An American PA in the UK

I’ve lived and worked in the UK since June 2019 and still sometimes pinch myself at how lucky I am to be here. It hasn’t always been easy (hello, COVID), and it hasn’t always been fun (cue frustrated tears as I stalled the manual transmission of our car for the hundredth time), but it has always been enriching.

So, what is life like as an American PA in the UK? Let’s take a look.

The NHS 

To understand practicing medicine in the UK, it’s first necessary to understand the NHS (National Health Service). The NHS is a source of great pride for most British people. 

The NHS is a publicly funded health system that is free at the point of care. It’s a common misconception that this means “free healthcare.” This isn’t the case. Every working person in the UK contributes to funding the NHS through their tax payments, regardless of how much or how little they use the service. These payments come out of each paycheck in much the same way that Medicare payments do in the US. 

The NHS includes emergency medical care, ambulance services, general medical care, mental health care, end-of-life care, maternity care, hospitalizations, surgery, physical or occupational therapy, specialty medical care, lab tests, imaging, and some dentistry. The NHS covers some eye appointments (to see the UK equivalent of an optometrist) for patients with certain conditions, such as glaucoma, though all medical ophthalmology services are covered. Dental services are subsidized and a patient pays a small fee for services.

What Isn’t Funded Through the NHS?

The NHS doesn’t fund purely cosmetic procedures, such as plastic surgery; anything that isn’t considered medically necessary; some dentistry; some eye exams, glasses, or contact lenses; some podiatry; chiropractic services; most types of experimental therapy (depending on what is being requested). There are procedures in place to request funding for something medically necessary.

How Does Someone Access Care Using the NHS?

The NHS is set up for all medical care to start in general practice (family medicine) except for emergency care. In this way, it’s similar to a PPO or the Veterans Affairs system in the United States. A person does not have access to specialty doctors before they’ve seen primary care except in a select few instances where they can self-refer (for example, sexual health, abortion services, and some mental health services). Emergency care is available 24/7 and does not require a referral, though patients are encouraged to speak to primary care before going to an emergency room if it isn’t a true emergency (e.g., concern for heart attack, stroke, trauma).

How Do PAs Fit Into the NHS?

Now that we have a basic understanding of how the NHS works, where can PAs work in the NHS? The answer is everywhere, just like in the United States. Similar to the US, PAs in the UK work in general practice and specialties, in outpatient and inpatient settings. Most currently work in general practice, emergency medicine, or internal medicine. PAs in New Zealand follow a similar model.

My Experience as a PA in the UK

I’ve worked in both Scotland and England in general practice. I worked full-time until the start of 2024 when I reduced my hours slightly by having a weekday off every other week. I enjoy 30 days of annual leave every year, which includes five days for continuing education or attending medical conferences/courses, as well as national holidays. If I work longer than my contracted hours, I am entitled to overtime pay, which is 1.5 times my regular salary.

Since Covid, my days have been a mixture of telephone appointments and in-person visits. I also have time built into my schedule for administrative tasks such as following up lab results, answering patient questions/concerns, writing referrals, or acting on the results of a referral I’ve previously done.

I work in a GP surgery (called a primary care clinic in American English) with two other PAs, four full-time GPs, occasional locums GPs, two nurses, and two phlebotomists. We also have physical therapists and a mental health counselor who see our patients in the surgery a few days a week. There is a fully stocked pharmacy in the same building as the surgery, though patients may choose to take their prescription elsewhere if they prefer. The providers and the pharmacy are supported by an excellent team of administrative staff.

What Do I Love About American PA Life in the UK?

