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Original poster

Physician Associate - have you come across this yet?

106 replies

ConversingWithStrangers · 14/12/2024 09:07

On Wednesday I had an appointment at the doctors due to finding a lump on my breast. However, once in the consulting room the woman I was being seen by explained that she was a Physician Associate.

I haven't come across this before and I'm curious about what people in health care think about this. (I'm in education and wondering if it's the same kind of move as HLTAs in teaching or PCSOs in policing etc.). Curious especially about how nurses feel about it, as that seems to be the area of biggest crossover.

(I was very happy with her consultation btw. She checked my breasts and referred me to the breast clinic. Only thing that felt a bit off/unexpected was that she used the word "arseholes" at one point).

OP posts:
NCJD · 14/12/2024 15:14

I wouldn’t have an issue at all. Not all treatment is or needs to be carried out by a doctor, and so long as they are used appropriately, a PA should be no different to a nurse or psychologist providing treatment

Most reasonable people think there probably is a role for PAs. Primarily, general ward work. No problem. A 2 year post grad degree sounds absolutely reasonable for that - 5 years total university education which is similar to an F1, who will also primarily do ward work. The pay should be similar.

It’s the scope creep that people are questioning. While it’s awful for doctors given the mass shortage of training positions, I suppose it’s also about bigger societal conversations. If we still want doctors doing complex things like endoscopy and surgery, we still want qualified teachers teaching our kids, we need to pay for it. It’s the back door approach to making these changes that is really frustrating.

Mostunexpected · 14/12/2024 15:30

kaela100 · 14/12/2024 13:37

I agree with you. PA entry requirements are rock bottom. Anyone with any grade at GCSE / Alevel and at least a 3rd in a 'biomed' course can become one. The entry requirements for nursing are higher yet PAs get paid more.

I should also add that a lot of PAs in my experience as a nurse are people who failed medicine or pharmacy and so have left uni with a bachelors degree which makes them unemployable as pharmacists / doctors. Yet they're being allowed to still see patients.

Show quote history

I only know of a handful of PA courses that will accept a 2:2. None will accept a 3rd.
Most of the ones that accept a 2:2 will only do so if the individual has a significant amount of work experience in a clinical setting.
I personally think a 2:2 is too low in any circumstances, but entry requirements are definitely not rock bottom

Keepingittogetherstepbystep · 14/12/2024 15:38

I first came across PA when my dad was in hospital following a hypo. I asked if he was a doctor and he said yes but it was evident he didn't know enough about how things actually work, kept repeating the same thing that my dad would be seen in a community setting and that would be enough. It never happened.

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Mirabai · 14/12/2024 15:40

olympicsrock · 14/12/2024 12:46

A GP will have done 5-6 years at medical school and 2 years foundation training and 3 years GP vocational training scheme .
A PA has trained for 2 years. You simply do not get the same training, exposure and broad clinical experience in 2 years which is needed to develop effective communication history taking skills and knowledge.
PAs are a cut price solution that does not deliver value for money or good care for patients .

I think if there’s any seriousness about continuing the physician associate role going forward - the training needs to be massively expanded. Buy then you’ve nearly got a doctor so you might as well do full medical training.

aodirjjd · 14/12/2024 15:43

Keepingittogetherstepbystep · 14/12/2024 15:38

I first came across PA when my dad was in hospital following a hypo. I asked if he was a doctor and he said yes but it was evident he didn't know enough about how things actually work, kept repeating the same thing that my dad would be seen in a community setting and that would be enough. It never happened.

I’m assuming this wasn’t necessarily recent but if it was you should report them for claiming to be a doctor.

Mirabai · 14/12/2024 15:44

Saschka · 14/12/2024 10:15

I think if anything they're going to be more cautious than GPs

Unfortunately there are plenty of stories where that has not been the case, and the PA has not known what they don’t know, and make reckless decisions as a result.

This one apparently hadn’t heard of DVTs/PEs, with fatal results.

