Physician Associate

Dr House

Dr House

Dr House

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What are your thoughts on Physician Associates (PAs)?

The government has finally commissioned an inquiry into the role of PAs. Personally, I feel they can be a helpful and valuable resource within the NHS. However, the lack of a defined scope of practice has led to hospitals using them as they see fit, often interchangeably with doctors. This raises significant concerns.

Becoming a GP takes around 11 years of training, followed by a lifetime of continuous learning. Even with this extensive education and experience, doctors can still make mistakes despite their immense knowledge and skills.

In contrast, PAs complete a two-year master's program (which reportedly has a 100% pass rate) and are then entrusted with responsibilities that seem disproportionate to their training. in GP surgeries and Emergency Departments, PAs are seeing patients in roles comparable to doctors. In some cases, they are even performing invasive procedures and operating, it really is the Wild Wild West of medicine.

influenced patient care positively or negatively?

Each and every one I have worked with have been really nice individuals with their heart in the right place, but they just don't know the extent of the gaps in the knowledge, "the eyes can't see what the brain does not know"
 
I had no idea Physician Associate was even a thing. Do they have to wear a special hat or a badge so you know you've got one?
 
I've heard similar concerns from other Drs and nurses I know tbh. A relatively cursory training before they are given really quite significant responsibilities, without a proper defined scope of practice. In theory they are all supervised by actual doctors and have to get their approval for most decisions, but in practice that is clearly not happening, and it's not even clear how it's supposed to work in theory given the number of PAs that a doctor might be overseeing and not having the time to actually talk to / examine all the patients themselves.

NHS trusts and GPs aren't always completely open about what PAs are either, and lots of patients might come away believing they have seen a doctor when they haven't.

Seems pretty clear to me it's a stopgap measure to add some extra capacity to the healthcare system on the cheap without proper consideration of the risks involved.
 
I've worked with quite a lot.

Individually, they've been all lovely. Genuinely nice people.

Professionally, their lack of knowledge considering their made-up roles is scary. I've seen them work at reg level. For comparison, for a doctor at that level, thats 5-6years medical school, 2 years foundation training, 3 years lower specialty training. So 10-11 years.
Then a PA can walk into the role after a 2 year "masters" course (with a 100% pass rate..... the examination is an absolute joke).

It is a further erosion of the medical workforce of the UK. I fully expect the NHS to be a two tiered service in the very near future - if you can pay, you'll see a doctor. If you can't, you'll see a PA/NP.

I am very fortunate to work in a GP practice where the partners have seen the risks, and refuse to hire PAs in their current role.

I feel sorry for the PAs. They have been missold a career.
I feel sorry for the patients. I have seen harm come to a good number due to PA decisions secondary to lack of knowledge.
I feel sorry for the doctors - often being forced to supervise, to prescribe for, to take responsibility for, an inappropriate workforce. I have personally seen countless examples of doctors losing training opportunities because of PAs.

The only way the position will work is if they go back to their originally defined role as physician assistants. No more pretending to be on the reg rota/EPIC, no more taking training opportunities, no more pretending to be doctor. Be a supporting role that would benefit patient care.

I firmly believe that every senior clinician promoting and hiring PAs in their current role should be ashamed of their ladder pulling.
 
Dr House said:
What are your thoughts on Physician Associates (PAs)?

The government has finally commissioned an inquiry into the role of PAs. Personally, I feel they can be a helpful and valuable resource within the NHS. However, the lack of a defined scope of practice has led to hospitals using them as they see fit, often interchangeably with doctors. This raises significant concerns.
Click to expand...
From an outside view this is just standard NHS, instead of taking hard and firm decisions at "Head Office" they let everyone run differently. No amount of funding will solve stupid decisions like this.
Edit
Firm up the role and train them correctly
 
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Bubo said:
Do they have to wear a special hat or a badge so you know you've got one?
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This is the crux of it for me. I have no problem with them being used to take the workload of "day to day problems" off from more experienced doctors, but there needs to be a) a clear scope of their work b) a clear escalation chain to pass it upto a more senior doctor c) absolute transparency and the ability for a patient to insist on someone more senior.

I imagine the next big NHS scandal will involve PA's and that they were doing jobs well beyond their pay grade.
 
Last year I was scheduled for a minor surgical procedure after diagnosis by a consultant. When I turned up for the op everything was normal, but after going through all of the prep was told the consultant had to be called off to an emergency and the procedure was going to be carried out by someone else. This didn't bother me too much but a few minutes before starting, the person who was now going to carry out the procedure introduced herself as what I now know to be a PA. I asked what that meant, and having never heard of such a thing before, became quite concerned. I asked some fairly blunt questions which didn't seem to phase her, e.g. "So you're not a doctor?", and "You're not even a nurse practitioner?", before politely declining to proceed. Despite being assured that there was a supervising doctor "on the campus", I was cheesed off.

