To be so hurt to have been replaced by a Physician's Associate?

[prawncocktailskips]

I'm a junior doctor who 'specialises' in psychiatry. Due to having a young family, entering training is not the right thing for me to do currently. For those who do not know much about the training pathways, these tend to involve moving around a lot, a fairly high out-of-hour burden, keeping a portfolio and revising for exams. I just can't make this work around my family, my husband's job (involves a lot of travel) and the childcare I have access to.

For the last few years, I've worked as a locum at my local psychiatric hospital. I've worked pretty much full time and gone well above my designated hours and work load. In particular, in addition to my usual responsibilities, I've taken on the physical health needs for a lot of patients and (I think!) made some real progress. This is something that can get overlooked in psychiatry.

I am perfectly happy with my pay but for context, I am not one of the mega-rich locum doctors the newspapers talk of. I earn around £23/hour and obviously have no sick pay or AL. Several times I've been approached about having a full time non-locum role for around £32k. I've always been really enthusiastic about this but there has never been the funding.

Anyway, I've recently been told that they don't need me anymore as they have a new physician's associate. I'm really sad and hurt. I've gone above and beyond for this job. I can't understand how there is funding for a PA who will earn more than I would have done and can't do a lot of what I can do. They won't be able to prescribe (I spend a lot of time prescribing and dealing with very heavy duty psychiatric medications) or detain patients (I perform emergency detentions under the MHA not infrequently). They won't have the same medical background I have to manage the physical health of the patients. I just can't really understand what they can do that I can't!

This isn't a problem unique to me. Lots of junior doctors locum not because they want lots of money (as the media might tell you) but because they can't make training work - or, in many cases, because there aren't enough training positions at all! Many of these positions are now being replaced by PAs. I know people who have left medicine because of it and now, I think I might have to too.

AIBU to be so hurt and sad and think it's just not fair?

It's not relevant to your AIBU, I agreed earlier YANBU, but the thread has moved on

This most of my collegues tried to get as much of their registrar training under their belts before motherhood as they could of these who had children whilst in training I guessttimate 50% stayed in training, the others couldn't make it work and took SAS jobs or locumed . Of those who took the gamble of waiting till consultancy I would say 50% had some sort of fertility difficulties.

So those of us who managed it ( children and CCT) are the lucky few. Most of us have had massive amounts of support from our families and our partners. There is usually a fair dose of good luck in there ( straightforward pregnancies, healthy children) and an enormous dose of determination and the men we went to medical school with still outearn us.😥

The problem is that this is how it starts out. It started out exactly the same way in education i.e. the alternative practitioner ‘freeing up’ the professional. But it doesn’t stay that way once that helpful new person is in the building and there’s a sudden bout of sickness, a bereavement, a resignation or someone’s suspended from duty. They aren’t just a theoretical PA whom no-one trusts; they’re Jane, who is always so cooperative and patients really seem to like her…

See my posts upthread for what has happened in teaching, with HLTA and cover supervisors being used to cover classes once the legal requirement for qualified teachers to teach classes had been removed. Thinking about it, it definitely contributed to me leaving the profession because when I later wanted to return to work after maternity leave those flexible cover roles (most primary schools previously had several cover teachers) were much more sparse than they had been before - even in London. They were still out there, but there certainly wasn’t the same high demand for qualified teachers to do these roles.

Hey ho, it’s all in the past for me now. I thought the unions were wrong and overreacting at the time but oh how wrong I was!

No it's not. Starting a new job and your colleagues purposely refusing to do something they're meant to do so you have to do it on top of your own work load? Being told to make your colleagues tea and biscuits so they don't bully you? Being unable to raise complaints about harassment, sexism, unfair rotas, staying hours late etc. because your seniors will refuse to sign you off? Accepting bullying from nurses because otherwise they'll close ranks and you'll see it reflected on your MSF? (all of which, by the way, disproportionately affects non-white british doctors...) Should we not speak out about these things? If you're NHS you must know bullying is rife. We have posters in our hospital asking people to consider whether they might be a bully! And I'm sorry you've been led to think you wouldn't cope in a corporate environment. My friends are nearly all in the private sector. There's nothing magical about the other side.

This is really interesting and sorry I missed your post upthread. Seriously depressing though. I asked my teacher friend who seemed surprised I didn't know this was happening! I genuinely had no idea.

I misremembered, top of band 7 then (https://x.com/tomstocks1982/status/1550259605057536002?s=46)

which is about 35% less than they’re currently paid!

Interestingly that is equivalent to my £25,000 in Y2K and probably what they are worth.

Agreed! I think that would be a fair salary for an FY1.

I only want to do the out of hours/ unsocial hours I have to do, no more. A lot of our team are the same. So I wouldn’t be prepared to do more so someone else could do less, everyone’s different. The shifts you describe are the norm for me and our team. Ive never gotten used to night shifts. Headaches and nausea are the norm whilst I’m on them.

