Are physician associates safe to see instead of GP?

[ourchildrenareourfuture]

The news articles are really scary seeing people getting misdiagnosed or being given prescriptions they shouldn't have been prescribed, and being made to think they're seeing a doctor when they're not.

Has anyone else had any issues with physician associates, or PAs, when they've wanted to see a doctor? Have you had a delay in getting a diagnosis for something, or misdiagnosed?

Doctors can also misdiagnose and prescribe inappropriate medication, , presumably that's where PA get their advice and training from. After personal experience, working as an hcp, reading threads here, I have lost confidence in the whole health system, all staff should clearly state their roles but it doesn't make them competent or caring.

I haven't seen the news articles but (a) I'm not sure what you think the alternative is as there aren't the GP's anyway, and (b) I recently saw TWO GP's about the chronic ear infection that they had diagnosed and prescribed, over several weeks, a multitude of drugs to clear it up. Two weeks ago I switched GP practice. Long story short, I was misdiagnosed by my previous GP's, I never had an ear infection, and none of the drugs that I was prescribed would have made any difference to the actual diagnosis. On the basis that I assumed two GP's would know what they are talking about, the actual diagnosis was delayed since mid-November, and I now have to hope that the problem can be resolved without surgery.

I personally work with them and find some are more thorough than some drs (not saying all), as they want to make sure the diagnosis and treatment is correct.
They also if in a hospital setting can run things by registrars/consultants if not sure.

Thats just my experience, I’m sure it’s different in other places.
But yes, I’d trust them.

My Mum sees a cardiologist who she's had a good relationship with for over 20 years and trusts implicitly and he knows her heart condition and how to manage it well after a lot of trial and error with various meds.

Her GP employed a PA last year and he's an absolute PITA. Constantly changing her medication to unsuitable ones she's already tried and shouldn't be on and scaremongering her when she says she wants to stay on her current regime from her consultant cardiologist (who is an award winning surgeon with 30+ years experience). I am angry at how he's messed her around and the pharmaceutical corruption that's clearly at play here with him always pushing certain drugs despite her not wanting them (and not needing them, she's got a cholesterol of 3.2 and he's forcing her to go on a statin which previously left her unable to walk). I don't trust PAs at all.

As acknowledged, doctors still make mistakes despite all of their training and experience. PAs have less than half of the training of doctors and none of the post-grad rotational training. Of course they’re not as safe! In my experience, they’re often unaware of what they don’t know, which is particularly dangerous. IME, they often have tunnel vision and completely lack the holistic underpinning that is vital when seeing patients. Fine, this might be ok for simple cases, but how can you know when allocating patients what’s going to turn out simple?

Also more thorough doesn’t necessarily equal better. Doing lots of tests because you’re not confident isn’t good medicine. Every test comes with risks to the patient. And a PA being more thorough in their examinations and history (if they are) is far more likely to be because of their reduced workload compared to junior doctors and more supernumerary role than because they are intrinsically more diligent clinicians.

I would insist on being seen by a doctor.

i believe thousands of doctors were turned down for GP training in 2023 - the government is choosing not to fund doctors. It is actively funding physician assistants instead.

Any healthcare worker can make a mistake. Who is more likely to make one though- a doctor who has been through medical school and minimally 2 foundation years , or a physican assistant who has had 2 years training?

It’s the next Post Office scandal, and lives will be lost and ruined as a direct consequence. Write to your MP.

I did, she can’t be bothered, she’s in a safe tory seat and is happy with it, knowing she’ll buy proper medical care for herself and her loved ones.

the rest of the public, not so much

I was seen by a PA. I knew, but it wasn't made obvious to me that I wasn't seeing a doctor. He told me everything was fine & ignored my request for some blood tests. I then had a call from him an hour later asking me to book in for the blood tests I knew I needed (I work in an allied area, but am not a medical professional). I believe he had checked with the doctor. I really would rather have seen a doctor in the first place.
I firmly believe they should say up front that they are not a doctor, but this one definitely didn't.

GPs have done an absolute minimum of 10 years, 5 years as a medical student and then 5 years working as a junior doctor/GP trainee before passing GP exams. Many do more years.
PAs do 2 years? Ones that are special interest, or just say do one specialty are ok and helpful but not replacing a Gp or hospital doctor.

I would rather see an experienced practice nurse than see a PA.

It’s not at all safe to allow people with only two years of training free reign to diagnose and treat and decide about ongoing care. There is a reason why a medical degree is five years and then two years of foundation training and then up to ten years of core and specialist training. Senior doctors need that level of experience plus all the postgraduate exams and assessments they have to pass to proceed in post.

PAs were designed as an entirely supportive role to do paperwork etc to help take away more mundane simple tasks from
doctors but the role creep has been insane and coupled with the fact some of them seem to be extremely disingenuous about their role with patients and consider themselves equal or even above the actual medics I think it’s a disaster waiting to happen. Have read of them referring to themselves as ‘one of the medical team’ or ‘a medic’ which is bound to confuse patients.

