I agree with all you’ve said Ollie. I think a big issue here are the universities. They inflate the expectations of the PA role (weve all seen the “become a specialist” adverts) which is because their main priority is attract tuition fees, not service provide for the NHS. That proximal expectation grows, and I don’t get the feeling many can embrace the relatively “superficial” training. The equivalency of time served without a clear training programme at postgraduate level is also a key conflation I’ve seen - I worry employers are falling into this as well.
One of the things which is quite deeply rooted in medical students is knowing there's alot you don't know. Lack of insight into your own limitations is actually quite a dangerous thing for any health care professional. And this is my worry about the attitude .I would be very worried about anyone working with a certain mindset of competition and lack of insight into their own boundaries, they are very dangerous for patient safety as well as to supervise as they will not be coming to you for things they ought to
This is good practice for everyone as we move forward. When you're working as a doctor, you realise the further you move forward how frighteningly little you know, and this only gets worse with time. In this context, people (doctors, PAs, whomever) with less training/knowledge/experience need to have a safe, consistent way of escalating for help/advice and feel comfortable to do so.
@OllieBurtonMed when patient safety is concerned being comfortable asking shouldn't really come into the decision making tbh..you do it regardless, we've all had to look stupid asking questions but we are there to learn even as consultants
@@OllieBurtonMedwhat is this videos point that isnt obvious already.Im a PA in ireland following this UK nonsense since the recent onslaught.Nobody in medicine Ive come across has ever claimed a PA is comparable to a doctor or the education equivalent.This is just repetition of the obvious.However, on a practical clinical level in wards and gen med clinics there is no observable difference in knowledge between a 2 yr PA grad and most SHOs ive met.I base that on the bedside teaching by consultants and their feedback on our performance in both hospitals ive worked in.I do agree that PA school do not cover Pathology or the basic med sciences as seperate subjects so their knowledge is not as deep or broad as a doctor.However, that would only be a concern if PAs were senior doctor replacements which is not a PA.Personally Ive seen some god awful junior docs who can barely speak English but I wont generalise about them like many docs have about PAs on social media.
@@scarred10 The point is to explore the tensions and the differences in the training, based on the social media post from a PA I referenced at the beginning. 'on a practical clinical level in wards and gen med clinics there is no observable difference in knowledge between a 2 yr PA grad and most SHOs ive met' - this is your experience, and is a valid opinion you can hold. It does not match my experience, and that's OK. But this is all anecdote and isn't useful to us in any meaningful way. The major thing I'm interested in is scope of practice and what that will look like.
No, I think this is a good take, it’s doing nothing more than just reiterating the point that PA and Doctor training is different (not a bad thing!) and therefore the different roles and expectations associated with them are different! It’s just drawing attention back to the fact that these roles seem to be being conflated as “equivalent” in one manner or another by employers, by universities etc and reminding people that these are different roles with different expectations and therefore different requisite training and practical ability.
Hi, Ollie! I largely agree with everything that you have said here. As a current ICU RN (in the US) who contemplated going to PA school but has now opted to go to medical school, I have spent an incredible amount of time with attending physicians, residents, mid levels, and of course other nurses. There is clearly a space for each one of these individuals on the healthcare team, and each role should be respected for the value and training that it brings. That being said, I, like you, believe that there is no substitute for the comprehensive training built into physician education, and no profession (be it nurse practitioners or PAs) should attempt to equate their training with that of a physician. One of the important problems that I see, though, is a general belief within the medical hierarchy that one has nothing to learn from those that are “beneath” him or her. Experienced nurses feel they have nothing to learn from novice nurses. Midlevels believe they have nothing to learn from the nursing staff. Residents believe they have nothing to learn from the midlevels. Fellows believe that the attending is can be their only source of training. And attendings believe they can only learn from other attendings who are more well-published than they are. (This, of course, is an incredibly broad generalization and is likely an unfair analysis for many…so my apologies to those individuals, but the general analysis remains). The PA profession in the US is notably more well developed than in the UK (so I speak through that lens), but there is a SUBSTANTIAL amount of information that resident physicians can learn from an experienced NP/PA about the PRACTICE of CLINICAL medicine. As the saying goes, patients don’t read the textbook. And because patients don’t read the textbook, early trainees (especially) should see experienced midlevel practitioners as an invaluable resource. Having more knowledge or training on a fundamental level should not preclude someone from feeling as though they can learn from someone with a more narrow scope of practice. I will strongly maintain that NPs, PAs, CRNA, AAs, CNMs, etc should operate under supervised practice. I have no problem arguing on behalf of my physician counterparts with respect to that point. I will say, however, that physicians are woefully undereducated on the knowledge and training process of other healthcare providers. In my experience, physicians have no earthly idea how much RNs, RTs, PT/OT/Speech, NPs, PAs, CRNA, etc. are expected to know and be able to do at the end of their training. Maybe if we all took some time to assess where we are on the Dunning-Kruger curve, this would be a significantly more productive conversation.
Thanks so much for your feedback - it's really appreciated, thanks for giving it the time. You're right about the learning - absolutely in agreement that anyone can learn something from anyone, no matter who they are. It's a much more fluid dynamic and we should all be able to understand and appreciate that that learning process happens, and that's likely a more 'experiential' form of learning. Re third paragraph - agree. It may interest you to know that in the UK, PAs aren't considered to study or practise medicine by its legal definition. This is the position of the GMC (medical regulator) who have clarified this, so there's an interesting difference there. The other flipside of this (and where I've seen danger happen) is that this experiential learning tends to come from pattern-recognition rather than true understanding/textbook knowledge. This can obviously then lead to inadequate or inappropriate treatment when the situation doesn't follow what the more experienced person is expecting - and I would further add to that that experience does not *necessarily* mean learning. If someone does the same year over and over for 10 years, they might not meaningfully learn much, but people can wrongly then start to think of that subject/field as 'easy' - when they don't actually have the skills/knowledge to understand what's happening. We need to find the harmony between these two states I think, as both have innate value. And re knowledge of other professions' education, no issues there - agree. I'm sure that line can be drawn between all professions, as none of us really knows what the others are doing at any given time.
