To be so hurt to have been replaced by a Physician's Associate?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

@Possimpible interesting! Sounds like we actually share views on scope of practice and training institutions/government pushing the boundaries on what constitutes adequate training support and experience in order to justify reducing medic posts.

It's such a shame that all of this creates so much hostility when behind it there's a whole cohort of people trying to work in healthcare for the right reasons. We have a brilliant pharmacist in my dept and she's such an asset to the whole MDT, but I'm sure as a nich sub spec we are a bit more protected from the kind of 'mission creep' you describe.

And all the while doctors are paid £15.33 an hour to be ward monkeys during day but at night are magically expected to take the responsibility for 100s of patients. DD has the cardiac bleep at nights.Unless they get the training time how are we going to have better doctors in the future. If PAs can now act as SHOs why do doctors need to do years of training, endless exams and rotate all over the place ? If it can be done by PAs after 2 years training (not the lovely PA here who has loads of experience) ?
And the stupidity of increasing medical school places without increasing training slots is criminal.
I'm v v sad about the way the NhS is going.

One should have a reference list when specifically referencing studies.

I was just about to ask the same question 🤣

The ANPs also sit under matrons so are used to plug gaps in the ward nursing workforce

Your trust really needs medical consultants fighting the acps corner with them. Ours were right behind us and put a stop to us being used to plug gaps as soon as it was attempted. The more of these threads I read , the more I realise what great support we have in our trust from our medical colleagues.

Absolutely feel your pain OP as the mum of a junior doctor. Good advice to contact the BMA's legal dept for employment law advice and to look at the fb site somebody mentioned upthread.
FWIW you sound like a lovely mum, wife, human being and doctor in whatever order you wish to put them 👏🤞💐💐

This week the government are passing a bill that means the GMC will register PAs. Not on a separate register, but the same 7 digit code as doctors. Think we can see where this going 😡

Blimey at this rate nurses will have had more training than “doctors”.

Don’t worry - which number belongs to the doctor will become very clear once the GMC needs to throw somebody under the bus…

Regulation is needed and a step in the right direction. Why the same register though , it should be a separate one.

@Spacecowboys they are not talking about any regulation, no definition of what a PA can and can't do. Just registering them.

And yes @Salacia, I'm very sure who will be to blame if a PA makes a mistake. My DD is following BMA guidelines and will not prescribe anything on anyone's orders, unless she has seen and assessed the patient herself. She worked very hard for her GMC number.

@mumsneedwine I’ve just checked the gmc website and it definitely says regulation, not just registering.

@Spacecowboys it does. But that is not what is happening this week. They are just going to give them a 7 digit number to say they are a PA.

But what is a PA ? There can't be regulation until there is a legal definition of what a PA's scope is. At the moment some act on the SHO rota, are doing complex procedures it takes doctors years to train for and being allowed to join in on foundation training with the doctors. In which case, why do doctors need to jump through all the hoops they do if PAs are doing the same thing ? The need for constant rotations seems unnecessary for PAs so it must be for doctors ?
Oh and doctors earn less. But take all the legal responsibility for prescribing.
Presenting yourself as a doctor when you are not is a criminal offence.

That's such a very kind thing to say and really appreciated

@mumsneedwine do you have a link? I can’t find on Google that they will be issued with a 7 digit pin imminently, prior to the regulation.

Your trust does sound pretty good from what you've said here! I think ANPs are brilliant and in my experience they act as a wonderful source of support and knowledge to junior doctors.

I’m a doctor. In an adult medical specialty so hospital based. We NEED doctors in psychiatry! Psych patients get physical health problems too and a doctor to see them stops unnecessary urgent admissions to acute trusts. This is appalling, I am truly horrified. The Tory party will not be seen by a mere physician associate, but it’s fine for the rest of us plebs to be seen by someone who’s done a two year masters instead of medical school and further postgraduate training. Terrifying. I hope you find a new job soon, sounds like you’re a wonderful doctor.

I think though this is the reality for female doctors. You need lots of family help or to do GP, the rest of us delay babies for career. I’m 31 and waiting a bit longer, I can’t afford a baby and want to get into my next stage of training or I might never manage it. It’s not a career where you can have kids young - and OP Kate 20s is younger than uk average. I want to have some in a few years time, maybe I’ve left it too late? I don’t know.

What used to be a great wage is now rapidly decreasing in value. So we’re not like people in the corporate world sacrificing their personal life for great financial gain. What’s the point in being a doctor nowadays? I’ll never ever lead the lifestyle consultants now currently have. I don’t know how I’ll pay for nursery fees, I may need a nanny to fit around my hours. As a hospital registrar, the most senior medical doctor on site at night, with two degrees, completed my post grad membership exams is it that unreasonable that I should be able to pay for childcare and my mortgage on my wage?

The OP probably knew having kids young was a bad idea for her career but we should have a system where she can actually return to work successfully and finish training to become a GP or cons if she wishes to.