It was a fairly simple procedure under a local anaesthetic, but it was invasive. It probably would have been okay, but I was worried about what would happen if things didn't go to plan. Finding out at T-5 minutes also didn't give me enough time to research and understand what I was dealing with

I offered constructive feedback afterwards but suspect it was given the severest of ignorings.

From a layperson perspective, I imagine if they can do most of the non-critical grunt work to enable doctors the headspace to focus on the critical work, there could be significant benefits. But unsurprisingly it seems that a little too much artistic interpretation of where the boundaries lie, probably driven by constrained resource, can and does lead to situations like the one I found myself in.
 
It devalues the hard work doctors has to do to get to where they are.
It puts patients at risk.
It is a potential for bigger problems down the line.
It is a potential for lawsuits.

It is however seen as a way to process patients through the system like a number, faceless number. I bet the suits higher up loves it.
 
The thing is in GP land you see lots of simple cases but it’s the training and experience that helps you spot the little sings that may hid something more serious.

The other issues is supervision, there Just is no time to supervise them safely.

They are cheaper than a GP but not by that much and they are a little more expensive than a hospital resident doctor.
 
Dr House said:
What are your thoughts on Physician Associates (PAs)?
Click to expand...

Not a bad idea in theory... but frequently a bad idea in reality (because of woke nonsense [insert Daily Fail rant] lol).

Firstly I'm not sure that 11 yrs vs 2 years is a fair comparison in all cases.... but there are some caveats to that AFAIK.

In the good case, it's more like 10 years vs 5 years.

GP: 5 years MBBS degree + 2 years foundation + 3 years GP speciality training = 10 years

PA: 3 years BMS degree (ideally) + 2 years PA training/MSc degree = 5 years.

(But how rigorous is that PA MSc degree in reality if they don't all have to be good BSc BMS grads or similar?)

Now I've been to see a cardiologist before who also had a Cardio Physiologist with him (I guess comparable in some way to what a PA ought to be but specialised) and that Physiologist was very sharp and knowledgeable. I understand there are other clinical physiologists who work in other specialist areas and there are anesthetist assistants etc. So the idea that you'd maybe have someone a bit like that but with an interest in general medicine and who could prescribe stuff for minor issues, help manage chronic stuff etc. seems quite reasonable in principle.

In reality, there certainly seems to be more of a mixed bag with PAs (both from what I've heard and what I've experienced first hand), AFAIK they like the same sort of life sciences undergrad degree clinical physiologists tend to have but they have broader acceptable criteria for PA training and can include less relevant degrees + some healthcare work experience.

A specialist clinical physiologist type is (this is purely vibes-based) more likely to be someone genuinely keen on life sciences, maybe interested in research too or someone who perhaps wanted to be a doctor initially but didn't quite make the grade and took BMS at a decent uni instead etc. whereas some of the PA types seem more like - went to any old naff uni because "wanted to go uni" and now have some mediocre Biology degree and want a career. But the NHS loves wokeness and people from mediocre unis are sought after these days for diversity or box-ticking stats re: whether their parents went to uni and what sort of household they grew up in and do they like bumming men or wearing skirts at the weekend etc..etc (all really important employment questions these days).

Seemingly it's also a potential career path for nurses even if they're absolute **** - this happened at my local GP surgery, I thought I was getting a Dr's appointment but the confirmation said "Miss Smith" - googled the name and she'd had not just one but two employment tribunals after being sacked by two different GP practices when she was a nurse, seemingly she's since failed upwards and become a PA now... the consultation was a joke, she spoke in broken English and spent most of the time staring at her computer trying to type (at a speed of about 15 words per minute). So re: the question about how rigorous that PA MSc degree is, it can't be too difficult if that woman managed to get one.

So I think it could work in theory if they get the right sort of people doing it - narrow it down to genuinely keen science grads/BMS types from good universities, not failed nurses or various randoms with low-quality degrees. And secondly, receptionists ought to make people aware (don't just say "she's equivalent to a Dr" when asked) and triage so that the PAs are dealing with more basic stuff.

With advances in AI I don't see why some smart BMS grad with a PA MSc and some AI assistant couldn't be a great way of helping with the GP shortage but it needs some better quality control/higher standards IMO.
 
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throwaway4372 said:
a way to get people doing "sort of the job" quicker/cheaper. Eventually you end up with none of the "proper" version left.
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Because people want to maintain services they had, but don't want to pay what it costs when inflation inevitably creeps up because they're already paying more for everything else, they just don't want another additional expense, so services have to resort to unconventional solutions like getting lower skilled people to do higher skilled work as quickly as possibly
 
Scuzi said:
Last year I was scheduled for a minor surgical procedure after diagnosis by a consultant. [...] the person who was now going to carry out the procedure introduced herself as what I now know to be a PA.[...]