@@OllieBurtonMed Wow. What an excellent reply. Thanks for responding. Again, I largely agree. I’ll just add this point for thoroughness sake. I believe that physicians are shooting themselves in the foot with the “pattern recognition” line of argumentation. This is the charge that is largely thrown at nurse practitioners here in the States, but I believe the argument largely undercuts the true interests of the physician. Allow me to explain. The thing that makes physician education so unique is its maximally in-depth didactic education PAIRED WITH an extremely well-developed, keen sense of pattern recognition. I’d be curious to know how many times one of your senior registrars or consultants (I really should do more to understand the English medical hierarchy but I get the sense that those two are the equivalent to the “attending” role) have diagnosed something that doesn’t come through often and they turn to the team and say “You won’t find this in the textbook, BUT…” What he or she is leaning on there is an extraordinarily refined sense of pattern recognition. That keen sense is why they are in charge. It’s not the bread and butter stuff that makes physicians special. NPs/PAs are genuinely well positioned to care for the bread and butter stuff. We need doctors because of the unicorn cases. The problem, though, is that when an undifferentiated patient shows up in the ED (A&E), no one actually knows whether or not they are a bread and butter case or a unicorn case. It’s the highly refined pattern recognition of the physician that we lean on there. That “what makes this case different” skill comes only after having really gotten into the weeds of the textbook AND after having seen THOUSANDS of patients during training. You made an excellent point in the video about the STRUCTURE of physician training. Taken together with your reply above, I see that training as meant to ensure that the physician isn’t doing the same thing year over year for 10 years but not actually learning anything meaningful. Another commenter explained that either all those years are necessary to do the job of medicine or they’re not. I wish to pair the few ideas together to make what I think is a stronger argument for the quality of physician education. The reason medical eduction is so long and tedious with crazy hours as a trainee is because in order to be at the top of medicine, you need the wealth of didactic knowledge PAIRED with thousands and thousands of hours building the skill of pattern recognition under the STRUCTURED supervision of other physicians who have been developing their pattern recognition skills for decades. When an NP/PA makes a diagnostic error that a physician would not have made, the underlying reason all comes down to this: they did not understand how one pattern is different from another pattern, how one constellation of symptoms differs from another. They had an underdeveloped pattern recognition muscle. To strengthen that muscle, they would need a more in-depth physiological understand AND to see the different constellations in a structured training program that calls upon others to guarantee that they understand how “this” is different from “that.” To support this, there is some data to suggest that midlevel providers order more diagnostic tests (increasing the overall cost of healthcare delivery) to reach a diagnosis even if that diagnosis is the same one that a physician would have ultimately come to. Why is this one might ask? It’s because the physician has a much stronger sense of pattern recognition. Because they have seen the same thing SOOOO many times in such a structured way, they simply don’t need as much information to reach the same conclusion. Doctors really should lean into the notion of pattern recognition. It does a lot more to validate the necessity of their long, intense training as opposed to arguing that midlevels rely too much on pattern recognition. Just my thoughts. Would love to here what you think.
Much shorter response only to say I agree - it's more pattern recognition *alone* based on experience that has led to some arguments I've had with nursing colleagues. If I asked for something to be done, I might get pushback because 'we normally do XYZ' or 'last time someone had that condition, we did Y'. What should then happen is obviously a collegiate discussion about the nuances and each of our perspectives. But instead what happened is my position being dismissed because of how 'junior' a doctor I was - despite the fact that I was right. There wasn't any acknowledgement that my textbook knowledge was probably better - although hand on heart, equally at the time I did not process well why they were being as dismissive as they were, which might be more to do with risk aversion.
I’m on a GEM course with PAs who still complain that their already illegitimate roles and authority has been revoked, following the magnifying glass over scope of PAs. They genuinely believe they are due this as a right, that they’ve earned it, by spending time on the ward. No thought about safety, about liability, it’s a selfish stance and this is the distinguishing factor between doctors and PAs - ultimately, they are irresponsible. I don’t think it’s fair to come for their pay, as many do, after all, what about all the other very questionable roles - cardiac physiologists on band 7? Non doctor roles are welcome in the NHS, though likening it to the role of a doctor was problematic. We must also question the relevance of such long, intensive training if we deem it not necessary to practice safely. It’s either needed and so in use, or outdated and should be reconsidered. We are trying to stamp out elitism here in the UK, but doing so have gone way past the threshold. We’ve no respect left for the role at all, to the demise of patient safety
The important thing for everyone to try to discuss and understand is why people feel this way, if they do. What were they sold at the start? Who was saying what about the role was intended for, or where it might be going? Deeply understandable if say a course lead was saying things from the beginning, and it later turns out not to be based on anything concrete.
@@OllieBurtonMed from speaking to my medical student peers who moonlight as PAs, it’s communicated to themselves on assumption that they have gotten away with it so long unquestioned, it seems crazy to take that away. Consultants have been happy to pass the buck and let F1s(!!!!!!) sign off prescriptions without reassessing the patient themselves, because let’s be honest, who wants the extra workload. It is only now that these same juniors - or residents, rather, are refusing to just sign off the prescription based off of solely the PA. It is this that they tend to contest to. It is not an excuse to continue doing something wrong if when asked why, your main reason is ‘I’ve been doing it since as far as I can remember’. They don’t like that rules are actually being imposed. It’s also one of the reasons why I personally cannot see a place for them doing anything but simple ward jobs, if it is creating further work for me and simultaneously being falsely likened to my own role… just without the training, effort or educational pursuit.
A good analogy I'm finding some success with is that people were driving cars on roads for years before speed limits came in. The people that were driving 100mph before that happened weren't still allowed to do it after the limits appeared - just because something was happening uncontested/unchallenged for a long time doesn't mean it was ever safe, or the right thing to do.
as someone who wants to apply for the PA programme I completely agree. I wanted to do medicine but now dont have the energy for another 4 years but still want a job in healthcare with a good pay as soon as i graduate, but i know its not the same as becoming a doctor.
I think that's an interesting piece of the puzzle too - the PA role is (relatively) very well paid within the NHS as straight to Band 7 (or after a preceptorship potentially). Few roles that will do that in such a short time period.
@@OllieBurtonMed There's not much progression in career for PA, when they graduate that's that i guess, they are trained already for that role. Maybe different for GP or hospital I don't know, but that's why the pay starts at band7, I don't think it gets any higher than that. The pay can be compared to like pharmacists. They start off good too.
@@sarrrrr318 The problem with that logic is that it can't be used to justify a higher starting salary - otherwise across the NHS, whoever has the least career progression would need to be paid the most, which we don't do. It also makes some troubling assumptions that other people *will* move up the bands, when we objectively know that many won't - look at proportion of nurses that are Band 5 for example. Pharmacists are a 6 I think after 4 years for the MPharm.
