UK Physicians, Decrying Scope Creep, Ask Royal College President to Resign

Amid rising concerns over expanding duties for physician associates (PAs), and the lack of clear-cut limits on their roles, leaders of the Royal College of Physicians (RCP) in the United Kingdom have called for the resignation of the group’s president.

On June 10, 2024, five of the six senior officers for the RCP—its treasurer, VP education & training, VP Wales, academic VP, and global VP & registrar—sent a letter to colleagues reporting that they’d met over the weekend with President Sarah Clarke, MD, an interventional cardiologist, and asked her to step down.

“We appreciate Dr. Clarke’s hard work to try and deal with the challenging matters that have faced the college,” the letter reads. “However, we have become increasingly concerned that she has lost the confidence of the RCP membership and [about] the continuing negative impact this is having on our college.” They go on to add that, at this “critical time” of blurred lines in the UK’s healthcare landscape, the RCP needs a reset that results in “someone at the helm with the skills to advocate fiercely for physicians.”

On social media, the RCP has announced that they intend to soon clarify their position on PAs.

The same day as the meeting between the senior officers and Clarke—who has refused to resign—more than 80 Fellows of the RCP signed a statement of concern expressing their discontent about what they view as an uncontrolled rollout of PA responsibilities with an undefined scope of practice.

Mamas Mamas, BMBCh, DPhil (Keele University/Royal Stoke University Hospital, Stoke-on-Trent, England), TCTMD’s Senior Clinical Editor and an RCP Fellow, has been speaking out about potential risks to patients and healthcare workers if the medical field comes to depend too heavily on PAs.

In an interview with the BMJ, however, he cautions against making Clarke a “scapegoat.”

“Many of the things that we have outlined—in our letters, on social media, and at the [College’s Extraordinary General Meeting earlier this year]—have been facilitated as collective decisions by RCP leadership and many of those senior figures signing the letter of no confidence in Sarah were among the most vociferous in support of the PA experiment,” Mamas is quoted as saying. Better than Clarke’s resignation, he says, would be for the RCP to listen to its members.

Also in the United Kingdom, as reported by TCTMD, a group of anesthetists is currently raising money for legal action targeting the General Medical Council, demanding more clarity and limits on PA scope of practice.

In the United States, where medicine is a licensed profession that’s regulated at the state level, the American Medical Association has been advocating against “scope creep.”

Asked for their position on this trend in healthcare, an American College of Cardiology (ACC) spokesperson directed TCTMD to the professional society’s 2015 health policy statement on the topic of team-based care involving advanced practice providers (APPs).

Subsequently, when providing feedback to US Centers for Medicare & Medicaid Services in 2020, the ACC’s then president, Richard Kovacs, MD, specified that the “College supports highly trained APPs who are part of a care team practicing autonomously within the scope and ability of their licensure. This is generally accomplished with collaborative practice between a physician and APPs on the care team.”