{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T06:28:27Z","timestamp":1793600907306,"version":"4.5.0"},"reference-count":57,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR153324"],"award-info":[{"award-number":["NIHR153324"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Social Science & Medicine"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.socscimed.2026.119892","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:11:48Z","timestamp":1790698308000},"page":"119892","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Paraprofessionals as liminal professionals: The case of physician associates \/ assistants in the UK NHS hospitals"],"prefix":"10.1016","volume":"409","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4937-4703","authenticated-orcid":false,"given":"Yingxi","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9442-0795","authenticated-orcid":false,"given":"Rhys","family":"Swainston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-2033","authenticated-orcid":false,"given":"Tricia","family":"Tooman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reece","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Nzekwu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-9896","authenticated-orcid":false,"given":"Shobhana","family":"Nagraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0440-0787","authenticated-orcid":false,"given":"Gerry","family":"McGivern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.socscimed.2026.119892_bib1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.JAA.0000513357.68395.12","article-title":"Development of the United Kingdom physician associate profession","volume":"30","author":"Aiello","year":"2017","journal-title":"JAAPA"},{"key":"10.1016\/j.socscimed.2026.119892_bib2","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1016\/j.nedt.2014.10.018","article-title":"People, liminal spaces and experience: understanding recontextualisation of knowledge for newly qualified nurses","volume":"35","author":"Allan","year":"2015","journal-title":"Nurse Educ. Today"},{"key":"10.1016\/j.socscimed.2026.119892_bib3","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/area.12791","article-title":"From liminal spaces to the spatialities of liminality","volume":"54","author":"Banfield","year":"2022","journal-title":"Area"},{"key":"10.1016\/j.socscimed.2026.119892_bib4","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/1350508411415563","article-title":"Performing a crisis: institutional politics and the construction of (ir)responsibility","volume":"19","author":"Bar-Lev","year":"2012","journal-title":"Organization"},{"key":"10.1016\/j.socscimed.2026.119892_bib5","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/0018726710371235","article-title":"Liminality and the practices of identity reconstruction","volume":"64","author":"Beech","year":"2011","journal-title":"Hum. Relat."},{"key":"10.1016\/j.socscimed.2026.119892_bib6","series-title":"The National and International Research Literature on Physician Associates and Anaesthesia Associates: Safety, Effectiveness and Patient Perspective","author":"Boaz","year":"2025"},{"key":"10.1016\/j.socscimed.2026.119892_bib7","article-title":"Physician associate courses suspended by multiple universities after leng review","volume":"390","author":"Bowie","year":"2025","journal-title":"BMJ"},{"key":"10.1016\/j.socscimed.2026.119892_bib8","series-title":"Sorting Things Out: Classification and its Consequences","author":"Bowker","year":"1999"},{"key":"10.1016\/j.socscimed.2026.119892_bib9","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1002\/job.2318","article-title":"Identity work in organizations and occupations: definitions, theories, and pathways forward","volume":"39","author":"Caza","year":"2018","journal-title":"J. Organ. Behav."},{"key":"10.1016\/j.socscimed.2026.119892_bib10","series-title":"One in Five PCNs Reduced their Use of Physician Associates in the past Year","author":"Colivicchi","year":"2025"},{"key":"10.1016\/j.socscimed.2026.119892_bib11","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.5465\/amj.2010.57318357","article-title":"Being the change: resolving institutional contradiction through identity work","volume":"53","author":"Creed","year":"2010","journal-title":"Acad. Manage. J."},{"key":"10.1016\/j.socscimed.2026.119892_bib12","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/padm.12115","article-title":"Broken \u2018two-way windows\u2019? An exploration of professional hybrids","volume":"93","author":"Croft","year":"2015","journal-title":"Public Adm"},{"key":"10.1016\/j.socscimed.2026.119892_bib13","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2025.118638","article-title":"Inter-identity threats and opportunities shaping professional influence for the allied health profession (AHP) healthcare workforce: a study of identity paradox","volume":"386","author":"Crozier","year":"2025","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib14","series-title":"The Regulation of Medical Associate Professions in the UK","year":"2019"},{"key":"10.1016\/j.socscimed.2026.119892_bib15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.socscimed.2017.03.045","article-title":"Physician associates in primary health care in England: a challenge to professional boundaries?","volume":"181","author":"Drennan","year":"2017","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib16","series-title":"The Semi-professions and their Organization: Teachers, Nurses, Social Workers","author":"Etzioni","year":"1969"},{"key":"10.1016\/j.socscimed.2026.119892_bib17","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1177\/0170840699204004","article-title":"Betwixt and between: temporary employees as liminal subjects in flexible organizations","volume":"20","author":"Garsten","year":"1999","journal-title":"Organ. Stud."},{"key":"10.1016\/j.socscimed.2026.119892_bib18","doi-asserted-by":"crossref","DOI":"10.1016\/j.nurpra.2024.105033","article-title":"Nurse practitioner's liminal space: applying foli's theory of psychological trauma","volume":"20","author":"Gill","year":"2024","journal-title":"J. Nurse Pract."