@@OllieBurtonMedI agree with that too. But for a student like myself who is doing a life science, to do a 2 years masters, and get that salary looks very good, especially from the background I come from. But with that I still acknowledge and will always advocate for better pay for nurses and doctors. I don't really know why they start at band 7, I thought that could be a reason.
@@sarrrrr318 Oh absolutely, that's the thing - on paper, it's a good salary for the training and I don't blame anyone for doing it at all. Sometimes that argument has been floated about there being no progression, but it's sort of died the death a bit now because it was seen to be nonsensical. I think it just more or less has to be a 7 because it requires the MSc/PgDip, it's more of a foible of how AfC pay scales value certain types of work. This is what's causing some problems now with the talk around scope of practice.
Hi Ollie, practising PA here. Completely agree with your discussion. I'd like to bring home the point that "practicing at registrar level" is total nonsense although in my personal experience I've never heard one of my PA peers talking like that. There may be situations where PAs have a lot of experience and may be able to teach the more junior resident doctors and be the contuinity that was originally promised so the doctors can go to doctor specific training/get procedures signed off but PAs shouldn't be on reg rota and are not replacements. There wouldn't be a role for PAs if 15 years ago the government put their money where there mouth is and increased number of med school places. Plus more investment in public health policy for prevention, but that's a whole conversation on its own. Best wishes, and please maintain the civil discussion it's very much appreciated.
Thanks for your considered comment, appreciate the time. I hope things are OK on the ground at the moment - have sadly heard of some PAs being made redundant in response which was not the outcome I wanted to see.
@@OllieBurtonMed Sadly I have seen that in my local area. Amongst the vitriol from both sides we have to remember - of course patient safety is paramount but - behind this Dr/PA discussion there are professionals who have invested 3 years of undergraduate studies, and 2 years postgrad education being made redundant or at risk of redundancy who have families to provide for. People are made redundant all the time but after tens of thousands of debt it's a heavy blow for sure. I do keep in mind that in some areas doctors are struggling to get jobs, though I hope the ARRS for GPs will be expanded (though I know some practices find this an encroachment of what little independence they have as it is). I hope the break away from your planned trajectory is going well.
For me it's just regulation and undefined scope. I've seen 1st hand how PAs work exactly how they were sold and it works brilliantly. I also had a placement where the PA was doing the ward rounds and running the show. I will never be one of those people who say a PA will know less than a Dr. When I graduate next year, obviously any PA who has been on a ward for years will know more than me but it will be hard pill to swallow knowing that a PA who has graduated at the same time as me, will be paid more, work less hours, have less responsibility and accountability. My biggest fear is being told to prescribe for them. Again, I'm not saying they're wrong, especially an experienced PA but the step up in responsibility will create a lot of pressure when I first start working and blindly prescribing scares me as it is ultimately my license on the line should it go wrong. If there was something i place whereby the consultant on the ward took responsibility for them than that would put my mind at ease but I know it'll just be a matter of my rotations as to how they're utilised. Should I be reviewing every patient they see to ensure what I'm being told to prescribe? Yes. In reality that just doesn't happen. Mr friend who graduated last year, on her first rotation the consultant told them to prescribe for the PAs. The PAs are obviously experienced but my friend was unstandably concerned about blindly prescribing and I will be too should I be put in the same situation
Blind prescribing is never acceptable under any circumstances. If consultant is insisting, needs flagging to your CS/ES and guardian of safe working, and you keep escalating from there, up to and including clinical director. This sort of behaviour doesn't survive under scrutiny. And importantly to flag 'any PA who has been on a ward for years will know more than me' - this is not self-evidently true. Your general medical knowledge should be better, because that's your job, you have deeper and broader training. What I mean to say is that do not blindly accept the judgement of your PA colleague without thinking for yourself, because they will have blind spots just like you do, and they are *more* likely to have them because of the nature of the training. Think for yourself.
I feel we should look at pre hospital and the associate ambulance practitioner role where to my impression they replace a paramedic in a place where there would traditionally be two. I.e you don’t need two independent practitioners one one will always be driving and always in a pair This may be able to be used in medicine for role where there would normally be two doctors for example some surgery’s where you would have a surgeon and an assistant Unfortunately I do not know enough about all the different roles doctors have to give more examples but I’m sure you get the gist of what I’m saying
@@OllieBurtonMednah that’s not how associate ambulance practitioners work. They are way of increasing training for paramedics upon clarification. An aap is basically an advanced emergency medical technician. It’s an apprenticeship then after 3-4 years experience they are then eligible to go for a paramedic practitioner apprenticeship and then after a further 2 years training they can then qualify as prescribers. AAP’s get more training and advanced emergency medical technicians work experience than university graduates do. It’s a skill based way of increasing the training programmes as they have longer training than university graduates of emergency medical technicians/AAP’s or university trained paramedics. The training programmes for aap/advanced emergency medical technicians to paramedics practitioner apprenticeship is actually more in depth and requires more training than those that study the degrees. The degrees are 3-4 years they apprenticeships are 4-7 years training and they have a higher skill base upon completion than traditional university trained paramedics.
Just so I understand, is AAP its own thing or is it part of a 'pathway' to being a paramedic? It looks from a quick google that it's intended almost as another way in to becoming a Band 6 Paramedic than the university route, is that correct?
@@OllieBurtonMed Yes, AAP is an entry route to become a Paramedic. Then upon completion of the training you have eligibility to apply for a technician role, then again once completion etc, the Paramedic degree apprenticeship becomes available and you therefore start your training as a newly qualified paramedic.
@@OllieBurtonMedthe best way I’ve heard it been described is our version of the American EMT In the uk depending on the service they are called AAPs or EMTs and some others It can be used as an entry route to a paramedic science degree many unis will cut the first year of the degree for already qualified AAPs but they are there own dependent practitioners a lot of ambulance services are running most there ambulances with a teem of a paramedic and AAP
There's some interesting stuff behind that, and a lot of it depends on your perspective. HCPC originally tabled as the most appropriate regulator I believe - unfortunately deemed to be a bit of a failing regulator. GMC I understand stepped up afterwards, and this represents a significant power grab for them. GMC also potentially vulnerable as a single-profession regulator if there were ever to be shakeups. Personally my suspicion is this is about consolidation (power,money,stability) from the GMC rather than anything especially to do with PAs or AAs. The other side is the optics though. We know that DHSC were very onboard with the name change from Assistant to Associate because it would help with regulation (that was DHSC advice). PR is therefore much better for the public if PAs/AAs attached to the 'medical' regulator because of the association to doctors, who are held in esteem generally among the public. The success of the project/role relies on the public being accepting of the role that PAs/AAs play/carry out. So basically my answer (honestly held opinion) is that the regulation of PAs/AAs by the GMC has very little to do with 'appropriateness' or otherwise of the regulator, and is instead basically all politics and spin. I think this is supported by the fact that the GMC are doing very little actual 'regulating', more 'registering' - which they've done despite acknowledging reputational risk to themselves by grandfathering in the previously unaccredited/unregulated courses.
