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?

A lot of the PA defenders on this thread don't realise that there are other HCP who have far more training and qualifications than PA's .
An advanced nurse practitioner as you stated is one, paramedic prescribers,speclist nurses, advanced clinical practitioners, etc.

The main problem with PA's is, apart from the lack of training etc is the push to employ them over GP's. Practice funds are being squeezed and there's ring fenced funding to employ them the former.

www.dailymail.co.uk/health/article-12630607/amp/NHS-blunders-prompt-call-stop-physician-associate-recruitment.html

And there are NO GP shortages. There are unemployed GPs because the government prefers to fund PAs. We could have thousands of extra GPs tomorrow.

Agree with this. There’s a gap and the govt are pushing a short sighted solution.

I think PAs originally would have a narrow field of expertise. And the original PAs were former nurses.

What I disagree with is the unregulated nature of their role. And that their conditions and pay are better.

www.mirror.co.uk/news/uk-news/nhs-plans-physicians-associates-8-32492871

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

Many F2 doctors have no jobs from August. Many incoming new doctors don't know where they are going in July. But hey, PAs can rock up, work 9-5 (don't do nights) and earn 30% more than a doctor. After 18 months 'training'.

But, they can't move abroad as no one recognises their qualification.🤔

@Pinkfluffypencilcase v few ex nurses or other healthcare staff choose it now. And the ones that do comment on the lack of decent training. It's a plan that seems to have gone v v wrong. Really feel for those PAs who don't want to play doctor and really do want to assist them instead. They do exist but are over shadowed by the ones who replace doctors in clinics, surgeries and GPs.

The original job scope makes sense if it was supposed to be 'progression' for other HCP. These days however those paths themselves have so many advanced routes, PA is irrelevant.

It makes sense for PA's to do the admin and provide more patient face time in place of a GP or other HCP. Routine things like taking blood etc fair enough.

Not replace doctors. If anything, I'd rather be seen by a nurse not a PA.

@onlyyarrknhe and if that was what they were doing it would be fantastic. But instead they are often pretending to be doctors, taking their training time and needing the doctors to prescribe for them.

I see this thread has made it to Med Twitter itself.

Good! I’m glad to be part of the conversation. And glad to be spreading the word of what is going on with (some) PAs.

Quite frankly, given the headlines about maternity care in the UK this week, the thing that is making me the least angry is PAs.

https://www.bbc.co.uk/news/articles/c4n1jv7xxpwo

Med Twitter is toxic right now. It’s all I use Twitter for, it used to be a good professional forum but right now there is one FY doctor who is absolutely unprofessional and ruining all sharing and learning opportunities. I’m not the biggest PA fan but at the end of the day neither would I refuse care in a public system where there may be no other option. And I do think that doctors don’t need to do everything. There is a role for PA’s in healthcare.

@Calamitousness but F1/2 face unemployment because of PAs. Are losing training opportunities yet have to sign their prescriptions for them. Can you not see why they might be a bit angry at the situation,

What does a PA do that a doctor can't ? Because we have enough doctors, we don't have enough jobs for them.

PS PAs are more expensive than doctors

That is scandalous.

PAs doing Anaesthesia or surgery only do elective cases and are always supervised.

they won't be involved in ELCS.

Think that's optimistic (I'm a obs anaesthetist) and I've seen PA students on 2 labour wards

But yeah not seen any qualified ones yet. But sure it's a matter of time

PA’s are not more expensive than doctors. Yes they earn more than junior roles but their rate doesn’t increase with experience. I agree with being non prescribers it devalues their role. I much prefer ANP’s for more experience, can prescribe, order imaging etc. PA’s are good for tasks I think, but yes everyone training wants to compete for procedures. It’s a tricky one. We definitely haven’t got the model right yet.

@Calamitousness PAs out earn doctors until ST6. And lots of doctors don't get there now after 8/9 years post graduation.

They are not supervised, that's the issue. They seem to want to play doctor but not do the work. If everything they does is supervised what's the point of them - a doctor could just do it themselves.

Again, we have enough doctors, but not enough jobs for the ones who are already qualified. But hey, let's take on more lethal students. 1,000 of them still waiting to find out where they are doing F1. Starting in July.

Medical, not lethal, but that's what a few PAs have been. But the doctor has been the one hauled in front of the GMC, for not supervising closely enough. Makes no sense.

@Destiny123 please don't train them at the expense of the doctors. Many are worried they won't be allowed in theatre if a PA is being trained instead. If they don't get practice they won't be able to get better.
Consultants were trained by their consultants, please please pay it forward to the next generation. That's all they ask.

PAs as assistants was a good idea, although doctors assistants exist. No one seems to be able to say what they bring to the team, except they don't rotate, which doctors would quite like not to have to do too.

@therealcookiemonster why are they doing surgery or anaesthesia at all ? We have doctors who need training but can't now get it as PAs doing it. How do you gain skills if don't get to do the basic stuff.

We have enough doctors to cover all of this !

I'm a reg (trainee) myself

@Destiny123 😊

we really absolutely do not have enough doctors. it's a struggle every single day to have enough staff around to provide a safe service. we are often having to pay consultants to do junior doctor jobs and there are only so many hours that existing staff can or will do.

PAs can be a very helpful addition. however the government is trying to use them to cover up the chronic and worsening lack of medical staff is a massive mistake. they also need to be regulated and their scope limited. I have worked with multiple, very competent PAs who do highly specialised tasks and are invaluable members of the team. I have also worked with a couple who needed improvement or were in over their heads.

@mumsneedwine btw have you worked much with PAs yourself?

@therealcookiemonster ratios to get into training this year up to 25:1. All over 4:1, which even taking into account multiple applications means many F2s looking at unemployment in August. Many many doctors stuck in bottlenecks of trying as no jobs. We DO have enough doctors but there are not tonight jobs.