Physician Associate - have you come across this yet?

[ConversingWithStrangers]

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).

GP here; I don't believe there should be any role for PAs in general practice. I think that because a lot of what we see is minor illness, there's a misconception that the job is easy, when in reality it's anything but. The value lies in recognising the one patient in 20 who has symptoms suggestive of a tumour, or who is showing early signs of sepsis caused by their chest infection. PAs simply don't have the knowledge base or experience to make those calls, and should not be seeing undifferentiated patients.

10 years training minimum to be a GP.

I give you ‘we need to rule out pregnancy before the procedure. What’s the date of your last period.’ Me: I’m on it now. PA: so you could be pregnant then. Or no. I’m not sure it’s confusing isn’t it? Me: erm

Thank god they do a urine test and only use this as back up.

Was almost 6 years not sure if I did complain at the time as my dad died 6 months after following errors but the hospital decided they didn't do anything wrong. His death certificate states he had pancreatic cancer but he didn't so there's at least one error in writing.

There's a world of difference between nurse training, clinical psychologist training and PA training. PAs should stick to scribing and chasing up. The A ought to be assistant, not associate.

The huge number of unemployed GPs have been truly shafted by the explosion of PAs in primary care

I was anaesthetised for an operation by an AA who lost my airway panicked and didn’t know what to do, luckily, he had an experienced ODP (operating department practitioner) who pull the crash bell and bagged me. It was a complete cock up and the surgeon was raging. I refuse to let touch my son and go into the anaesthetic room to check name badges. I’d had horrific headaches after my surgery and I’m sure it’s from lack of oxygen.

Except newly qualified PAs get paid more than newly qualified doctors. Ridiculous state of affairs.

The AA role takes it to an even higher level of madness.

That’s ridiculous in my opinion. It should be at least a 2:1 in a relevant life science subject and these requirements should be more strictly regulated.
I genuinely can’t believe students are allowed to take the course with an irrelevant first degree (although I know it’s true - I’m not suggesting you’re wrong)

A two years masters degree with a 100% pass rate is still not a Medicine degree equivalent even with a life science degree. The scope creep of the role is very dangerous.

I’m definitely not suggesting that after an undergraduate degree and then a masters, that they should be allowed to do what a medicine graduate can.
I think PAs can play an important role, but they shouldn’t be paid close to junior doctors and their role should absolutely be limited

But a 5 year university education for a PA is not the same training or equal to the 5 years that medical students do. It's not the same
The pay shouldn't be similar, F1s should be paid more as they are far more qualified

Thinking from a pay perspective, I think it's worth noting the trajectory and earning potential of PAs and Dr's. For PAs Band 7 is generally their max potential, they don't have the scope or option to progress due to limits of their role so their pay is unofficially capped. Whilst Jnr Dr's might start off on the same or less, their earning potential across a life time is generally much higher should they chose that pathway.

Yes the role has existed in the States for a long time and with the right parameters it could make sense but in its current form it is worrying. It is also causing problems for newly qualified doctors as the higher paid 9-5 PA roles present blocks to their medical training. And to add insult to injury, doctors who can't get jobs are not allowed to apply for the PA posts. No wonder so many young doctors are fleeing to Australia.

Wouldn’t it make more sense if it was the same? 5 year medical degree would be better than 3 yrs random BA + 2 yrs post grad.

Yes!! I had a rheumatology app in March After years of problems which resulted in an acute episode.

PA pent a lot of time and seemed thorough however one of the main features of the acute episode he dismissed as being something not covered by 'them'?? Weird.

And one big problem (not his fault) was that a raft of blood tests taken by the doctor had gone missing, ideally the appointment should have at best been rearranged or he should have reserved making a diagnosis until he'd seen them, he was though very keen to diagnose Fibromyalgia even tho I had symptoms which didn't fit that.

He said he wouldn't discharge until he'd seen the blood tests.

The blood tests had to go via immunology who said it was positive for Sjorens and Sub cutaneous lupus and recommended referral to rheumatology - these explain so much. However when we got the discharge letter it said the results were not significant. And he was sticking with Fibromyalgia (you know the thing that they don't treat as you're making it up), refused to see me for a follow up to discuss the issues and said a large proportion of the population will test positive for these things doesn't mean that it presents clinically, the thing is those tests were ordered because of my symptoms!!!!!! It just seems like madness.

Interestingly results and his discharge notes were sent to a hospital in a neighbouring county for a second opinion in August (really had to push for this via gp who said they likely won't see me). Well an actual consultant finally is next month

There should be no such thing as an 'anaesthesia associate'. You were close to being killed by that AA. It's horrifying.

That whole appointment was a waste of your time and a delay to diagnosis and treatment. I would complain if I were you. That hospital is choosing to hire a PA to fob you off.

A relative of mine was seriously misdiagnosed by a P A, They were told they had a condition that has a high fatality rate and they even sat their kids down and explained how potentially bad things could get. Then because they themselves are a nurse they decided to ask for a second opinion. Turned out that a scan had been misinterpreted

A theme of posters who have seen PAs is that 'they were very thorough'.

Honestly that isn't necessarily a sign of being any good.

It's a sign of a very junior and inexperienced person religiously going through a whole history and examination that they don't really understand, can't work out what they have found and don't know what to decide at the end.

Crunchyqueen's experience is typical, a long appointment, seems thorough but can't go off pathway and tell's her they don't cover her problem. And misses the significance of what she says altogether.

This. No way would I want a PA anaesthetising me. So dangerous.
Neither should a PA be attempting to diagnose rheumatological conditions. It is absolutely ridiculous and irresponsible.
I had a good experience with a PA in hospital. She introduced herself, explained that she was a PA and was also a neuro nurse with a master's degree and 12 years experience. Her role was to do lumbar punctures and she did around 10 every day. I was happy for her to do my LP and she was excellent. This, IMO, is a suitable level of training, qualification and role for a PA, similar to the PAs I worked with in USA.

If you’ve got any money I would pay for a private rheumatology appt. Sjogrens is nothing like fibromyalgia. Fibro is what is diagnosed when there’s pain + fatigue but no sign of an AI. You have markers for 2.

I don’t know why you would even be seeing a PA at specialist level? Surely they’re not qualified to diagnose?

I know a good private rheumatologist who specialises in Sjogrens in London if you want to PM me.

A PA who is already a trained nurse with 12 years experience is a very different kettle of fish from a person with 2 years postgrad training.

I've had this. He didn't know anything and was super over cautious, writing a me a letter to present immediately at A&E for a very rare and serious issue almost unheard of in someone my age. The A&E doctor I saw subsequently for my decidedly non emergency was certainly not impressed.