Clarke resigned as RCP President in June 2024 following an expression of no confidence in her leadership, by over 80 fellows and five of the college's six senior officers, over her handling of the physician associates policy dispute.
[13] In an interview with The Times, published on 24 September 2022, she commented that she did not support junior doctors going on strike as although she had sympathy with their concerns this did not override the potential impact on patient care.
[14][15] The British Medical Association (BMA), a doctors' trade union, responded to the article by commenting that they felt that the "greatest risk to patient care" was from "government policies and a lack of coherent workforce plan" and asked for Clarke to apologise.
[19] Clarke chaired an extraordinary general meeting (EGM) of RCP fellows on 13 March 2024 on issues related to physician associates (PAs) including their scope of practice, accountability, impact on training opportunities, pace and scale of the role's expansion, and regulation.
Fellows were invited to vote on five motions including a call to "limit the pace and scale of the roll-out" of PAs until issues of regulation, standards and scope of practice" had been addressed.
Clarke initially did not declare any competing interests but on 19 March 2024 amended the piece to include that the RCP "receives membership and examination fees from physician associates..." and "therefore risks a financial loss from a limit in the rollout of PAs".
Palliative care doctor and writer Rachel Clarke commented that there was a "lack of respect" shown from the leadership towards fellows and subsequently withdrew from the RCP's annual conference in April 2024 in which she was due to be the keynote speaker.
[24] The summary showed that the majority of members felt that PAs negatively impacted training opportunities, that the role was unclear, and "were not appropriately supervised in secondary care".
Five of the six senior officers of the RCP met with Clarke on 9 June 2024 and asked her to resign over a perceived lack of confidence after over 80 fellows including three council members signed a statement of concern in the college's leadership on the issue.