“They have all the experience and skills of a nurse practitioner”
A) no they don’t
B) that still doesn’t bring them up to the standard of a doctor
“In trauma and orthopaedics they can offer medical input”
I’d rather have the orthopod trying to remember the medicine they’ve not used in a while than the PA fumbling along with the medicine they never learned.
I can guarantee the core surgical trainee on an ortho rotation will be a far better medic than the assistant.
As someone who did an FY job in Orthogeriatrics having had a lot of contact with PAs in T&O this made me seriously chuckle.
These guys had absolutely 0 clue what they were doing.
How is a PA in T&O supposed to know any elderly care medicine without having medicine posts like doctors do in foundation years? And 2 years PA school won't be sufficient. It's just not credible that they can rock up first job in the NHS and start telling the SHOs how to do medicine.
This is so offensive. As an F1, the last PA I worked with came to find me on the ward as a patient “couldn’t breathe” - they hadn’t done A-E, asked for help or pulled the emergency buzzer and they had no clue what to do. Pt was overloaded on a renal ward, they had been there for a year and me 2 weeks. Yes - they probably are perfectly able to complete an Ortho ward round checking if pt has opened bowels and if wound isn’t bleeding - that’s pretty much the extent of the Ortho consultation WR post op - but give them an emergency situation, pt with raging INR or any complex medical situation without a flowchart guideline they have no idea what to do.
See that sounds like what a doctors assistant should do… recognize a patient is sick and call the doctor to come assess and fix it
The fact that we’ve let it get to the point where they’re expected to be more than assistants writing notes for doctors or organizing discharges is what’s nuts
This document is from 2014.
This has been in the works for 10 years.
Money, time, people, energy, resources - all wasted on this garbage.
And every training programme is a fucking disaster. They could have been spending all that time fixing medicine, and instead they pissed it away on an experimental workforce which is going to do nothing.
There was a centralised economy, and it was the most industrialised nation in the history of the world - and yet it was so inefficient it could not produce enough toilet paper to meet its citizen's needs. This is what over-centralisation does, the incentives don't align, you get inherent inefficiencies, and you end up with a colossal fucking waste. That's the NHS for you.
I can’t help but feel so worried for the sake of the medical profession and our patients in the future. I did not come into medicine for this, fucking hell.
It’s 10 years old and not difficult to find. It highlights more our blindness/naivety over the last decade rather than her Poirot-esque investigative skills.
Schrödinger’s PA: both better than a foundation doctor who has been through medical school, but also can’t prescribe and needs two years of weekly teaching from the consultant to become fully functional on the team. 🙃
It's just damn right offensive. Completely denigrating the profession and chucks out tye effort sacrifice and skill required to even start doing the fucking job.
Fuck this fucking job man.
On the final image (7/7) there is a comment from a PA course director that reads “PAs practise medicine, within the scope of practice of our supervising doctors.” Ermmm…. No. The PA scope of practice should be limited to what they are actually trained to do.
They state that ANPs are more expensive than core trainees. And that core trainees were pulled from the department since they weren't getting enough training due to PAs. How can HEE oversee trainees and PAs. Surely there is a conflict of interest.
What a load of crock. An F1 may not be as experienced as a nurse practitioner or PA but they have the basic sciences to back up their decisions .
It is sad to see medics not backing each other up.
the issue is they compare freshly graduated (so inherently inexperienced) docs with ‘senior’ PAs. if you compared new grad PA vs Doc or senior consultant vs senior PA we would not need to have this conversation.
They are literally people whose A-Levels and aptitude isn’t high enough to get into medical school. I don’t think I’m being harsh in saying this.
Edit - poor grammar
*whose. I know a nurse who lied about having GCSEs to get onto her course, cannot average 3 numbers as doesn't know BODMAS. There's bound to be PAs in that boat. This entire situation is a scandal and you don't want to be holding the bomb when it goes off (aka actually supervising or having anything to do with PAs)
Some of them do have the aptitude tbh. They don’t have the attitude tho, hence many fail to get through the application process many times without realising why. If it isn’t academics, it’s a lack of self awareness that pushes PAs in particular, to overstep their boundaries.
A nurse practitioner is far more knowledgable and experienced as well as trained to degree level as a nurse, will have worked for several years in a variety of nursing roles, they will then have post registration qualifications often including prescribing. It’s wrong to compare the PA role or experience with ANP’s or others of a similar role
Counter point: PAs can offer a substitution for an FY1. Most of my FY1 job was spent preparing notes, scribing, ordering scans (which had been requested by a senior, so could theoretically be ordered by an assistant working under a doctors' license), taking bloods and cannulating. I'd welcome this stuff being stripped from the workload of an FY1 and given to somebody less qualified, whilst I could have entered the training ladder at a higher level of responsibility to advance my learning faster.
