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?

@therealcookiemonster I was almost killed by a PA. Prescribed me pencilin, no idea who signed the prescription as I thought I was seeing a doctor (he claimed to be a physician). It was only because I happen to know our local pharmacist as a friend that I didn't take it. I'm allergic and would be dead. And I didn't spot the name as wasn't one I'd seen before.

GP was v apologetic. PA couldn't give a shiny shit when challenged.

Just one speciality.

@mumsneedwine I am obviously very sorry that you had such a terrible experience. the competition ratios signify many different factors - I mean you used cardiothoracics as an example, it's one of the most over subscribed specialties as obv more people are interested any than are either suitable or needed. sure we could do with a slight increase in the number of training contracts, but that won't reduce the competition ratio, so it's a bit misleading.

there are definitely not enough training contracts being given out, however even if we increase the number of specialty training contracts tomorrow, I won't solve the problem. on average it takes 3-4 years of specialty training for doctors to be providing that service with minimal supervision. longer for more complex specialties
the bigger issue here is that healthcare is growing in complexity every day and the demands on it growing at a rate that is very difficult and expensive to cater for. PAs can be an effective way of providing accessible care with the emphasis of can be.

I am a specialty trainee in Anaesthesia and intensive care. I have worked with multiple PAs doing very specialist tasks in the last ten years over several trusts eg. providing regional blocks for orthopaedic surgery, acting as support on very busy intensive care units and as assistants to surgeons. except for one case, they have all been exemplary.

I find this whole PA thing absolutely terrifying.

I do have a life sciences degree, but I chose nearly all genetics modules in my second and third year.. so my knowledge of how the body 'works' is probably not a whole lot deeper than an educated member of the general public.

The idea of me starting a course tomorrow, and being set loose on patients (in the way PAs are currently being used) in 2 years time is questionable. Hand on heart, I would be completely out of my depth.

The idea of someone WITHOUT a science degree, so no deep understanding of anatomy and physiology, treating patients within 2 years is absolutely hideous. There is just no way they are equipped - they won't even know what they don't know.

I feel sorry for them because it's not their fault they're being deployed in this way... but wow. So no OP, I wouldn't blame you for this. I recently advocated for my mum in a similar way - every time we saw someone I asked were they a doctor. If it was something that, IMO, was better dealt with by a doctor (as in not basic blood work, ECG, blood pressure etc) and we were in front of a PA I'd ask for a doctor.

You would not be unreasonable, but actually very wise, to do the same!

@therealcookiemonster can I just ask what you'd say to the F2s with no job in August. When PA positions are advertised as being on the SHO rota, so effectively taking a doctors job. How do you think those F2s, with £100,000 debt, feel about not having a job. As a doctor in the UK.

I started working in the maternity ward (postnatal/antenatal) mixed in 2017, we had a PA then. No PA in Labour Ward. We have had 3 since then, all very experienced with many qualifications and degrees. I must admit they were such lovely people to work with, the ward wouldn’t have survived without them. Hearing of PA’s helping with c sections is shocking 😮 just like anyone who is not qualified or supposed to be doing that level of care.

I totally agree, I hope this is an isolated incident however, in my London trust this would never happen. Our PA did the following tasks: taking blood, blood gases, TTA’s, giving advice, assisting doctors with tasks, such as paperwork and getting the discharges ready. They were kind of like a doctor's assistant, they never actually went to the Labour Ward, but I can see how different trusts could definitely have different set ups. I would ask, you have the right to ask. You could phone to speak to a Matron who will find out the information for you. Just ask what role the PA plays (if they have one) and what tasks will they usually be involved in during my pregnancy, delivery and aftercare. I am sure a staff member will be happy to have a chat. If more people start asking these questions before going into hospital then they will be more aware of who is treating them, and hopefully feel a bit more comfortable.

Do you know where those stories were in the UK of the PA helping with surgery? I’ll be honest, if anything strange was going on, I would hope another staff member would report it. To ease your mind your midwife should be in theatre with you as well if you have to go in. Unless it’s a big cover up, you could ask him/her if you are concerned as she will hopefully put your mind at rest xx

Also a PA phoned me from my GP practice yesterday, never had that before. She was phoning about my test results. I’m happy with that, but I wouldn’t be happy if she was actively giving me advice or dealing with my health on a serious level. As an example if she has the clinical knowledge and permission to send me for a scan or referral, then great but… I can see how the lack of training they have compared to a GP is 😕 concerning. I would be worried they would miss certain signs or symptoms of something being wrong. It’s a difficult one, assisting the doctor is great, but being a practitioner taking on patients care is quite worrying, especially as general practice is so broad.

Ok I am not sure how many cesareans you have seen. Seriously delivering the placenta is a non job, couldn't matter less who does it. An elective cesarean is a very routine operation, absolutely something a AHP could be trained up to do. Having a consultant tied up all morning doing v. routine surgery is not a good use of NHS resources.

