Speciality spotlight series – a 'physician assistant' turned physician associate shares her story

Physician associates (PAs) were formally introduced into the UK healthcare service in 2003. Before this, the profession had been active in the USA since the 1960s, with the role being known as ‘physician assistant’. Derrin Jarvis qualified as a PA in 2013 from the Massachusetts College of Pharmacy and Health Sciences, USA, and practiced in urology for 5 years before coming to the UK in 2019. Currently based at the Royal Free London NHS Foundation Trust, she continues to expand her knowledge of the speciality. Here, Derrin shares her story.

What made you decide to become a PA?

During high school, I chose to volunteer with the ambulance service. I enjoyed my experience so much that I became a certified emergency medical technician. I volunteered for over 10 years and then studied pre-medicine in New York. At that time, I had planned to go to medical school. In America, the system works differently to the UK, and you need a science degree before being accepted into medical school.

I studied for a degree in health and exercise science. During my fourth year, I accepted a medical internship, and I shadowed a range of medical professionals. I came across the PA role, and it was the variety and flexibility of the profession that
interested me most. Coming to the UK was an easy decision as the role is still upcoming here and it's exciting to be part of its evolution. 

Can you tell us more about your experience of working as a PA in urology? 

Given my emergency medical background, I had always thought I would work in that area. During rotations on my PA course, I fell in love with surgery and then completed a surgical internship. I worked in various departments but found that I had a passion for urology. It’s very procedure-led, which I love. In the USA, I was a physician assistant in surgery and was exposed to a wide range of cases, including robotics.

I came to the UK just a few months before the COVID-19 pandemic began. All junior doctors at the Royal Free London were assigned to ICU wards, and our team of four urology PAs maintained the service. We became integrated into the urology clinics and wards, 7 days a week. It was an opportunity for the PA role to be showcased, and it helped to build my confidence. Alongside my PA colleagues, we were able to manage the system during an unprecedented time, while maintaining continuity of care for our patients.

What diagnostic/investigation/procedural skills have you gained?

Since I joined the Royal Free London, the consultants have been very forthcoming in having PAs involved in urology clinics and giving us opportunities to learn specialised skills. I’m trained and confident in performing flexible cystoscopies and have been integrated into the bladder cancer pathway, which is an interesting and rewarding element of my role. Currently, I’m learning how to perform prostate biopsies which will then allow me to be part of that clinical pathway.

The skill I am most proud of is that I’m specialised in placing urinary catheters. I’ve had experiences of using a variety of methods – some that registrars and consultants would normally be required to do. This helps my learning and growth as a PA and supports the wider team. I always remember a particular patient’s feedback following a catheter procedure, thanking me for the ‘fascinating work’ and the kind attitude shown.

How would you describe the impact your role as a PA has had?

Consultants enjoy having PAs in the team due to how versatile we are, and the support we provide by getting involved in multiple clinical pathways. Junior doctors appreciate us too. Urology is a skill-based specialty and for a new junior doctor it can be daunting; we can help guide them through the learning curves.

After the first wave of COVID-19, we had some backlogs in urology clinics. The schedule I created to place PAs in each clinical pathway is helping us to reduce this number. It’s helpful that we’re a permanent fixture for patients too. We're here when they come back for their re-scheduled appointments and having a familiar voice and face to guide them helps to put them at ease.

As a PA working in urology, what challenges do you face?

The main challenge and difference between practising as a PA in the UK versus the USA is regulation. In the USA, a large portion of my role was in urology surgery. Since arriving in the UK, I haven’t secured time in surgery, due both to the pandemic and to the differences in regulation between the two countries. This is an area I would like to continue progressing in the future as I’m keen to maintain my surgical skill level.

What do you find most enjoyable and rewarding about being a PA?

The flexibility of the role drew me to the profession initially, and I’m pleased that this aspect remains. I enjoy how I can support outpatient clinics and then care for patients on the wards. It’s a special part of the role spending time with them and gaining their trust, and helping them to feel comfortable in your presence is very rewarding.

I’m also lucky to work at the Royal Free, which is a teaching hospital. Medicine is constantly evolving and being taught new developments in a learning environment is exciting.

What does the future look like for you as a PA?

I want to remain practising in the UK, and I’m looking forward to how the profession will evolve. It would be positive to see PAs discover more autonomy in the future. We’re lucky as a profession that we have the luxury of moving between specialities. Having the opportunity to continue learning and building knowledge of other areas is really exciting.

Personally, one of my goals is to continue volunteering. I am involved in an organisation that coordinates volunteers to perform surgery in developing countries. I have been on three trips so far and hope to go on more in the future.  

What advice would you give to a PA looking to practice in urology?

Secure time shadowing the profession in a speciality you are interested in. While medicine is continually changing, it is important to know what interests you and what you enjoy. I found having a positive relationship because of my placements helpful too. Knowing you have a consultant to look to as a mentor can be beneficial.

The journey to becoming qualified takes a solid commitment. There is a lot of studying involved, and it won't always be easy. Once you do reach your goal and qualify, the profession is so rewarding.

We’re always looking for qualified FPA members to share their story. If you’re interested in sharing yours, get in touch using the contact details below. If you’re thinking of a career as a PA, you can learn more about how to begin your journey here.

Get in touch to share your PA story:

Jenna Donaldson – FPA communications officer
[email protected]