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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Original poster

To be so hurt to have been replaced by a Physician's Associate?

457 replies

prawncocktailskips · 06/12/2023 09:40

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?

OP posts:
Thread gallery
14
Issummernearlyover · 07/12/2023 19:26

Bippertyboppertyboob · 07/12/2023 18:52

@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.

That's awful. I always treated cover as if they were in a lesson with their actual teacher. They are being failed. How can they behave in those circumstances?

ScrantonDunderMifflin · 07/12/2023 20:32

@onthetrainsomewhere where did I say PAs should replace doctors? PAs should support them, not replace them

DrBlackbird · 07/12/2023 21:18

Just wondering who, for the love god, are the 10% voting that the OP is unreasonable? The OP is not being unreasonable. It is not BU for the OP to be personally to be upset, after investing time and energy into doing this role. Neither is it BU to be concerned about a less qualified position being hired over an actual doctor.

The only AIBU is being sad, you ought to be really angry. I am over the total mishandling and under funding and political football this government is doing with the NHS. Constantly seeking to undermine its functioning and priming us all to accept we ‘can’t afford it’ and must move to an insurance-based system.

Let’s all look really shocked when the US health care firms move swiftly into fill the breach (with Tory politicians in partnership) after legislation. And that’s really gone so well for Americans. Especially in the pandemic.

https://gizmodo.com/teen-who-died-of-covid-19-was-denied-treatment-because-1842520539

How does U.S. life expectancy compare to other countries? - Peterson-KFF Health System Tracker

The U.S. has the lowest life expectancy among comparable countries, but spends twice as much as similar countries on healthcare per person, on average.

https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/#Life%20expectancy%20at%20birth%20by%20sex,%20in%20years,%202021

Middleagedspreadisreal · 07/12/2023 21:50

I blame the toxic Tories.

PlusThyme · 07/12/2023 22:37

ScrantonDunderMifflin · 07/12/2023 20:32

@onthetrainsomewhere where did I say PAs should replace doctors? PAs should support them, not replace them

But that’s exactly what this thread is about? PAs replacing doctors.

Maternityleavelady · 07/12/2023 23:18

I totally agree with you, OP. The two PAs I have had consultations with have been hugely disappointing. One misdiagnosed me, another had 3 attempts before getting the right prescription for my daughter, turning what should have been a couple of weeks of pain into a couple of months of pain, needlessly. It’s a ticking time bomb.

Ukrainebaby23 · 08/12/2023 05:00

You are not unreasonable to feel hurt and unwanted, but that's the thing about locums, it's not a permanent position. Just because you were doing a great job you don't get extra job security. The government probably has a fund that pays for PhysAss and the accountants will see an opportunity to save on locum costs which are unpopular with the public.

So, not unreasonable to be hurt and sad, but on the other hand, you might have expected it.

mumsneedwine · 08/12/2023 09:31

I am so disheartened by what doctors have to put up with. My own is an F1, like needsmore, and has just started her new rotation. Day 1. On nights. Has done 3 sets of nights already and 2 lates. She had a lovely PA on last ward, who was just that, an assistant.
But she's already worrying about what happens after F2, as competition is so bad. Australia is looking more and more attractive. I am sad as she's worked so hard to get here. And feels unvalued.

Araminta1003 · 08/12/2023 10:07

Let’s say a junior doctor cannot do the antisocial hours for a while or get on a rotation, can they be a PA for a bit and then can that be accredited towards their training somewhat? And if not, why not? If they were to PA in different departments then won’t it almost amount to the same thing? If not, why not? Or is it just the system/unreasonable use of deterrents?

MTistheDB · 08/12/2023 10:24

This reply has been withdrawn

Withdrawn at poster's request.

MjB4 · 08/12/2023 11:21

As a PA i feel its probably pertinent to weigh in on my profession's behalf since we're often not represented in these conversations.

For context, before my two year PA masters I was a nurse and have that degree plus 7 years of nursing experience including emergency, surgical and medical wards in this country and abroad.

