What Makes a ‘Doctor’? UK Anesthetists Raising Funds for Legal Action

As the lines between physicians and other healthcare professionals in the United Kingdom continue to shift, a group of anesthetists is raising money for legal action targeting the General Medical Council (GMC), the independent body tasked with regulating UK-based doctors.

Their aim: because the GMC will soon oversee not just doctors and surgeons, but also physician associates (PAs) and anesthesia associates (AAs), they insist that the organization must clearly define scope of practice for PAs and AAs, something Anaesthetists United says the regulator has so far failed to do.

In just a few days, the group has raised more than £56,000.

Richard Marks, MBBS, co-founder of Anaesthetists United, told TCTMD that at this point they’re raising money to pay for legal advice on whether there is a solid case to be made. What comes next isn’t set in stone but depends on the GMC’s response and could well involve a lawsuit, he said.

In and of themselves, “titles don’t mean anything,” Marks said, adding that a more relevant question is, “What is a physician’s associate? The GMC regulators have said: ‘They’re not doctors.’ Ok, so what are they? And that’s what needs to be defined. That’s really the heart of the case.”

While the current news is specific to anesthetists, questions over who delivers healthcare in the United Kingdom also impact cardiologists. As reported by TCTMD last summer, for instance, rumors that an advanced nurse practitioner had performed TAVI at Glenfield Cardiology sparked debate about expertise and “scope creep.”

Speaking with TCTMD, Asif Qasim, MBBChir, PhD (King's College Hospital, London, England), pointed out the problem isn’t PAs and AAs, who can provide valuable contributions in medical settings. Rather, “we are very concerned that financial pressures have pushed the government to use PAs to replace doctors,” Qasim stressed. This spring, he and other Fellows of the Royal College of Physicians brought this to the attention of the professional society and called for an Extraordinary General Meeting of the College, only the second in its 500-year history.

Early-career doctors, too, are concerned about how these shifts will alter their training and future, Qasim said, citing recently released survey data from the British Junior Cardiologists’ Association. Among the main themes: while the survey showed notable geographic variations and reports of PAs practicing outside their scope, there also were no strong signs that PAs hinder cardiology training.

We are very concerned that financial pressures have pushed the government to use PAs to replace doctors. Asif Qasim

“One of the major issues is the General Medical Council has said that they will register PAs, but they won’t determine their scope of practice,” said Qasim. What’s happened thus far is the scope is determined locally, leaving room for some centers to “look at them as a cheap alternative to doctors,” he explained. “That means that in cardiology, in some places PAs support the team, help with administration, and do what’s expected. In others they’re already training in echocardiography, angiography, and some invasive procedures at the expense of training the doctors,” with possibly increased risk to patients due to unregistered professionals providing healthcare.

Mamas Mamas, BMBCh, DPhil (Keele University/Royal Stoke University Hospital, Stoke-on-Trent, England), urged that “there needs to be a pause in the rollout until the scope of practice is determined.”

On a national level, “there hasn’t really been a been a full debate. . . . It’s almost been forced on patients without proper thought and consideration around safety,” he told TCTMD, adding, “Patients are often seeing physician associates and not realizing they’re not seeing doctors.”

The Anaesthetists United effort “is something that’s really welcomed across specialties,” Mamas agreed.

Indeed, interest in the controversy continues to grow on social media, even among those outside the medical field.

The To-and-fro

Back in March 2024, Anaesthetists United sent a letter to the GMC asserting that confusion over associates and doctors “is a serious issue that adversely affects patients and public confidence.

“We are writing to set out how referring to associates as ‘members of the medical professions’, ‘medical professionals’, and in ‘medical practice’ constitutes a failure to fulfil your statutory duties and must cease,” the letter states. The GMC’s initial reply, though lengthy, did not alleviate their concerns, the group said.

On June 5, Charlie Massey, chief executive and registrar for the GMC, issued yet another letter, this time clarifying their plans for setting professional standards.

“As a multiprofessional regulator, we will recognise and regulate doctors, PAs, and AAs as three distinct professions. PAs and AAs don’t have the same knowledge, skills, and expertise as doctors. They are not doctors, and they can’t replace them,” it reads. “It’s clear that they can, and do, play important roles within multidisciplinary teams when appropriate and effective clinical governance and supervision are in place.”

Massey says plans are afoot to set standards of care, professional behavior, training (including specific curricula), and ongoing requirements for competency. The GMC also intends to advise PAs and AAs on what’s expected of them, and investigate any areas where there are worries about patient safety and public confidence.

In the United States, where medicine is a licensed profession regulated at a state level, there also are concerns about the expansion to nonphysician providers. According to the American Medical Association, “state legislatures saw a record number of scope of practice expansion bills in 2023.” They say they’re pushing back on efforts to “replace physician supervision with a weak definition of collaboration,” as well as bills that would “allow pharmacists to diagnose a patient based on the results of a test the pharmacist administers and then prescribe medication to treat those patients, known as ‘test to treat.’”