To be so hurt to have been replaced by a Physician's Associate?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

I hope you can get back into training OP. FWIW in England and Wales GP training schemes are geographically smaller which means you apply to the town not the entire deanery which means lots less travel, and GP training is now 12 months hospital 2 years gp. Lots and lots of less than full timers and it's is possibly to have substantially less out of hours for that year if you have caring commitments. Many of our trainees do no OOH at all as they are single parents or have no childcare.
I can't speak for psychiatry but whilst you'd be broke as a LTFT GP trainee it is very doable.

Plus GP is great fun and SOO much really meaty psychiatry.

The fiasco of MRSA today just seems to sum up the whole mess. Lots now can't get slots to even sit the exam.

Or the GP exam disaster. I recently spent over 800 quid on an exam and the college ‘lost’ some of the images for one of the stations off the provided ipad. Thankfully it was doable with the rest of the information provided but for the thousands of pounds the exam raised you’d think basic IT issues wouldn’t be a problem.

take the training opportunities of the doctors.

Which training opportunities are being taken away from F1s in other trusts and given to PAs. I’ve not experienced this.

@Spacecowboys there are many examples seen on Reddit and Twitter. All seem legit and verified by other doctors. Examples include:
Doctors doing ward work while PAs attend surgery
GPs not getting jobs as PAs employed instead
Doctors being trained by PAs and having to take instruction from them
PAs attending foundation training

I am very sure there are lots of lovely PAs who do a fantastic job. But there seem to be a few who act as doctors and present themselves as doctors (the case of the young lady who died). There seems to be no scope of practice so no one can say what they should be doing.
The worst one I saw was a PA telling an ST1 to prescribe amoxicillin, and when the ST1 pointed out the patient was allergic to penicillin the PA said 'I've not asked you to prescribe that so just do as I say'. Madness.

It is actually scary that a PA would be telling an ST1 what to prescribe despite clearly not having an understanding of the drugs (not surprising given they have very limited training in this area). What did the ST1 do?

@coffeeaddict77 I believe the ST1 told them they would kill the patient if they prescribed as asked. PA went off in a huff to consultant who gave the correct drug. ST1 never even spoken to to say well done/thank you/sorry.

It seems the 'be kind' and 'one team' mantra doesn't apply to doctors. I don't understand why.

It's suprised me how much interest this thread has gathered. I'd believed that the public hate doctors now, and think we are entitled, elitist, greedy and paradoxically stupid/failing to do or know things deliberately that someone else would do much better and cheaper and more happily.

We are stuck in this horrible situation where we don't have enough doctors (see our numbers compared to healthcare systems we like to imagine we are comparable to), beds or other staff, and whereby it has become totally unacceptable to say that the reason for that is because people don't want to pay for what quality healthcare really costs.

The PA vs junior dr situation has arisen due to our collective fear of articulating the difference between people who apply to med school and people who seek alternative routes to provision of clinical care. The difference, brace yourself, is educational attainment, in terms of academic achievement and application of hard work throughout secondary school age. Then you end up with a cohort of people who are better able to assimilate large volumes of information, deal with pattern recognition more swiftly, and cope with missing information more accurately. We are so aghast at the idea of saying that (in general) doctors are more intelligent and this is a good thing, and worthy of better t&c and retention, that we would rather chuck away 'ungrateful' doctors who have had the temerity to attempt a bit of a normal life before the age of 35.

seriously the decline of healthcare in the uk is in a great part due to the 'everyone is sick of experts' anti-elitism that is racing us towards the most basic provision of first aid type healthcare that only

there I've said it

Are PA the ones in burgundy on wards? How do you know if you’re being treated by one instead of a doctor?

I don’t think the public hate doctors.

Surely part of the problem is the elitist system of applying to med school with privately educated students unfairly represented. Plenty more are capable of a medical degree however there are very few places and hoards of perfectly capable students are turned down.

@Nearlythere80 perfectly put. My DD went to the local comp, worked incredibly hard to get goods grades and jump through all the hoops to get into Uni. Then 5 years hard slog through Covid. To end up being paid the same as she earned stacking shelves at Waitrose.

She wants to stay, she wants the NHS to work. But she doesn't even know if she'll have a job after F2. Yup, we are going to have unemployed doctors as not enough jobs for them. But hey, let's get more medical school places.