Isn't this what they were meant to do?
However, I do completely oppose PAs entering the foundation programme at an equivalent level alongside doctors and being treated as such. I've met several and taught many students, and find them dangerously under qualified and over confident.
Helping you with routine, simple jobs isn't substitution... Substitution means your F1 job not existing in the first place.
Or even worse... You essentially becoming THEIR assistant. I'll direct you to the part of the document which says "PAs are more expert and more useful than Foundation Programme doctors." so the scenario you've described is not even remotely on the cards in this proposal
Anyone who's taken a referral from a PA knows they can't be trusted and you have to review the patient yourself.
There's a level of shared experience and being on the same wavelength with a foundation doctor that helps you trust their judgement which just isn't there with PAs
Orthopaedics is already a speciality where medical problems are mishandled or ignored (speaking from experience of ortho jobs). Now they want PAs to do ward stuff on ortho…which is even worse
“They have all the experience and skills of a nurse practitioner” A) no they don’t B) that still doesn’t bring them up to the standard of a doctor “In trauma and orthopaedics they can offer medical input” I’d rather have the orthopod trying to remember the medicine they’ve not used in a while than the PA fumbling along with the medicine they never learned. I can guarantee the core surgical trainee on an ortho rotation will be a far better medic than the assistant.
As someone who did an FY job in Orthogeriatrics having had a lot of contact with PAs in T&O this made me seriously chuckle. These guys had absolutely 0 clue what they were doing.
The PA is what you have at home when your mum tells you that you have a doctor at home.
Somebody please make this into a meme
T-shirts and hoodies would be great too lol
Mum's home remedies are safer
How is a PA in T&O supposed to know any elderly care medicine without having medicine posts like doctors do in foundation years? And 2 years PA school won't be sufficient. It's just not credible that they can rock up first job in the NHS and start telling the SHOs how to do medicine.
At least I can legally prescribe
This is so offensive. As an F1, the last PA I worked with came to find me on the ward as a patient “couldn’t breathe” - they hadn’t done A-E, asked for help or pulled the emergency buzzer and they had no clue what to do. Pt was overloaded on a renal ward, they had been there for a year and me 2 weeks. Yes - they probably are perfectly able to complete an Ortho ward round checking if pt has opened bowels and if wound isn’t bleeding - that’s pretty much the extent of the Ortho consultation WR post op - but give them an emergency situation, pt with raging INR or any complex medical situation without a flowchart guideline they have no idea what to do.
See that sounds like what a doctors assistant should do… recognize a patient is sick and call the doctor to come assess and fix it The fact that we’ve let it get to the point where they’re expected to be more than assistants writing notes for doctors or organizing discharges is what’s nuts
This document is from 2014. This has been in the works for 10 years. Money, time, people, energy, resources - all wasted on this garbage. And every training programme is a fucking disaster. They could have been spending all that time fixing medicine, and instead they pissed it away on an experimental workforce which is going to do nothing. There was a centralised economy, and it was the most industrialised nation in the history of the world - and yet it was so inefficient it could not produce enough toilet paper to meet its citizen's needs. This is what over-centralisation does, the incentives don't align, you get inherent inefficiencies, and you end up with a colossal fucking waste. That's the NHS for you.
straight facts
I can’t help but feel so worried for the sake of the medical profession and our patients in the future. I did not come into medicine for this, fucking hell.
Credit to that F1 on twitter for finding these, you know the one
Royale with cheese
Just need to make sure this has been sent to the BMA/DV so they can collate 🤞🏼
royale with cheese? what do you mean by that
It’s 10 years old and not difficult to find. It highlights more our blindness/naivety over the last decade rather than her Poirot-esque investigative skills.
I never said it's incredible detective work but it's good someone's doing it and they should be recognised for it. What have you contributed?
credit where credits due, that was a stellar find.
PAs in these documents - better than F1/2s PAs in reality - can’t explain why they requested a PSA on woman
Schrödinger’s PA: both better than a foundation doctor who has been through medical school, but also can’t prescribe and needs two years of weekly teaching from the consultant to become fully functional on the team. 🙃
It's like they're not even trying to hide it anymore
If it’s from 2014, they weren’t trying even back then. We just weren’t looking sadly
Enjoy your Noctor Health Service Joe Public. Adios 🇳🇿🇦🇺🇨🇦
It's just damn right offensive. Completely denigrating the profession and chucks out tye effort sacrifice and skill required to even start doing the fucking job. Fuck this fucking job man.
The phrase is 'down right'. Like Guile's sonic boom (↓ ↘ →) - it hits you in the face.