Hey, I want to know your opinion as to why there seems to be a conflict with doctors and physician associates specifically and not other healthcare professions such as physiotherapists, optometrists, pharmacists ect... Because don't they play a similar role to PAs?
This is a very interesting question, and is at the heart of this debate/discussion. Part of this comes because of the 'medical model' phrasing that gets bandied about, and people being told that they're studying/working in 'medicine' specifically, at least that's my perception. There is (wrongly) a relatively larger proportion of people within that subgroup (UK PAs) specifically who seem to want to do effectively what a doctor does, but without the extent of training, rotation, responsibility etc - and equally, some people have sold them this. That may be related to the fact that approx 50-60% of UK PAs are thought to have applied to medical school at least once prior, but it may not be. In the US for example this line is much more clearly drawn and there seems less overlap at this stage. Other professions tend to overlap/encroach on territory a bit more through the guise of 'advanced practice', which is another highly nebulous concept but crucially it's not called 'medicine'. An ACP for example isn't going to tell people they study or practice medicine - it's instead 'advanced practice of nursing' or whatever. So butting heads is a bit less direct. The other challenge is time/embedding. Advanced nurse practitioners, ACPs etc have been around a lot longer. Emergency departments up and down the country are dependent on them to run. So although inappropriate substitution definitely does happen with these other roles, consultants are very rarely willing to see/discuss it, because it would cause them massive problems if that curtain was pulled down. I do hold the position that PAs and AAs are unfairly being targeted as the only examples of scope creep, when actually it has happened everywhere. But other roles - it's too challenging a discussion for many people to want to have at all, so they don't. All of this can be summarised with 1) PAs and AAs (more so than other roles) were specifically brought in to the UK to displace doctor labour and thus reduce locum spend. The motives aren't exactly the same as in the US where the model comes from. 2) While other roles are also used to substitute doctor labour, this tends to come from an extension of their existing role which was something else, and then extends into that territory once enabled by consultants to do so.
They arent simular at all since they do not do doctors jobs and have a clear scope of practise with regulation I am a PA myself and disappointed with the complete lack of guidance or teaching once I began working.The hospital didnt have a clue what to do with me despite their generic job descpription.
Unfortunately we have evidence from more than 100 trusts where PAs are on medical rotas - that's pretty straightforward role substition. I'm sure we can agree that's not appropriate and needs to be stopped. PAs do not have a defined scope of practice in the UK at the moment and won't do even after regulation - hence the legal case that's being brought at the moment against the GMC.
@OllieBurtonMed thats the trusts fault not the PA as a role.The scope of pracrise isnt defined outside of no prescribing or ordering ionising radation for now but those need to be removed after regulation to fully realise potential in patient care.That allows them do everything an SHO would do but not independantly and they will never make critical clinical decsions.This is the scope in holland, US and African nations and theres no massacre of patients going on.
@@scarred10 I think we disagree there, as it's definitely not appropriate that someone with significantly less training than an SHO would do the same things as an SHO - I don't see how that can be objectionable. That's exactly what we're trying to prevent - especially since as you say there's lack of independence, that risk has to go somewhere. We're arguing that it should go to the supervising consultant only, and not the nearest resident doctor.
This video is still a blow on PAs. You said you believe all professionals should be valued but then go on to say PAs have no role in the NHS either. Doctors alone aren’t filling gaps. It would’ve been nice for you to address the excellent contributions PAs make, and not belittle their role especially amidst the negative media campaign against them.
Are you able to give me the timestamp in the video where I said PAs have no role please, or indeed belittled the role? I do not remember saying these things. I think our jobs are to do different things.
@@OllieBurtonMedfrom 7:10 onwards you mentioned how the course has no regulated postgraduate training nor do you think there is necessarily a place for that training. You did not mention how in a couple months time it will be regulated by the GMC. You also called them ‘doctor-alikes’. PAs aren’t trying to mimic doctors. I think it is important for you as a doctor with a public platform to help de-bunk that narrative to the public so that all healthcare professionals can work in harmony.
OK I see, thanks for sending. To be clear, there is not any regulated postgraduate training now, nor does there appear to be any even with the advent of GMC regulation for PAs (and AAs) - as remember what the GMC is functionally doing is registering, not regulating PAs as they're refusing to say anything about scope of practice. This is what the AU/BMA/Chesterton legal case is about that's just been sent to the High Court. Also going to push back on the 'no role' thing - that's not what I said. I said there wasn't a place, as far as I can see it, for that postgrad training developing - I still think there is a place and a role for PAs, but it doesn't involve ongoing training. NHS officials, course leads, whoever should not have sold that vision to people because there's never been a model for that in place. I do think (and have argued this before in a published essay, so very happy to commit to paper) that PAs will want/need some sort of marker that they belong to a specialty, which might take the form of a PgCert/Diploma or something much in the way that a CNS (specialist nurse) would progress. But *regulated* postgraduate training is relatively very rare, and I don't know what the NHS would functionally be gaining by developing that for PAs or putting them through it - what is the goal? What would someone be trying to achieve by doing that? What would they be able to do after that training that someone can't do before it? Doctors have regulated postgrad training, have a much deeper education when they start that, and the govt isn't willing to put enough people through it - there are massive bottlenecks in postgrad training. To introduce new regulated postgrad training for PAs specifically and not other roles (nurses, paramedics etc that have been around significantly longer) I suspect would only lead to more infighting. That is what I mean when I'm talking about doctor-alikes, if you developed that kind of training for PAs then you would be essentially producing a 'doctor-alike', I didn't say PAs are doctor'-alikes now. Although this is why scope discussions become so important, and the scopes being set at the national scale become relevant.
"Doctors alone aren't filling gaps" This is because there are not enough doctors, and there aren't enough training spots. The solution is not to create a new profession with less than half the training.
I agree with all you’ve said Ollie. I think a big issue here are the universities. They inflate the expectations of the PA role (weve all seen the “become a specialist” adverts) which is because their main priority is attract tuition fees, not service provide for the NHS. That proximal expectation grows, and I don’t get the feeling many can embrace the relatively “superficial” training. The equivalency of time served without a clear training programme at postgraduate level is also a key conflation I’ve seen - I worry employers are falling into this as well.