It was a fairly simple procedure under a local anaesthetic, but it was invasive.
Click to expand...

WTF - yikes!!!

Most GPs don't even do that, it's only some small subset of GPs with special interests who might do something surgical (if surgery is their special interest) and even then it's stuff like cut out a cyst.

How TF is a PA (clearly not a fully trained GP) taking on a sub-specialism too????

(Incidentally, the GPs with specialisms are super useful - like say you have an ENT referral to the hospital, you might find there is a GP with an ENT specialism in your local area and you can book an appointment with him/her within a few days rather than wait weeks for the hospital appointment etc. - obvs if you need surgery for something in that area you still need the actual ENT consultant tho).
 
They have their uses but NHS Trusts abuse the situation by hiring them for tasks they are ill-suited for. At the end of the day, they need supervision. They can't work autonomously - yet that's the position many Trusts force them into. Similar situation with advanced nurse practitioners. They are not a substitute for actual fully trained medical consultants.
 
I do not know enough except what I've heard on the news but logically they should not exist in any form and if news reports are to be believed, PAs can in some instances earn more than fully trained medical personnel which seems plainly wrong.

Ideally, you'd have fully trained medical staff and administrators to handle the paperwork / liaison between departments / appointment aspects. I don't really get it; 100k+ medical roles are not fulfilled, so why aren't these PAs getting full medical training to fill these positions?!
 
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dowie said:
Not a bad idea in theory... but frequently a bad idea in reality (because of woke nonsense [insert Daily Fail rant] lol).

Firstly I'm not sure that 11 yrs vs 2 years is a fair comparison in all cases.... but there are some caveats to that AFAIK.

In the good case, it's more like 10 years vs 5 years.

GP: 5 years MBBS degree + 2 years foundation + 3 years GP speciality training = 10 years

PA: 3 years BMS degree (ideally) + 2 years PA training/MSc degree = 5 years.

(But how rigorous is that PA MSc degree in reality if they don't all have to be good BSc BMS grads or similar?)

Now I've been to see a cardiologist before who also had a Cardio Physiologist with him (I guess comparable in some way to what a PA ought to be but specialised) and that Physiologist was very sharp and knowledgeable. I understand there are other clinical physiologists who work in other specialist areas and there are anesthetist assistants etc. So the idea that you'd maybe have someone a bit like that but with an interest in general medicine and who could prescribe stuff for minor issues, help manage chronic stuff etc. seems quite reasonable in principle.

In reality, there certainly seems to be more of a mixed bag with PAs (both from what I've heard and what I've experienced first hand), AFAIK they like the same sort of life sciences undergrad degree clinical physiologists tend to have but they have broader acceptable criteria for PA training and can include less relevant degrees + some healthcare work experience.

A specialist clinical physiologist type is (this is purely vibes-based) more likely to be someone genuinely keen on life sciences, maybe interested in research too or someone who perhaps wanted to be a doctor initially but didn't quite make the grade and took BMS at a decent uni instead etc. whereas some of the PA types seem more like - went to any old naff uni because "wanted to go uni" and now have some mediocre Biology degree and want a career. But the NHS loves wokeness and people from mediocre unis are sought after these days for diversity or box-ticking stats re: whether their parents went to uni and what sort of household they grew up in and do they like bumming men or wearing skirts at the weekend etc..etc (all really important employment questions these days).

Seemingly it's also a potential career path for nurses even if they're absolute **** - this happened at my local GP surgery, I thought I was getting a Dr's appointment but the confirmation said "Miss Smith" - googled the name and she'd had not just one but two employment tribunals after being sacked by two different GP practices when she was a nurse, seemingly she's since failed upwards and become a PA now... the consultation was a joke, she spoke in broken English and spent most of the time staring at her computer trying to type (at a speed of about 15 words per minute). So re: the question about how rigorous that PA MSc degree is, it can't be too difficult if that woman managed to get one.

So I think it could work in theory if they get the right sort of people doing it - narrow it down to genuinely keen science grads/BMS types from good universities, not failed nurses or various randoms with low-quality degrees. And secondly, receptionists ought to make people aware (don't just say "she's equivalent to a Dr" when asked) and triage so that the PAs are dealing with more basic stuff.

With advances in AI I don't see why some smart BMS grad with a PA MSc and some AI assistant couldn't be a great way of helping with the GP shortage but it needs some better quality control/higher standards IMO.
Click to expand...
Firstly, Lets abandon the 3+2 year theory for PAs -
- although a health or life science degree is recommended, there are no restrictions, and many have gone onto the 2 year course with undergrads completely unrelated
- even if it is a health or life science undergrad, it won't be 3 years of dedicated learning aimed at clinical 'medicine', it'll be something that might overlap at best.

Secondly - THERE IS NO GP SHORTAGE. There are plenty of GPs out of work or looking for more work.
 
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