Diving into the Unknown: Becoming PAs in Ireland

How Six Audacious PAs Entered the Profession in Ireland

By Margaret Allen PA-C, MSL, DFAAPA

With contributions from Patricia Anderson, PA; Michael James Tracey, PA; Maria Macken PA; Jessica Maddox, PA; Ciara Melia, PA; and Alexandra Troy, PA. 

“Do not follow where the path may lead. Go instead where there is no path and leave a trail.” – Ralph Waldo Emerson

Alexandra Troy, Maria Macken, Jessica Maddock, Michael James Tracey, Ciara Melia, Patricia Anderson on Graduation Day
Graduation day May 2018 for the first Irish PAs. (L to R) Alexandra Troy, Maria Macken, Jessica Maddock, Michael James Tracey, Ciara Melia, Patricia Anderson.

Physician Associates are now practicing in the Republic of Ireland! Six intrepid people, with no domestic role models or mentors, took a dive into the unknown to pioneer a new profession in their country. They graduated from Dublin’s Royal College of Surgeons in Ireland (RCSI) in May 2018, with a Master of Science (MSc) in Physician Associate studies. They are currently working in a variety of medical and surgical settings throughout the country, providing much-needed continuity and improved access to care.

I recently spoke individually with each of the six newly qualified PAs. I wanted to know what kind of person takes the plunge into a career previously unknown in their country. Were the “Irish Six” natural risk-takers, confident adventurers, and innovators? Or were they normally timid and hesitant, perhaps knowing they had a potential for leadership that had not previously surfaced? I was also interested in any characteristics that identify the ideal candidate for such a risky undertaking, and whether the students changed during their training in terms of developing confidence and leadership skills.

Background

The RCSI is “proud to be developing healthcare leaders who make a difference worldwide.”1 Leaders at the college have been enthusiastic about introducing the PA role to Ireland since 2007.2 Many senior college doctors have experienced working with PAs in hospitals in the U.S. and are impressed with their skill, versatility, and ability to integrate.2 A bold decision by the dean of the medical school and other leaders led to the introduction of a pilot program. In 2015, after considerable research and preparation, four PA clinicians from North America were recruited by RCSI to test the role in one of their teaching hospitals as part of a 2-year pilot project with the Irish Department of Health. Working alongside residents and senior house officers, they provided continuity while demonstrating their skills in breast, ortho, vascular, and colorectal surgery. Parallel to the pilot project, a master’s level Physician Associate program was developed and introduced, incorporating the overseas PAs for mentoring and teaching in addition to their clinical commitments. The first PA students entered training in January 2016.

Today, the third cohort, the Class of 2019, is already well into the first year of training. In January to March 2018, I had the privilege of working with them, and met eleven positive, enthusiastic, mature people that mirrored the diversity of modern Irish society. Supporting them are the new graduates, blazing the trail and acting as role models.

Who does this?

Most people commit to PA training with a somewhat realistic idea of what they will face. They usually come prepared, with a trove of information – having shadowed a PA, read about PAs, or been treated by a PA. Although two of the students had familiarity with the American PA profession, for the other four, joining the new Physician Associate class at the RCSI was a risky undertaking. Applicants were advised that, as PAs, they would have to demonstrate leadership, take initiative, enjoy collaborative working and flexibility, and be able to explain the role when working within a framework unfamiliar to most colleagues. They would need to be the voice of the profession.[1] It would be critical to be adequately equipped to cope with stress and to be able to lead a new profession with confidence and dynamism.

“To make this move to a brand, new profession required courage, strong character and a willingness to take risks,” said Michael James Tracey.

 Rosarii Mannion, head of human resources at the Irish Health Services Executive, believes that the PA role has a lot to offer: “The medical workforce in Ireland needs to adapt to changes … There is significant need to discover and deliver the correct skill mix, and PAs have a reputation for working collaboratively, providing care to vulnerable people, and understanding the need for diversity and equality in the workplace.”3

The students had no hesitation about committing to the training. Alexandra Troy, who had experience with PAs in the United States said, “I was truly ecstatic when I heard RCSI was pioneering this new program.” There were no qualms for Ciara Melia either: “Even with the risk of no guarantee of a job, I knew this was exactly what I wanted to do.”

With a background in science, Patricia Anderson had always wanted to work in medicine. “I am older and busy as a parent and small-business owner, so I didn’t think there would be a role for me. All the same, I happened to be looking through the RCSI website when I saw that the PA program open day would be that same night. I rushed up to Dublin, enjoyed the evening, and knew that was exactly what I wanted to do. That’s my personality: I am determined and have self-discipline. I have learned to keep going and be time-efficient.”

Jessica Maddock never thought of herself as a go-getter. Entering the pioneer class, however, was almost a foregone conclusion. “I’m Irish but my family lives in the U.S. My father is an MD there and encouraged me to choose the PA profession rather than go to medical school. My brother is in PA school in the U.S.  I had full cultural immersion into the PA world.” She decided to study in Ireland because “I had heard that the Irish health system had problems with access and continuity and felt sure development of the role would work out.”