Random but that vest is working for Dr. Ollie. He may challenge Dr. Gill's status as the most vest wearing UA-cam doctor in the UK.
One of the things which is quite deeply rooted in medical students is knowing there's alot you don't know. Lack of insight into your own limitations is actually quite a dangerous thing for any health care professional. And this is my worry about the attitude .I would be very worried about anyone working with a certain mindset of competition and lack of insight into their own boundaries, they are very dangerous for patient safety as well as to supervise as they will not be coming to you for things they ought to
This is good practice for everyone as we move forward. When you're working as a doctor, you realise the further you move forward how frighteningly little you know, and this only gets worse with time. In this context, people (doctors, PAs, whomever) with less training/knowledge/experience need to have a safe, consistent way of escalating for help/advice and feel comfortable to do so.
@OllieBurtonMed when patient safety is concerned being comfortable asking shouldn't really come into the decision making tbh..you do it regardless, we've all had to look stupid asking questions but we are there to learn even as consultants
The 2 yrs is actually almost 3 yrs of medical school term time since there are no summer breaks in PA sshool .
@@OllieBurtonMedwhat is this videos point that isnt obvious already.Im a PA in ireland following this UK nonsense since the recent onslaught.Nobody in medicine Ive come across has ever claimed a PA is comparable to a doctor or the education equivalent.This is just repetition of the obvious.However, on a practical clinical level in wards and gen med clinics there is no observable difference in knowledge between a 2 yr PA grad and most SHOs ive met.I base that on the bedside teaching by consultants and their feedback on our performance in both hospitals ive worked in.I do agree that PA school do not cover Pathology or the basic med sciences as seperate subjects so their knowledge is not as deep or broad as a doctor.However, that would only be a concern if PAs were senior doctor replacements which is not a PA.Personally Ive seen some god awful junior docs who can barely speak English but I wont generalise about them like many docs have about PAs on social media.
@@scarred10 The point is to explore the tensions and the differences in the training, based on the social media post from a PA I referenced at the beginning.
'on a practical clinical level in wards and gen med clinics there is no observable difference in knowledge between a 2 yr PA grad and most SHOs ive met' - this is your experience, and is a valid opinion you can hold. It does not match my experience, and that's OK. But this is all anecdote and isn't useful to us in any meaningful way.
The major thing I'm interested in is scope of practice and what that will look like.
No, I think this is a good take, it’s doing nothing more than just reiterating the point that PA and Doctor training is different (not a bad thing!) and therefore the different roles and expectations associated with them are different! It’s just drawing attention back to the fact that these roles seem to be being conflated as “equivalent” in one manner or another by employers, by universities etc and reminding people that these are different roles with different expectations and therefore different requisite training and practical ability.
Hi, Ollie! I largely agree with everything that you have said here. As a current ICU RN (in the US) who contemplated going to PA school but has now opted to go to medical school, I have spent an incredible amount of time with attending physicians, residents, mid levels, and of course other nurses. There is clearly a space for each one of these individuals on the healthcare team, and each role should be respected for the value and training that it brings. That being said, I, like you, believe that there is no substitute for the comprehensive training built into physician education, and no profession (be it nurse practitioners or PAs) should attempt to equate their training with that of a physician.
One of the important problems that I see, though, is a general belief within the medical hierarchy that one has nothing to learn from those that are “beneath” him or her. Experienced nurses feel they have nothing to learn from novice nurses. Midlevels believe they have nothing to learn from the nursing staff. Residents believe they have nothing to learn from the midlevels. Fellows believe that the attending is can be their only source of training. And attendings believe they can only learn from other attendings who are more well-published than they are. (This, of course, is an incredibly broad generalization and is likely an unfair analysis for many…so my apologies to those individuals, but the general analysis remains).
The PA profession in the US is notably more well developed than in the UK (so I speak through that lens), but there is a SUBSTANTIAL amount of information that resident physicians can learn from an experienced NP/PA about the PRACTICE of CLINICAL medicine. As the saying goes, patients don’t read the textbook. And because patients don’t read the textbook, early trainees (especially) should see experienced midlevel practitioners as an invaluable resource. Having more knowledge or training on a fundamental level should not preclude someone from feeling as though they can learn from someone with a more narrow scope of practice.
I will strongly maintain that NPs, PAs, CRNA, AAs, CNMs, etc should operate under supervised practice. I have no problem arguing on behalf of my physician counterparts with respect to that point. I will say, however, that physicians are woefully undereducated on the knowledge and training process of other healthcare providers. In my experience, physicians have no earthly idea how much RNs, RTs, PT/OT/Speech, NPs, PAs, CRNA, etc. are expected to know and be able to do at the end of their training. Maybe if we all took some time to assess where we are on the Dunning-Kruger curve, this would be a significantly more productive conversation.
Thanks so much for your feedback - it's really appreciated, thanks for giving it the time.
You're right about the learning - absolutely in agreement that anyone can learn something from anyone, no matter who they are. It's a much more fluid dynamic and we should all be able to understand and appreciate that that learning process happens, and that's likely a more 'experiential' form of learning.
Re third paragraph - agree. It may interest you to know that in the UK, PAs aren't considered to study or practise medicine by its legal definition. This is the position of the GMC (medical regulator) who have clarified this, so there's an interesting difference there. The other flipside of this (and where I've seen danger happen) is that this experiential learning tends to come from pattern-recognition rather than true understanding/textbook knowledge. This can obviously then lead to inadequate or inappropriate treatment when the situation doesn't follow what the more experienced person is expecting - and I would further add to that that experience does not *necessarily* mean learning. If someone does the same year over and over for 10 years, they might not meaningfully learn much, but people can wrongly then start to think of that subject/field as 'easy' - when they don't actually have the skills/knowledge to understand what's happening. We need to find the harmony between these two states I think, as both have innate value.
And re knowledge of other professions' education, no issues there - agree. I'm sure that line can be drawn between all professions, as none of us really knows what the others are doing at any given time.
@@OllieBurtonMed Wow. What an excellent reply. Thanks for responding. Again, I largely agree. I’ll just add this point for thoroughness sake. I believe that physicians are shooting themselves in the foot with the “pattern recognition” line of argumentation. This is the charge that is largely thrown at nurse practitioners here in the States, but I believe the argument largely undercuts the true interests of the physician. Allow me to explain.
