Gardner came to Scotland from the US in 2006, when the National Health Service (NHS) of Scotland launched a pilot PA program. Gardner was among the initial group of 12 American PAs involved. Her assignment was to set up diabetes and COPD clinics at a local primary care health center in Edinburgh.
As in England, the PA profession is not fully recognized in Scotland. PAs do not yet have prescribing privileges. The UK PA association is working on this, but Gardner says she is still in the process of applying for registration. “As you can imagine, there is much red tape and politics involved in such a process,” she says. “Things here move rather slowly.”
Gardner describes her first year in Scotland as “extremely challenging.” For example, the clinic staff refused to give her access to computer programs and medical records that she needed. “I had two wonderful supervising physicians who used their influence to remove all barriers and obstacles in my path,” Gardner says.
Despite their kindness, Gardner sensed a general lack of trust from the medical community there. “Many seem to feel PAs will take away jobs; others are resistant to change and new ideas,” she says. “Some feel the NHS nurses are equally skilled and trained, so why hire a PA?” In the end, it’s probably a matter of people not understanding the diversity of the PA role and the level of education required, Gardner adds.
When the pilot study ended, Gardner’s employers asked her to stay. Her role blossomed into providing education about the PA role for the NHS. She also helped train nurses and prepare them for clinical exams. Later, she was hired for her current position in the Edinburgh Cancer Center.
It has been an interesting educational experience to work in a socialized medicine system, after having been trained in the US, Gardner says. In some respects, it makes her appreciate what we have in America.
“In Scotland, this system provides patients with limited to no choices in the types of treatment they receive and what doctor they will see,” she says. “They often do not have access to the newest treatments, medications, or facilities, and technology lags.”
Gardner has been surprised by the lack of preventive medicine and patient education programs, despite a nationwide problem with heavy drinking and smoking. “The majority of patients continue to practice unhealthy behaviors, even though they are being treated for cancer,” Gardner says.
Despite these issues, Gardner loves being where she is and feels hopeful that with large enough numbers, PAs will succeed in Scotland.
“The country of Scotland is extremely beautiful and the Scottish people are very friendly, kind, genuine, and humble,” she says. “The PA can be someone who will take the time to listen, show compassion, and go an extra mile for a patient. If used correctly, and enabled to function within his/her full scope of practice, PAs can definitely be cost-effective for the NHS.”