As far as pay goes, anyone who thinks that experience and financial outlay warrants under band 7 in today's financial climate is frankly deluded. I fully believe junior doctors should be paid much more than they are and support the strikes. But that doesn't mean other profession's should receive less. Tearing others down just preoccupies us from the real issues in healthcare funding which is what the government wants.

In terms of working hours,I work one in three weekends,plenty of nights and don't get paid for my breaks unlike my doctor colleagues. This is true across my Trust . I will never be beyond a band 7 as it stands regardless of how long I remain in post.

As far as quality goes, there are now academic studies which demonstrate PA'S to be as safe as junior doctors and have great patient satisfaction scores. Sadly these rarely see the light of day because they don't fit the current media rhetoric or the BMA agenda. We tend to forget that PA'S are widely utilised in healthcare settings across the world with great success, the issue here is the system and cost cutting.

It is totally crap that this has happened to the OP and I 100% agree with previous responses that it's probably a funding issue. In GP for example we can be funded along the AHP line and in some areas the first 12 months is funded.

I've been scandalised by the number of doctor training posts that are disappearing, as are many of my PA colleagues. We joined to be in a supporting role, not to replace doctors and have no interest in doing so.

Finally for those saying why can't doctors be PA'S I don't see why they couldn't do the masters if they felt so inclined. But it is a job in it's own right not a freebie given to people who dont like their medical role anymore. I had a place to study medicine and chose PA instead precisely because I don't want to be a consultant and prioritise work life balance (although as time goes on we are losing this just as everyone in the NHS is).

IheartNiles · 08/12/2023 11:37

MjB4 · 08/12/2023 11:21

As a PA i feel its probably pertinent to weigh in on my profession's behalf since we're often not represented in these conversations.

For context, before my two year PA masters I was a nurse and have that degree plus 7 years of nursing experience including emergency, surgical and medical wards in this country and abroad.

As far as pay goes, anyone who thinks that experience and financial outlay warrants under band 7 in today's financial climate is frankly deluded. I fully believe junior doctors should be paid much more than they are and support the strikes. But that doesn't mean other profession's should receive less. Tearing others down just preoccupies us from the real issues in healthcare funding which is what the government wants.

In terms of working hours,I work one in three weekends,plenty of nights and don't get paid for my breaks unlike my doctor colleagues. This is true across my Trust . I will never be beyond a band 7 as it stands regardless of how long I remain in post.

As far as quality goes, there are now academic studies which demonstrate PA'S to be as safe as junior doctors and have great patient satisfaction scores. Sadly these rarely see the light of day because they don't fit the current media rhetoric or the BMA agenda. We tend to forget that PA'S are widely utilised in healthcare settings across the world with great success, the issue here is the system and cost cutting.

It is totally crap that this has happened to the OP and I 100% agree with previous responses that it's probably a funding issue. In GP for example we can be funded along the AHP line and in some areas the first 12 months is funded.

I've been scandalised by the number of doctor training posts that are disappearing, as are many of my PA colleagues. We joined to be in a supporting role, not to replace doctors and have no interest in doing so.

Finally for those saying why can't doctors be PA'S I don't see why they couldn't do the masters if they felt so inclined. But it is a job in it's own right not a freebie given to people who dont like their medical role anymore. I had a place to study medicine and chose PA instead precisely because I don't want to be a consultant and prioritise work life balance (although as time goes on we are losing this just as everyone in the NHS is).

Edited

Out of interest, why did you go down a PA route rather than ANP? As an ANP you would have been independent, a prescriber, able to order imaging, etc. Plus you would have been specialist, respected. You would be on B8a with potential to be a nurse consultant or manager down the line? Seems oddly limiting decision.

mumsneedwine · 08/12/2023 11:37

@MjB4 we wish there are more like you. Some PAs are calling themselves doctors (have had this as a patient). And most are not ex nurses either your experience. I've met a few who did good science then the 2 year PA degree and now take the place of doctors on surgery.