The thing that makes physician education so unique is its maximally in-depth didactic education PAIRED WITH an extremely well-developed, keen sense of pattern recognition. I’d be curious to know how many times one of your senior registrars or consultants (I really should do more to understand the English medical hierarchy but I get the sense that those two are the equivalent to the “attending” role) have diagnosed something that doesn’t come through often and they turn to the team and say “You won’t find this in the textbook, BUT…” What he or she is leaning on there is an extraordinarily refined sense of pattern recognition. That keen sense is why they are in charge. It’s not the bread and butter stuff that makes physicians special. NPs/PAs are genuinely well positioned to care for the bread and butter stuff. We need doctors because of the unicorn cases. The problem, though, is that when an undifferentiated patient shows up in the ED (A&E), no one actually knows whether or not they are a bread and butter case or a unicorn case. It’s the highly refined pattern recognition of the physician that we lean on there. That “what makes this case different” skill comes only after having really gotten into the weeds of the textbook AND after having seen THOUSANDS of patients during training.
You made an excellent point in the video about the STRUCTURE of physician training. Taken together with your reply above, I see that training as meant to ensure that the physician isn’t doing the same thing year over year for 10 years but not actually learning anything meaningful. Another commenter explained that either all those years are necessary to do the job of medicine or they’re not. I wish to pair the few ideas together to make what I think is a stronger argument for the quality of physician education. The reason medical eduction is so long and tedious with crazy hours as a trainee is because in order to be at the top of medicine, you need the wealth of didactic knowledge PAIRED with thousands and thousands of hours building the skill of pattern recognition under the STRUCTURED supervision of other physicians who have been developing their pattern recognition skills for decades.
When an NP/PA makes a diagnostic error that a physician would not have made, the underlying reason all comes down to this: they did not understand how one pattern is different from another pattern, how one constellation of symptoms differs from another. They had an underdeveloped pattern recognition muscle. To strengthen that muscle, they would need a more in-depth physiological understand AND to see the different constellations in a structured training program that calls upon others to guarantee that they understand how “this” is different from “that.”
To support this, there is some data to suggest that midlevel providers order more diagnostic tests (increasing the overall cost of healthcare delivery) to reach a diagnosis even if that diagnosis is the same one that a physician would have ultimately come to. Why is this one might ask? It’s because the physician has a much stronger sense of pattern recognition. Because they have seen the same thing SOOOO many times in such a structured way, they simply don’t need as much information to reach the same conclusion.
Doctors really should lean into the notion of pattern recognition. It does a lot more to validate the necessity of their long, intense training as opposed to arguing that midlevels rely too much on pattern recognition. Just my thoughts. Would love to here what you think.
Much shorter response only to say I agree - it's more pattern recognition *alone* based on experience that has led to some arguments I've had with nursing colleagues. If I asked for something to be done, I might get pushback because 'we normally do XYZ' or 'last time someone had that condition, we did Y'. What should then happen is obviously a collegiate discussion about the nuances and each of our perspectives. But instead what happened is my position being dismissed because of how 'junior' a doctor I was - despite the fact that I was right. There wasn't any acknowledgement that my textbook knowledge was probably better - although hand on heart, equally at the time I did not process well why they were being as dismissive as they were, which might be more to do with risk aversion.
I’m on a GEM course with PAs who still complain that their already illegitimate roles and authority has been revoked, following the magnifying glass over scope of PAs. They genuinely believe they are due this as a right, that they’ve earned it, by spending time on the ward. No thought about safety, about liability, it’s a selfish stance and this is the distinguishing factor between doctors and PAs - ultimately, they are irresponsible.
I don’t think it’s fair to come for their pay, as many do, after all, what about all the other very questionable roles - cardiac physiologists on band 7? Non doctor roles are welcome in the NHS, though likening it to the role of a doctor was problematic.
We must also question the relevance of such long, intensive training if we deem it not necessary to practice safely. It’s either needed and so in use, or outdated and should be reconsidered.
We are trying to stamp out elitism here in the UK, but doing so have gone way past the threshold. We’ve no respect left for the role at all, to the demise of patient safety
The important thing for everyone to try to discuss and understand is why people feel this way, if they do. What were they sold at the start? Who was saying what about the role was intended for, or where it might be going? Deeply understandable if say a course lead was saying things from the beginning, and it later turns out not to be based on anything concrete.
@@OllieBurtonMed from speaking to my medical student peers who moonlight as PAs, it’s communicated to themselves on assumption that they have gotten away with it so long unquestioned, it seems crazy to take that away. Consultants have been happy to pass the buck and let F1s(!!!!!!) sign off prescriptions without reassessing the patient themselves, because let’s be honest, who wants the extra workload. It is only now that these same juniors - or residents, rather, are refusing to just sign off the prescription based off of solely the PA. It is this that they tend to contest to.
It is not an excuse to continue doing something wrong if when asked why, your main reason is ‘I’ve been doing it since as far as I can remember’. They don’t like that rules are actually being imposed. It’s also one of the reasons why I personally cannot see a place for them doing anything but simple ward jobs, if it is creating further work for me and simultaneously being falsely likened to my own role… just without the training, effort or educational pursuit.
A good analogy I'm finding some success with is that people were driving cars on roads for years before speed limits came in. The people that were driving 100mph before that happened weren't still allowed to do it after the limits appeared - just because something was happening uncontested/unchallenged for a long time doesn't mean it was ever safe, or the right thing to do.
Very nice tie Ollie!
Grateful BAOMS has made a clear statement about not having any need for PAs now or in the future!
as someone who wants to apply for the PA programme I completely agree. I wanted to do medicine but now dont have the energy for another 4 years but still want a job in healthcare with a good pay as soon as i graduate, but i know its not the same as becoming a doctor.
I think that's an interesting piece of the puzzle too - the PA role is (relatively) very well paid within the NHS as straight to Band 7 (or after a preceptorship potentially). Few roles that will do that in such a short time period.
@@OllieBurtonMed There's not much progression in career for PA, when they graduate that's that i guess, they are trained already for that role. Maybe different for GP or hospital I don't know, but that's why the pay starts at band7, I don't think it gets any higher than that. The pay can be compared to like pharmacists. They start off good too.
@@sarrrrr318 The problem with that logic is that it can't be used to justify a higher starting salary - otherwise across the NHS, whoever has the least career progression would need to be paid the most, which we don't do. It also makes some troubling assumptions that other people *will* move up the bands, when we objectively know that many won't - look at proportion of nurses that are Band 5 for example.
Pharmacists are a 6 I think after 4 years for the MPharm.
