Paraprofessionals as liminal professionals: The case of physician associates / assistants in the UK NHS hospitals.

Abstract

We examine how paraprofessional physician associates/assistants (PAs) experience and navigate their everyday work, drawing on 126 interviews and one focus group across five NHS hospitals in England and Scotland. PAs described sustained ambiguity around their professional regulation and scope of practice, their ambiguous positioning between doctors and nurses, and organisationally being physically embedded within medical teams but governed under non-medical frameworks. We explain PAs' experiences of liminal enduring status drawing on Söderlund and Borg's (2018) conceptualisation of liminal process, position, and place. Moreover, to analyse this ongoing liminality, we introduce the concept of liminal markers - the material, symbolic, and organisational features, such as human resource classification, pay bands, governance arrangements, uniforms and everyday artefact - through which liminality is made visible and stabilised. We explain how PAs respond to enduring liminality with collective identity work oriented towards local legitimacy, relational continuity, and narrowing temporal focus to immediate clinical practice. We also conceptually reframe paraprofessional PAs' liminality as structurally embedded and collectively sustained, rather than temporary transitionary experience.