To put that I don’t want to be treated by PAs in my ELCS birth plan?

[BPquestion]

I have recently been following the news, and ‘med Twitter’ about the growing problem of physicians’ associates. It seems there’s an issue with many of them performing outside of their limits of capability, expertise and knowledge. I also understand that they are not currently regulated by a professional body.

I recently read of a PA taking on an anaesthetic role, and another taking on a surgery role.

I am having an ELCS soon. Would I BU to put in the birth plan that I don’t want any PA to be involved in any part of the surgery itself?

Should be fine. I said no students for my last c section. I’d done my bit, having a crowd of trainees gawping at my 3C tear and having a go stitching me, and then again in my disastrous first c section 😅

Bradford

Life Science, Biomedical Science, or Healthcare subject from a UK University or overseas equivalent

Me too. And if a consultant was “watching over them” then that just proves there are dodgy consultants too and I would question that consultant’s decision making.

Using the fact it’s unregulated as your reason is fair. Not entry reqs.

It’s different with students though - they are still in training so the patient has to consent to their presence but not so with employed staff. There have been cases where trans women nurses are doing cervical smears and patients have asked for a biological woman to do it but been refused.

I studied biomedical science. I and a number of other students in my cohort looked into the available PA masters courses around the country, some of whom went on to study it. All of them required a health science, life science or healthcare degree, such as radiography.

And as a PP said (possibly you @Pinkfluffypencilcase?) it’s more like three years as there’s no break. It’s a very tough course. I decided it wasn’t for me.

Doctors fuck up all the time. I think the OP has been reading too much of the Daily Mail comments section.

This is simply not true. Find me a ward with a nursing associate 'in charge' and I'll raise you some unicorn shit
They're just a different training route/pipeline like apprenticeship routes etc.
B6 nurses and above with still be in charge of wards..

I told my specialist my birth plan. Preferably a c-section and lots of drugs! That's exactly what I got. I think he found me a refreshing change from his other thirty something patients who were going to ante natal classes and wanted natural childbirth and birthing pools and sticky mucus covered babies plopped on their stomach. I didn't even mind the flock of students who were urged to gather closer after the obstetrician found something in my nether regions that he declared to be very interesting. To be fair, he probably wanted them to see a potential prolapsed cord which is rare. Afterwards everybody agreed it was a very good thing I'd had a planned section. (I did have some medical indications so it wasn't just like I felt like one.)

And for the people think the PA training is tough I am fairly sure it is nothing to the five years medical training my son is doing on top of his BSc in a medicine related major. I am fairly sure that two years into his training neither he nor anybody else would think he was qualified to do a c-section which is not just a cut and stitch proposition.

Yeah their training is NOTHING like as thorough as a junior doctor. And the rotations are essential for making doctors rounded and having an understanding of the whole body.
PAs are dangerous and the government is setting up a Mickey Mouse healthcare service with them.

I am fairly sure that two years into his training neither he nor anybody else would think he was qualified to do a c-section which is not just a cut and stitch proposition.

Which PA is doing a c-section? Where has this idea even come from? The OP hasn’t even been told a PA will be involved her care, never mind that a PA is doing her c-section.

I am a nhs manager. I've worked with three PAs. Two were absolute stars and are now at medical school. Which is absolutely deserved and they will be superb doctors. The other is very sound and works, in a supportive team, to her limits and not beyond them. So on a personal level I have good experiences of PAs. But there is so much out there about people working way above their level. I don't think this is unreasonable OP.

Not meaning to negate your experience but no, it's not the same. You may have had bad experiences with junior doctors - even GPs routinely fob people off, especially women.
However, all junior doctors are regulated and have had to undergo the same several years of rigourous training.
PA's by contrast not only have very limited training, they're also currently not regulated.

I also find it worrying that people are willing to put up with low standards of care and telling people to go private... Is this really what we want? A two tier system where only those who can afford it get acceptable - not even excellent, just acceptable - care?

That's just privatisation by stealth

The ones I know work within orthopaedics; they help in clinics seeing patients; who they then discuss treatment plans with the consultant and then work as a theatre assistant-eg holding the leg mainly and will probably close the wound. They don’t actually do the surgery or joint replacement itself. The ones I know are highly skilled though and know their boundaries.