There’s lots to love about being an American PA in the UK. Here are a few examples:

1. Multiculturalism. I have met or worked with people from all four nations that make up the United Kingdom: England, Scotland, Wales, and Northern Ireland. In addition, I have met or worked with people from Italy, France, Romania, Spain, Portugal, Belgium, Germany, Ukraine, Czechia, Poland, Macedonia, Greece, Turkey, Ghana, Cameroon, South Africa, India, Pakistan, Hong Kong, New Zealand, Zimbabwe, Ireland, Mauritius, Ecuador, Brazil, Vietnam…and that’s just what I can think of in a few minutes. You can’t help but see things from other points of view when there are so many of them around you.
2. The hours. Full-time in the UK is 37.5 hours a week, but employers are flexible about how many hours an employee works. I know several doctors who work two days a week (18-20 hours a week) because of caring obligations, either for children or aging parents. When health insurance isn’t tied to a job, this becomes a feasible option as long as personal financial situations allow. Other people work a few days in two different jobs – for example, one provider I know works three days a week in general practice and does PRN emergency room shifts. Parents of school-age children are often able to negotiate their working hours around when their children start and end school.
3. Not dealing with insurance. Health insurance isn’t common in the UK, since everyone has access to medical care. Some people do choose to purchase a private insurance plan in case they wish to access the private medical system in the UK (that’s a different post altogether). But in those cases, the patient is responsible for dealing with their insurance, not us.
4. The inability to pay isn’t a consideration in the treatment plan. I had a patient when I was practicing in the United States who was self-employed and thus uninsured. He was unable to pay for imaging that would have diagnosed the cancer he had had for over a year by the time he got to me. He’d even be strongly encouraged by a previous provider to find the funds for the imaging, as there was concern for cancer, but had been unable to do so. That year’s lag in diagnosis likely cost him his life. The cancer had spread by the time he reached me, and he died in his early 50s.
5. Medical lawsuits are very uncommon. They can happen, but not as frequently as in the US. This makes practicing good medicine the most important thing, not practicing defensive medicine.
6. Travel. I love to travel and always have. Within a 3-4 hour plane ride, I have access to all of Europe, often on direct flights. Not to mention, the UK is overflowing with history, culture, and nature, right outside my door. 

What are the Challenges of American PA Life in the UK?

Like any place, living and working in the UK has some challenges. Here are a few:

1. Not being able to prescribe. This can be frustrating, since like all American-trained PAs, I was taught to prescribe and comfortable with doing so by the time I graduated from PA school. In the UK, I must get someone else to sign my prescriptions, which is a logistical hassle for me, the person doing the signing, and the patient. However, there are steps underway for PAs to start prescribing, hopefully by the end of 2024. 
2. Learning a whole new medical system. The UK medical system is organized very differently from the US, and not just because it’s structured like a PPO. It’s not always easy to know where to refer someone for the care they need, as some specialties cover different things than in the US. In addition, different parts of the UK can set up their local systems differently. 
3. UK general practitioners have a broader scope of practice than US family medicine doctors. Conditions I would generally refer to a specialist in the US (e.g., pregnant patients, babies, and children, chronic pain management) are all done by UK GPs. Pediatrics is a specialty for children who are very ill, not the PCP for children. Obstetrics only cares for high-risk pregnancies in the UK; a midwife takes care of normal-risk pregnancies and births, and the GP takes care of all other health issues unrelated to the pregnancy for the mother.
4. Different medical terminology.

Oesophagus  = esophagus

GORD = GERD

BM = random blood glucose

BO = bowel opening = bowel movement

Cannula = IV

The list of terminology differences, in spelling or use, is long. It took some time for me to become comfortable with them.

5. Lower salaries. All medical personnel, including PAs, generally have lower salaries in the UK than in the US. However, this is offset by an excellent retirement plan, excellent standard of living, and no concerns regarding medical care/medical insurance/bankruptcy because of medical problems.

The Verdict: Is American PA Life in the UK Worth It?

Absolutely. My quality of life, both at work and outside of work, is much better in the UK than in the US. Living abroad is an education in itself and one I am enjoying immensely (even the frustrations and occasional misunderstandings). 

Oh, and in case you’re wondering…yes, I learned to drive a manual transmission.