My God that’s basic lay knowledge! I took a friend of my mother’s to A&E with what she thought was just cramp - but I thought could be DVT - it was.

Saschka · 14/12/2024 15:47

AnnaMagnani · 14/12/2024 13:36

History taking is a hard skill to learn and part of the many years of doctor training is learning when to ask what questions.

It saves no time if the history has to be taken all over again from scratch.

We don’t have them in our department, but they are used to fill gaps on the SHO rota for our acute medical take. I have been told by numerous acute medicine registrars and consultants that a PA clerking is treated like a medical student clerking - completely ignored, and they send an SHO to do a proper clerking afterwards. So a total waste of time.

I do think they can be useful as scribes on the post-take round, and chasing up investigations. For whatever reason, that isn’t what they are used for.

TreeSquirrel · 14/12/2024 15:52

NCJD · 14/12/2024 15:14

I wouldn’t have an issue at all. Not all treatment is or needs to be carried out by a doctor, and so long as they are used appropriately, a PA should be no different to a nurse or psychologist providing treatment

Most reasonable people think there probably is a role for PAs. Primarily, general ward work. No problem. A 2 year post grad degree sounds absolutely reasonable for that - 5 years total university education which is similar to an F1, who will also primarily do ward work. The pay should be similar.

It’s the scope creep that people are questioning. While it’s awful for doctors given the mass shortage of training positions, I suppose it’s also about bigger societal conversations. If we still want doctors doing complex things like endoscopy and surgery, we still want qualified teachers teaching our kids, we need to pay for it. It’s the back door approach to making these changes that is really frustrating.

The BMA have opposed increasing the number of training positions.

Crinkle77 · 14/12/2024 16:20

Mirabai · 14/12/2024 15:44

My God that’s basic lay knowledge! I took a friend of my mother’s to A&E with what she thought was just cramp - but I thought could be DVT - it was.

Show quote history

Yeah agree. I'm not a doctor or nurse and even I know leg swelling and breathlessness can indicate a blood clot.

RafaistheKingofClay · 14/12/2024 16:25

I’ve got a feeling there’s another case where the PA missed classic appendicitis with McBurney’s sign and sent the patient home with a diagnosis of reflux.

NCJD · 14/12/2024 16:25

Source? I the BMA had opposed expansion to medical school places without addressing the massive bottle necks in postgraduate training.

RafaistheKingofClay · 14/12/2024 16:28

NCJD · 14/12/2024 16:25

Source? I the BMA had opposed expansion to medical school places without addressing the massive bottle necks in postgraduate training.

I don’t know about the BMA’s reasoning, but my understanding was that there was a bottleneck further up that makes things more complicated than just increase training places.

aodirjjd · 14/12/2024 16:47

Don’t we all have a horror story or 3 of a gp dismissing something obvious though?

I’ve heard of a few “to young for cancer” so gp sent them home and turns out they did have cancer and had much worse outcomes than they would have if gp had correctly referred them.

Searchingforthelight · 14/12/2024 16:57

Anyone can make a mistake
Hence there are examples of doctors who have made errors cited on this thread

There will not be LESS mistakes if you are treated by someone with a FRACTION of the training

There will be many more errors, and avoidable deaths.

ThereIsALifeOutThere · 14/12/2024 17:01

aodirjjd · 14/12/2024 16:47

Don’t we all have a horror story or 3 of a gp dismissing something obvious though?

I’ve heard of a few “to young for cancer” so gp sent them home and turns out they did have cancer and had much worse outcomes than they would have if gp had correctly referred them.

Yep and it’s going to be even worse with people who only have 2 years training.

Thats why they are supposed to be supervised by a doctor - who btw is supposed to be taking the responsibility for their decision.

Its even more the case I think in GP surgery when there is no undifferentiated cases.

I mean imagine doctors are still making mistakes after 7? 10? Years training and we think someone could do just as well after 2 years? If that’s the case, why the heck are we training people for so long, everywhere in the world?

ThereIsALifeOutThere · 14/12/2024 17:03

@Saschka its also not how much they are paid!!

