Do Doctors Hate Physician Associates? | 2024 | Doctor Reacts
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- Опубліковано 24 чер 2024
- Today I'm talking about the debate surrounding physician associates (PAs) and junior doctors working in the NHS.
00:00 Intro
00:16 What are PAs?
01:41 How do you become a PA?
02:02 How do PAs work?
02:30 How are PAs and doctors different?
04:26 What are the pros of PAs?
07:30 What are the cons of PAs?
13:25 Why are doctors unhappy?
WHO AM I:
I’m Triya, I graduated from Oxford Medical School and I’m currently a junior doctor in London. I make videos about life in London, Oxford, medicine and more.
Links
Instagram | / triyaac
Twitter | / triyaac
#nhs #juniordoctor #physicianassociate #medicalschool #premed #medicalstudent #medschool #doctor #physicianassociate #physicianassistant
Suggested further reading:
Malone R. The role of the physician associate: an overview. Ir J Med Sci. 2022 Jun;191(3):1277-1283. doi: 10.1007/s11845-021-02661-9. Epub 2021 Aug 5. PMID: 34351601.
Halter M, Drennan V, Wang C, et alComparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomesBMJ Open 2020;10:e037557. doi: 10.1136/bmjopen-2020-037557
Glen E. The physician associate role remains poorly understood BMJ 2023; 382 :p1996 doi:10.1136/bmj.p1996
I can very clearly recall the headlines:
“UK doctors protest at extension to nurses' prescribing powers” in 2005
“BMA meeting: Doctors vote to limit the number of medical students” in 2008
The PA profession is safe, thriving, and expanding in so many countries, including the US, Canada, Netherlands, New Zealand, Republic of Ireland, India, Israel, Bulgaria, Myanmar, Switzerland, Liberia, Ghana, etc., but in the UK, "they're not safe." PAs are not good, but the thought of their existence keeps me awake at night because they are taking our jobs, training posts, and filling our rotas. The most striking aspect of this orchestrated, dreadful campaign and vile bullying of Physician Associates in the UK was how old-fashioned professional jealousy and protectionism, disguised as "patient safety concern," sparked intense hatred and bitterness towards a comparatively small workforce of less than 5,000 individuals. Isolating and attacking a whole group of healthcare professionals who are doing their best in this manner is disgraceful on many levels, to put it mildly, but the public is not foolish enough to understand that this revolting campaign has all the hallmarks of selfish ambition for PROTECTIONISM disguised as "patient safety concern."
The Physician Associate (PA) is: “a new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision.” (DOH, 2006).
Another country where this protectionism is in full play in 2024 is:
“South Korean doctors strike in protest of plans to add more physicians." “The junior doctors are protesting the government's plans to train more physicians." (BBC News, February 20, 2024). Ever heard of Tiny Island Syndrome?
References:
Cole A., (2008). BMA meeting: Doctors vote to limit number of medical students. BMJ. 337:a748
Day M., (2005). UK doctors protest at extension to nurses' prescribing powers. BMJ. 331(7526): 1159.
Department of Health. The competence and curriculum framework for physician assistants. London: Stationery Office; 2006. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4139317 (Accessed 30 May 2024)
I like the way you have included both sides of the argument - I think it is important to be respectful to both professions and the value they bring :)
Thank you, I agree! I'm glad you noticed, I really tried to be balanced
@@TriyaAnushka ❤
Im currently a student radiotherapist and i am interested in studying to be PA when I graduate and I'm not sure how to feel as I think it would be a good career for me, medicine is a very inaccessible career for many people, especially postgrduate study, if u arent rich its almost impossible to achieve. But i also don't want to go into a career where i am stigmatised and looked down on by my peers.
Then you no well to avoid the PA role😂
But the names shouldn't be the ones deciding if they are parallel to a qualified doctor. It's literally going to do more harm than good
Good point!
why is patient safety being flagged up time and time again. if you think about it PAs are discussing all their cases with reg / consultant and not making independent decision.
By your faulty logic, if you give a very junior FY1/FY2 an extremely complex to manage ON THEIR OWN without a senior input, the patient is safe and patient safety uncompromised by default just because they are doctors and they went to medical school? DONT MAKE ME LAUGH.
by your faulty logic, FY2 are baby doctors and even if they make a mistake its okay because they will LEARN as as they go along and with years will gather more knowledge and experience. but if a PA makes a mistake they are incomptent, they are unsafe and all the negative shit.
