Psychological safety, anxiety and professional identity among UK surgical physician associates

Abstract

Abstract Background Physician Associates (PAs) are increasingly embedded within UK surgical teams, yet little is known about their psychological safety, occupational wellbeing, risk orientation, exposure to online hostility, or career aspirations. Surgical PAs represent a small specialist subgroup within the wider PA workforce, working in high-acuity, hierarchical environments where role clarity, supervision and team integration are central to safe practice. This study examined the psychological and occupational experiences of PAs working in UK surgical specialties. Methods We conducted an exploratory mixed-methods cross-sectional study of PAs working in UK surgical roles. Participants were recruited through an identified specialist register of 70 surgical PAs held by the College of Medical Associate Professionals. Structured interviews collected demographic, occupational and qualitative data. Psychological safety was assessed using the Neuroception of Psychological Safety Scale, anxiety using the Generalised Anxiety Disorder-7, and risk orientation using the Risk Propensity Scale. Quantitative data were analysed descriptively and through exploratory correlations. Open-ended responses underwent thematic analysis. Results Fifty PAs completed the study. Participants reported high confidence in supervised perioperative support roles, with 98% comfortable undertaking surgical first-assist activity and 86% comfortable performing scrubbed operating department practitioner-related responsibilities. Mean GAD-7 score was 7.86, indicating mild-to-moderate anxiety overall. Mean NPSS total score was 100.80, with stronger social engagement but lower body-sensation scores, suggesting that interpersonal support may coexist with physiological vigilance or unease. Risk propensity showed negligible associations with anxiety, job satisfaction or procedural exposure. 20% reported doxing or targeted online harassment. Career aspirations were directed mainly towards supervised perioperative contribution, education, leadership, procedural development within scope, and multidisciplinary integration rather than independent operating. Conclusions Surgical PAs report confidence in supervised perioperative roles, but also experience anxiety, role uncertainty, online hostility and incomplete psychological safety. Safe workforce integration requires more than task allocation: structured training pathways, explicit role boundaries, named supervision, pastoral support and digital safety processes are likely to be central to sustainable surgical PA practice.