To be so hurt to have been replaced by a Physician's Associate?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

Quite disheartening reading all these comments about PAs but oh well.
Saw multiple people celebrating the fact they 'aren't employed in Scotland' - sorry to disappoint but there are lots of PAs working in Scotland.

I'm genuinely unclear on what place there is for PAs. What place is there for them when we already have Advanced Nurse Practitioners who can do everything that a PA can do and more ie prescribe. ANPs also have years of experience behind them. I'm really not sure why this additional role has been introduced when we already have HCPs who can fulfil the PA role and responsibilities and more.

Apologies if I'm repeating stuff OP - the thread is too long for me to read right now - but speaking as someone who was until fairly recently Clinical Director of a large department in a hospital I would urge you not to see this as a personal slight. In reality it is highly unlikely that this is a decision to replace you as a person.
It's far more likely that the Business Manager for your Directorate (or whatever the equivalent in your Trust is called) has money saving targets and reduction of the locum bill is often a priority. Whilst you as an individual may not be particularly expensive, as I am sure you know, locum costs in general are high and you'll probably be lumped in with everyone else. Also, from a service delivery perspective, having posts filled by locums, even long term ones is often less than ideal for lots of reasons and there is frequently a lot of pressure on departments to come up with staffing strategies that are seen as sustainable in the long term.
Personally, I am not a fan of PAs in general. I also locked horns with management on plenty of occasions as their proposed cost savings were not infrequently risky and not even likely to save money in the longer term, but I do have some understanding of the pressures they are under.
I presume you are not employed to cover a pre existing non training grade vacancy? If you are, then it should have been fairly straightforward to employ you permanently but specifically creating a job isn't always as easy as it sounds like it should be. If you are being employed to cover a gap in what should be a training rotation then a Trust can't necessarily unilaterally decide to change that to say, a Specialty Doctor or Trust Grade post. And if there isn't an existing substantive post at all, then management /HR will be looking at how that role will be best filled in the long term. Whilst they may have you there, ideal for the role right now, there's no guarantee that you are going to be there forever (and from what you've said, in all honesty, for your own sake you probably shouldn't be) and they need to think how that work can be delivered longer term. Finding another "you" might be quite difficult whilst replacing a PA is potentially fairly easy.
I do sympathise. I am no fan of PAs and I know that it's really hard juggling family commitments with a medical career. I'm sorry that you're in this predicament. But please don't let it knock your confidence. It almost certainly is a longer term financial and workforce planning decision and no reflection on you as an individual. I hope you find a new direction with better prospects soon.

Thanks so much for taking the time to reply @AgeingDoc, I really appreciate it. You’re right in that it isn’t a pre-existing vacancy. I suspect / have been told as much pre-funding but it’s reassuring to hear this again. Thank you!

Hopefully, down the line you will be grateful for them having liberated you.
100% it's not personal, its a business decision. You sound like a fabulous human being. Please take the opportunity to reflect on how else you can experience career fulfillment at an appropriate pay grade that fits with sustaining a family life and your own health and happiness.
(Friend works in similar role in Germany but different system there).

That's interesting. Which NHS trusts?

Here's one

And another

Thank you for being so kind, much appreciated.

There are ward and other jobs that PAs could and should safely do but there's push back against that because the argument is that its too boring, and if you have a member of staff on the team who doesn't rotate it's easier to train them for some of the more interesting stuff than support a new doctor every 6 months. They were called physican assistants previously afterall. There is a role for someone to do certain tasks, but I don't think personally PAs are it on the pay band they're at. A hybrid HCA with administrative duties as part of the role or something with better pay would be better. There's a very clear agenda at play though.

The best thing for PAs would be to fight for a clear scope to be agreed and to be regulated, and to support their doctor colleagues in fighting for better pay. Sorry to say i doubt there'll be much support by many whilst the scope keeps creeping and whilst a PA with less responsibility, less knowledge, working more social hours, who doesn't have to rotate and gets paid more than a doctor and that's fair enough. The PA role is definitely morphing in many trusts and some are working well beyond their scope. There's nothing a PA offers that a doctor can't, but because funding is coming from a different pot settings admist a purposefully shortage of training posts etc settings are strong armed into employing PAs.

This isn't personal towards individual PAs, and it's unfortunate that many universities are being purposefully misleading in their recruitment material that makes people think the role is something it shouldn't be; but it's not unfair or sad that people are rightfully highlighting the issues with this.

Agree. Jobs that frequently fall on junior doctors in my experience (because there is no one to do them and junior doctors can't really say no for reasons I've touched on above) include fixing printers, tracking down equipment and paperwork over the hospital, running blood tests to labs when the system to send them is broken, staying on the phone to GP surgeries / care homes etc. for hours to try and find out basic information about a patient, re-stocking equipment cupboards, arranging translators, running discharge letters to pharmacy, running investigation forms to the correct location etc. Any pushback usually involves a smarmy comment about the doctor in question thinking they are 'too good' for such a job. I don't think I'm 'too good' for anything, but if there is 1 doctor for 60 patients I don't think it's a good idea to have that doctor going on frequent 15 minute round trips to run errands that anyone could do around the hospital. Having people to do those jobs in hospital would make such a difference. Even just someone to answer the phone! Any HCP on this thread will know how difficult it is to contact another ward for information because there is no one available to answer the phones (likewise, many relatives will also know this pain!). Even better would be having the staff to do bloods and ECGs. I've never worked anywhere with a functioning phlebotomy service...

