To be so hurt to have been replaced by a Physician's Associate?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

please speak to the BMA about this if you are a member. Also look at med twitter - there has been a lot of backlash about exactly your situation

Oh well, we're all a Physician Associate now then!

Everyone who is concerned about this (which should be everyone who uses the NHS) please ask to know exactly what kind of practitioner you're seeing at an appointment, and refuse to see a PA. If patients, nurses, and real doctors all push back, we might get rid of them.

I understand how you feel.

I work in primary care. We have 2 PAs now in our surgery. As lovely as they are, they just don’t have the training or experience that doctors do. Or even nurses - I’m a very experienced nurse practitioner, with qualifications up the ying yang. I train doctors in some areas and am now expected to “train” PAs, as my role is eroded.

More of my work, in which I have 25 years experience, is being taken from me and given to PAs, HCAs and pharmacy technicians. I do wonder why I spent so many years studying and training and learning sometimes.

Oh and the PAs start on 8 grand a year more than I’m on, just to rub salt in the wound!

It’s very unfair, my son in law is a junior doctor and is sitting his exam to get onto the training pathway. He has sat it once and is in the top 20% but can’t find a placement as if you don’t score in the top 10% there is nothing as the roles are being filled by PAs.

This has been going on for a long time in the US- many practices are covered wholly by NPs or PAs. Nobody sees the need to invest in training more doctors when you can hire a (slightly) cheaper PA. Many young people are actually choosing PA school over medical school- it's cheaper, faster and allows for career switching with ease (no need to train in one specialty for years). Many of the PAs I work with are excellent but they do not have the breadth of knowledge to recognize and manage unusual situations. In the end you get what you pay for.

'get rid of them' - as if they're some sort of enemy. There are lots of hard working passionate PAs.
I did really well at school and uni, I stupidly didn't go into medicine straight after school but did science and got a really good science job. Every day I have been regretting not going into medicine after school because I can't afford it now that I have a mortgage, family etc.
PA is a great option for people like me but is it really worth it given all the abuse?

I’d never be rude to a PA but realistically they’re not doctors and I’m not going to embrace being replaced by one! Perhaps you’ve missed somewhere that I’m a working mother who has lost her job to a PA…

@ScrantonDunderMifflin there’s no abuse directed at the PAs themselves. Most are hardworking, enthusiastic and bright.

The ire is directed at the government who are touting PAs as the answer to all the woes on the NHS and that’s wrong. They are not and should not be replacing other clinical staff. They should augment the service. It’s interesting that they were introduced as Physicians Assistants and have morphed into Physicians Associates…

Anyway @ScrantonDunderMifflin don’t regret not going into medicine. I genuinely think being a PA is a great option (for an individual deciding between the two, not necessarily the NHS…) and wish I’d known about it myself. You get to do lots of the cool parts of being a doctor without the constant rotation and out of hours work.

@prawncocktailskips you didn't say anything mean towards PAs, sorry for confusion, my comment wasn't directed at you.
I understand that your situation is unfair.

It's not personal, once the role fairly regulated with clear boundaries then yes I'm sure they'll be an asset. As is they're being utilised to fulfil a tory agenda and its affecting lots of people within the NHS and patient care. I haven't seen any being treated badly at actual work though, nor any personal attacks- questioning the role is different to personally disliking PAs.

This. I’ve worked with some and I genuinely don’t understand what their role is next to mine. I’m not being facetious when I say that. They pretty much do the junior doctor job but with a bit more cherry picking (can’t blame them!) and without the prescribing or requesting of investigations. Go on Twitter or Reddit and you’ll see scores of doctors who want trust grade / specialty roles like this as they’re not in the right position to apply to training (not everyone can just move around at a deanery’s whim for years) or can’t get into training. Why don’t these jobs go to junior doctors? I understand arguments about training times but it seems crazy that we pay so much to train doctors and then don’t have jobs for them. Surely even those decision makers most removed from junior doctors’ lives know there will always be some who simply can’t embark on training.

Thanks. I do know some people are unkind to and about PAs. It’s not acceptable but it comes from a place of confusion, hurt and probably resentment. We’ve been told we must jump through so many hoops and do 5 years of study and rotate around to be good doctors. Now we’re told PAs are more attractive because they don’t do those things.

I sometimes wish I’d been a midwife. If tomorrow a role was created that allowed me to train as a midwife in half the time and then get to work on one ward doing the best parts of midwifery with no out of hours commitment and better pay than the actual midwives I’d jump for the opportunity! But I wouldn’t be surprised if the current midwives didn’t welcome me with open arms …

@ScrantonDunderMifflin that is very sad that you regret not choosing medicine from the get go, but I don’t want patients to suffer as a result. This is where we are heading. There is no way a PA staffing a registrar level job (as we have seen happening) is safe. I hope you can see that in order to protect patients something must be done, and to be honest if you become a PA despite that then I think there is some blame to lay on you. If you are naive enough to think that PAs replacing doctors poses no risk to patient safety, then I’m not sure you would have got in to medical school.

Personally I am sad that I didn’t become a corporate lawyer. That doesn’t mean I think paralegals should be allowed to become corporate lawyers without completing the necessary training contracts or exams.

Obviously not a doctor. Until you do the job stop making ridiculous remarks. Come post in 6 years when you qualify if you manage to get into medical school.

From the otherside of speciality training I disagree it's " the good bits". PA's wil never run their own ward rounds or hold their own case loads. To me it sounds like being an eternal perfectly competent ST1/2 (old SHO grade) I was a junior doctor for 15 years after 3 years as an SHO ( I am that old) I was ready to be a reg, after 10 years as a registrar I was ready to be a consultant. Might be fun for a bit and the money isn't bad, but I wouldn't want to do it forever.

I'm really sorry that this has happened to you. This very issue was mentioned by the President of the RCPsych just 2 weeks ago, where it merited a disbelieving eye roll at 13.51:

It may be worth contacting RCPsych to let them know that it is happening and that will absolutely impact on patient care. I work with an SMI population and I would want a Doctor involved their care over a PA any day of the week.

Just wondering if you may be within travelling distance for the likes of Priory group? They have jobs available for Specialty doctors and Staff Grade doctors.

Best of luck and I hope that you will be able to look back at some stage and realise that it was a lucky escape!

Exactly. There is no ‘must’ about it. We can and do leave. Junior doctors are adults with real lives, not lazy naughty school children to be chastised. Doctors are leaving. What’s more likely to aid retention - improving conditions or telling us we knew what we signed up for and so put up and shut up?

OP. I am very sorry that this has happened to you. It must be extremely upsetting, given that you have been so caring and conscientious, as well as putting in extra time and effort.

Sadly, this is the way things are going now, but we may all live to regret it.

Are you an LED or SAS? If so there are some really supportive social media based groups I can let you know about. Or the other option is telling your story to an anon account who are concerned about junior doctor training.

Have you thought about approaching your local medical school and asking about teaching? Just trying to think of something you could do which isn’t training and no nights. I do some lecturing at my local med school (I’m a midwife not a doctor) but some of the medical lecturers are junior doctors.

@Issummernearlyover None of the cover supervisors in my secondary school (MAT) have teaching qualifications. They read instructions from a PowerPoint and endeavour to get the children to produce some work. Quite often you'd be lucky if the kids manage to write the date in their books nevermind any actual work.

It's not a great option. As a PA you wouldn't be a doctor or anything near it but you would be making things much harder for real doctors and compromising patient safety. No matter how well meaning they are, they need to go.

That poster I was replying to is pathetic. Plenty of us vote with our feet. An MBBS does not force us to stay in the NHS.