@@OllieBurtonMedI agree with that too. But for a student like myself who is doing a life science, to do a 2 years masters, and get that salary looks very good, especially from the background I come from. But with that I still acknowledge and will always advocate for better pay for nurses and doctors. I don't really know why they start at band 7, I thought that could be a reason.
@@sarrrrr318 Oh absolutely, that's the thing - on paper, it's a good salary for the training and I don't blame anyone for doing it at all.
Sometimes that argument has been floated about there being no progression, but it's sort of died the death a bit now because it was seen to be nonsensical.
I think it just more or less has to be a 7 because it requires the MSc/PgDip, it's more of a foible of how AfC pay scales value certain types of work. This is what's causing some problems now with the talk around scope of practice.
Hi Ollie, practising PA here. Completely agree with your discussion. I'd like to bring home the point that "practicing at registrar level" is total nonsense although in my personal experience I've never heard one of my PA peers talking like that. There may be situations where PAs have a lot of experience and may be able to teach the more junior resident doctors and be the contuinity that was originally promised so the doctors can go to doctor specific training/get procedures signed off but PAs shouldn't be on reg rota and are not replacements. There wouldn't be a role for PAs if 15 years ago the government put their money where there mouth is and increased number of med school places. Plus more investment in public health policy for prevention, but that's a whole conversation on its own. Best wishes, and please maintain the civil discussion it's very much appreciated.
Thanks for your considered comment, appreciate the time. I hope things are OK on the ground at the moment - have sadly heard of some PAs being made redundant in response which was not the outcome I wanted to see.
@@OllieBurtonMed Sadly I have seen that in my local area. Amongst the vitriol from both sides we have to remember - of course patient safety is paramount but - behind this Dr/PA discussion there are professionals who have invested 3 years of undergraduate studies, and 2 years postgrad education being made redundant or at risk of redundancy who have families to provide for. People are made redundant all the time but after tens of thousands of debt it's a heavy blow for sure. I do keep in mind that in some areas doctors are struggling to get jobs, though I hope the ARRS for GPs will be expanded (though I know some practices find this an encroachment of what little independence they have as it is). I hope the break away from your planned trajectory is going well.
For me it's just regulation and undefined scope. I've seen 1st hand how PAs work exactly how they were sold and it works brilliantly. I also had a placement where the PA was doing the ward rounds and running the show.
I will never be one of those people who say a PA will know less than a Dr. When I graduate next year, obviously any PA who has been on a ward for years will know more than me but it will be hard pill to swallow knowing that a PA who has graduated at the same time as me, will be paid more, work less hours, have less responsibility and accountability.
My biggest fear is being told to prescribe for them. Again, I'm not saying they're wrong, especially an experienced PA but the step up in responsibility will create a lot of pressure when I first start working and blindly prescribing scares me as it is ultimately my license on the line should it go wrong. If there was something i place whereby the consultant on the ward took responsibility for them than that would put my mind at ease but I know it'll just be a matter of my rotations as to how they're utilised. Should I be reviewing every patient they see to ensure what I'm being told to prescribe? Yes. In reality that just doesn't happen.
Mr friend who graduated last year, on her first rotation the consultant told them to prescribe for the PAs. The PAs are obviously experienced but my friend was unstandably concerned about blindly prescribing and I will be too should I be put in the same situation
Blind prescribing is never acceptable under any circumstances. If consultant is insisting, needs flagging to your CS/ES and guardian of safe working, and you keep escalating from there, up to and including clinical director. This sort of behaviour doesn't survive under scrutiny.
And importantly to flag 'any PA who has been on a ward for years will know more than me' - this is not self-evidently true. Your general medical knowledge should be better, because that's your job, you have deeper and broader training. What I mean to say is that do not blindly accept the judgement of your PA colleague without thinking for yourself, because they will have blind spots just like you do, and they are *more* likely to have them because of the nature of the training. Think for yourself.
@@OllieBurtonMed thank you for getting back to me. I’ll let them know
I feel we should look at pre hospital and the associate ambulance practitioner role where to my impression they replace a paramedic in a place where there would traditionally be two. I.e you don’t need two independent practitioners one one will always be driving and always in a pair
This may be able to be used in medicine for role where there would normally be two doctors for example some surgery’s where you would have a surgeon and an assistant
Unfortunately I do not know enough about all the different roles doctors have to give more examples but I’m sure you get the gist of what I’m saying
For sure, I get what you're saying - thanks for your input
@@OllieBurtonMednah that’s not how associate ambulance practitioners work. They are way of increasing training for paramedics upon clarification. An aap is basically an advanced emergency medical technician. It’s an apprenticeship then after 3-4 years experience they are then eligible to go for a paramedic practitioner apprenticeship and then after a further 2 years training they can then qualify as prescribers. AAP’s get more training and advanced emergency medical technicians work experience than university graduates do. It’s a skill based way of increasing the training programmes as they have longer training than university graduates of emergency medical technicians/AAP’s or university trained paramedics. The training programmes for aap/advanced emergency medical technicians to paramedics practitioner apprenticeship is actually more in depth and requires more training than those that study the degrees. The degrees are 3-4 years they apprenticeships are 4-7 years training and they have a higher skill base upon completion than traditional university trained paramedics.
Just so I understand, is AAP its own thing or is it part of a 'pathway' to being a paramedic? It looks from a quick google that it's intended almost as another way in to becoming a Band 6 Paramedic than the university route, is that correct?
@@OllieBurtonMed Yes, AAP is an entry route to become a Paramedic. Then upon completion of the training you have eligibility to apply for a technician role, then again once completion etc, the Paramedic degree apprenticeship becomes available and you therefore start your training as a newly qualified paramedic.
@@OllieBurtonMedthe best way I’ve heard it been described is our version of the American EMT
In the uk depending on the service they are called AAPs or EMTs and some others
It can be used as an entry route to a paramedic science degree many unis will cut the first year of the degree for already qualified AAPs but they are there own dependent practitioners a lot of ambulance services are running most there ambulances with a teem of a paramedic and AAP
How do you feel about the governing body for PA’s will be GMC?
There's some interesting stuff behind that, and a lot of it depends on your perspective.
HCPC originally tabled as the most appropriate regulator I believe - unfortunately deemed to be a bit of a failing regulator. GMC I understand stepped up afterwards, and this represents a significant power grab for them. GMC also potentially vulnerable as a single-profession regulator if there were ever to be shakeups. Personally my suspicion is this is about consolidation (power,money,stability) from the GMC rather than anything especially to do with PAs or AAs.