Government and managers are allowing it because it’s cheaper than training a doctor even though they pay PAs MORE than doctors (because they start and stay on a similar wage whereas doctors become GPs and consultants who rightly are paid more) as well as half the time their pay comes out of a different pot given to specifically expand this role.

It’s truly awful how healthcare is being reduced to cheap unregulated processes and we have no say about it at all.

I wouldn't trust them as far as I could throw them.

The bottom line is - they are not doctors, they have not gone through the rigorous education doctors have undertaken, and they are far more likely than doctors to be less than competent.

Agree with @Searchingforthelight's assessment of the reason for the proliferation of PAs and the consequences will be as she describes.

But we also have 'Consultant Physician Associates' who introduce themselves as a "Consultant" and one of the medics in the team. This is so confusing for the public. Soon you will have Anaesthetists who are also "Associates' and will only have at least 1:2 ratio supervision from a real Aneasthetic Consultant!

This is the Government and the NHS bringing in private health care by the back door as all the doctors will move to private hospitals and these so called associates will deal with the everyday public. It is time to stand up for your Junior doctors right now as the NHS are allowing training opportunities that are highly sought after and difficult to enter to be swamped by Associates. They will even have GMC registration but do not have to pay for the insurances and registrations that a Doctor who has trained for many years have to pay out of their wages themselves.

Unfortunately, at hospital, patients do not have the right to refuse to be treated by Physician Associates so the public are being led up the garden path by who is actually treating them.

There is a place for them but the swing to lower level qualified staff, their insistence on not actually telling patients of their actual status and the Junior Doctor still having to take responsibility for them is not acceptable!

As a GP myself I would say absolutely not given my experiences with the PAs I supervise

If it takes 10 years to train a GP, it takes ten years.

It can't be done in two years.

It's obvious, really.

Rishi Sunak, the king, Jacob Rees Mogg etc... None of them will be seeing a PA when they're worried they have cancer, will they? They'll see a doctor. A real one. On the GMC register.

The plebs are being expected to accept quacks.

I find the GPs bad enough to be honest, I wouldn’t want someone with less training.

I agree it’s a deliberate move to pay less qualified healthcare workers as a way to save money. The public lose out - again!

I was seen by a PA, it turned out he was a Paramedic. Very very thorough, more so than our normal GP. Was not dismissive and sent me for tests based on a low oxygen level. Previous Dr had dismissed 94% as ok!!

Some PAs will have a background of being a nurse or paramedic and are going to be better than someone who has done two years training after a “science degree”.

Also with your symptoms of 94% SATS that’s bread and butter to a paramedic. There are some things a paramedic might be better than a GP at, if I needed CPR I’d take the paramedic over a GP. I wonder how he’d have got on if you’d gone with symptoms of some obscure autoimmune illness or neurological issue?

Was he a paramedic before training to be a PA? I think it's cheap labour to fill the gaps and it will continue until the public and health professionals put their foot down and say enough of this complete shitshow and actually do something positive about training, pay, conditions and the backlog is so bad now they can never catch up or get the lists down.

How have they managed that when they aren't legally allowed to prescribe (or request imaging)?

I'm a doctor and work with PAs. They are good for supporting doctors but in my view should not be working independently and should be making it abundantly clear to patients what their role is.

@GlitteringUnicorn

They go back to the GP (who keeps changing and most likely has never met my mother) and say she's agreed to the change and get them to prescribe. Then,
unless she has an upcoming Out Patients appointment, she has to pay privately for an appointment with her Cardiologist as it would take forever for an NHS one and she'd have to go through the GP anyway and he ends up having to write to the GP or phone and demand she gets put back on her original meds/dosage etc.

It's an F-ing pantomime I tell you and she ends up in tears thanks to the PA phoning her meddling with her meds or wanting to put her on some other med she doesn't actually need pretty much every 6 weeks. She's never even met this man. He just appeared 18 months ago and has made it his personal business to interfere when she was doing great on the previous regime (and costing the NHS LESS...now she is on more meds due to the side effects the meds he gives her causes).

He also, the first time he phoned, introduced himself as "the Consultant Physician from Oak Tree Surgery" and my Mum is a retired nurse so was very confused as to why she was under a new consultant, and a physician at that when she hadn't been referred...she asked his name and he only gave his first name "Mitchell" so she said, "Mr Mitchell?" and he said no, so she said "Oh sorry, Dr Mitchell, then?" and he pretended to be a doctor then she got upset when he started changing all her meds and said could she get Mr Smith, her Cardiologist, to talk to him and he had to admit he wasn't a doctor and that his first name was Mitchell. He never gives his last name! And lets other patients call him Dr.

I think the role has a different title if they were first a paramedic, nurse or other regulated hcp.
These hcp have to have a degree in their original area of health care, then a certain number of years experience before doing a masters and further training. So 3 years initial degree and training, I think it’s at least 5 years experience then 2 years for the masters and on the job training.

If you see a paramedic in a gp surgery there are different grades of paramedic as well.