RafaistheKingofClay · 14/12/2024 17:03

There’s a difference between missing things that are difficult to diagnose or an unlikely differential diagnosis and missing something blindingly obvious though.

ThereIsALifeOutThere · 14/12/2024 17:05

Mostunexpected · 14/12/2024 15:30

I only know of a handful of PA courses that will accept a 2:2. None will accept a 3rd.
Most of the ones that accept a 2:2 will only do so if the individual has a significant amount of work experience in a clinical setting.
I personally think a 2:2 is too low in any circumstances, but entry requirements are definitely not rock bottom

Show quote history

I know some students who were taken after a degree in computing…..
Yes they had a degree bit totally irrelevant to medical stuff.

ThereIsALifeOutThere · 14/12/2024 17:09

RafaistheKingofClay · 14/12/2024 17:03

There’s a difference between missing things that are difficult to diagnose or an unlikely differential diagnosis and missing something blindingly obvious though.

I agree.
That’s why PA are supposed to be under supervision of a doctor.
But they aren’t and it’s easy to see why.
GPs are already struggling to see their own patients. They dint have time to ALSO review what the PA has done. Or they might as well have done it themselves.
Bit also in primary care, how do you know what is or isn’t going to be difficult to diagnose? So much going on that look innocuous to start with.

SnakesAndArrows · 14/12/2024 17:20

aodirjjd · 14/12/2024 14:25

I think their remit needs to be clearer but doctors can also be dismissive /bad at “missing” what should be obvious cancer referrals or cardiac issues.

The fact that some doctors are poor is in no way an argument in favour of replacing good doctors with PAs and AAs.

This is the same ridiculous argument that is used to justify the replacement of pharmacists by pharmacy technicians, with their equivalent of 2 A levels.

RafaistheKingofClay · 14/12/2024 17:21

Exactly. Which is why I can’t really see a use for them in GPs unless it’s for follow up care. Although I feel like having more GPs would be a better investment.

There probably might be a use for lots of them in hospital wards but I’m not sure why you’d be paying them on band 7.

Given how overstretched services are I doubt that the supervision is worth the paper it’s written on. Be interested to know how often incidents have been Datixed due to a doctor signing off on a PAs plan or prescribing based on PA suggestion without properly reviewing the patient.

SnakesAndArrows · 14/12/2024 17:21

Ohnonotmeagain · 14/12/2024 09:42

i’m kind of hoping they will find a place- I know PSCO’s were/are mocked but having worked with a couple they are an amazing resource. They aren’t “police lite”, it’s a different job and has developed into an invaluable asset.

i have heard that PA’s used correctly can be fab- getting a thorough history, taking the time to listen, then referral on to the correct pathway. Takes all the appt’s off GP’s and NP’s that simply need an oh yes, you need a referral to x dept”

history taking is a skill and most appointments don’t allow the time. if PA’s are doing that and feeding back it will save so much time and money, get quicker diagnoses, and most of all patients will feel heard, so it may get some of the repeat offenders dealt with.

i am happy to see whoever initially, our surgery I’ve not seen a GP, only NP’s. They take the history and refer on /prescribe as necessary, which tbh most of the time is all that’s needed.

PAs simply do not have the requisite knowledge to be able to take pertinent histories of undifferentiated patients.

aodirjjd · 14/12/2024 17:30

What is the justification for PAs starting on the same banding as ANPs?

edit: and if they cost the same why would a gps office ever want a PA who can’t prescribe over an ANP? Or is that we don’t have enough ANPs either?

Mirabai · 14/12/2024 17:38

RafaistheKingofClay · 14/12/2024 16:25

I’ve got a feeling there’s another case where the PA missed classic appendicitis with McBurney’s sign and sent the patient home with a diagnosis of reflux.

On a lower key PAs at my parents’ practice missed varicose eczema - I had to tell them what it was, and thought my mum’s allergic reaction to a new medication was sunburn, confirmed as an allergy and treated by an actual GP.