To be so hurt to have been replaced by a Physician's Associate?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

@Spacecowboys @PlusThyme we do have an onsite consultant until 2am in my division.

The PA roles are often fully funded by the ICB or direct from NHSE funding. There is an array of what they call ARR’s roles and PA is one of them. So it’s possible they aren’t funding it, it’s been funded for them and they are taking the opportunity. Which doesn’t make it suck less but explains the finances aspect

@PosyPrettyToes you surely must know that it is a highly unusual situation to have a consultant on site until 2am (A&E excluded)

Would absolutely love to know what trust this is as this isn’t my experience (or any of my colleagues experiences) at all. At least of doctors in training schemes - locum doctors obviously can pick up shifts they do/don’t want as that’s the trade off with locum work.

The only doctor I know who does no night shifts (in specialties that require them) is a type 1 diabetic and has ended up in DKA a couple of times due to the time swapping making insulin regulation almost impossible. They still worked weekend days/lates though. I also know doctors who have come off night shifts in the later stages of pregnancy. My DH is LTFT in an on call specialty and you don’t get the option to drop the OOH work (it’s just adapted to make the hours work). Plus a PA needs to work under supervision so you’d still need a doctor surely unless you’re running an unsafe rota?

Would you consider becoming a gp it would work really well around family and your knowledge of mental health would be amazing in a gp setting as this is often lacking and about 40% of gp appointments involve mental health.

You have my sympathy OP having done psychiatry jobs in the past - I’ve worked in old age and you definitely needed a robust knowledge of physical health (dealt with some pretty hairy situations as an F1 with very little support).

Off the top of my head you could look at public health, histopathology (some deaneries are small so commutable and no on call), chemical pathology etc - although appreciate that what it sounds you enjoy in psych going to be lacking in these specialities.

Drs in non-training posts will often preferentially take core hour only jobs. Even though doing OOH would pay a bit more, the stress of it etc makes it less attractive unless it's part of your overall contract and a step towards something else later.

Let the managers swing on their own rope. These decisions are so short sighted, and will come back to haunt them when a person who is not a doctor, who doesn’t know what they don’t know, makes a grave error. How can we have sat for 5 years in back to back lectures to have our experience and knowledge replaced by an 18m conversion course.

i am sorry this has happened to you - it is to the collective shame of our profession that we have allowed ourselves to be demoted and undermined. Good luck finding an alternative role!

To do GP training the OP will have around 18 months of hospital rotations which will have a significant on call burden (important placements include A&E, O&G). It’s definitely not family friendly while training unfortunately.

I fell out of training because I couldn't balance young children and work and study - this was rather a long time, before run-through training, and I got my exams but at the time there was a limited pot of funding for working part-time at all, and I couldn't master one aspect of what I needed in the time I was given at SHO level. Recently I've tried to get back into community paediatrics and have similarly met, we thought we were going to have more posts but the funding isn't coming through. Even though they desperately need more staff for the workload. I've had one short-term post but can't find the next one, limited by wanting to remain part-time so as to continue another line of work I developed over the last 10 years.

I agree that PAs in psychiatry can only worsen the difficulties maintaining adequate care of medical issues in this group of patients. Their training is too quick and too limited for them to gain the crucial understanding of knowing what they don't know, or to have the sudden recognition that "something is different here" that helps you pick up the unusual but important.

You sound like someone who really needs to be supported into a proper training post to be honest, I hope that you are able to get to that point in the not too distant future. When run-through training was invented, the benefit of people being able to choose to stay longer in SHO posts was under appreciated.

Oh I assumed he'd done the rotations with him specialising but I don't know how this stuff works

I haven't come across a cover supervisor that wasn't qualified in some way. I worked as one in a highly academic school. I had been a college lecturer and have a degree which focussed on additional needs and behaviour management, which was a change of career in my forties. My colleague was a secondary school teacher. When we retired we were replaced by people with extensive teaching experience.

Ask your Management not Mumsnet

https://www.bbc.co.uk/news/uk-england-birmingham-67478818

PAs are working as OOH 'registrars' without supervision.

Junior doctors have been screaming into the wind about this for years.

That’s ok - medical careers are confusing to those of us in them let alone on the outside!

What you’ve rotated in as a foundation doctor doesn’t count for specialty training. I do know some people who have switched from psych to GP and were able to negotiate out of an additional psych rotation in GP training as they could demonstrate the competencies from their previous job and it made more sense to get increased exposure to a specialty they hadn’t done since med school/foundation years - they still had to do general medicine/A&E/O&G jobs etc though. Some areas were more flexible on this than others though.

This is terrible. The service is being very short sighted. My understanding is that psychiatry is very much a shortage speciality. I’m sure you will be able to find another job that does value you and your skills. Start actively looking. Go and speak to other units. I think you will be snapped up.

Are some trusts using PAs as a way to get more diversity and inclusions hires into higher ranking roles, and also as a way of hospital trusts having a more loyal/malleable staff at those higher levels?

So have you not even completed MRCPsych yet? How far along are you?

Unless they have reasonable adjustments agreed with occ health (which anyone can apply for) then junior doctors invariably unless in speciality training such as GP have to work nights. PA's however are contracted to work 9 to 5 and any not are the exception to that- this comment makes little sense.

So who covers the rota from 2 am? The ACP can’t, as the consultant has gone home, so some poor junior doctor does the worst shift in the world I.e 2 am-8 am???? No wonder your juniors are up in arms.

It is but training posts are exceptionally competitive, many who apply don't get accepted. Doesn't make sense does it? Especially when they evidently do have the funding as they're ploughing it into the rapid expansion of PAs.

I believe that there is a higher proportion of those from minority backgrounds in medical training vs PA training. I also think it’s interesting as how medicine has become more female dominated it’s become worse paid and less respected on the whole (by politicians and the public) - that’s a discussion for another time though.

I think the real reason behind the push for PAs is their qualifications are less easily recognised overseas so they’re tied to the UK (and therefore the NHS). Suits the government nicely when more and more doctors are aiming to quit or emigrate.

OP, I don't normally post about these things but just felt I had to. Your comment about choosing medicine at 17 really hit me because I had the same thoughts once I had my kids. I didn't really understand just how expensive (and impossible to find!) childcare would be when working late evenings, nights, weekends, particularly on a doctors salary....so I understand not getting into a training role right now due to family commitments. Anyway, I don't have any helpful suggestions but just wanted to comment out of support. I know that feeling of being undervalued! I left medicine ultimately. If my children ever want to enter the world of medicine, I'll make sure they go abroad so they can at least earn well enough to pay for a nanny and whatever else they need to survive the crazy hours expected of junior doctors.

People know what is required during the training of junior doctors and they must work their personal life round this.

Some women with foresight are training as PA’s: well paid from the start of their career and good life work balance. Don’t knock it