Physician associate… should I report? Yes or no?

[Elsie256]

phoned my GP to book an appointment, was told by reception I’d be seen by the emergency doctor covering.

i’ve really been struggling with really back pain and weight loss and was so grateful to have gotten an appointment. Arrived at the surgery and was called into the room and the guy introduces himself as ‘one of the medics’ , I go onto tell him my symptoms and he was very dismissive, told me I was probably overreacting and that I need not worry.

I felt something wasn’t right in how dismissive they were so I asked if I could see someone else at reception before I left the surgery.

the receptionist said ‘well if you’re still worried I can book you in with a doctor in a few days’. Turns out I’d seen a physician associate but they’d just introduced themselves as ‘one of the medics’ so I thought that meant doctor

finally got to see a doctor a few days later who looked very worried and referred me onwards straight away and very sadly been diagnosed with kidney cancer

I’m really upset about this initial visit to the GP and felt I was really misled especially as they didn’t properly introduce themselves and clearly didn’t have the appropriate clinical experience to recognise my symptoms were something more serious. should I be complaining?

not necessarily the case as there are many who’ve been qualified for years who don’t need everything checked but are well aware of their unknown unknowns so get support when they need it

How many years? PA haven’t been around long.

not sure about ACP/ECP usually they do a 1 year masters and then do advanced practice on the job with support from the employers they’re potentially already with or find a role within gen practice as the ARRS scheme is giving practices funding to employ paramedics physios PAs social pharmacists etc.

with doctors they do have a lack of training places - specialty training is like a bottle neck - only so many places available and it becomes very competitive to get a place - leaving some to go down a 2nd choice specialty they did not prefer or do extra years as trust grade or locum til they get their place or in other cases just leave altogether.

It's not true there are too few GP training places. Many areas struggle to recruit, and recruit many IMGs because there are gaps.

It's funding. And retention. Who wants to be a GP these days? It's relentlessly hard work, the media hate you, the government hate you, patients think you're useless, and you have to supervise PAs who are under trained, and haven't the debt from training you have.

PAs are the latest cheap idea. And they think patients won't notice. Because they've seen a "medic".

They've been around for 20 years https://www.fparcp.co.uk/about-fpa/who-are-physician-associates

20 years? Never saw one or heard of them even till a couple of years ago!

you have every right to be upset and im sorry to hear about the diagnosis. Please report this to your MP and the GMC. Physicians associates are completely unregulated, and if one is going rogue, your GP practice wont do much. Even if they leave the practice, they’ll go elsewhere and behave the same. Imagine you had not asked to see someone else?

What do you think the GMC can do about it, given that they don’t regulate PAs?

Yes you should. I am a Doctor: the public are being misled every day always ask if the person you are seeing is a ''registered medical practitioner'' . PAs get 2 years training after any science degree. GPs 5 years reading mediicne + F1 and F2 years + GP training scheme 3 years = 10 years....

PAs don't know what they don't know (unlike moest nurses) and constantly try to deceive.

Please note it is a criminal offence under the s49Medical Act 1983 to hold yoruself out to be a qualified medical practitioner when you aren't :
''49Penalty for pretending to be registered.
(1)F1... any person who wilfully and falsely pretends to be or takes or uses the name or title of physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner or apothecary, or any name, title, addition or description implying that he is registered under any provision of this Act, or that he is recognised by law as a physician or surgeon or licentiate in medicine and surgery or a practitioner in medicine or an apothecary, shall be liable on summary conviction to a fine not exceeding level 5 on the standard scale ''

Please write a letter of complaint to the Senior Partner, the CCG, NHS England your MP and anyone else.....

It is shocking and dangerous

Exactly ....it is a scam
We need good young doctors not pretenders who don't know what they don't know.
So many of your daughter's generation have gone to Australia: double pay and well treated who can blame them.
PAs see to have an inflated opinion of themesleves when they receive 2yrs training: like the old State Enrolled Nurses who knew their limitations.

Interesting article published online last month by the BMA "Call for alternative regulator of – and to rename – physician associates"

@sammylady37 the GMC also take action against people who Illegally represent themselves as Drs.

As someone posted previously, the practice are unlikely to do much (ime) other than say don't do it again.

Acp training is three years.

I’ve been following this thread for a few days.

My daughter is currently in her first year of PA training and clearly knows her lane. She is not training to be a doctor, doesn’t want to be a doctor nor pretends she is a doctor. She has had excellent feedback from her placements - from the GP, to the FY1s and consultants - and studies incredibly hard to learn the competences under which she will be operating. She has done a three year under graduate course, and will have done a further two years by the time she has finished the course plus around 1600 hours of clinical placement. Her role is not to replace doctors but to complement them and they shouldn’t be used by surgeries in lieu of GPs.

What do you suggest happens to her, and probably the majority of PAs if that role goes away?