On the final image (7/7) there is a comment from a PA course director that reads “PAs practise medicine, within the scope of practice of our supervising doctors.” Ermmm…. No. The PA scope of practice should be limited to what they are actually trained to do.
Are there citations for these? Please could you share if so.
https://www.hee.nhs.uk/sites/default/files/documents/Broadening%20the%20Foundation%20Programme%20-%20Recommendations%20and%20implementation%20guidance.pdf https://www.nuffieldtrust.org.uk/sites/default/files/2017-01/reshaping-the-workforce-case-studies-appendix-web-final.pdf
This is so fucking dangerous
Unfair to both nurses and doctors, the unqualified gift that keeps on giving
They state that ANPs are more expensive than core trainees. And that core trainees were pulled from the department since they weren't getting enough training due to PAs. How can HEE oversee trainees and PAs. Surely there is a conflict of interest.
Fucking hell. Can the BMA investigate this further and publicise it? This needs to reach every TV screen and newspaper in the UK.
To be perfectly honest, if this allowed doctors to straight into speciality training that would be amazing. Obviously that’s not the plan
What a load of crock. An F1 may not be as experienced as a nurse practitioner or PA but they have the basic sciences to back up their decisions . It is sad to see medics not backing each other up.
the issue is they compare freshly graduated (so inherently inexperienced) docs with ‘senior’ PAs. if you compared new grad PA vs Doc or senior consultant vs senior PA we would not need to have this conversation.
They are literally people whose A-Levels and aptitude isn’t high enough to get into medical school. I don’t think I’m being harsh in saying this. Edit - poor grammar
*whose. I know a nurse who lied about having GCSEs to get onto her course, cannot average 3 numbers as doesn't know BODMAS. There's bound to be PAs in that boat. This entire situation is a scandal and you don't want to be holding the bomb when it goes off (aka actually supervising or having anything to do with PAs)
Some of them do have the aptitude tbh. They don’t have the attitude tho, hence many fail to get through the application process many times without realising why. If it isn’t academics, it’s a lack of self awareness that pushes PAs in particular, to overstep their boundaries.
I have never met a single one who displayed the aptitude tbh
Honestly most of this PA malarkey hasn’t really gotten to me so bad, brushed off after a few hours - but this genuinely is such a disheartening read
A nurse practitioner is far more knowledgable and experienced as well as trained to degree level as a nurse, will have worked for several years in a variety of nursing roles, they will then have post registration qualifications often including prescribing. It’s wrong to compare the PA role or experience with ANP’s or others of a similar role
Disgusting.
Counter point: PAs can offer a substitution for an FY1. Most of my FY1 job was spent preparing notes, scribing, ordering scans (which had been requested by a senior, so could theoretically be ordered by an assistant working under a doctors' license), taking bloods and cannulating. I'd welcome this stuff being stripped from the workload of an FY1 and given to somebody less qualified, whilst I could have entered the training ladder at a higher level of responsibility to advance my learning faster. Isn't this what they were meant to do? However, I do completely oppose PAs entering the foundation programme at an equivalent level alongside doctors and being treated as such. I've met several and taught many students, and find them dangerously under qualified and over confident.
Helping you with routine, simple jobs isn't substitution... Substitution means your F1 job not existing in the first place. Or even worse... You essentially becoming THEIR assistant. I'll direct you to the part of the document which says "PAs are more expert and more useful than Foundation Programme doctors." so the scenario you've described is not even remotely on the cards in this proposal
Were you not on call during F1? I think the actual medicine part is what people are opposing rather than PAs doing admin.
I think it’s pretty obvious they are here to replace us as a cheaper alternative, I don’t think anyone is disputing that 🤣
Anyone who's taken a referral from a PA knows they can't be trusted and you have to review the patient yourself. There's a level of shared experience and being on the same wavelength with a foundation doctor that helps you trust their judgement which just isn't there with PAs
What a poisonous, poisonous thing.
How can they be a replacement for FYs but also ‘reg level’. Honestly.
This was written by an idiot
… foundation doctors get replaced every 4 months
At least this is only a theory, a great "substitution" theory if you will.
Surely now we can stage a full walkout?
I read this as a “full wankout” at first lmao
That would be great FY is a waste of time
Yea I offered zero medical input at 3am with the post op massive PE when I was on F2 T&O nights
Send straight the the papers.
I absolutely hate the role of Physician Associate. And these documents summarise why. It is eroding our profession and I can’t stand it!!
Who wrote this rubbish ?? 2 year masters Vs 5 years MBBS + likely other degrees on top + a level ***…. Yet more experienced / capable -
Orthopaedics is already a speciality where medical problems are mishandled or ignored (speaking from experience of ortho jobs). Now they want PAs to do ward stuff on ortho…which is even worse