Yes, so paying those shifts more will attract more people to do them who won’t mind them as much as you! We should pay more for antisocial hours to attract people to those shifts. This would allow you to do less of them, and someone else to do more but in return for more money!

That won’t happen though, especially when other sectors get no uplift in pay for weekends etc, even those on minimum wage ( which is shocking of course). I still remember their plan to remove enhancements when agenda for change came in, until they realised it would be a large pay cut for most nurses.

@prawncocktailskips
Thanks, unfortunately I think this pattern is being seen across public sector roles. But it is very rare to have one professional grouping speak out in support of another, or even notice what is happening.

Ultimately it is the people at the bottom of the pyramid who will be replaced by non-human workers i.e. refuse collectors might be replaced by an intelligent robotic arm that can collect the bin as long as it’s placed in a specific spot.

But the prospects don’t look promising for traditional professions either. Even the widespread availability of medical information online has eroded respect for doctors - not saying that’s right, but it’s quite likely the case. Remote surgery has implications for that profession. I have also heard of moves to generate giant legal databases, with every possible permutation of legal opinion, that will dramatically reduce the need for legal staff. And of course AI is the next big problem!

Perhaps a life of health and leisure beckons? But I suspect there will be some very painful changes first.

I don’t see why it couldn’t happen! Just because things are bad in multiple sectors doesn’t mean we have to continue down that path for reasons of fairness. I’d be supportive of anyone in any role lobbying for increased pay for antisocial hours. AFAIK this is how doctors are paid in Australia.

Really? In a sector where it takes about 6-8 months to get an agreement for more than a 2% pay rise. Decreasing enhancements I can see happening, not increasing them. We already have a disparity according to banding.

This is how it used to be. I am old enough to remember the 2002 contract coming in . Managers had massively underestimated how many hours we did, most of us ended u on band 3.

Described here
https://www.juniordoctorfinance.co.uk/what-is-junior-doctor-pay-banding/#:~:text=The%20%E2%80%9Cold%E2%80%9D%202002%20contract,%2C%20Scotland%20or%20Northern%20Ireland).

Yes I would agree that doctors and nurses should be included in the ARRS funding

It is very worrying how much doctors are suddenly being replaced by less qualified staff. I think it is only matter of time before things starts to go horribly wrong and they try to employ doctors again only to find they have gone to Australia or have stopped practicing as doctors altogether.

It’s the logical way to structure things! It’s like locum shifts being significantly better paid OOH - if you want someone to do something a bit crap, you have to compensate them or they have no incentive to do it.

I am a consultant psychiatrist. Your supervision and on call support arrangements don’t sound great.

A locum like you would be snapped up at my Trust.

I am in awe of junior doctors who navigate the system with kids. When I did my MRCPsych, it was the colleagues with young children who kept failing. They simply didn’t have time to revise. I had the luxury of time. I was able to pass my exams and become a consultant at 30. Before I had kids. That would be impossible for someone with children.

I have huge admiration and sympathy for trainee doctors who have kids and do training. With the exams and oncalls. Even part-time is tough as you have to do the same stuff for your portfolios. I look at my juniors with children and there is still so little understanding in the system. Last-minute rotas, long distances to travel, no consideration at all for family life. It was hard enough for me without children.

I think it’s appalling you are being replaced by a PA. I hope the BMA fights this one to the end.

A junior doctor wouldn't be appropriate for the initial MS appointment at all. A PA review wouldn't be appropriate for many patients between consultant neurologist appointments either. What do they do about the drug treatment many patients will be on for example? At the moment patients would be seen by specialist MS nurses who coordinate their care with other health care professionals as necessary.

Thank you for being so understanding - I really appreciate it. Just hearing someone acknowledge the realities makes me feel a bit better.

Sorry to hear about whats happened OP..Its happening in General Practice too.
No more jobs for recently trained Gps but plenty of jobs for PA/ Anp.
Going to medical school is a waste of time.
Just become a PA instead.

My friend is a recently retired consultant psychiatrist. She says she is certain she wouldn't have reached, or remained until retirement, at that level if she had been able to have children. Op, you sound like a committed and caring doctor, I hope you can find a way through and can remain in medicine.

And @PlusThyme I read your article - it made me cry :(.

Yes @PlusThyme sorry I didn't comment on your article. I actually read it when it came out. Really sobering reminder of what we all went through...

@Lola2121 you're right. I wish I could re-train as a PA sometimes! Someone upthread asked me about pay. Yes, I would 100% take the pay to work social hours only in a fully supported well-defined role, rather than being the punching bag of the hospital (or so it feels). I know, logically, that decisions are made based purely on cost effectiveness and the balance of staff retention (I think, anyway!). But with doctors being replaced by PAs who are paid more than us and who we have to prescribe for, it's really hard to feel valued at all.