Physician associates missing diagnoses

[Rover1992]

Doctors are highly trained - and they too make mistakes. If they’re making mistakes after all the years of training, how can we expect physician associates not to? They have TWO YEARS of training. This expansion of them is terrifying

https://www.dailymail.co.uk/health/article-12738457/amp/Breast-cancer-tragedy-shows-vital-health-chiefs-clamp-physician-associates-just-TWO-YEARS-training-MoS-handed-dossier-400-reports-concerned-doctors.html

There are lots of widening access routes into medicine. There are grad entry medical courses that don’t require a science degree. But they are very competitive. However, medical training is incredibly expensive aside from the loans payment. Just paying for the training is expensive. However, apprenticeships are being trialed.

You’d not get into PA courses as they usually require a good undergrad in a science subject and then the 2 year masters on top (not all are apprenticeship models).

Medics misdiagnose all the time. There is a definite role for pas at the less complex end.

Just to correct a lot of misinformation in your post. It sounds like you don’t have a science background so your routes into medicine or pa will be limited.

I’m a doctor . PAs are fine if they were physicians assistants , taking bloods etc and being an assistant but they need to work under the supervision of a doctor and cannot replace a doctor.

The title physicians associate is confusing. They can’t prescribe. Many doca are not happy to be responsible for a diagnosis and plan made by someone with 2 years of training and much less experience .

Their starting salary is a slap in the face to junior doctors who are paid much less but have to work nights and take on more responsibility.

I recently had a PA trainee ask to scrub in for a case I was doing. I had no idea of if he was appropriately trained to do this ( said no) . He spent several hours asking stupid questions and eventually I realised his level of knowledge was low.

A worrying issue .

PAs don't have a regulatory body unlike other HCPs with the GMC, GDC, NMC, HCPC registers etc. So can't be struck off. There is no accountability; it's a joke.

https://www.gov.uk/government/consultations/regulating-anaesthesia-associates-and-physician-associates/regulating-anaesthesia-associates-and-physician-associates

there is a timetable in place for regulation as this document sets out

They will be gmc regulated next year. They all have to pass a national exam as well separately to final exams at university.

Being treated but a Physician associate sounds scary but an Anaesthesia associate WTAF! That is truly terrifying!

my father died 3 weeks ago, after a dramatic decline in his health following moving to a care home at the end of July. He had Parkinson's disease and dementia but was in good physical shape. 2.5 months later he'd lost 20kg and was admitted to hospital with severe dehydration, severe b12 deficiency, covered in friction wounds and bed sores, multiple bleeds to the brain and pneumonia. He was admitted to hospital following my intervention, due to concerns over his worsening condition. He was being seen weekly in the care home by the gp - or so I thought. Last week I learned that the very young lady who had introduced herself on more than one occasion to my mother and I as 'your fathers doctor' is a Physicians associate with around 18 months experience. On the day my Father was admitted to hospital, I telephoned the gp practice and asked to speak to my dads gp. I was put through to the PA. I phoned my fathers actual GP last Friday and gave her both barrels. She had never met my father. She said she was 'involved' in his care. She was absent for most of August. WTAF. I feel totally deceived. I'm a professional and if I deceived someone about my professional status I'd be in very serious trouble. It is illegal to describe yourself as a doctor when you are not. If id known, id have made sure my dad had been seen by a gp. Too late now, the coroner is investigating potential negligence in my fathers care. I hope the GP has to answer to an inquest about why a PA apparently has sole responsibility for all care home visits and the GP the awls never sets foot in there, no matter how ill the patient becomes.

Oh, that sounds awful @EasylikeSundayevening. I'm so sorry about your Dad.

Lots of different issues here. One is PAs doing work that’s beyond their role, and the doctors either letting them or not stopping them. Another is PAs calling themselves doctors. Why are there no consequences for this?

Junior doctors must be so demoralised by this, even more than they already were. 6 years as a med student then F1 and F2 years. Paid 34-39k as an F2 after all those years. PA comes in on over 41k as a starter after TWO YEARS training- a year less than a standard degree in anything. Basically junior doctors are having to “supervise” people who are way less qualified but earn more than them for working fewer hours.

I understand that we are short of doctors. But this isn’t right. By all means train and recruit people to do simple tasks, freeing up doctors for when their expertise is needed. But don’t pay them more than doctors ffs, don’t let them misrepresent who they are and stop them wading in carrying out procedures they’re not capable of.

@EasylikeSundayevening I'm sorry for your loss and that sounds appalling. It's hard to fight a battle when someone close has died but you should be shouting about this from the rooftops.