Can i point out what the biggest flaw in your logic is (and all the other doctor sharing your view) it is that you very ignorantly think PA's learning is capped at PA school whereas med students continue to learn and grow after med school and you are unable to comprehend the fact that PAs continue learn after PA school just like medical students.
also people thinking 3000 odd PAs taking away training opportunities from >300,000 doctors- gotta take the L.
What utter bollocks. First of all, there are numerous instances in primary and secondary care where it is known that PAs are working independently and therefore unsafely. Second, there are again many documented instances where PAs have been taking training opportunities away from doctors. Theatre lists, endoscopy lists etc. What is the point of a PA being scrubbed up and assisting? Zero long term benefit. There are plans to increase numbers of these unregulated and undefined roles. There are PA roles being advertised at registrar level. It's beggars belief you can compare a doctor who has completed 5 years of medical two, two years foundation training and completed speciality membership exams with a physician ASSISTANT. The role of a PA is to write down ward round notes, basic ward jobs, chase results. They are instead being used to replace doctors in an completely unsafe manner. I am advising everyone I know who has to see a health professional to ask, if they are seeing a doctor or a PA and make sure that they are seen by a doctor. I would trust a 4th year medical student more than PA when it comes to clinical judgement.
@@MrCheeseify1 here we go another disgruntled utterly ignorant medic affected by herd mentality.
lets address each points you have raised shall we.
"numerous instances in primary and secondary care where it is known that PAs are working independently and therefore unsafely".
whats the source? where is the evidence? social media? and by numerous, how many ? do yo have an acctual number or just what read on social media?
if PAs are working independently than those PAs are likely the ones who have been in the same GP practice for a long time >3-5yrs. they probably know the local demographic quite well. and their supervising GP / consultant trusts them as they have demonstrated that competency whilst closely working years under them. so what's wrong with that? why are you undermining experienced PAs? ??
"Second, there are again many documented instances where PAs have been taking training opportunities away from doctors. Theatre lists, endoscopy lists etc"
there are 3000 odd practicing PA in the entire country and about 350,000 doctors. the ratio is. like 1PA : 1000doctors.
ED is probably the only speciality that hires PAs in relatively high numbers, we're talking 7-8. other speciality like haem, neuro, cardio, derm probably hire 1 or 2 PAs at max. and you are telling taking some time to train a comparatively much much small workforce is taking away training opportunities??? make it make sense. again m8 you are not thinking clearly, in fact you are not using your brain at all.
there is national.
you gave example of endoscopy list. google it m8 search "national shortage of endoscopists" or "capacity crisis" and see that and slap your face before you sprout another BS without thinking and for being severely affected by herd mentality.
"There are plans to increase numbers of these unregulated and undefined roles."
GMC will regulate PAs and regulation will come. so that PAs can also be held accountatble for their own clinical practice so be reassured.
"It's beggars belief you can compare a doctor who has completed 5 years of medical two, two years foundation training and completed speciality membership exams with a physician ASSISTANT." so you went to medical school. So fucking what? In this day and age of internet, digital media advanced technology, where knowledge and knowledgeable teachers are available everywhere on a touch of a finger tip why is your thinking still stuck and unevolved? why do you think that learning only happens in 4 walls of some elite institution? when PAs and med students have access to same resources, same books, same online sources like geeky medics, osmosis etc. what there stopping PAs from accumulating same wealth of knowledge? tell me please? open you mind and think. cos clearly you are not thinking. or you are telling me that there is a secret book of medicine only avilable to med student on MBBS course that bestows upon you the knowledge to make 100% accurate diagnosis. some kind of magical portion from narnia only available to med student who go med school. 💀💀 LMAOOOOOOO. what an utterly hilarious thing to say. how utterly ridiculous.
"They are instead being used to replace doctors in an completely unsafe manner"
how? in what situation? give examples. don;t just sprout BS.
"I would trust a 4th year medical student more than PA when it comes to clinical judgement"
well that's your call. that's alright. keep ignorantly sticking to your ignorant beliefs fulled by herd mentality.
GOOD BYE.
@@MrCheeseify1 I think junior doctors are treated unfairly and 100% need to have pay restoration. I can appreciate why there is so much frustration however I do not believe all these long-standing issues such as medical training opportunities, pay is due to the PA role. I think alot of anger has been misdirected at PA's who have chosen the profession, to help and improve patient outcomes. I don't think PA's and Dr's are comparable they are different roles, which are both valuable and have a contribute to make. I think regulation is a much needed and long-waited step forward.
