To be so hurt to have been replaced by a Physician's Associate?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

Because we are the ones who carry and birth the children (and possibly feed them). So we certainly need to be considered above men at least during the pregnancy ...

Thank you. I've really valued your support and input on this thread.

The bma pay gap report for 2020 says that there is 18.9% pay gap between male and female hospital doctors.

So when you choose who has to stay home on parental leave and who does the pick ups and drop offs then most couples will be financially sensible and choose the higher paid person i.e. the man.

Sort out the pay gap and then women can have better choices!

@Salacia, I so so agree with you that medicine has lost its status and doctors skills, intelligence, dedication and commitment is just not respected to it's true value.

The general public has no idea what the job entails, physically, mentally and psychologically. The number of paperwork and bureaucracy is mad. This is why though I am in support of freeing their time and commitment to do what is more complex and are trained for rather than focusing on the mundane every common tasks.

A new patient is referred with symptoms of MS. Never ever appropriate to be seen at first appointment by a PA. Consultants only or Junior Doctor whose specialised. 2 years down the line, the patients is seen every 6 months to check on progression of the disease, symptoms, side effects of medication, or discuss social issues such as finances, social care and need to be sign posted to the right agency...that would be a waste of consultant appointment and a PA review is totally appropriate. If the patient has deteriorated beyond expectation, suddenly don't do so well on their meds, is experiencing new symptoms or has now co-morbidies, they should then be reviewed by a doctor.

Getting back to @prawncocktailskips - have you looked on the LTFT or medic parenting forums on Facebook? Might be a good place to start to find out what training is like in local deaneries. Some are a lot better than others and you may find a training programme that will work for you. I understand why you feel that a training programme won’t work but there are always exceptions and whilst I’ve been incredibly pessimistic on this thread there are some good head of schools out there who do care.

Exactly this. My DH is deeply supportive. I couldn't have made my current role work if he wasn't! But he earns more than me, and all going well, will earn a lot more than I ever will. In some ways his job is very flexible, but he has to travel. We have to make the right decision for our family. I resent individual women (and couples) having to take responsibility for the way our society works.

No I haven't and I didn't know they existed (I'm not very social media savvy!) but I will take a look. Thanks so much.

@Salacia I'm also being very pessimistic I'm afraid! I know there are ways for me to stay in medicine if I want to. I just feel like the balance is being tipped further and further towards leaving and this particular episode has really made me want to go far away from the NHS to lick my wounds!

Because we are the ones who carry and birth the children (and possibly feed them). So we certainly need to be considered above men at least during the pregnancy
No one mentioned during pregnancy. No reason afterwards why leave can't be shared. The NHS offers one of the best shared care package.

The bma pay gap report for 2020 says that there is 18.9% pay gap between male and female hospital doctors
Does it total hours in considerations, grades etc...it means nothing alone when not knowing which factors have been or not taken into account.

It is an adjusted gap based on a comparison of full time equivalent mean pay. The unadjusted is 24.4%

So when you choose who has to stay home on parental leave and who does the pick ups and drop offs then most couples will be financially sensible and choose the higher paid person i.e. the man
Or the opposite...maybe women are choosing to work fewer hours, are not as keen to progress etc..egg and chicken effect.

No it's adjusted for hours.

The 'lean in' argument is postfeminist twaddle.

@vivainsomnia why is that person being seen by a PA at all? Why not a specialist nurse with a 3 year nursing degree, potentially decades of experience and a masters degree in clinical neuroscience? It feels to me that PAs are taking work away not just from junior doctors, but also from specialist nurses who have eons more knowledge and experience than your average PA.

I think it’s a tricky one regarding out of hours generally. A previous poster stated that she can’t do shift work or weekends and how inflexible the nhs is. But, allowing some staff members to do 9-5 Monday to Friday would only mean someone else having to take on additional unsocial hours. And it would probably be a staff member who also has children. Having to do extra unsocial hours to accommodate someone else’s family, at the expense of your own isn’t really on. Of the female medics I know, some continued their training on reduced hours ( so it took longer) and others only had children when they achieved consultant level - so in their 30’s. It’s a difficult decision to make.