},{"key":"10.1016\/j.socscimed.2026.119892_bib19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/1094428112452151","article-title":"Seeking qualitative rigor in inductive research: notes on the gioia methodology","volume":"16","author":"Gioia","year":"2013","journal-title":"Organ. Res. Methods"},{"key":"10.1016\/j.socscimed.2026.119892_bib20","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s10459-017-9802-1","article-title":"The bargaining of professionalism in emergency care practice: NHS paramedics and higher education","volume":"23","author":"Givati","year":"2018","journal-title":"Adv. Health Sci. Educ. Theory Pract."},{"key":"10.1016\/j.socscimed.2026.119892_bib21","first-page":"163","article-title":"Navigating knowledges: community health workers as liminal professionals","volume":"11","author":"Golden","year":"2024","journal-title":"J. Prof. Organ."},{"key":"10.1016\/j.socscimed.2026.119892_bib22","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1111\/medu.14219","article-title":"Doctors' identity transitions: choosing to occupy a state of \u2018betwixt and between.\u2019","volume":"54","author":"Gordon","year":"2020","journal-title":"Med. Educ."},{"key":"10.1016\/j.socscimed.2026.119892_bib23","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/0959354317693120","article-title":"From paradox to pattern shift: conceptualising liminal hotspots and their affective dynamics","volume":"27","author":"Greco","year":"2017","journal-title":"Theory Psychol"},{"key":"10.1016\/j.socscimed.2026.119892_bib24","doi-asserted-by":"crossref","DOI":"10.5465\/AMBPP.2018.190","article-title":"Climbing invisible walls: the construction of career (im)mobility in liminal professional roles","volume":"2018","author":"Gustafsson","year":"2018","journal-title":"Acad. Manag. Proc."},{"key":"10.1016\/j.socscimed.2026.119892_bib25","series-title":"Independent Review of the Physician Associate and Anaesthesia Associate Roles: Final Report","author":"Leng","year":"2025"},{"key":"10.1016\/j.socscimed.2026.119892_bib26","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.s205","article-title":"Physician assistants: six months on from leng review, where does the profession stand?","volume":"392","author":"Limb","year":"2026","journal-title":"BMJ"},{"key":"10.1016\/j.socscimed.2026.119892_bib27","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"10.1016\/j.socscimed.2026.119892_bib28","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/padm.12119","article-title":"Hybrid manager\u2013professionals\u2019 identity work: the maintenance and hybridization of medical professionalism in managerial contexts","volume":"93","author":"McGivern","year":"2015","journal-title":"Public Adm"},{"key":"10.1016\/j.socscimed.2026.119892_bib29","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1177\/0170840617708004","article-title":"The silent politics of temporal work: a case study of a management consultancy project to redesign public health care","volume":"39","author":"McGivern","year":"2018","journal-title":"Organ. Stud."},{"key":"10.1016\/j.socscimed.2026.119892_bib30","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12960-024-00966-1","article-title":"A contentious intervention to support the medical workforce: a case study of the policy of introducing physician associates in the United Kingdom","volume":"23","author":"McKee","year":"2025","journal-title":"Hum. Resour. Health"},{"key":"10.1016\/j.socscimed.2026.119892_bib31","doi-asserted-by":"crossref","first-page":"60","DOI":"10.18778\/1733-8077.11.3.05","article-title":"Collaboration in healthcare through boundary work and boundary objects","volume":"11","author":"Meier","year":"2015","journal-title":"Qual. Sociol. Rev."},{"key":"10.1016\/j.socscimed.2026.119892_bib32","series-title":"NHS Long Term Workforce Plan","year":"2023"},{"key":"10.1016\/j.socscimed.2026.119892_bib33","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1287\/orsc.1110.0664","article-title":"Understanding the role of objects in cross-disciplinary collaboration","volume":"23","author":"Nicolini","year":"2012","journal-title":"Organ. Sci."},{"key":"10.1016\/j.socscimed.2026.119892_bib34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/cjas.1262","article-title":"Organizational culture evolution in temporary organizations: the case of the 2010 olympic winter games","volume":"30","author":"Parent","year":"2013","journal-title":"Can. J. Adm. Sci. Rev. Can. Sci. Adm."},{"key":"10.1016\/j.socscimed.2026.119892_bib35","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1080\/0158037X.2018.1447918","article-title":"Liminal practice and reflection in professional education: police education and medical education","volume":"40","author":"Rantatalo","year":"2018","journal-title":"Stud. Contin. Educ."},{"key":"10.1016\/j.socscimed.2026.119892_bib36","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1186\/1472-6963-14-460","article-title":"The experience of community first responders in co-producing rural health care: in the liminal gap between citizen and professional","volume":"14","author":"Roberts","year":"2014","journal-title":"BMC Health Serv. Res."},{"key":"10.1016\/j.socscimed.2026.119892_bib37","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2025.118382","article-title":"A liminal duality of expert authority: the perpetuation of hierarchical authority in UK surgical teams contrary to a national collective leadership policy","volume":"382","author":"Rosell","year":"2025","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib38","series-title":"Physician Associate Registration Assessment \u2013 Annual Report 2025","year":"2026"},{"key":"10.1016\/j.socscimed.2026.119892_bib40","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2021.804008","article-title":"The training setting as a social and liminal space for professional hybridization","volume":"12","author":"Scaratti","year":"2021","journal-title":"Front. Psychol."