Yabu to be "hurt" - employers owe you nothing except the contractual pay as agreed, and their legal obligations to employment law. If you are 'hurt' you are too emotionally invested.

Take your skills to a role where they are wanted. There's no shame in being a staff-grade doctor off the training-track to consultancy if that's what works for you. If that particular employer would rather have a P.A. than a locum then that's their choice and won't have been based on emotions or any other personal reason.

Just goes to show that they are now creeping into NHS Scotland 👀 thanks for searching. I tried looking on NHS Scotland recruitment pages and couldn't see any. As another poster rightly said it may be that all posts have been filled.

I suppose you’re right but I think most of us working in the NHS are emotionally invested. If we weren’t we’d go and find better conditions doing something else. The NHS relies an awful lot on our good will to make up for staffing and resource shortages. It does hurt when we all have not infrequent reminders that to them, we are just a number whereas to us, our careers are our vocations. This is an extreme example but I’m sure every doctor, nurse, HCA, porter, physio, PA and more on this thread will have had times when they’ve felt very unvalued at work.

This doesn’t sound right. I am an acp and don’t do any of those jobs you have listed there, other people do them. I think when you look back on this in the future , you will realise you have probably had a lucky escape.

@Spacecowboys this has been the case in every department I’ve worked in and my med school friends working around the country all report the same sadly. Glad it’s not the case where you work though - gives me a bit of hope that things are better somewhere out there! Funnily enough, my male med school peers experience this far less …

Just writing from a patient perspective I find that vacancy a bit alarming because it is situated in the 'Hospital at home' setup in Glasgow. I thought that PAs were supposed to be working in a hospital or primary care setting, with a doctor close at hand. How is that the case if they are going out on the road, visiting people at home?

The point is they probably wouldn't rather have a PA than a doctor but are being strong armed into it by a different pot of funding. There's nothing a PA can offer that a JD can't, and with the chronic shortages up the chain we should be investing in doctors. If you're a trust with a squeezed budget though of course if you're offered 'free' money over having to dip into your existing funding to fill a role then it doesn't take a genius to realise the majority will do this. Its awful, and it's fine for highly qualified professionals to be disgusted at the erosion of their profession and the direction its heading. Scores of doctors are leaving with is an issue, taking their skills to somewhere they're actually valued as you say; but where does that leave patients? With sub standard care from a lesser qualified workforce, sounds really aspirational.

Worrying isn't it? Glad I posted about NHS Scotland otherwise another poster would not have noticed that advert.

All it's doing is cheapening the healthcare service.

One of the most eye opening things I've ever read was an extract from the book-

Rich dad,poor dad.

It's about financial literacy.

The main character wants to learn how to make money so starts working for a local entrepreneur- so he can learn his secrets.

He gets worked like a dog. Working late,puts it all in,and basically gets treated like crap. Doing manual work. Working extra days,weekends etc. He is exhausted but keeps going back he wants to learn from the businessman.

And it's only when he says he's gonna leave that he's told- if he had carried on coming into work the business man would have sacked him. And refused to mentor him.

You learn- the business man extracts all the work he can from his employees for the least amount of payment and cares not a jot for their wellbeing, and no one ever made cash by working for someone else.

The way to make cash is not by being an employee- but being the boss- but anyway that's not really relevant to this thread.

But basically the NHS's job is to get as much labour they can for the least amount of cash- they don't care about your wellbeing, or how hard you've worked.

You keep repeating how hard you've worked- they don't care.

The relationships you've made- they don't care

How much the Consultants like you- they don't make the decisions.

If the trust can do the job for less,as a locum with no employment rights you are the first to go.

You need to stop caring about propping up the NHS and take care of yourself- because trust me the NHS does not care one jot.

Where I work. The government give us cash to help recruit. But we aren't allowed to spend it on doctors, only PA'S,pharmacists,physios- and basically not who the patients actually want to see. It's all driven by the government.

Take care of yourself.

It seems that as long as you can get a consultant on the phone, this counts as adequate supervision.

Thanks @Finteq. Some important lessons and things to think about. It is so tough because we never meet those who make the decisions about our employment, where we work, what time off we get etc. They don’t know or care about our individual circumstances and work ethic. But who we do see is the patient who won’t get to go home to their families if we don’t skip lunch to do their discharge or the colleague who will miss an important event if we don’t cover their shift or the consultant who already stays late and will stay even later if we insist on leaving on time with our jobs half done. These people do care about how hard we work but have zero power over our conditions. Not unique to the NHS I assume but a bit sad all the same, and it’s tough to look after yourself first as the people you have to face are not your employers but patients and relatives and colleagues who rely on you and will be directly and typically immediately affected if you don’t go the extra mile…

Creeping into NHS Scotland, seriously...
There are plenty of them in Scotland already.