I have seen several examples on placements, where when there is adequate supervision, PA's are contributing significantly to the medical team. E.g in AMU each case is discussed with a registrar, although the role is different, as a PA gains more experience especially within a certain specialty or GP setting, they continue to learn and develop and become a valuable part of the MDT. As the literature indicates there is no evidence to suggest that PA's are unsafe, they are trained to recognise where they need to seek support. Also, a large majority of Dr's have actually never worked with a PA - there are alot of misconceptions around the role. I agree that there should be clearly defined guidelines for supervision - especially newly qualified PA's. In GP i have seen PA's taht have been trained to diagnoses and treat common conditions - the GP's in the practice were grateful to the PA's and they had an open door policy for any queries - they said they had never experienced any safety concerns for PA's working in practice for over 10years.
Dr's need to be treated better by the health care system - while I think valid points should be raised and debated. Putting PA's down based on education and comparing education to a Dr does not help anyone.
@@Sonia-ig9fj What value can a PA offer that a doctor cannot? What do they bring to the MDT that a doctor is unable to bring? The role is nothing more than a political tool to undermine the healthcare system even further. If we take primary care as an example, why are PAs needed in this setting? Why not have more GP positions? Where they don't even need to have an open door policy to discuss patients because they are actually qualified to to their job. We have GPs struggling to find jobs currently. Absolve the current PA role and direct all funding towards more training positions and roles for a better qualified, more knowledgeable actual physician and it will lead to better healthcare in the country. Current use of PAs is unsafe.
In order to progress to core training or registrar level rigorous written exams, OSCEs/PACES are required. Never mind research publications, courses and audits etc. However there are numerous reports of PAs being unsupervised, “performing” the role of registrars and even performing surgical procedures. Where is the rigour in their training? There is none! The whole situation is a shambles. The rationale behind the PA role was to perform simple medical tasks to reduce workload for doctors (eg admin, bloods) but instead we are seeing horrendous scope creep and erosion of training for doctors. PAs are a VALUABLE asset to the mdt when they are utilised safely and correctly. Currently this is not the case for some (not all) PAs. This is not just a problem for PAs. It’s a problem for a lot of MAPs. I feel bad for MAPs who are being put in these positions and who are being sold the fantasy of becoming “pseudo doctors” by universities. If an MAP disagrees with that patient safety is being compromised then that in itself is incredibly worrying and the dunning kruger effect has truely taken ahold. I don’t mean to bash MAPs at all but we need regulations to define their role. If you want scope expansion then please go to medical school. I don’t think you truly understand the rigour of just basic medical training. It is absolutely necessary to practice medicine!
Sorry can I just ask you whether you have actually gone on the FPA website for Physician Associates to read CRYSTAL CLEARLY their SCOPE OF PRACTICE? Or do you and the other doctors who hate the idea of Physician Associates just create videos to continue to promote hate on the profession that is here to stay. Junior doctors need supervision from their seniors too likewise Physician Associates. You should start by doing a thorough research before spreading further false information to the general public for the sake of speaking up on "patient safety" when there are doctors who have missed diagnoses on similar cases as some PAs who have been dragged down.
By the way, the very first title given to PAs was actually Physician ASSOCIATES before it was changed to assistants and BACK TO ASSOCIATES. if you had done a thorough research, you would have known about the name and of course the PA SCOPE OF PRACTICE that has existed since DAY ONE OF THEIR INTRODUCTION IN THE UK 20 PLUS YEARS AGO.
I used to believe the information from the doctors against the profession until I read it MYSELF. Stop spreading FALSE/HALF STORIES.
We just don't want PAs. They always need to be supervised. which creates extra work. And can be used to drag down physicians salaries. Only clinic management profits form employing PAs instead of using real doctors.
They do not always need to be supervised - dependent on the settings newly qualified PA's have to be closely supervised similarly to an FY1. However, as a PA gains more experience they are able to work more autonomously - a PA working in the same department for 5+ years will not require the same supervision. I don't agree that they create extra work - I have have seen examples in AMU/ GP where they considerably help to reduce the workload safety and are valued by the Dr's in the team. PA's are a small profession compared to Dr's there are currently only 3250 PA's in the UK and 376,000 Dr's - PA's are not a replacement for Dr;s they are a supplementary role, similarly to specialised nurse practioners who runs asthma clinic - but simply just through the numbers the idea that they are a replacement for Dr's have bee overexaggerated and untrue.
I have the pleasure to work alongside 10 fantastic physician associates. Because PA's stay in one area they are able to provide a high level of care and can support jr DR and nursing staff with their knowledge and skills.
Please stop this PA witch hunt, Dear doctors... they are not after your job...
@@woutervk Thank you for highlighting this 🙂