It depends what the PA is meant to be doing surely?
We don’t currently have PAs where I work but every now and then we have a woman turn up who will want a consultant doing everything for her and doesn’t “consent”
to any care from junior docs, midwives, HCAs etc.
Obviously we aren’t able to facilitate/indulge that so the women are informed they won’t get care.
I imagine if they have a PA doing a regular, routine task, like doing everyone’s bloods, then you will get a similar answer.
Or women saying they’ll only accept a consultant doing their ELCS, or even only accepting a consultant with x years experience? Obviously they’ll be told that can’t be facilitated if a a SpR is doing the list that day. The hospital decides who can do which tasks and that’s who’s on to do if. You can’t demand they don’t do it any more than you can demand the head of Medicine come down and do your BP?
You can decline care from anyone of course but that will often mean you don’t get the care rather than you get someone else.

Great, another PA bashing thread. Just what’s needed.

YANBU to make whatever birth plans you feel you need to, but you can’t denigrate an entire profession - most PA’s are extremely thorough and dedicate themselves to their work and their patients. I’ve seen some REALLY shit doctors. Dangerously shit. I’ve seen some amazing PA’s, and some not so great. It’s impossible to make blanket statements and generalise.

PA’s have their place in the NHS. What’s vital is that patients understand who is treating them (onus is on the individual PA to be clear and honest) and that without exception, they must work within their defined scope of practice.

This is what I was thinking. I wouldn’t go with such rigid plans, I think birth plans are pointless anyway I’m not doing one.
PAs have specific tasks they’re trained to do. The issue is they’re expected to cover tasks that should be done by doctors.

Can you give a link to what you are reading?

Hey,

for those saying PAs must have a life science or science degree

https://www.telegraph.co.uk/news/2024/03/30/physicians-associates-qualify-courses-degrees/

having a science degree in itself does not count as training towards human anatomy physiology, pathology and pharmacology that makes up the science of medicine.

An intelligent person with a pHD in fungal mechanics and propagation (for example) will be no further forward in their understanding of medicine.

PAs learn ‘medicine’ at a superficial level with multiple choice exams that have a 100% pass rate nationally, and much less stringent entry criteria (all medical students must achieve top marks at school to have a chance to get in to medical school).

there is already a fast track medicine route known as graduate entry medicine where the medical curriculum is condensed into 4 years. 2 years is simply not enough to have a reasonable grasp of the complexities of the human body. It does not help that PAs are consistently told they are studying medicine. The degrees are not comparable as attested by the few PAs who completed their degree and went on to study medicine.

there are tensions as PAs with far less training and skill are being used to replace doctors, getting preferential treatment, and getting paid £11k more at starting salary. Indeed it takes junior doctor up to 7-10 years to out earn PAs, presuming a PA doesn’t move up the pay scale.

if junior doctors are losing training and career opportunities, this eventually means fewer, and less well trained consultants in the future.

i have been following med twitter, and appreciate their frustrations

I read that article and it says accepted with healthcare experience. So they’re not without a skill set.

You can get onto a nursing degree from any level 3 course.
So it’s not a big surprise that experience is accepted.

We don't have PA's in maternity at my unit. It's kind of an accepted thing that there isn't really a role for them in obstetrics.

@OneFlakyReader Even healthcare experience isn't necessarily going to be a nurse or paramedic though I can see both of those would be good foundations. It could be a few weeks as a HCA as to a homeopathy degree....
Personally I am very happy to see an advanced nurse practioner as they are highly skilled and experienced. I'm afraid I would not trust a PA other than to complete paperwork or take bloods.

Seriously physician's associates do not act as anaesthetists or surgeons. They just don't. These stories are pure scaremongering.

@Neverpostagain yes they do, some have even killed people. And the doctors were blamed for not supervising (Google it). BMA now issued guidance so doctors can say no to prescribing for patients they have never met.

They DO work unsupervised in some hospitals (Cornwall, Birmingham are 2). There's one doing unsupervised endoscopies in Cornwall - he even has a van to go mobile. On his own.
Just because 'you've not come across them' does not mean they don't exist.

And they do not need a degree in science. So could do 3 years English and then 18 months PA and off you go. I'll find some evidence when get a minute. It's all frankly terrifying

@wednesdayaffairnc they are in some hospitals. Torbay being one.

www.bma.org.uk/bma-media-centre/bma-calls-for-independent-investigation-into-hospital-trusts-replacing-doctors-with-physician-associates-on-medical-rotas