The other side is the optics though. We know that DHSC were very onboard with the name change from Assistant to Associate because it would help with regulation (that was DHSC advice). PR is therefore much better for the public if PAs/AAs attached to the 'medical' regulator because of the association to doctors, who are held in esteem generally among the public. The success of the project/role relies on the public being accepting of the role that PAs/AAs play/carry out.
So basically my answer (honestly held opinion) is that the regulation of PAs/AAs by the GMC has very little to do with 'appropriateness' or otherwise of the regulator, and is instead basically all politics and spin. I think this is supported by the fact that the GMC are doing very little actual 'regulating', more 'registering' - which they've done despite acknowledging reputational risk to themselves by grandfathering in the previously unaccredited/unregulated courses.
Hey, I want to know your opinion as to why there seems to be a conflict with doctors and physician associates specifically and not other healthcare professions such as physiotherapists, optometrists, pharmacists ect... Because don't they play a similar role to PAs?
This is a very interesting question, and is at the heart of this debate/discussion.
Part of this comes because of the 'medical model' phrasing that gets bandied about, and people being told that they're studying/working in 'medicine' specifically, at least that's my perception. There is (wrongly) a relatively larger proportion of people within that subgroup (UK PAs) specifically who seem to want to do effectively what a doctor does, but without the extent of training, rotation, responsibility etc - and equally, some people have sold them this. That may be related to the fact that approx 50-60% of UK PAs are thought to have applied to medical school at least once prior, but it may not be. In the US for example this line is much more clearly drawn and there seems less overlap at this stage.
Other professions tend to overlap/encroach on territory a bit more through the guise of 'advanced practice', which is another highly nebulous concept but crucially it's not called 'medicine'. An ACP for example isn't going to tell people they study or practice medicine - it's instead 'advanced practice of nursing' or whatever. So butting heads is a bit less direct.
The other challenge is time/embedding. Advanced nurse practitioners, ACPs etc have been around a lot longer. Emergency departments up and down the country are dependent on them to run. So although inappropriate substitution definitely does happen with these other roles, consultants are very rarely willing to see/discuss it, because it would cause them massive problems if that curtain was pulled down. I do hold the position that PAs and AAs are unfairly being targeted as the only examples of scope creep, when actually it has happened everywhere. But other roles - it's too challenging a discussion for many people to want to have at all, so they don't.
All of this can be summarised with
1) PAs and AAs (more so than other roles) were specifically brought in to the UK to displace doctor labour and thus reduce locum spend. The motives aren't exactly the same as in the US where the model comes from.
2) While other roles are also used to substitute doctor labour, this tends to come from an extension of their existing role which was something else, and then extends into that territory once enabled by consultants to do so.
They arent simular at all since they do not do doctors jobs and have a clear scope of practise with regulation I am a PA myself and disappointed with the complete lack of guidance or teaching once I began working.The hospital didnt have a clue what to do with me despite their generic job descpription.
Unfortunately we have evidence from more than 100 trusts where PAs are on medical rotas - that's pretty straightforward role substition. I'm sure we can agree that's not appropriate and needs to be stopped. PAs do not have a defined scope of practice in the UK at the moment and won't do even after regulation - hence the legal case that's being brought at the moment against the GMC.
@OllieBurtonMed thats the trusts fault not the PA as a role.The scope of pracrise isnt defined outside of no prescribing or ordering ionising radation for now but those need to be removed after regulation to fully realise potential in patient care.That allows them do everything an SHO would do but not independantly and they will never make critical clinical decsions.This is the scope in holland, US and African nations and theres no massacre of patients going on.
@@scarred10 I think we disagree there, as it's definitely not appropriate that someone with significantly less training than an SHO would do the same things as an SHO - I don't see how that can be objectionable. That's exactly what we're trying to prevent - especially since as you say there's lack of independence, that risk has to go somewhere. We're arguing that it should go to the supervising consultant only, and not the nearest resident doctor.
This video is still a blow on PAs. You said you believe all professionals should be valued but then go on to say PAs have no role in the NHS either. Doctors alone aren’t filling gaps. It would’ve been nice for you to address the excellent contributions PAs make, and not belittle their role especially amidst the negative media campaign against them.
Are you able to give me the timestamp in the video where I said PAs have no role please, or indeed belittled the role? I do not remember saying these things. I think our jobs are to do different things.
@@OllieBurtonMedfrom 7:10 onwards you mentioned how the course has no regulated postgraduate training nor do you think there is necessarily a place for that training. You did not mention how in a couple months time it will be regulated by the GMC. You also called them ‘doctor-alikes’. PAs aren’t trying to mimic doctors. I think it is important for you as a doctor with a public platform to help de-bunk that narrative to the public so that all healthcare professionals can work in harmony.
OK I see, thanks for sending. To be clear, there is not any regulated postgraduate training now, nor does there appear to be any even with the advent of GMC regulation for PAs (and AAs) - as remember what the GMC is functionally doing is registering, not regulating PAs as they're refusing to say anything about scope of practice. This is what the AU/BMA/Chesterton legal case is about that's just been sent to the High Court. Also going to push back on the 'no role' thing - that's not what I said. I said there wasn't a place, as far as I can see it, for that postgrad training developing - I still think there is a place and a role for PAs, but it doesn't involve ongoing training. NHS officials, course leads, whoever should not have sold that vision to people because there's never been a model for that in place.
I do think (and have argued this before in a published essay, so very happy to commit to paper) that PAs will want/need some sort of marker that they belong to a specialty, which might take the form of a PgCert/Diploma or something much in the way that a CNS (specialist nurse) would progress. But *regulated* postgraduate training is relatively very rare, and I don't know what the NHS would functionally be gaining by developing that for PAs or putting them through it - what is the goal? What would someone be trying to achieve by doing that? What would they be able to do after that training that someone can't do before it? Doctors have regulated postgrad training, have a much deeper education when they start that, and the govt isn't willing to put enough people through it - there are massive bottlenecks in postgrad training. To introduce new regulated postgrad training for PAs specifically and not other roles (nurses, paramedics etc that have been around significantly longer) I suspect would only lead to more infighting.
That is what I mean when I'm talking about doctor-alikes, if you developed that kind of training for PAs then you would be essentially producing a 'doctor-alike', I didn't say PAs are doctor'-alikes now. Although this is why scope discussions become so important, and the scopes being set at the national scale become relevant.
@@HtbsjWhat exactly is the role of a PA?
"Doctors alone aren't filling gaps" This is because there are not enough doctors, and there aren't enough training spots. The solution is not to create a new profession with less than half the training.