Why is there so much hate towards the role of Physician Associate in the UK.

The animosity is borne purely out of the arrogance that is part and parcel of the medical profession. A PA needs a postgraduate degree just to enter the field, making them already far more educated than your average medic who insists on the title of Dr without ever actually earning it. This is why I feel very strongly that medicine should be a graduate degree like it is in the States. There is no need to segregate the profession in such a bizarre fashion, especially when you end up with a situation where insecurities run amok and MBBS discriminates against MSc. I mean, seriously? Grow up.

Think we found the PA...

No actual arguments addressing my questions....just emotions.

You need to make the distinction between their role on paper (e.g. what we are told their role officially is) and their actual role on the wards in 2023.

In principal, a PA is an excellent idea. They should basically act as little clinical secretaries for their doctor (remember - they were initially called physician assistants). They should document what the doctor wants, take bloods the doctor orders ect. This is what the government told the medical field in the UK 10 years ago. Things are very different know!

However, the mundane nature of this job soon bore down upon the PAs. They wanted to specialise into different areas of clinical medicine and become more engaged in medicine rather than simple administration - because it gives PAs the impression that they are like doctors. PAs have a huge inferiority complex. That is why we always hear of PAs presenting themselves as doctors to patients, or using deliberately ambiguous titles, or by changing their names from assistant to associate. NHS management also actively encourage the increasing scope of practice of PAs simply because PAs are cheaper than doctors in the long run...hence reducing overheads, and compensating for a shortage of real doctors.

They do not have the intellectual capacity or the motivation to deliver patient care equivalent to that of a doctor. If they did, they would not have done a sh*tty PA course at the university of Lancashire. If they did have the competence, they would have gone to Oxford to study MBBS, with an MSc intercalation, and then train in orthopaedics/plastics/ENT and become a real doctor.

PAs do not undergo rotational training. So they spend their whole life in the same crumbling DGH. As such, they begin to identify patterns amongst patients in that particular ward. They simply perform pattern recognition, without properly understanding the medicine behind. E.g. the consultant yesterday gave xxx treatment to Dorris because Dorris has the following symptoms yyy. Dave presented today with yyy, so lets give them treatment xxx like the consultant did yesterday. But applying such an algorithmic thought process requires understanding of the nuances in the flowchart....and PAs don't have the medical knowledge to make those nuances. So when Boris, an anomalous patient, shows up, the PA thinks she knows what she is doing. Look at me look at me im like a doctor, and then fuc*s up. https://www.bbc.co.uk/news/uk-england-manchester-66168798

If you only get AAA in A Levels, let alone a B, you should not be prancing around with a stethoscope on your neck pretending your a doctor. So dont tell me Sharron from Essex, who did a biomedical degree at the University of Colchester after doing 2 BTECs or getting AAB in her A levels, and then spent 2 years surrounded with other Sharrons in PA school, is equivalent to an F2.

Well what does their profession add that can't be fixed by there being more doctors? What can a PA do that a doctor can't do?

The animosity is borne purely out of the arrogance that is part and parcel of the medical profession. A PA needs a postgraduate degree just to enter the field, making them already far more educated than your average medic who insists on the title of Dr without ever actually earning it. This is why I feel very strongly that medicine should be a graduate degree like it is in the States. There is no need to segregate the profession in such a bizarre fashion, especially when you end up with a situation where insecurities run amok and MBBS discriminates against MSc. I mean, seriously? Grow up.

