INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
The Evolving Role of Physician Assistants in Multidisciplinary  
Healthcare Teams: A Focus on Interprofessional Collaboration in  
ICUs  
Deivadharani G1, Priscilla Princy S2, Bharathi B3*, Deepa C. Philip4  
1,2Student, III BSc Physician Assistant, MMM College of Health Sciences, Chennai  
3Associate Professor- Microbiology, MMM College of Health Sciences, Chennai  
4Principal, MMM College of Health Sciences, Chennai  
*Corresponding Author  
DOI: https://dx.doi.org/10.51244/IJRSI.2025.12110080  
Received: 29 November 2025; Accepted: 05 December 2025; Published: 09 December 2025  
ABSTRACT  
Critical care environments are increasingly challenged by rising patient acuity, workforce shortages, and the  
growing need for coordinated, team-based care. This review synthesizes evidence from various complementary  
studies examining: (1) interprofessional collaboration (IPC) challenges in South African intensive care units  
(ICUs), (2) the integration and impact of physician assistants (PAs) across diverse Canadian clinical settings,  
and (3) national workforce trends of PAs in United States critical care medicine. The findings reveal persistent  
organizational and system-level constraints—including staffing deficits, communication gaps, hierarchical  
barriers, and role ambiguity—that hinder effective collaboration. Evidence from Canada demonstrates that  
well-integrated PAs enhance workflow efficiency, continuity of care, and patient access, while U.S. data  
highlight a rapidly expanding PA critical care workforce with increasing postgraduate training, high job  
satisfaction, and substantial contributions to ICU operations. Collectively, the studies underscore the  
importance of structured IPC, comprehensive specialty preparation, and supportive organizational  
environments in strengthening ICU performance. Addressing burnout, improving role clarity, and expanding  
training opportunities remain essential for building a resilient and sustainable critical care workforce capable  
of meeting growing global demands.  
Keywords: Interprofessional collaboration; Physician assistants; Critical care workforce; Intensive care units;  
Postgraduate training  
INTRODUCTION  
Critical care environments are among the most complex areas of modern healthcare, requiring timely decision-  
making, coordinated teamwork, and well-trained professionals to manage rapidly deteriorating conditions.  
With rising ICU demands, workforce shortages, and increasing clinical complexity, interprofessional  
collaboration (IPC) and the integration of advanced practice providers—including physician  
assistants/associates (PAs)—have become essential components of critical care delivery. The studies  
synthesized in this review provide complementary insights into:  
(1) Interprofessional collaboration dynamics in South African ICUs,  
(2) evaluation of PA integration across diverse Canadian clinical settings, and  
(3) national workforce characteristics of PAs in U.S. critical care medicine.  
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INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
Together, they offer a cohesive understanding of teamwork, role clarity, staffing pressures, and professional  
contributions across different health systems.  
II. Interprofessional Collaboration in ICU Settings  
ICUs demand coordinated actions from multiple health professionals to ensure timely interventions, optimise  
decisions, and improve patient outcomes. However, evidence from South African decentralised clinical  
training platforms shows that IPC is often hindered by scope-of-practice misunderstandings, professional  
hierarchies, and fragmented communication patterns [1,2,3]. In these settings, delayed referrals, unclear  
professional boundaries, and inconsistent participation in ward rounds reduce the quality of teamwork. Similar  
challenges are reflected internationally, where rigid hierarchies can restrict nurse and allied health  
contributions, limit shared decision-making, and compromise holistic patient management [4,5,6].  
The COVID-19 pandemic intensified pre-existing barriers. Staff shortages, increased workloads, and physical  
distancing policies disrupted routine interdisciplinary meetings, reducing real-time communication and  
heightening stress among team members [7,8]. Despite these constraints, clinicians expressed motivation to  
improve collaboration by strengthening communication systems, conducting structured interdisciplinary  
rounds, and promoting mutual professional respect. These recommendations align with the WHO Framework  
for Action on IPE, highlighting the necessity of building collaborative competencies early in training [9].  
III. Organisational and System-Level Barriers to Teamwork  
Across settings, systemic challenges limit collaborative practice. South African ICUs experience chronic  
staffing shortages, high patient turnover, and inconsistencies in allied health coverage [10,11]. These  
constraints reduce opportunities for coordinated rounds and can delay rehabilitation, nutritional assessments,  
communication interventions, and discharge planning. Similarly, inefficiencies in clinical workflow and  
administrative processes can impede patient flow and contribute to staff fatigue.  
These structural barriers are paralleled across global critical care systems. Limited human resources, uneven  
rural–urban workforce distribution, and high burnout rates continue to undermine optimal care delivery in  
multiple countries. The literature suggests that while individual clinicians may value collaboration,  
organisational readiness and adequate staffing remain vital for sustaining IPC.  
