King's College London

As the UK grapples with its own healthcare staffing crisis, a new study offers a timely reminder: the challenges of training, deploying, and integrating doctors’ assistants are not new - and neither are the tensions they provoke.

Professor Clare Herrick argues that these roles - often seen as a uniquely American innovation born in the late 1960s - is in fact part of a much older, interwoven history of medical assistants and auxiliaries that spans continents and centuries.

In today’s NHS, physician associates are at the centre of a heated debate. Introduced in the early 2000s to help address workforce shortages, physician associates are trained to postgraduate level and work under the supervision of doctors. They take medical histories, perform examinations, and assist in diagnosis and treatment—but they are not doctors and cannot prescribe independently.

Despite their growing presence, the role has become controversial. Critics, including some doctors and professional bodies, have raised concerns about patient safety, transparency, and the potential for PAs to be used as cheaper substitutes for fully trained doctors.

Published in the Social History of Medicine, Professor Herrick’s research challenges the conventional wisdom about the origins of the physician associate (PA) role, revealing a far more global and complex history than previously acknowledged.

“The PA wasn’t a revolution,” she says, “but an evolution - one deeply entangled with global experiments in healthcare staffing, colonial legacies, and international development.”

The article traces how the assistant role emerged in the U.S. during the 1960s as a response to physician shortages, rising healthcare costs, and the expansion of Medicare and Medicaid.

But Professor Herrick shows that similar roles - medical auxiliaries, feldshers, health officers - existed long before in places like Uganda, Fiji, Sudan, and the Soviet Union.

These roles were often shaped by colonial and post-colonial dynamics, with local assistants trained to deliver care in underserved rural areas while full medical training remained the preserve of elites.

In many cases, these assistants outnumbered doctors and were essential to the functioning of national health systems.

Professor Herrick critiques the way the U.S. model has been exported to countries like the UK as a “new solution” to workforce shortages, without acknowledging its international antecedents.

She said: “This erasure of global histories has allowed the physician associate to be framed as a cost-effective, innovative fix - while sidestepping the complex debates about professional boundaries, training, and patient safety that have long surrounded such roles wherever in the world they have been.”