},{"key":"10.1016\/j.socscimed.2026.119892_bib41","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2020.113598","article-title":"Adverse events as transitional markers - using liminality to understand experiences of second victims","volume":"268","author":"Schr\u00f8der","year":"2021","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib42","series-title":"Handbook on the Sociology of Health and Medicine","first-page":"199","article-title":"Chapter 13: sociology of the medical profession and para-professions","author":"Schupmann","year":"2023"},{"key":"10.1016\/j.socscimed.2026.119892_bib43","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/ijmr.12168","article-title":"Liminality in management and organization studies: process, position and place","volume":"20","author":"S\u00f6derlund","year":"2018","journal-title":"Int. J. Manag. Rev."},{"key":"10.1016\/j.socscimed.2026.119892_bib44","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1177\/0162243910377624","article-title":"This is not a boundary object: reflections on the origin of a concept","volume":"35","author":"Star","year":"2010","journal-title":"Sci. Technol. Hum. Values"},{"key":"10.1016\/j.socscimed.2026.119892_bib45","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1177\/030631289019003001","article-title":"Institutional ecology, \u2032translations' and boundary objects: amateurs and professionals in berkeley's museum of vertebrate zoology, 1907-39","volume":"19","author":"Star","year":"1989","journal-title":"Soc. Stud. Sci."},{"key":"10.1016\/j.socscimed.2026.119892_bib46","first-page":"56","article-title":"Physician associates in the UK: development, status, and future","volume":"35","author":"Straughton","year":"2022","journal-title":"JAAPA Off. J. Am. Acad. Physician Assist."},{"key":"10.1016\/j.socscimed.2026.119892_bib47","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2025.118489","article-title":"What seems to be the problem? Locum doctors, liminality and concerns about performance","volume":"383","author":"Stringer","year":"2025","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib49","first-page":"141","article-title":"Liminality and experience: structuring transitory situations and transformative events","volume":"2","author":"Szakolczai","year":"2009","journal-title":"Int. Polit. Anthropol."},{"key":"10.1016\/j.socscimed.2026.119892_bib48","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/0959354317694095","article-title":"Permanent (trickster) liminality: the reasons of the heart and of the mind","volume":"27","author":"Szakolczai","year":"2017","journal-title":"Theory Psychol"},{"key":"10.1016\/j.socscimed.2026.119892_bib50","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1177\/104973200129118840","article-title":"Utilizing insider-outsider research teams in qualitative research","volume":"10","author":"Thomas","year":"2000","journal-title":"Qual. Health Res."},{"key":"10.1016\/j.socscimed.2026.119892_bib51","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.socscimed.2015.05.020","article-title":"Occupational closure in nursing work reconsidered: UK health care support workers and assistant practitioners: a focus group study","volume":"136\u2013137","author":"Traynor","year":"2015","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib52","series-title":"Space and Place: the Perspective of Experience","author":"Tuan","year":"2011"},{"key":"10.1016\/j.socscimed.2026.119892_bib53","series-title":"The Rites of Passage","author":"van Gennep","year":"1960"},{"key":"10.1016\/j.socscimed.2026.119892_bib54","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2026.119000","article-title":"\u2018They\u2019re big and I is small\u2019: the precarious identity reconstruction process of a low-status occupational group","volume":"392","author":"Van Wieringen","year":"2026","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib55","article-title":"How did the RCP get into a mess over physician associates?","volume":"387","author":"Waters","year":"2024","journal-title":"BMJ"},{"key":"10.1016\/j.socscimed.2026.119892_bib56","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1186\/s12916-025-04530-z","article-title":"Developing and integrating physician assistants\/associates in UK hospital teams: a realist review of lessons from international experiences","volume":"23","author":"Zhao","year":"2025","journal-title":"BMC Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib57","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2024.117226","article-title":"Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems: findings from an empirical study of medical and nurse interns in Kenya","volume":"357","author":"Zhao","year":"2024","journal-title":"Soc. Sci. Med."},{"key":"10.1016\/j.socscimed.2026.119892_bib58","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2025.118021","article-title":"Making sense of absent-yet-present others: representing the liminal vegetative state beyond life and death","volume":"373","author":"Zulato","year":"2025","journal-title":"Soc. Sci. Med."}],"container-title":["Social Science & Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626009706?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0277953626009706?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T05:48:55Z","timestamp":1793598535000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0277953626009706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":57,"alternative-id":["S0277953626009706"],"URL":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119892","relation":{},"ISSN":["0277-9536"],"issn-type":[{"value":"0277-9536","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Paraprofessionals as liminal professionals: The case of physician associates \/ assistants in the UK NHS hospitals","name":"articletitle","label":"Article Title"},{"value":"Social Science & Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.socscimed.2026.119892","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"119892"}}