A former seminary student before coming to Ireland, Tracey had been able to offer vulnerable people hope, dignity, respect and comfort, but it wasn’t enough. “In my native country, I witnessed loss of life, horrific injuries, displacement, turmoil and suffering. I felt helpless and hoped that one day I would have the education, medical qualifications and opportunities to reach out to people in their time of need.” When the opportunity arose, he seized it gleefully: “I’ll never forget the day I heard that the Physician Associate program was being introduced to Ireland for the first time.” He attended the open evening, and “feeling excited and adventurous, I decided to take the plunge!”

Despite knowing little about the PA profession, Maria Macken decided to give it a go and  “jumped in with both feet.” Although concerned that her prior lack of confidence would let her down, as it had in the past, she was determined to excel and threw herself whole-heartedly into the studies. Melia never thought of herself as a particularly outgoing person. “In secondary school, I was always the quietest in class. I was the one who sat back and observed others.” Despite her youthful reticence and restraint, she is, in fact, quite adventurous. A fan of extreme sports, she enjoys scuba diving, bungee jumping, and jumping out of airplanes. All, interestingly, are pursuits that require close teamwork for safety and success. She recently went cliff-diving off the west coast of Ireland, into the Irish Sea in severe weather. “My dad says I’m fearless.” Paradoxically, she does not think of herself as brave.

Joy and compassion

The personality and compassionate nature of the students become apparent when talking with them. Tracey recalls “the sacredness of the anatomy lab.” For him, “It was an extremely uplifting experience.” Melia feels that life changed when her supervising physician showed his confidence in her early on in training. “There is one moment that will stay with me forever. I was asked to assist with a laparoscopic hysterectomy. At the end of the procedure, the surgeon invited me to clamp the uterus and remove it vaginally. I was so happy to be able to do that and to help the patient. I came home late, after spending extra time in the OR, and told my parents ‘This was the best day ever.’”

Physicians in training rotate every six months. For Troy, that “changeover” day in Irish hospitals, was a turning point. “The changeover with the new physicians works well but can be hectic. With a PA, the transition is smoother and you can see how essential continuity of care is.”

Leadership and confidence

Students grew in confidence and leadership ability during the training. Although she captained several sports teams in high school and college, Macken’s lack of self-assurance had let her down. Her success as a PA gives the lie to earlier projections of mediocrity: “I’ve always worked hard and wanted to do well, but with the course I was inspired and went all-out for excellence!” She continues: “I am still quite cautious – I’m dealing with peoples’ lives after all! But I am learning to trust myself and my instincts.” Anderson tells me: “We are all very different. We are driven in diverse ways and are strong and have a good understanding of who we are. I have always been confident and a leader, but those qualities became distinctly more evident during the course.” The graduates work hard, stay late, and step outside their role if necessary to help the team. Maddox says she is now more willing and able to put herself forward confidently.

Now that she is able to look after patients from the beginning of their encounter to the end, Macken feels that she is really making a difference. She adds: “I like getting to know the patients, and they appreciate the continuity.” Melia feels more self-assured and confident on the job now. A close friend of hers, amazed at the transformation in her since completing the training, enthuses: “You have this passion and confidence when talking about being a PA and doing the things you enjoy.” Buoyantly, she says, “I love it.”

The graduates are already demonstrating leadership in the profession. Presentations to colleagues and supervisors have been well-received, and they have been warmly accepted as teaching assistants by the current cohort of students. Anderson says she is looking forward to getting together with her fellow PAs and having “dynamic CPD workshops.” Troy is enjoying some teaching and is looking forward to taking on more and learning to perform additional procedures. She’s becoming more assertive and is not afraid to ask for additional training.

An exciting future

The enthusiasm is palpable. “It will be so great when this really takes off in Ireland!” says Maddox. For one student in particular, the rewards are especially great: “I have always had a huge love of medical dramas. Now I understand so much more – and I can point out the flaws! My friends text me every time they see or hear about a PA,” said Melia.

The “Irish Six” are excited! They are all working extremely hard, effectuating and demonstrating the PA role. They are providing continuity and access to patients and are constantly learning and adding more skills. All have a very positive outlook for the future. They will soon be joined by 13 more PAs, the graduating class of 2018. Keep an eye out for these new leaders in the PA profession!

PA Ciara Melia about to take the plunge off a cliff into the treacherous waters of Ireland’s west coast in winter
PA Ciara Melia about to take the plunge off a cliff into the treacherous waters of Ireland’s west coast in winter. With permission.

More Resources:

JAAPA Musings: Piloting PAs in Ireland 

PA Foundation Fellow Focuses Research on PAs in the United Kingdom

International Rotations Expand Opportunities for PA Students

PA Richie Kalker Commutes 6,000 Miles

Acknowledgment

Special thanks to Dr Pauline Joyce, EdD, MSc, Academic Director and Senior Lecturer, MSc Physician Associate studies program at Royal College of Surgeons in Ireland.

Margaret Allen PA-C, MSL, DFAAPA, is based in California. Contact her at [email protected].

References

http://www.rcsileadership.org.  Accessed 7/25/18.

2   Kuttler, H.  “Irish Surgeons Anxious to give PAs a try”.  AAPA News, May 15, 2007.

3  Rosarii Mannion.  Head of HR, Health Services Executive. Notes from personal communication, February 22, 2018.

[1] Rosarii Mannion.  Head of HR, Health Services Executive. Notes from personal communication, February 22nd, 2018