You all are absolutely right - registration to allow personal responsibility is an absolute must - with the ability to remove those who are incompetent. And it is happening albeit slowly.

It is so disheartening to read and feel the level of vitriol and hate towards the PAs. A good PA and doctor relationship will ultimately only benefit - but it must be clear what the level of competences are, and that must be understood by doctors and PAs equally. Allow them to take the appropriate training to be able to order X-rays and prescribe medications - for the competences they are trained for.

I totally get that some have found PAs to be arrogant and claim they are equivalent to FY1/2. That is clearly madness and they should be pulled on that. But have you ever considered that the level of vitriol on social media may play into this - imagine having your very existence ridiculed and mocked by the people you are working with? How would you feel?

I also feel that doctors should be easily identifiable - so why not have every allied healthcare, PA etc in uniform? A clear distinction.

As to being booked in with a PA rather than a doctor - this should be clear on booking an appt. Transparency is key from all sides.

This thread also details examples of where a PA has acted promptly and correctly in at least two cancer cases.

And for what it is worth I wholeheartedly say for the OP to report this experience. It was wrong and it was not within the guidelines they are taught to operate in. Perhaps contacting the FPA who hold the voluntary registrar? Was this PA even on it? (https://www.fparcp.co.uk/)

@quandry101

Why didn't your daughter do graduate medical or nursing school? What about the PA role attracted her?

(Short training and money? Those are the issues that everyone has with the role- they are under trained and over paid for what they do.)

I had a very similar experience except I knew the guy was a PA, not because anyone told me but because I'd seen it on the website. I was interested to find out how he introduced himself and he said " I am a physician "
So most people would take that to mean doctor.
He missed a red flag (vomiting blood) and dismissed it. He said he didn't want to refer me for an endoscopy because "they're not very pleasant ".

Two weeks later a GP referred me on a 2ww suspected cancer. Thankfully it wasn't.

Fair question.

She worked in a hospital, on wards doing covid tests during the pandemic. She struck up conversations with all types of medical
professionals and the PA role just grabbed her interest. She liked the idea of having her her patients, of running a clinic and following patients through.

She wants to work in a hospital once she has qualified. Her focus will just be on that ward.

under qualified and over paid? Really? I don’t think so. She will not have the career progression of a doctor and will not see the increases and nor should she. She will be running her own clinics. She will also be regulated and personally responsible by the time she is qualified. As I said doctors are underpaid. Take away the PA role and they will still be underpaid. Push PA below that salary and they will still be underpaid. I would happily pay more in tax if it was ringfenced for that purpose.

Please don’t tear down a whole profession just because one is woefully underpaid.

I’m sorry for your experience Parsleymint - and I’m pleased to read that it was not cancer.

How many doctors have missed red flags?

Regulations and personal responsibility is key. It must happen and happen soon. Then people who are not performing can be identified and removed from the registrar if necessary.

I’ve experienced first hand what misdiagnosis does. I buried my husband because of it. You can search my name if you want the details.

On what basis should she be running her own clinics with such extremely limited training? Diagnostic clinics? It’s just wrong imo.

From what I can gather the training that she has, in the competencies that she will be in’s cope for, will provide that training.

She will not be a doctor. She will not be a GP. She will not have the scope of training that they have as she will not be expected to perform the role of a doctor.

She, and PAs like her, will complement doctors. But only if the role is allowed to be exactly what it is supposed to be. And not constantly torn down.

Nurses and doctors run their own clinics etc. And so do plenty of other registered, regulated health professionals.

What made her choose PA over graduate medicine? Or a regulated, established, respected profession?

Because as I’ve said, she didn’t want to be a doctor.

Because she thought that she was going into a respected role

How wrong was she.

I believe her. I believe in the role. I believe it has its place.

I’m sorry that you don’t. But I’m not going to change your mind about that. You’ve clearly made your mind up - which to be fair, so have I!

I think the only things we may agree on is that the role needs to be regulated and for PAs to be able to take personal responsibility and to be challenged if they are misleading or miss huge red flags, and to be retrained or indeed removed from the role where necessary.

And that doctors are underpaid, understaffed and this needs to change.

What is unique to the PA role? What can PAs do, that someone better trained can't?

You know what. You do you. You are not willing to listen or learn or understand what the true role is supposed to be. You want to scapegoat those that have and are working really hard to learn and practice a role within the competency framework it was set out to be. Yes there have been appalling and avoidable mistakes and tragedies, and I so wish that hadn’t happened. I know that pain. I am living that pain. You just want the role to go away.

Fine. Fair enough. Maybe you’ll get you wish, maybe you won’t.

OP, I wish you so much love and luck as you fight this awful disease and I sincerely hope you are ok.

Sorry to hear about your diagnosis and wishing you all the very best.

Yes do report him. He sounds like he didn’t know what he was doing.