I can see that you have a strong opinion about the role of physician associates (PAs) in the UK health system. I respect your views, but I would like to offer some facts and perspectives that might challenge your assumptions.
Perhaps you may not know what we do so please allow me to share my experience. I cannot speak for all PAs but when I work in the SAU I document for my registrar, follow up on tests, write discharge summaries and liaise between nurses and registrars among others such as difficult bloods, cannulas, catheters and manage follow-ups and liaising with the wider MDT. This allows my registrar to focus on more complex patients without worrying about the admin side. I cannot do what my surgical registrar does because I’m not a doctor or a surgeon and I will not bear the burden of responsibility without the same training. Physician associate and doctor roles diverge when you consider speciality training. I know that many have expressed issues with prescribing for PAs. If anyone declines to prescribe for me, that’s fine and I don’t mind because it’s risky and I invite them to see the patient. You may ask then what's the point of us existing so I refer you to my role and responsibility I explained above.
Also, remember that not everybody can afford to go to medical school (even though they may be intellectually capable) and remember a large proportion of the patients are from low socioeconomic backgrounds and you seem to have them being treated by an opposing socioeconomic group who may not understand the barriers to health as well therefore inclusivity within the MDT allows for better care.
In summary:
This is my personal opinion and experience as a PA, and it may not reflect the views of all PAs or doctors in the UK. I hope this information helps you to understand the role and value of PAs in the UK health system better. I do not intend to change your mind or start an argument, but I think it is essential to have a balanced and evidence-based discussion on this topic. Thank you for your time and attention.

Looking online from various sources and discussion threads I get the general impression there seems to be some sort dissatisfaction towards the general role and future of Physician Associates (PA) in the UK primarily from Doctors working in the field.

I genuinely don't understand why this is the case, as, from my understanding, PA's are individuals who have to complete a masters degree and undergo a one year training programme. This is in addition to having already completed a degree in a relevant science subject, required by most universities, and even now we can see some places requiring the UCAT to be sat by applicants wanting onto the MSc Programme.

So why is there so much anger around them? Surely they are qualified enough to work within their designated scope of practise without the need of other professionals in the field having this sort of bias against them, after all their role is to assist doctors by off loading a lot of the less serious cases so that the doctors use their time more efficiently in more serious cases, I dont see why this profession cannot not do this?

This sort of thing is already established in other countries such as the US and other countries around the world are also doing the same so again I don't see why PA's cannot work effectively here either.

Note: I am not saying all Health care professionals have the same attitude but the general portrayal of the profession for now at least seems to be negative by a lot of people.

There are potential risks to patients. As doctors have done 6 -7 years training.
Whereas a Physician asscoiate has only done undergrad in a science and a masters… their is not enough practical skills to assist not only the associate but importantly the welfare to patients. Medicine is very complex and not straightforward. Therefore, you need to be aware , they are not ‘Doctors’.
I can see other potential problems, for instance, a GP giving certain patients to PA as they are too busy and prefer to work on more complex cases.
It has to be said that the PA will feel overwhelmed and anxiety inducing. As patients understandably have high expectations and this of course may make PA’s unable to cope under these circumstances.

Instead, we ought to be recruiting individuals that are able to withstand the rigours of training as a doctor and stay for the duration. This means that the training of Doctors needs reviewing.

I am not sure why you think the PA will be overwhelmed? Or be unable to cope?
Just because someone has the title of Dr. does not change how well they can cope or if they become overwhelmed or not.

PAs are not, nor do they want to be, Doctors. I personally can't think of anything I would want to do less.
The undergrad that a PA has is science based so that gives them a head start - you would also need to learn that while doing your BMBS, unless they don't teach anatomy, physiology or biomedical science to med students?

I am really not sure what the problem is here? Do you get this upset about nurses, HCAs or ACPs? PAs are just another part of the team, not sure why you feel so threatened by them, they are not after you job but are there to make your job easier.

How do PAs maker doctors' jobs easier?

I'm curious what the critics of PA's think of other roles that are there to help bridge the gap between nurses/AHP's and doctors, such as Advanced Practitioners, Consultant Radiographers and CNS's.

Not a PA, but in the middle of applying for PA courses.

From my understanding, not everybody needs to be seen by a doctor. PA's are trained to diagnose and treat the most common (& more simple) conditions. This frees up a lot more time for doctors to be able to see more complex patients (patients with complicated conditions, on multiple medications etc).

I do think that due to the role not being regulated, this may have had an adverse effect on the workload of doctors due to PA's needing prescription/radiation requests signed off by doctors. I've read that this can be time consuming for doctors but also may put patients at risk as many doctors just sign off the request without looking further into the case (to save time). However, recent news suggests that the PA role will finally be regulated by the end of this year, therefore they will be able to prescribe (following a prescribing course), therefore I think this issue should hopefully no longer exist.