IV. Integration of Physician Assistants into Clinical Services  
The Canadian study contributes important evidence about the feasibility, acceptance, and impact of physician  
assistants in improving service capacity. Initial concerns among physicians and community stakeholders—  
regarding patient acceptance, role ambiguity, and possible overlap with nursing or medical responsibilities—  
did not materialise during the evaluation [11,12,13]. Instead, PAs were found to: Improve workflow  
efficiency, Reduce physician workload, Enhance patient continuity, Support timely follow-up care and  
Strengthen communication within teams.  
Patients demonstrated high acceptance, frequently emphasising the accessibility and attentiveness provided by  
PAs. The versatility of the PA role also enabled smoother interprofessional interactions, reduced waiting times,  
and allowed physicians to allocate more time to complex clinical tasks.  
Challenges were not absent: scheduling constraints, diagnostic follow-up responsibilities, and administrative  
role clarification required adjustments. However, these issues diminished as clinics refined internal processes  
and established clearer supervision strategies. Overall, the Canadian evaluation concluded that PAs enriched  
service delivery and contributed meaningfully within diverse practice environments, especially in underserved  
settings.  
V. Workforce Trends and Characteristics of PAs in Critical Care Medicine  
The U.S. analysis by Hunton et al. (2025) [14] offers the first national picture of PAs in critical care medicine  
(CCM). Using the 2023 NCCPA dataset, the study identified 2,561 PAs practicing primarily in CCM—a 141%  
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INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
increase since 2015 (NCCPA, 2023). This rapid expansion reflects national shifts in ICU staffing structures,  
where advanced practice providers have become indispensable due to growing patient loads and limited  
intensivist availability [15,16,17].  
Several key trends emerged:  
Demographics and Practice Settings  
CCM PAs were generally younger and earlier in their careers:  
They predominantly practiced in urban hospitals (97.7%), reflective of national ICU resource imbalances  
[18,19]. Gender representation was nearly balanced, marking a shift from earlier decades.  
Postgraduate Training and Professional Development  
A significant proportion (16.1%) completed postgraduate fellowships—three times higher than other  
specialties—indicating an expanding appetite for specialty training [20,21]. These structured programs provide  
essential skills for managing complex ICU patients, including mechanical ventilation, invasive procedures,  
hemodynamic monitoring, and rapid response leadership. As PA education remains generalist, the authors  
argue that postgraduate programs will continue to play an important role in specialty preparation.  
Work Patterns and Role Responsibilities  
CCM PAs worked more hours per week, frequently held multiple clinical positions, and often rotated through  
night and weekend shifts. They were extensively involved in:  
procedural tasks  
ventilator and sedation management  
sepsis stabilisation  
multidisciplinary rounds  
discharge coordination  
These responsibilities align with evidence demonstrating the positive effects of APP-supported ICU models on  
patient flow, team communication, and physician workload [22,23].  
Burnout, Job Satisfaction, and Retention  
Burnout among CCM PAs was higher than in other specialties (38.5%), consistent with patterns in ICU  
physicians and nurses [24,25]. Contributors included emotional intensity, complex clinical decisions,  
prolonged shifts, and unpredictable emergencies. Yet, satisfaction remained high, and most reported strong  
commitment to remaining in CCM—suggesting deep professional fulfilment despite stress [26].  
Compensation  
CCM PAs earned higher salaries than PAs in other fields, reflecting both specialty demands and hospital-based  
pay structures [27].  
VI. Comparative insights  
Workforce Shortages and Rising Demand  
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INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)  
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025  
Whether in South Africa, Canada, or the United States, ICU workloads are rising while specialist shortages  
persist. This creates urgent demand for flexible, well-trained clinicians—including PAs and other allied  
professionals.  
Importance of Interprofessional Collaboration  
IPC remains central to patient safety, efficiency, and continuity. Both the South African and Canadian studies  
emphasise how teamwork strengthens service delivery, while the U.S. analysis highlights how PAs integrate  
into multidisciplinary ICU teams.  
Need for Structured Training  
Structured interprofessional education (IPE) and postgraduate fellowships emerge as critical to ensure  
readiness, build mutual respect, and prepare clinicians for coordinated intensive care environments.  
Burnout and Workforce Sustainability  
All studies underscore the heavy emotional and physical demands of critical care. Sustaining the ICU  
workforce will require addressing burnout, optimising staffing ratios, and reinforcing team-based models.  
Organisational Support as a Prerequisite  
Successful collaboration and PA integration depend on organisational support—adequate staffing, attention to  
scheduling, clear referral systems, and administrative pathways.  
CONCLUSION  
Across different countries and health system structures, various studies collectively highlight the indispensable  
role of interprofessional teams and the expanding contributions of PAs in meeting critical care demands.  
Strengthening IPC, improving clarity of professional roles, expanding postgraduate training, and enhancing  
workforce distribution will be essential to build resilient ICU services. These findings provide strong evidence  
that effective collaboration and strategic workforce planning can significantly improve quality of care, patient  
outcomes, and team functioning across critical care settings.  
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