To be so hurt to have been replaced by a Physician's Associate?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

It's not unusual in big, complicated organisations for funding to be available for one thing but not another.

Can you locum somewhere else?

Well, the NHS plan is to double the number of doctors but it will take 5 years to graduate a doctor (they are looking at shorter training) and another 5-10 years to reach consultant level.

That said, Psychiatry is a heavily fragmented specialty with lots of contracted out care, which underrecruits as a specialty - are you sure you can't find another locum post? Secondly, have you considered moving over and doing the GP training? Your psychiatry skills will be hugely beneficial as mental health is a massive aspect of GP presentations. There is more flexibility and for now, they work in the working week.

I assume the PA post bought the potential for a stable, permanent member of staff. In addition to what you get an hour do they also pay an agency? It may be more than £23 per hour to the trust. Do you know for certain they haven't recruited higher up as well, so the PA will do slightly different things as someone can cover the more advanced areas?

I know this^ isn't a popular opinion, but @vivainsomnia is not wrong.

Imagine this wasn't healthcare because that's always emotive and we all have a natural instinct to want to protect our nurses and doctors.

If this was a corporate job, OP wouldn't be getting sympathy - she'd be told that she shouldn't have opted to have children so young while she was still climbing the professional ladder.

It's like applying for a job as a pilot and then complaining there's too much travel.

OP, you say you didn't know what the job involved as a 17 year old, but surely by the time you decided to have children you knew what was required? Having children so young when you're trying to progress through a demanding, antisocial career makes no sense at all.

Sometimes you have to make difficult choices, and having children young without finishing your full training means there's been a knock-on effect on your career. Doesn't mean that you made the wrong decision, it may well have been the right decision for you. But all decisions we make have consequences and choosing to have children without being properly qualified/trained was always going to mean sacrifices were going to have to be made somewhere.

And although you've gone to great lengths to stress your expertise, you've also admitted there's a lot that you can't do without completing the rest of your training. So that's a place at medical school that's not been properly utilised because there's so much you can't do.

I am sorry you have been passed over for someone that's not as knowledgeable but you have created a lot of your own difficulties. Of course it would be wonderful if the system was more flexible and accommodating but we all know that it isn't. So until changes are made, we're stuck with how things are - and sometimes that's going to mean difficult choices have to be made.

Everyday is a school day !
It sounds like my pre-reg job at the turn of the century ! I thought we had got beyond that. Jist as an aside I earnt circa £25,000 for that in the year 2000. Google tells me this equivalent to £57K today. We also had free accommodation. I am sorry for all junior doctors these days, it's shit.

Unless GP training has changed a lot since I did it, OP would still have to do 2 years in hospital specialties, with the required shifts and out of hours work.

If this were a corporate job they’d be trying their hardest to retain the doctors they spend a lot of money on training.

They are increasing medical school places, but this year I think it was 3 out of 4 doctors who applied for specialty training did not get a place. So what will that mean? A load of junior doctors with no training posts who will either leave or go abroad?

It won’t be personal OP. In the longer term scheme of things and what trusts are moving towards, it will all be about cost saving measures.

Everything is moving to farming more and more stuff out to lesser qualified staff to save money. When you ring for a GP appt now they almost always try to get you to see a nurse or some other healthcare professional. The cost per slot with these is clearly less. It’s like seeing the junior at the hairdressers instead of the top stylist….but the NHS and government are fitting the bill and want more of us with the junior.

It’s reasonable to a point. Lots of appts probably can be dealt with by other people. However, as you illustrate, often they can’t.

My experience with the GP surgery making me see other people, was it took 4 appts with other professionals before I eventually saw the GP and got the prescription I actually needed. So it cost the gov the price of a GP appt plus all the others too….and my health condition worsened whilst waiting and probably meant my care cost more too.

Don’t take it personally.

Thanks. I'm just the mum so get the occassional tired phone call where she sounds utterly defeated. She is tough and her colleagues and patients probably don't see that side of her, and why I am sounding quite fierce. I am actually waiting for her to wake up so she can download about something that happened the night before last.

Her trust is very short of money. DD has also come across (not come across) the missing registrar which was apparently quite scary. (The 70 year old consultant stayed on for as long as they could and then told the F1/F2s to phone if they had to, but they needed their sleep.) Whilst admin staff, presumably thinking numbers not practicalities, recently tried to push her to doing a long day shift immediately following a night shift.

Question. If the NHS had less management would the management be better?

I did feel bad for the poor reg (who was meant to be clerking rather than supervising me much…) who was on for me on that first shift. I made her come and supervise my bloods and cannulas having only done 5 or so a few months previously at medical school…! I did get those skills up to scratch by the end of those nights though.

If this were a corporate job they’d be trying their hardest to retain the doctors they spend a lot of money on training.

Corporate jobs tend to not care much about retention unless these people are massive fee earners. And most aren't.

I have a 17yo I am gently discouraging her from applying.

@SecretSoul I like to think I'd be sympathetic either way if someone from the corporate world posted about how they'd been replaced by someone with less training, who could do less and who was paid more than them. I'd be even more interested if it was a career that the media told me was impossible to recruit for. As I've said up thread, I have my own personal reasons for when I had my children and am not interested in debating that. I haven't gone to great stresses to say what I can do in general - just in comparison to a PA. I know what I can't do. I'm a middle grade junior doctor doing typical middle grade jobs. I've explained them a bit as many on this thread are not medical and possibly don't know what a 'junior' doctor is doing. Much like @JennieTheZebra , I'm well aware of what I am and am not capable of doing and would never go beyond my abilities. The point of my post really is just to bemoan why can't doctors do these flexible posts? What is the point of replacing us with less qualified PAs? I think I'm allowed to be a little hurt that I worked so hard in this job and have just been replaced without warning by someone who can't do parts of the job. (And to a previous poster - definitely no one else recruited. It's a middle grade junior doctor vacancy and it's been filled with one PA. The fact I can't do reg level stuff isn't relevant here).

