PA

A quick question.
What are physcian associates and are they above FY1 (e.g. can they tell FY1 wht to do+ when)?

I am not entirely sure if they are senior to junior doctors but did not want to ask them directly to avoid any potential confrontation.

Thank you

Reply 1

jellybabyqq

OP

Also in relation to the post above (slightly off topic) but if a FY1 appears not confident why do nurses/ pharmacists on wards feel they can make demands that are beyond their remit (e.g. pharmacist - pt has this diagnosis so treat with this). I do appreciate their input but their tone is slightly rude.

Reply 2

MonteCristo

14

Original post by jellybabyqq

A quick question. What are physcian associates and are they above FY1 (e.g. can they tell FY1 wht to do+ when)? I am not entirely sure if they are senior to junior doctors but did not want to ask them directly to avoid any potential confrontation.

I don't think there is really an answer to this question. PAs don't really fit within the medical hierarchy and so they're not above or below an FY1. Their precise role will depend on your department, their skills, and how trusted they are by the consultants. If it's someone who's been there a long time, I would treat them a little like a ward sister or nurse practitioner - they might guide you and even make demands on your time but it's not really their place to manage you ("take these bloods... then do X... then Y...).

I do think it's sensible to avoid confrontation in your first few jobs until you grow in confidence. That might be difficult if you are faced with a tricky colleague, though...

Ultimately you are (of course) responsible for your own clinical decisions. You can certainly be guided by an experienced PA (as by an experienced nurse) but you have to reach your own decisions. If you think they are wrong then you need to seek further advice, e.g. from a more senior doctor.

Reply 3

MonteCristo

14

Original post by jellybabyqq

Also in relation to the post above (slightly off topic) but if a FY1 appears not confident why do nurses/ pharmacists on wards feel they can make demands that are beyond their remit (e.g. pharmacist - pt has this diagnosis so treat with this). I do appreciate their input but their tone is slightly rude.

It's difficult to know whether they are trying to be helpful or taking the opportunity to be condescending. Don't let it bother you - learning how to work with different types of colleague is part of your training.

Reply 4

Ghotay

13

Original post by jellybabyqq

A quick question.
What are physcian associates and are they above FY1 (e.g. can they tell FY1 wht to do+ when)?

I am not entirely sure if they are senior to junior doctors but did not want to ask them directly to avoid any potential confrontation.

Thank you

I don't think that looking at them as 'above' or 'below' anyone is a helpful way or looking at things. Nor is 'who can tell who what to do'. If you are unsure of someone's position though, I do think it is best to ask them. Just don't do it in a confrontational way. Something simple like "I'm sorry, I've not really worked with PAs before, could you explain your role to me?" It's perfectly polite, and their answer will probably tell you everything you need to know about their place in the pecking order.

With regards to being told what to do by nurses/pharmacists... I think it can be frustrating for them if they have plenty of experience and know exactly what needs to be done, but aren't allowed to do it themselves. It's easy to then just tell you to do it. It's okay, because they know it's the right thing to do, there's no problem! But at the end of the day if it's your name on the documentation, it's your arse on the line if anything goes wrong. You just have to be polite and explain to them that just can't/won't work outside of your competence levels and they just have to deal with it.

(edited 8 years ago)

Reply 5

junior.doctor

18

Physician associates are university graduates who have then gone on to do a 2 year postgraduate diploma in physician associate studies - learning basic medical skills and knowledge. What this means in practice (I think) is that a PA can work alongside junior doctors and nurse practitioners, taking histories, examining, doing clinical skills such as cannulas. They are not allowed to prescribe.

I have worked with student PAs but never with qualified PAs. I don't think I would fit them into a hierarchy as you are suggesting - ie I don't think they are above or below FY1s. They do a lot of the same things, but they're a bit different. I would see them as just another member of the team to work alongside, to help get our collective job done - just the same as I would count nurses, physios, pharmacists… Ask one of them to explain their role to you - if you ask in the right way, you wouldn't be seen as rude. 'Are you junior or senior to FY1s" is probably not the right way - but "tell me about your role and responsibilities" shows that you're interested and respectful.

As to your other question, about input from nurses / pharmacists - I have generally found this to be very helpful. As a brand new FY1, most of us were very junior and our nurses covered our backs and could have no doubt done our job for us - but they helped us, taught us, looked out for us, were patient with us when they could have done it 10x faster. They just get us licked into shape and then 4 months is up, off we go, and in come another brand new lot, start all over again. Same with pharmacists spotting the drug errors etc. As far as prescribing is concerned, of course you need to make sure that you're happy with what you're prescribing, as at the end of the day you have responsibility for the prescription you're writing. However in general terms, nurses and pharmacists know what they're talking about. My suggestion: thank them for their advice. If you want to check it in the BNF / with a colleague, that's fine. If they're waving a drug chart at you and want it right now, tell them in a friendly polite way that you're sure they're probably right but you're quite new to this and would just like to check. Lots of thanks and friendliness always diffuses a situation well, even if underneath you're feeling a bit irritated. Be careful that you're not coming across as a little bit aloof and irritated, even if that's not what you were intending, as that might be what's in return causing attitudes that you're perceiving as rude from other people. These folk can teach you a lot. They are not always right - but they are a lot of the time. And you need them watching your back.

Reply 6

belis

17

Original post by jellybabyqq

Also in relation to the post above (slightly off topic) but if a FY1 appears not confident why do nurses/ pharmacists on wards feel they can make demands that are beyond their remit (e.g. pharmacist - pt has this diagnosis so treat with this). I do appreciate their input but their tone is slightly rude.

They have a task on hand that they need completing. If the FY1 is not confident to do it it creates delays and frustration. From their perspective they want the job done ASAP. Also they may not fully appreciate that FY1s don't have much experience. For some of them a doctor is a doctor. I remember catching one of my FY1s writing up section 17 leave (only a consultant psychiatrist can legally do it) because they were pressured into it.

It is an opportunity to practice assertiveness. Not everyone is going to be nice to you. In fact working in the NHS you will encounter a lot of rude, pushy people and probably some bullying along the way. Not everyone will want to be friendly with you and some members of the MDT are rude to doctors by default.

Reply 7

belis

17

Original post by jellybabyqq

A quick question.
What are physcian associates and are they above FY1 (e.g. can they tell FY1 wht to do+ when)?

I am not entirely sure if they are senior to junior doctors but did not want to ask them directly to avoid any potential confrontation.

Thank you

It is much more complex than a simple hierarchy. Power comes from many different sources and will be individual to each department. You may find that a PA with years and years of experience is considered to be well above not only FY1s but also core trainees and occasionally registrars. If they have embedded themselves within the department and have a lot of specialist knowledge they will be much more valuable to the team than FY1 doctor who comes in for 4 months and needs their hand holding for most of that time.

Then there is personalities and relationships. People can become very powerful by the way they conduct themselves. A PA with a strong personality and good leadership skills can be defacto leading a department if the consultant does not have much of a presence and junior doctors dip in and out on short rotations.

If you are in doubt if what the PA is asking you to do is appropriate ask your supervisor. Don't do anything you are unsure about. Don't get yourself to hang up on who is 'above' or 'below' though. It is a team effort and everyone brings different skills and experience to the table. At the moment you don't have much of either and seeing yourself as 'above' of anyone on the ward is not recommended.

Reply 8

nexttime

22

They're getting paid way more than you whatever their actual role!

PA

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