Spotlight series: physician associates (PAs) in surgical specialties – urology

The number of physician associates (PAs) practising in surgical specialties continues to rise. At this exciting time, this spotlight series will feature qualified PAs sharing their surgical stories.

Alice Gissel qualified as a PA from St George’s University of London in 2018. Soon after, Alice secured her PA role in urology surgery at Charing Cross Hospital, part of Imperial College Healthcare NHS Trust. Here, she shares her experience of being a PA in urology surgery.

What made you decide to become a PA?

I always knew my career would follow a medical pathway. I studied medicinal and pharmaceutical chemistry for my undergraduate degree and, after a year in industry, I realised I didn’t want to pursue working in a laboratory. I didn’t want to commit to medical school, as I’d already done a gap year.

I saw an article about the PA profession that one of my friends shared on Facebook. The role itself was new to many people, and I found and watched some YouTube videos to find out more. I found out that the role is medically based, but less structured, which was important and appealed to me. As someone who has always wanted children, I wanted to maintain a positive work–life balance.

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

I almost knew I would work in urology before it happened. My sister worked as a nurse on a urology ward and my mum was a secretary for a urologist. During university holidays, I would do work experience and I got to understand the specialty. I then chose it as my elective and I was offered the role during my placement at Charing Cross. I was one of the first three PAs to join Imperial College Healthcare NHS Trust, and I’m very proud of that.

Initially, I was trained in flexible cystoscopy/ureteric stent removals and have carried out my own lists. Charing Cross is a tertiary referral centre, performing a range of complex cases. This means I’ve been exposed to – and assisted in – surgeries that aren’t performed at other hospitals. Charing Cross is also one of the only NHS trusts in the country to perform gender reassignment surgery (male to female). Assisting in those cases is very interesting, as it’s not a case we often see.  

What diagnostic/investigation/procedural skills have you gained?

My supervisors were keen to get me involved in surgery as early as possible. I’ve assisted in several laparoscopic procedures and supported cancer teams in surgery, which has been interesting and rewarding. Currently, I’m working towards completing my urodynamics course and I have passed my surgical skills course.

I’m confident in stent removals and help to support junior doctors coming into post with their lists. I’m also waiting to be signed off on diagnostic cystoscopies, which will allow me to perform them independently.

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

I was one of the first PAs to join Imperial College Healthcare NHS Trust, and the role has since evolved as more PAs have joined the team. We’re great support for junior doctors joining the specialty as we’re available to answer questions and help guide on conditions they haven’t previously seen.

Having been trained in uretic stent removal, I was able to help reduce the number of patients who had been waiting for this procedure due to COVID-19. I thoroughly enjoy creating relationships with my patients; hearing their kind comments about how I have helped put them at ease and reduced their wait time makes my job even more rewarding.

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

PAs do not currently have the ability to prescribe, which is the main challenge for our profession. Urology is a scan-centered specialty, with CTs and X-rays often required. Not being able to request these scans can have a knock-on effect on a case. I am hopeful this will change for the better after the profession becomes regulated.

In terms of patients understanding the PA role, it’s not questioned very often, which is positive. Patients are so pleased to be receiving the treatment and care they need that they are not preoccupied by the role of person who is helping them. If I do get asked, I have a standard response that explains more about what I’m there to do, and it's always well-received.

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

I thrive on expanding my knowledge and continuing to grow my skills is. While the PA course teaches urology-based conditions, in practice I’m exposed to rarer cases. This allows me to build on my foundation of knowledge, and I look forward to continuing to do that in the future.

On the urology wards we also treat a volume of complex cancer cases and I get to know the patients from the moment they are admitted. It’s so gratifying to be present for their entire journey, and to see the difficult path they sometimes follow after surgery through to how well they handle their recovery.

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

I want to continue practising in urology, and I don’t have plans to move into a new specialty. Currently, I’m working towards being signed off to perform urodynamics and diagnostic flexible cystoscopies. I would also like to undertake training to insert ureteric stents, which is performed by some PAs at other trusts. While this would require training from my seniors, it would be beneficial for PAs to offer this service, especially in emergency cases.

I have also run ad-hoc clinics in the past and I would like them to become more structured. This would help to continually grow my knowledge and help with the throughput of patients.

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

Spend time familiarising yourself with complex urology conditions. The PA course teaches the common ones, but it is beneficial at interviews to know others. It helps to understand what area you would like to practise in – ie if you want to secure time in surgery. I suggest passing the basic surgical skills training course first, as it helps at the interview stage and to hit the ground running when in your role.

Being a PA is so rewarding, and we can create our progression avenue. It’s also important to use your voice. If you want to gain knowledge or experience of a particular procedure, speak up and share it with your seniors. They are always so keen to have you involved when you show that you’re willing.

We’re always looking for 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]