To fix this :
Pay doctors the equivalent of their 2008 pay (not all at once, but have a plan to do so in the next 3-5 years, like Scotland)
Fund enough training places for the number of medical school places so everyone can progress who wants to
Don't increase PAs until we know what they are supposed to be for and they have a defined scope of practice (& do not expect doctors to carry their liability)
Stop rotational training. Why do you need to move every few years. Settle and work at hospitals up to an hour away. Offer more money if some places see less popular. Then doctors could be 'part of the team' too

I say all this as an outsider looking in. I may be completely wrong, but it's all a big mess.

@Cranb3rryF122 you don't know, that's the problem. Know the only profession that didn't get a colour for their scrubs ? Yup, doctors.

Are PA the ones in burgundy on wards? How do you know if you’re being treated by one instead of a doctor?

If they don't start by clearly announcing their role "I'm X, a junior doctor/ registrar / PA" then ask what they are. If they're a PA, ask to see a real doctor.

But who has the confidence to demand to see a doctor when you’ve been waiting to see anybody?

doctor are not given uniforms.

the uk doesn't want to pay for more doctors in training, whoever fills the places available doesn't make the difference to that

We all should. It's worth waiting another hour to see a real doctor. And if you're desperately ill that another hour would make a difference, it's even more important that you aren't 'treated' by a pretend doctor.

Don't worry that the doctors will think you're difficult or demand. Most of them want PAs gone as well.

A bit off topic but how can a qualified doctor (and one with some experience by the sounds of it, you’re not just fresh out of uni), only earn £32k? And there’s still no money for that it seems! When pay for graduates in sectors like marketing is higher fresh out of uni, and all that’s required is a three year BA(Hons), with no responsibility for anything much, let alone for people’s lives, that’s absolutely mad. Honestly I’d switch career OP, I don’t know much about the alternatives but some PPs have suggested what sound like viable alternatives. We won’t have any doctors left at this rate, or they’ll come from abroad. I know the vast majority do already, but supposedly a big chunk of the population don’t like immigrants much, so I don’t understand why they keep voting for the party that’s engineering this scenario.

Not off topic at all, and exactly why the junior drs are striking next week.

I’d have more confidence at a GP surgery to demand a doctor. Our GP is well worth waiting 2 weeks for and I can do that without being a pain. However in a busy overstretched ward I would feel awful being difficult. My dd has been in a lot the last 3 years. We generally get doctors I think at ward rounds but it’s when people drop in for interventions and discussions at other times that is a worry.

Has your union thought of doing an information campaign re this as the vast majority of people don’t know?If it was more widely known and people were encouraged to push for doctors and reassured that it’s ok to do so you may get more support.

@Hayliebells bonkers isn't it ! 5 years, so more than a masters, and earn less than most graduate trainee jobs.
Last night my DD was holding the cardiac bleep in a v large hospital. A&E had over 150 patients and ambulances piling up at the door. She ended up doing a 15 hour shift as so bad and so short staffed. For £15.33 an hour.
She doesn't want to strike and can't afford it, but feels she has no choice, if she is to stay in the UK. It's more than pay now - it's training numbers, PAs and just generally being made to feel like crap. Her seniors sound awesome but many of them are leaving. Australia offering up to £125,000 next year !

Based on the post, I do think you're elitist tbh. And arrogant. I've worked with lots of doctors who are not that intelligent. Mummy and daddy are doctors and they've put them through private school and tutoring to get into med school. The spelling is shocking - 'steriods' is one that I see a lot!

This just isn't true. Maybe in your trust but in mine doctors/surgeons are in light blue, med students in black, A&E consultants in green. I'm a different profession and we have to provide our own scrubs.

And here we go. Doctor bashing is as common as teacher bashing.
My family grew up in a 2 bed council flat. I was FSM. My parents left school at 15 (my husbands at 14). Because they had to work for money.
Elistist ? Really. Idiot.

Yes elitism and arrogance are common retorts to statements about entirely feasible differences between groups. Those sorts of remarks are why people feel uncomfortable even raising it.
It's just not plausible to be able to pass through medical school and then post-graduate training (whilst working) and be less than intelligent by any particular measure.

@Possimpible I'll leave this here for you.