From a physician associate at breaking point: ‘We came to help not harm’

With the publication of the Leng Review, one PA pens a letter to Pulse, urging GPs to focus on reform – not rhetoric – to move forward

Dear all,

I am writing this letter anonymously. Not because I’m ashamed of being a physician associate, but because it’s no longer safe to speak openly. In recent months, the backlash against PAs has been so fierce that some of my colleagues have left their roles entirely. Not because they were unfit for the job, but because the abuse, hostility, and public humiliation became unbearable.

I became a PA to help people. Like most of my colleagues, I work under supervision, within my scope, and with deep respect for the medical profession. I’ve never claimed to be a doctor, nor have I ever wanted to replace one. I left a successful career in pharmaceutical science to support a system in crisis, to be an extra pair of hands, a listening ear and a familiar face for patients who might otherwise go unseen. I chose this path to ease the pressure, not add to it.

We’re not against doctors. We’re not a threat to doctors. We are part of the team, and like you, we’re burned out, overstretched, and trying to hold on to the reason we went into healthcare in the first place.

But when systemic failings are pinned on individual PAs, and when the conversation turns to blame, hostility, and public shaming, people break. And many already have. I know colleagues who have left the profession entirely, not because they lacked ability or compassion, but because they could no longer withstand the abuse. They gave up their jobs, their stability, and in some cases, compromised their families’ financial security, because that felt less terrifying than remaining a PA in this climate.

What makes this even harder is that many of us stood beside our resident doctor colleagues during their fight for better pay and conditions. We respected their struggle. We supported their strikes, both publicly and privately, because we believe in fair pay, safe staffing, and a future where doctors are valued.

In return, we were vilified.

Instead of solidarity, we were met with suspicion. Instead of working together, we were bullied online, in the press, and sometimes in our own workplaces. Many PAs faced targeted abuse, harassment, and exclusion. Not for doing anything wrong, but simply for existing in a role the system created.

The irony is that, for the most part, we’ve all been working toward the same goals: regulation, clearly defined scope, and public understanding. We could have achieved this together. With 5,000 PAs and 75,000 resident doctors in the UK, we never stood a fair chance of gaining traction without your support. But the way this has played out has caused real harm, not only to thousands of PAs, but also to public trust in the medical profession as a whole. It’s not just confidence in PAs that has suffered; it’s also in doctors, some of whom have taken to social media to bully and shame others publicly.

I still believe in this profession. I believe that PAs can offer something good and meaningful when we’re integrated properly. You don’t have to love the role. You don’t even have to agree with its existence. But I ask you to remember that behind the job title is a person who came here to help, not harm.

Let’s have the conversations that matter. Let’s focus on safety, clarity, and accountability. Let’s fix the governance. Let’s listen to and respect the patient voice. But let’s do it without dehumanising the people who are simply trying to make a difference.

I hope the Leng Review can serve as a reset. The evidence is now on the table. Let’s use it to drive informed decisions and shape legislation that reflects reality, not rhetoric.

Sincerely,

A physician associate (now assistant) at breaking point