IMO gives cautious welcome to review but warns of concerns around regulation and resourcing

 ‘The role must remain a support to the clinical team, not a substitute for a doctor’

 Thursday May 7, 2026. The Irish Medical Organisation (IMO) has cautiously welcomed the publication by the HSE of an independent review of the role of physician assistant (PA) in the Irish public health system but has warned that concerns around regulation and resourcing need to be addressed for the grade to integrate effectively.

The IMO said that it welcomed the review’s clear distinction between doctor and PA, and its recommendation to refer to the grade as ‘physician assistant’ rather than ‘physician associate’, to minimise the risk of patients confusing the grade with that of a doctor. It also welcomed the review outlining limitations to the scope of practice.

However, it said that no clear regulatory obligations have been outlined, and it is unclear how consultants would be in a position to supervise, train and monitor PAs given their existing onerous workload.

Speaking today, Professor Matthew Sadlier, President of the IMO and a consultant psychiatrist, said: “While the IMO cautiously welcomes this review, significant work remains. The physician assistant role must remain a support to the clinical team, not a substitute for a doctor. The HSE’s review categorically states that the role of physician assistant must not be employed in such a manner. It is also our position that the implementation of the position into a clinical team should only happen where consultants have been engaged with directly.

“There remain notable concerns amongst doctors around the lack of clear regulatory obligations in relation to the role. Moreover, expecting already overstretched consultants to supervise and train PAs without a substantial increase in consultant numbers is simply not realistic. Resourcing and regulation will determine whether this new initiative succeeds or fails.”

He added that the work of PAs cannot negatively impact on the training of NCHDs which should be the priority, and that NCHDs should not be expected to undertake any training or supervision role in respect of PAs.

 The IMO said it expects the HSE to engage with it in discussions regarding a national framework around the introduction of the PA position into the health system.