@Neurodiversitydoctor so how do the next consultants learn ? If the PA is doing the routine surgeries the doctors are not, so how do they learn. Consultants should be training their replacements, who should be doctors. Not PAs.

There are many many examples of this. Why bother with 5 years of uni, 2 years foundation and many years training. 18 months will do just as well.

@Pinkroselondon here's one story. There are many, many more.

www.bbc.co.uk/news/articles/cd1w84dl4pzo

Has to be a Dr to sign it ... so said Dr is at fault more than the PA for not clarifying allergies.

(All scripts should have allergies documented at the top... so pharmacist is also at fault

I taught them for a year during my education fellowship (when didn't get into training) my gang were fab really knowledgeable and knew their limitations. I def feel there is a role for them but its the lack of regulation that worries me.

Got examined by one when admitted with flu via ooh gp.... she checked for dvts through my jeans and knee high boots, was so breathless it didn't even click what the heck till I'd gone home lol

Seriously delivering the placenta is a non job, couldn't matter less who does it. An elective cesarean is a very routine operation, absolutely something a AHP could be trained up to do.

This is patently nonsense. By all means contribute to this important and interesting discussion but let’s not flippantly minimise the risks of what is a major surgery.

Theres definitely a lot of cases of them at least assisting (and think 1st operator for lap choles)... if you join the Facebook group the oncall room they're often highlighting this and showing freedom of information requests on PAs filling junior rota slots. Can't remember the trust now for the lap choles but was in England somewhere

@Destiny123 can see a role for them, as long as not taking doctors jobs or training opportunities (so we have some consultants in 10 years). Because I think we'd all prefer ourselves and our loved ones to be treated by a doctor 🤷‍♀️

I had an anaesthetist associate during my c section. There was a main consultant anaesthetist who did all the work and he was there helping her by giving her whatever she asked for, holding things, etc.

After I saw the many posts about it on MN, I was worried when I saw him, but honestly, I can see why they’re helpful.

@GreenFairies but that should have been a doctor assisting. So in a few years they are the consultant! Instead the poor doctor was probably stuck doing the admin on the ward - the job that PAs were supposed to do.

Good point, I didn’t think of it like that.

Yes a bit like saying flying a plane is easy. Until it goes wrong. You wouldn't let a plane fly with no captain!

And as someone else said....if PAs are doing surgery then how do the next junior doctors get trained.

Increase in medical school places is no good unless there are places for those graduates to work
https://www.bbc.co.uk/news/health-68849847

My niece is a year for med student. Not only are PAs taking training opportunities from F1s PA students are taking training opportunities ahead of med students.

sorry to say but you are fundamentally misunderstanding the way doctors training works/job allocation works.
the issue with foundation training job allocations is to do with the new software they are using. its not that the f1/f2 doctors don't have jobs, it's that they have not been allocated them. f1/f2 jobs are guaranteed for uk graduates (unless someone does something to lose their ability to practice which is v rare at that stage). yes the new way of allocations has caused a massive shitshow but it has nothing to do with PAs.

the ones going from foundation on to specialist training are also not affected as training numbers haven't been reduced. it has always been the case that at the end of foundation training, some doctors are unsuccessful in getting into their chosen specialty. they usually find another non training job while they reconsider their options until the recruitment for specialty cycle starts again. there are sooo many unfilled Dr roles. in every Trust I have worked in there are so many empty slots and they are continually recruiting doctors from abroad to fill those roles. we used to have a good, reliable supply of docs and nurses from the EU but many left after brexit.

I also think you misunderstand my opinion on PAs, I am not happy with the government's current approach of trying to bring in huge numbers of them while ignoring the real problems. i think that as allied health professionals they can (emphasis on can) be very useful and there definitely is a place for them in the future of the NHS.

that's a totally different thing to PAs. all Anaesthesists have an assistant. they make no decisions or provide any actual care.

@therealcookiemonster Do you know that we are the only country in the world who do not prioritise our own doctors ? So increase in IMGs and 500+ applications for a trust job. They close within 4& hours as too many applicants. GPs being made redundant, F2s not even getting interviews for ANY job - not even dreaming of getting a training number. There are no jobs. There are doctors wanting to do one.

I know it's always been competitive to get into specific specialities, but since when did we train doctors to not provide them with jobs. 1,000 newly graduated doctors do not have a job in July. And won't find out where they are going to be until July. NHS had 5 years to plan this, they knew how many doctors we were training. No shortage of PA jobs though !

@therealcookiemonster but there are Anaesthetic Associates, who have been working independently. But it's ok, a doctor is nearby 'supervising'. All fine, until it isn't,

@therealcookiemonster sorry, me again. Can you send me the trusts with jobs going as I know several F2s desperate at the moment. Thank you.