MjB4 · 08/12/2023 11:43

Totally get that. Honestly I think we need to revise the entry requirements to include lived work experience in healthcare of at least a year post first degree and/or bring in an internship year post qualification at band 6 to gain further experience.

But I'm a cranky nurse in my (later...) thirties and probably not in the majority:D

Possimpible · 08/12/2023 11:46

@MjB4 Also interested in why you did PA rather than ANP? A much more established role with prescribing qualifications and potential for progression. I'd be really interested to read the academic papers that demonstrate equivalent safety - are any of these in the UK? As it seems to be a bit of a different thing here to say USA.

Also medics on the thread have said they're excluded from retraining as PAs, although I'm struggling to find a source for that.

PlusThyme · 08/12/2023 11:52

@MjB4 you personally sound like a fantastic PA who understands the scope of their role. I am also interested in these academic studies though - the one I’ve seen touted are horrendously biased (eg self reporting confidence in consultations where one could take that to mean PAs are dangerously overconfident compared to doctors!)

Mirabai · 08/12/2023 11:53

MjB4 · 08/12/2023 11:21

As a PA i feel its probably pertinent to weigh in on my profession's behalf since we're often not represented in these conversations.

For context, before my two year PA masters I was a nurse and have that degree plus 7 years of nursing experience including emergency, surgical and medical wards in this country and abroad.

As far as pay goes, anyone who thinks that experience and financial outlay warrants under band 7 in today's financial climate is frankly deluded. I fully believe junior doctors should be paid much more than they are and support the strikes. But that doesn't mean other profession's should receive less. Tearing others down just preoccupies us from the real issues in healthcare funding which is what the government wants.

In terms of working hours,I work one in three weekends,plenty of nights and don't get paid for my breaks unlike my doctor colleagues. This is true across my Trust . I will never be beyond a band 7 as it stands regardless of how long I remain in post.

As far as quality goes, there are now academic studies which demonstrate PA'S to be as safe as junior doctors and have great patient satisfaction scores. Sadly these rarely see the light of day because they don't fit the current media rhetoric or the BMA agenda. We tend to forget that PA'S are widely utilised in healthcare settings across the world with great success, the issue here is the system and cost cutting.

It is totally crap that this has happened to the OP and I 100% agree with previous responses that it's probably a funding issue. In GP for example we can be funded along the AHP line and in some areas the first 12 months is funded.

I've been scandalised by the number of doctor training posts that are disappearing, as are many of my PA colleagues. We joined to be in a supporting role, not to replace doctors and have no interest in doing so.

Finally for those saying why can't doctors be PA'S I don't see why they couldn't do the masters if they felt so inclined. But it is a job in it's own right not a freebie given to people who dont like their medical role anymore. I had a place to study medicine and chose PA instead precisely because I don't want to be a consultant and prioritise work life balance (although as time goes on we are losing this just as everyone in the NHS is).

Edited

I’m surprised you didn’t go for ANP, but you must have your reasons.

Coming to the PA role with a nursing degree and 7 years of clinical experience is a totally different kettle of fish from some with a general science degree with 2 years of training.

Imo it needs to be at least 4 years with a year of clinical practice - just for the ground that needs to be covered.

therealcookiemonster · 08/12/2023 11:56

@prawncocktailskips Hi OP, I am a doctor in postgraduate training. I think you will find that deaneries are very understanding with locating their Trainees- you can work part time and have a say on which trusts you work in (within reason) if it affects childcare for you. it helps if you choose a deanery that has a smaller geographical area so trusts are fairly close together. for example, I am in Birmingham and the furthest I would have to drive is 30 mins. I have a chronic health condition and have had so much flexibility from the deanery ( I am in a different speciality but psych is known for being very supportive). in your position I would apply for training and go part time.

MjB4 · 08/12/2023 12:06

Hi, I didn't do ANP for a few reasons - I wanted to retrain full time under the medical model and gain a greater breadth of understanding of different specialities with the option to go into a job in the specialism of my choice at the end. In my Trust I would have been ANP funded by the ED and been somewhat pigeonholed into either ED or primary care afterwards. Our ANP training pathway was also three years part time and I wanted a more immersive learning experience. As I'm sure you're aware, it's not an option to just enrol on an ANP programme, you really need to get a Trust training post.