Junior doctors must be so demoralised
They absolutely are. Another blow on top of the poor pay.
My neice is in her final year of med school and tells me all the students are horrified by the PA rollout. Not least because they will be paid substantially less than the PAs but also the responsibility falls on the doctor if anything goes wrong.

Search the topic on Twitter to find lots of examples of PAs introducing themselves as doctors as well as where things have gone wrong.

@Nippi
“My neice is in her final year of med school and tells me all the students are horrified by the PA rollout. Not least because they will be paid substantially less than the PAs but also the responsibility falls on the doctor if anything goes wrong.”

Then like me, she needs to take a stand and refuse to take on that responsibility. Certainly until their training and our guidelines change.

We wouldn't be short of doctors if the government sorted out our pay.

It is indicative of their attitude that they are happy to pay physicians associates more when they can do less than junior doctors (like prescribe or order XRs). Both are pretty basic to function as a doctor.

The fact they have been allowed to go this far unregulated is scandalous and I have no confidence in the sodding GMC to start regulating them properly. For a start they are proposing using the same numbering system doctors get so it will be impossible to tell based on their GMC number whether they are a doctor (medical practitioner) or a physicians associate.

Start saving for private healthcare now.

Yes, it's terrifying. There was another equally terrifying thread on here some months ago about the same thing happening in (of all things) anaesthetics 😳

Many people seem happy to just sleepwalk into a situation where we don't expect to see a doctor any more, and don't recognise the difference between doctors' training and that of other significantly less and/or differently qualified health care workers. I quite regularly see posters on here recommending that people with potentially complex medical issues should pop to the chemist to consult a pharmacist.

We wouldn't be short of doctors if the government sorted out our pay.
Absolutely. Very much like teaching. We have the doctors but can't retain them. Improve pay and working conditions and they would stay, it seems so simple, yet the government seem to be blind to it.

This is horrible I had no idea. Thanks for sharing.

Not only do PAs have a hell of a lot less training than doctors, but they do not currently have a regulatory body. If a nurse or midwife or nurse practitioner cocks up, they can be restricted or struck off by the NMC. A doctor is regulated by the GMC. No one is regulating the PAs. (I actually refused to run a session on safe prescribing for PA students unless the university could tell me their regulatory body, as I always reference the relevant standards when teaching HCPs on the topic)

I’m a Dr, except I had a long break for childcare reasons. I tried to go back and would have been very happy with a restricted role in my specialty.
But it meant working for no pay at all for a long time and with no perceivable plan or structure to my return to work.
I gave up. It just wasn’t doable.
and it really pisses me off the number of people who have quasi Dr jobs, but aren’t actually Drs.

I’m another who’s had cancer diagnosed later than it should be because it’s so difficult to see an actual Dr these days. If I wasn’t medically trained the cancer would have been missed for even longer. I saw a nurse specialist and a paramedic specialist before I eventually got to see a GP

It’s just that these ‘specialists’ think in algorithms and if you don’t fit a common algorithm, you’re stuffed.

I think that if PAs were used properly they would be a positive addition to the workforce.

However some of the horror stories I have read here show that currently this isn't happening.

The issue as others have said is that the current workforce within the NHS can't keep it going. There are too few people, in all roles, the NHS fails to attract and retain its workforce. PAs are just part of a bigger problem.

The GMC flat out refused to take any responsibility for PAs when the role was first introduced around 9 years ago. My guess is that there has been government pressure around this.

The alternative to a physician associate is not a doctor though. The alternative is bugger all. There are no doctors and there are no real plans to train more doctors. Very few doctors want to be GPs because it is a bloody rubbish job. If seeing a doctor is important to you and you can afford it, private GP appointments are available.

My DH was sent home with a prescription for strong painkillers by a PA when what he presented with was quite clearly a hernia. Even I knew what it was and I’m not remotely medically trained. Thanks to her he ended up in A&E and it all got quite stressful. All good now though.

I had a general health check with one last week which was fine and probably an appropriate use of resources, but she got very huffy with me when I asked about her training

They are less well qualified than a nurse.
Should be re-named doctor's assistants.
Hospitals using them as much if not more than GPs.

Not sure they should even be called Drs assistants - still elevates them above nurses who may have done more years of training or have more experience.

Not sure what they should be called. Think they should be got rid off and we should concentrate on retaining actual Drs

There are thousands of junior doctors who have been turned away from training in multiple specialties including GP, despite the alleged shortage of GPs.
The reality is that there is no shortage of doctors, but there is a shortage of training posts. This is an active choice by the government not to fund these posts.

yes, patients will die and suffer harm as a consequence. ITV will probably make a drama about it.

There’s nothing you can do aside from voting wisely next time

They are going to be GMC regulated this year.

There aren’t 1000s of doctors in this position,