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?

that's the problem with having done a few easy ones without the benefit of a lot of experience (as one might expect with a PA) - you don't know what you don't know and might be tempted to crack on without thinking 'hang on a sec, what could go wrong here'. Uterine inversion is a rare (extremely rare at c-section) but life threatening complication which needs very quick and skilled management. And if all you did was take placentas out you might not make the association between the cardiovascular presentation of an inverted uterus (because it's the cardiology PA that 'does' hearts) and the bloodbath that's about to take place. Now clearly I'm being a bit dramatic here, because hopefully a few other people might be in the room who did have the skillset to spot and manage an inversion, but you get the idea. There are some things that are only easy in retrospect and until it was easy you need to be able to manage all the possibilities...

A B6 is an experienced nurse! Yes they are NICs everywhere but they are hardly nursing assistants!

@Neurodiversitydoctor what is your speciality?

non UK nationals are not even allowed to apply for training contracts unless they graduated from UK medical schools in the first round of applications! what on earth are you talking about?

you are confusing training contracts, which junior doctors need to have to go into training jobs where they both work and train and service provision jobs which do not have any scope for formal advancement or further training. immigrant doctors can go into the latter because almost all UK medics are aiming to avail training posts and hence there is a big demand for doctors to fill the non training posts. sometimes UK medics will do a short stint in a non training job while they wait to get into their chosen specialty. UK graduates and non UK graduates very rarely compete for jobs as a result.

birth plans are more a guide. labour is complex. you may have had crap care but healthcare providers are usually focused on keeping patients safe and that can require birth plans to be thrown out of the window

@therealcookiemonster yes they are. From 2019.

IMG Doctors
Speciality training positions can be very competitive depending on the speciality in question. There is no favouritism based on where applicants have graduated from. This means that candidates from international medical schools (IMG medical schools) and those from British schools have the same chances of gaining these training posts.

Full document

www.bmj.com/careers/article/a-guide-to-img-applications-for-specialty-training-in-the-uk

But the PAs cost a lot less for their training. And in terms of supervision a doctor could supervise more than one PA.

Excuse me??

ffs have you read the full nhs specialty application guidelines? no? because I had to. because when I applied (and i had to apply twice because i am a dual trainee), I wasn't a UK national although a graduate from UK medical school.

After that I had to do a lot of research in the last year for a relative graduated from abroad (non EU) who wanted to train here. she wasn't eligible to apply in the first round.

the favouritism referred to here is that once they apply (I.e. in the second/third rounds of applications after all eligible UK nationals/UK graduates applicants have been given a post that they accepted), they then can't discriminate between imgs and UK grads. which is a moot point in a lot of specialties because applications don't even get to second round as there are not that many jobs. there are exceptions eg. EM and GP which are undersubscribed.

please spare me. I am no longer interested in this convo. if you want to prove yourself right so badly, take the win. I lose you win. you are the big expert on how nhs employment works. now please go away and leave me alone ffs.

@Riversideandrelax why bother - doctor could just do it themselves. Much quicker. And safer.

And yes, PAs are v cheap to train. I think that's the problem - the training is very basic.

But they cost more than doctors for 8 years. So not really cheap to employ, when need supervising by the doctors earning less than them. Unless the consultants do it, as per BMA guidance. In which case. Not cheap as need a consultant to be there at all times to supervise.

PS most doctors will repay £250,000+ on their student loans over 30 years. So not sure they cost too much in real terms.

@therealcookiemonster but you applied a while ago. Rules have changed. Or is the BMJ lying ?

I'm not sure why you get so cross. The rules have changed, in a lot of ways, in the last few years.

@therealcookiemonster oh and 11,000 people applied to be GPs for 4,000 posts. GPs being made redundant.

www.pulsetoday.co.uk/news/breaking-news/swathes-of-gps-at-risk-of-redundancy-as-gp-at-hand-owner-announces-consultation/

Did you do MSRA ? Seems a strange exam to me. Even students in top 20% didn't get interviews this year for some specialities.

Things have changed, massively in the last 12 months. I'm not saying it be provocative. I work with many young doctors and they are worried about their employment. Surely as a doctor that worries you too ?

Rules required for IMGs to qualify for speciality training.

I support students into medicine. Some go abroad for Uni so we research how they come back.

As I said because a doctor could supervise more than one PA. Supervising doesn't necessarily mean standing next to them watching them.

exactly. trainee doctors also need supervision and also are usually coupled with consultants for training purposes. in fact PAs almost never have the consultant in with them whereas training doctors almost always will be allocated to a consultant especially in operating theatres.

and PAs are not slower! they are faster than a lot of trainee doctors because they usually to ver specific things. eg. the PAs in my trust who do regional block lists do the blocks much faster than even most consultants because they do far more of the exact same cases.

Definitely an AA. Said so on his name page. I wouldn’t have really noticed it if I hadn’t seen the threads on MN about it.

Anaesthetic associates are the anaesthetic equivalent of PAs, they've been around longer.i debated becoming one when I deemed myself too stupid to do Anaesthetics when came across AAs in med school. Till realised they won't allow medicine as a medically related entrance degree to be a PA/AA. They can only anaesthetise for very healthy minimal comorbidities and routine surgery under a 1:2 consultant supervision ratio. Seems to be creeping in the trust tha have them though.

I've never seen them in obs in 8y of Anaesthetics tho they tend to be mainly in ortho doing regional blocks

I work as part of a surgical team in our Trust PA s are used to support on wards
They may assist in Theatres but as they are unable to prescribe, I can't imagine a scenario where they would be left to operate on their own without supervision?
I agree they should not be used in place if medical team but do bear in mind these PAs kept many of your elective operations possible and wards covered during the strikes to allow senior Consultants to cover where needed!

yes I realise. but that is not what the poster was describing.

can't believe you felt you were too stupid to do Anaesthetics!!! hope it wasn't some ego tripped consultant who made you feel like that!

oh yes never seen AAs in obs. the ones in our Trust do the ortho lists (they are damn good and I look sooo incompetent next to them lol) and in icu supporting the reg on call

hmm. .....maybe they were an AA in training? because AA would at least be drawing up drugs/doing other things whereas the way you described it sounds like an ODP

Christ on a bike we now have PAs doing brain surgery:

https://x.com/medregoncall1/status/1800895494014837078?s=46&t=FhtAOuIw6WFA6GfY51MJFw

Bumping this thread because the more people learn about what’s actually going on, the better.

Some at GOSH doing surgery on neonates. It's terrifying !

A lumber puncture is not neurosurgery. Neither is a burr hole, please don't be so alarmist.

I'd still rather it was a trained doctor going near my spinal cord or drilling into my skull. Whatever you call it.

www.gponline.com/devastated-partners-highly-rated-gp-practice-hand-back-contract/article/1876776

This is alarming (perhaps you didn't read the link).

"[The PA] now scrubs in and operates on things like subdural haematoma evacuations, which involves removing a pool of blood from a brain bleed after drilling a hole in the skull. He told the Physician Associate podcast that he had 'zero training in neurosurgery or neurology' during his course and it was 'all on the job learning.'"