I think most women would be happy to do more OOH if they got paid enough to cover the childcare for it. That is the crux of the matter. Doctors used to be paid enough to have full time nannies- those days are sadly long gone. I’ve never understood why we don’t get a significant uplift for OOH - then those who are willing to take those shifts (and some people love them!) get paid their worth for them.

how much would someone have to pay you to work random 12h days, one week of nights a month and 1 in 2 or 3 weekends?

Yes, like @PlusThyme said, it's a combination of factors. Realistically I don't enjoy OOH and often get migraines following nights but I accept that. We'd all find OOH less stressful if we were better supported for a start. Then agree about affordable childcare. Adding in the randomness of rotations, moving away from support networks or just meaning the commute is much longer so more childcare must be found etc. Again, add in getting rotas last minute (I can make this job work with DH's travel just fine because I know my hours and can request AL long in advance, unlike previous jobs I did where AL requests were ignored and rotas were given out weeks in advance and changed frequently without warning - yes, in theory this shouldn't happen and I think(?) one can refuse to work a shift but this does not go down well with consultants - the same consultants who we need to sign us off as competent )... Add in again frequently leaving late because someone hasn't come to relieve you on time and you're the only doctor. There are a lot of factors that make it really hard. I'm not opposed to hard work and OOH in general. I wouldn't have survived med school and foundation if so and, even as a naive 17 year old, I didn't expect to never work a weekend or to have every christmas off with my children.

I wonder in general if non-medics on this thread realise how reliant we are on good relations with our consultants and the MDT in general to get adequate feedback and pass our rotations. We move into new teams frequently and the onus is on us to get on with people. Have you ever seen #tipsfornewdoctors on twitter in August? Imagine starting a new job and being told you must make the established team tea and biscuits so they'll be nice to you! Happens every August. I mentioned my first weekend as an F1 upthread. That weekend I stayed hours late because the nurses insisted they couldn't help me with some physical tasks. Once I knew them better, they admitted they actually could but they like to 'lay down the law' to new doctors. Imagine that on your first days! Life can be very, very difficult if you complain. I've seen it again and again. It's generally easier to just accept staying late and getting rotas late, keep your head down, get signed off and moved on. Part of the reason I adore this job is because I've been accepted into a team. Work is so so much easier when you always know what you're doing, where you're going, who you need to talk to to get something done, and when you have working relations with the nurses (who themselves have to quickly size up new junior doctors and adapt to their styles - rotational training is difficult for all!)

Plus, how are junior doctors going to be able to learn basic skills if PAs are playing doctor with all the easy cases? You can't go straight from med school to taking on the most complex patients.

PAs aren't the answer to anything except Tory ideology.

Exactly. We need simpler cases. It's really depressing how some consultants seem to resent having to train juniors, particularly due to our rotations. I know this will be down to their own workload but it really stings. We are doctors in training.

@PlusThyme how much would someone have to pay you to work random 12h days, one week of nights a month and 1 in 2 or 3 weekends?

A huge % of the NHS workforce do this for a band 5 though. Look I do agree medicine has gone to shit, but between this and OP's latest post it makes doctors look a bit privileged

Totally agree. There’s hardly enough training to go round as it is. What I would have given to be in clinic with a consultant debriefing me before and after my patients! Or in theatre assisting. Instead I was stuck on the wards doing discharge summaries and blood forms, prescribing for the PAs.

This is just... having a job? Getting on with colleagues and doing the grunt work when you're new. I'm NHS myself, but lots of us would not be able to cope in a corporate environment.

so why do PAs get to do 9-5 on band 7 starting? On AFC I think a newly qualified F1 would be at least band 8, if you want to compare like for like.

Not a race to the bottom. Most doctors are very privileged, I'd never deny that. I always, always advocate for the rights of nurses and AHPs. Their shift pattern is far more random than ours, it must be really hard to find childcare. Unsure how that's at all relevant to my AIBU though? If a nurse managed to get a community 9-5 job that worked for their family and then was replaced by someone less qualified, less experienced, less skilled and who earned more than them, I bet they'd feel like I do. Also, nurses aren't as beholden to one trust as we are ... I know plenty of nurses who have moved from hospital to community, or who do solely bank shifts. It's really not a race to the bottom. I'd never deny that I'm in an incredibly privileged position to be able to choose to leave if the job becomes too unfavourable.

I have no idea, some daft government initiative made up by managers who couldn't cope with a patient-facing role I assume, as I said upthread.

I think an F1 would probably be more of a band 6 though, not an 8