You say your niece is only 24 and finishing training - is that med school or foundation? If med school she still has at least 5 years before she could become a consultant (working on the assumption she gets straight into GP training after FY2 so she’ll be nearly 30. If she wants a different training programme (pretty much any other specialty) she’ll be looking at least 7 years training after med school (2 years foundation plus 5 years for hospital medicine, psychiatry, pathology, paediatrics, ED etc, 7 years in many of the surgical specialties) so she’ll be over 30 by the time she reaches consultancy (again, presuming there is a job which isn’t a given and presuming you’re not in a specialty where needing to take time out for research etc isn’t almost essential to get a consultant job). Waiting at 24 is one thing - getting into your early/mid/late 30s and waiting is very different (again, speaking as somebody juggling medical training, albeit in a non-on call specialty alongside ivf).

@Locutus2000 ooh interesting 🤔, didn't even know we had them here!! Thank you for this link🙌

If PAs did things to support doctors in their roles then this would be true. However, as the OP has found, they often aren't supporting - they are replacing doctors. I think most doctors would wholeheartedly support more admin support from appropriately qualified people like PAs - as the OP mentions further up.

As to having no sympathy and comparing OP's situation to a corporate job, this is pure nonsense. What corporate organisation is the monopoly employer and sole provider of training for an entire profession? Come on, the OP does not have the kind of options a corporate employee does, and blaming her for having kids rather than pointing out the obvious flaws in this is really insulting.

Also the public sector and private sector are different, you can't just compare them like for like. If it was a corporate job no one would be sympathetic perhaps but also I'd hopefully be paid more and be able to apply to individual jobs and employers rather than a big centralised monopoly employer. Ultimately, if I want to be a UK psychiatrist (including practicing privately) I need to do a core training programme. There is one application system. I work where they tell me, I work the hours they tell me. I can't just apply to a new hospital because I don't like it. My deanery is massive. A friend was given a job in X hospital. Just before starting, she was told she was actually in Y hospital, nearly 2 hours in the other direction on public transport. Did they care that she had housing sorted or that she didn't drive? Of course not. You stay or you leave medicine.

Oh dear 🤦🏻 that's not what the thread is about....

Thank you @sheepisheep. It does feel hurtful. Having children in late 20s is a perfectly 'normal' thing to do (not that I think we should ever be judging anyone's reproductive choices). Why can't I want better for women in the workplace? I've given so much to medicine, I wasn't going to potentially give my fertility as well.

@prawncocktailskips if you could go back and hear the presentation on reforming postgraduate training and "modernising medical careers" that I attended in 2002, whilst pregnant with my first child, you would weep.
Everything they were proposing was about better transferring of competencies between specialties, more flexibility to move in and out of training (and in and out of research, maternity leave etc), and just generally a more effective system to allow people to try out different areas but also progress their training efficiently.

When MMC was instituted a few years later (by which time I was in a research post and largely fell foul of "computer says no" in the application system), the form it took seemed almost the exact opposite of those proposals I'd first listened to.

God this is depressing.

Depressing that nothing has changed over the last 40+ years to help women get to senior positions in medical professions (because it disproportionally affects women) and that women are held back due to giving birth.

Training for Drs was designed for people who didn't have to worry about childcare - they either didn't have any or their partner did it.

My DB is a consultant psychiatrist - got to that grade pretty quickly - ONLY because he is childless, was able to work unsociable hours and was super mobile when he was a junior doctor. He moved from Bristol to London to the North West to get his promotions. If you have a young family this is nigh on impossible.

Employing physicians assistants is short sighted - probably cheaper in the short term, disastrous in the long term.

To everyone - please don't vote tory

Don't fall for this as this poster always pops up on threads with ridiculous opinions. It never fails.

We’re numbers on a spreadsheet to the NHS and society at large. I find it baffling that there are people on here arguing that doctors should potentially sacrifice their fertile years for the sake of a monopoly employer that really doesn’t care. And happily extolling that it’s the case for women in general in professional jobs who also deserve judgement for having children. Surely it’s not a race to the bottom and we should want better for everyone?

Thanks @Pipsquiggle. Feeling a bit disheartened. My original thread was about feeling sad (nothing more!) that I've lost a job I'm good at and have put a lot into to someone less qualified because of funding. That's all. I didn't ask to have my decision to have children questioned, nor to be compared to the corporate world. The NHS isn't the corporate world. At least there I might get a bonus or free tea and coffee . Why oh why should I be punished in my career for having children? Why can't we want better for each other?

apologies, I see you were telling me not to reply to someone else 😳

Everything comes down to money in the end.
While your rate is quite low surely it would increase the longer you're there and gain experience.
As someone who works in the health service generally locum workers are not favourable due to cost and unreliability. If the post does not require the additional things were doing (prescribing/detaining) then they shouldnt really be paying for a locum doctor when a PA can do the equivalent. If you want a particular role you need to apply for it not through locum as locum jobs are not secure or guaranteed long term