity of the medical condition. In addition wait time is a primary motivator for selecting the PA over doctor option. These findings suggest a need to improve communication about the PA role among Irish medical students.