Interestingly the acceptance of ACPs is very high and I don't think people are fully aware that they aren't always longstanding nurses or paramedics - a friend of mind is doing ACP training currently and one of her colleagues is a physiotherapist. I do wonder how many patients would be overjoyed to know that their acute medicine ANP was a physio with an advanced practice MSc. Not saying this is right or wrong, I just think there are similar arguments against to PA'S, they just haven't caught the public eye.

I'd definitely recommend comparing the modules if you're interested in the difference, there are plenty of similarities but a more uni hrs and clinical medicine modules for PA'S.

I've not looked into the retraining issue. As I said I simply don't know why they wouldn't allow it (perhaps because of the concerns over losing doctors currently, although this feels like shooting oneself in the foot!)

Obviously there are more American studies (quite established in NZ too interestingly)since they've had PA'S since the 60s, but there are some emerging in the UK now. BMJ is a good starting point for articles with links to the research to date if you fancy a read.

MjB4 · 08/12/2023 12:15

@IheartNiles Personally I didn't think so. I could already order imaging as an ED nurse and any nurse can do a non medical prescriber course. It didn't feel like a critical decision maker for me.

I was more interested in being a supportive practitioner and therefore having the capacity to give great care and listen to my patients, to work in different specialities depending on what I enjoyed during my training and have a decent work-life balance after years of feeling knackered.

IheartNiles · 08/12/2023 12:35

MjB4 · 08/12/2023 12:15

@IheartNiles Personally I didn't think so. I could already order imaging as an ED nurse and any nurse can do a non medical prescriber course. It didn't feel like a critical decision maker for me.

I was more interested in being a supportive practitioner and therefore having the capacity to give great care and listen to my patients, to work in different specialities depending on what I enjoyed during my training and have a decent work-life balance after years of feeling knackered.

Edited

I hear what you’re saying.
Where I work the ANPs get all the shit hours as (being able to prescribe and order imaging) they backfill the OOH rota. While the PAs get the nicer hours and jobs- working alongside consultants doing clinics and ambulatory.
The ANPs also sit under matrons so are used to plug gaps in the ward nursing workforce. The tendency to use nurses as jack of all trade, do all the undone work of others makes it a frustrating profession. But in terms of career progression I think it has more potential than the PA. For now, anyway…

Possimpible · 08/12/2023 12:43

@MjB4 I'm aware of BMJ, I assumed that as you were quoting the literature you'd have some examples to share to back up your point. Unfortunately that doesn't seem to be the case.

People on this thread are well aware of ACPs, they were talking specifically about ANPs.

MjB4 · 08/12/2023 12:47

Absolutely- if you equate progression to banding then sure and ANPs definitely get hit with all the leftover jobs in a lot of departments. I know some Absolutely amazing ANPs and they deserve every penny of that 8a!

I guess it depends where you're willing to make sacrifices. I certainly didn't expect to go into a job to help people and end up 'most vilified profession in the UK 2023' but here we are :D

MjB4 · 08/12/2023 12:50

Interested to know your professional background @Possimpible as you clearly have strong feelings on this?

I didn't realise one had to come with a full reference list to reply to a post on mumsnet :D

Possimpible · 08/12/2023 12:53

@MjB4 Hospital pharmacist (IP), pushing back against the advanced practice framework. Management want us to have caseloads, independently review patients etc. They want us to step back from reviewing medicine charts and start acting as mini-doctors, pushing the charts back on to FYs (who are pretty awful at it, let's be honest). It's not what we're trained for, we don't have a background in diagnosis and could seriously miss things. We should be part of the MDT, supporting doctors with treatment decisions, advising on (and at a senior level, independently) prescribing. Newly qualified pharmacists are going to come out as Independent Prescribers... they just don't have the knowledge or experience.

ETA - with a DH in nursing