'Not everybody needs to be seen by a doctor'. That is an erroneous opinion in my view. Everybody should be seen by a doctor, that the present state of the health service does not actually make this possible is a travesty.

I don't believe undifferentiated patients should be seen by PAs and so there should be no role for them whatsoever in primary care and only a very limited scope for them in the emergency department. If PAs are used in any other way in these services it heightens the risk to patients because there just isn't enough time for full supervision by senior clinicians.

The model used in America actually makes complete sense. I think PAs should be assigned to a specific ward to do everyday ward tasks that would free up clinician time that is otherwise used ineffectually. Arranging bloods, taking bloods, performing ECGs, writing discharge summaries and creating prescriptions for patients to take home along with liaison with outside parties or departments. Totally accept that this kind of work cannot be done by administrative staff and it would be well performed by people with moderate clinical training. This kind of function would actually free up clinician time and let them get on with actual clinical work- you know, the stuff that the tax payer has paid nearly a hundred thousand pounds in training them to do.

PAs should not be placed on the rota in tertiary units or high acuity situations. Research has shown that this merely increases workload because they have to be supervised (or should be- that some of them are clearly not being supervised is due to failures in the management of the departments in the trusts concerned.

You cannot learn medicine in 2 years of a course which features such a low amount of contact time. It cannot be done, irrespective of your prior education or experience. Paradoxically you can try to practice medicine through the use of guidelines and flow charts and pattern recognition alone but that is not how most doctors operate because very little of human medicine is completely black and white and presents with textbook cases. Even the most experienced consultants have the background knowledge of anatomy and physiology to be able to start at first principles if necessary when presented with a case that doesn't fit their prior experience.

Fair enough, you’re entitled to your opinion and I do agree with some of what you’ve said. However, like I previously mentioned - PAs are getting regulated this year so hopefully their scope of practise will be a lot better defined so PA’s themselves as well as clinicians they’re working alongside will have a clearer understanding of what they can and can’t do.

Re rota - I agree to an extent and don’t think PA’s should be placed on the rota as it’s a way hospitals are attempting to have them replace doctors in a way and this isn’t the purpose of the role at all. In this case you need to be mad at the system, not PA’s as they have no control over it. I’ve heard some PA’s flat out refuse, but it’s difficult as you’ll be seen as not wanting to be a team player etc.

On the other hand, being placed on the rota gives PA’s more opportunities to learn and thus better contribute to patient care. I’ve heard some doctors say that PA’s don’t have the adequate skills (especially in the ER) as they don’t do night shifts and this is where majority of doctors get to see different cases you wouldn’t necessarily see during the day but also have to work under a higher amount of pressure.

So one may say giving PA’s the opportunity to go on the rota would be beneficial towards how they work alongside other clinicians as well their approach to treating patients.

A PA can never be a registrar or a consultant, that much is evident.

Why then should PAs be given slots on rotas or be involved in procedures that would normally be the part and parcel of foundation or registrar training programmes? You surely accept that to be doing this as a PA would simply be detracting from teaching and learning opportunities from doctors who are training to bring more expertise to the workforce?

The role makes no sense as it stands and it should be far more strictly defined as a scope of practice and they should be operating under supervision at all times. The present situation seems to have occurred where trusts are using them for service provision or to fill rota gaps, that isn't acceptable and contributes to inefficiency overall.

As I said, they have a defined scope of practice in the USA and would be able to make a positive impact on workflow in most departments if they were deployed properly.

I remain cynical that regulation will make any difference myself, we will see.

Nobody’s saying that PAs will be registrars or consultants..it’s very well known that the role has little career progression.

It’s not just doctors that are on rotas, many other healthcare professionals work via a rota system e.g nurses, radiographers, midwives - so what makes PA’s different?

Re training I do agree that if there was a PA and a junior doc involved in a procedure, then the doc should be prioritised for the reasons you mentioned.

The issue isn't their shift patterns. The issue is when they are placed on a rota that is supposed to be staffed with doctors.

Trusts are using PAs instead of doctors purely for reasons of cost. Again, the health service should not be doing this- it is clearly inefficient, decreases available shifts for doctors (many of whom rely on them for their own learning and income) and contributes to inefficiency because PAs are supposed to be supervised.