Can your husband offer more support so you can return to training? If you love psychiatry I hope you find a way to pursue it.

Completely agree and thanks for your post. I'm sure there are roles for physicians associates but psychiatry really needs easy and timely access to those who can prescribe emergency medication and perform emergency detentions. This is already an issue in my hospital as it is physically very spaced out (plus usual staffing issues and the fact doctors may be at meetings or in teaching sessions). Reducing the number of staff who can do these doesn't seem a good idea (and creates terribly stressful and dangerous situations for our nursing colleagues!!). We are also essentially acting somewhat as the patients' GPs until discharge. Whilst we have access to secondary care specialties, these are not on site and so it is important that we can accurately assess and give information to our colleagues. The medications we give also come with a lot of side effects and some can cause patients to become acutely and severely unwell if they are not managed properly. A holistic understanding of medicine is really needed in psychiatry, even once a physical cause of presentation has been ruled out. It is not uncommon that we diagnose cancers or other serious illnesses as our patients struggle to access healthcare in the community for a number of reasons and so don't get a full work-up until they come into us. I struggle to understand how a 2 year course can set someone up for that. There's still so, so much I don't know after 5 years and my foundation training!

@mumsneedwine completely agree. Training destroys our lives. But apparently under trained, unregulated physician associates don’t need to do any of the hard bits we do and can cream off the nice parts of the job?

@Medstudent12 thank you for articulating so well what lots of us doctors are thinking. And you're right, I did have my children on the younger side and I did know it wouldn't be great for my career although probably didn't appreciate quite how much until I was actually in the realities of it. I'm just a little defensive about it as it seems so unfair that we have to accept that our reproductive choices affect us like this. DH wanted children as much as I did and it's neither of our fault that I was the one who had to physically carry and birth them... DH is wonderful and would do anything he could to help me make it work. He'd never, ever expect me to give up my career, although the reality is his earning potential is far, far higher than mine. I'm grateful that he truly understands my job and the associated lifestyle. I'm the one grumbling about it and suggesting I'd have to leave was probably an immediate defence mechanism because I felt so rubbish and unappreciated. I guess we have to sit down and work through the balance of what is best for each of us and also for our children. I'd love to know where some of the commenters on this thread work though as it really does sound like there are better trusts out there. I was genuinely astounded when someone commented that junior doctors fixing printers and running physical errands isn't done in their department .

@MjB4 sorry I didn't reply to you earlier - I really am glad a PA has commented on this thread! You sound great, but I do think there is a big difference between a PA who was an experienced nurse (and I guess quite a few will be HCPs of some kind?) vs. someone who has come from a biomed degree or similar. The one PA I know socially (not through work) is the latter and her knowledge (or lack of) is frightening. She was genuinely laughing to friends about how she doesn't have a clue what she's doing with kids in GP(!) although at least this was (late...) in her training. I often didn't have a clue as a med student either but I had the insight to know that it wasn't funny and that I damn well needed to do the learning I needed to have a clue before being faced with real patients! ... I imagine PAs who have worked in the NHS elsewhere are far better and will come in with a much greater understanding of the system and a much better clinical grounding.

I would be horrified if my trainees were ‘expected’ to fix the printer. If they wanted to ‘have a go’ and try and sort it, that’s fine if they had the time. We all pitch in and do random stuff like trying to fix the ancient air conditioning unit, change the clocks when they go forward etc. Random acts in a team. But that’s different to it being an ‘expectation’ of any clinician.

I work in London where in my team, we truly adore our trainees and are sad when they leave. We have just said goodbye to a fab FY2. And good non-training grade doctors are like gold-dust and we would be clinging on to them for dear life.

I am convinced there is a job out there for you. Change trust if you can.

I would be horrified if my trainees were ‘expected’ to fix the printer.
Me too. And I qualified in the 80s when my job as a House Officer did include many tasks which would probably be seen as low value now, such as filing the day's blood result slips. (It did make sure you definitely saw them mind you.) But I have never at any stage in my career been expected to do clinically unrelated maintenance tasks in any of the numerous hospitals I have worked in. Well, I might have changed an ink cartridge or unblocked a paper jam now and then but that's because it would have been the quickest and easiest solution and to my own advantage, not because I had to. In fact more often than not I'd be frustrated about having to, say, wait for someone from maintenance to come when I would have happily walked down to stores to get a new lightbulb for my office and change it myself.
There are lots of rubbish things about working for the NHS OP, but some of what you describe is definitely not what I recognise as normal - and I have worked in a lot of hospitals in more than one region. Honestly, whilst I understand you are currently upset I think this may be to your advantage in the longer term. Find somewhere where you are better valued - there will be somewhere I'm sure.

DD said she'd just like the letter E on the ward keyboard. Has made prescribing some drugs a bit of a lottery. And not to have to work 15 hour shifts because of under staffing (she does exception report and does get paid eventually).
I am still trying to find a legal definition of a PA and their scope of practice. Each Uni says something different, and GMC and NHSEE say nothing at all.