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Physician Associate - a new role in NHS?
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Original post by LosPA
Finally as for progression, the situation can be much as it is for nurses when they move outside of the traditional nursing role. Show capability, commitment and interest. Then more training and responsibility can come your way. For example some things offered to applicant PAs: indirectly supervised on the ward, running services for more minor problems like claudication, performing thrombolysis in CCU or Stroke, Advanced resus training and procedures like EBUS, central lines, chest drains etc. Or we may train up to do minor operations like hernia repair, endoscopy and cholecystectomy.
Finally as for progression, the situation can be much as it is for nurses when they move outside of the traditional nursing role. Show capability, commitment and interest. Then more training and responsibility can come your way. For example some things offered to applicant PAs: indirectly supervised on the ward, running services for more minor problems like claudication, performing thrombolysis in CCU or Stroke, Advanced resus training and procedures like EBUS, central lines, chest drains etc. Or we may train up to do minor operations like hernia repair, endoscopy and cholecystectomy.
It's quite scary that you think a hernia repair or cholecystectomy is a "minor operation".
Original post by LosPA
running services for more minor problems like claudication, performing thrombolysis in CCU or Stroke, Advanced resus training and procedures like EBUS, central lines, chest drains etc. Or we may train up to do minor operations like hernia repair, endoscopy and cholecystectomy.
That is legitimately terrifying.
Besides, this isn't where the need is. The need for PAs is on the ward, helping to navigate the ****storm of 32 patients to 1 FY1 so that we can all go home at 5pm instead of 7pm.
What the NHS doesn't need is more people skimming the cream off medical practice and hiding behind the 'oh, I'm not a doctor, I can't do that/sign that/authorise that' line when the **** hits the fan.
As the bodybuilder Ronnie Coleman once said: "Errybody wanna be a doctor, but nobody want no heavy ass GMC number".
(edited 8 years ago)
Original post by LosPA
Or we may train up to do minor operations like hernia repair, endoscopy and cholecystectomy.
They're not minor operations.
Who has told you this? Why would they be given to someone who isn't in core training, particularly when those within core training are already struggling for experience?
Original post by LosPA
Or we may train up to do minor operations like hernia repair, endoscopy and cholecystectomy.
I would love to see what my old upper GI boss would say about this.
As has been said - it's on the ground, on the wards where services are struggling and could do with an extra pair of hands where you don't necessarily need an MBBS (although when things go wrong - you can put your money on who I'd want around). There's already enough surgical trainees clamouring to get into theatre. I feel you may be overestimating what the service is asking for somewhat.
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Claudication, stroke thrombolysis, central lines - minor problems?
Endoscopy, hernia repair and cholecystectomy - minor surgery?
Hahahahhahahahahha no. Get out. Apart from the fact that you're clearly deluded about what constitutes 'minor' and the role of the PA, these are all areas where the NHS isn't even short of manpower; there's not even any demand.
Endoscopy, hernia repair and cholecystectomy - minor surgery?
Hahahahhahahahahha no. Get out. Apart from the fact that you're clearly deluded about what constitutes 'minor' and the role of the PA, these are all areas where the NHS isn't even short of manpower; there's not even any demand.
I must mirror that the notion of a lap chole or hernia repair being a minor operation is utterly absurd. My very senior Consultant with registrar at hand had to abandon a lap chole just yesterday because it was such a challenge. He then admitted to me his past 5 lap choles have been extremely challenging. I think I'd rather live with biliary colic than let a PA whip out my gallbladder.
If a surgical trainee with 5 years at medical school and 5 years post-graduate training can't do those operations alone then they are far from minor. With a bottleneck of surgical trainees there is zero need for PAs to be involving themselves in the domain of surgeons.
If a surgical trainee with 5 years at medical school and 5 years post-graduate training can't do those operations alone then they are far from minor. With a bottleneck of surgical trainees there is zero need for PAs to be involving themselves in the domain of surgeons.
(edited 8 years ago)
Original post by Sinatrafan
I must mirror that the notion of a lap chole or hernia repair being a minor operation is utterly absurd. My very senior Consultant with registrar at hand had to abandon a lap chole just yesterday because it was such a challenge. He then admitted to me his past 5 lap choles have been extremely challenging. I think I'd rather live with biliary colic than let a PA whip out my gallbladder.
If a surgical trainee with 5 years at medical school and 5 years post-graduate training can't do those operations alone then they are far from minor. With a bottleneck of surgical trainees there is zero need for PAs to be involving themselves in the domain of surgeons.
If a surgical trainee with 5 years at medical school and 5 years post-graduate training can't do those operations alone then they are far from minor. With a bottleneck of surgical trainees there is zero need for PAs to be involving themselves in the domain of surgeons.
And I don't see many surgeons being keen on a PA Assisting vs a Doctor in Specialist Training , a Nurse or ODP advanced Practitioner , a Nurse or ODP First Assistant or a Foundation / core trainee Doctor.
You Don't get HCA first assistants so quite why PAs think they will be operating...
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Original post by zippyRN
And I don't see many surgeons being keen on a PA Assisting vs a Doctor in Specialist Training , a Nurse or ODP advanced Practitioner , a Nurse or ODP First Assistant or a Foundation / core trainee Doctor.
You Don't get HCA first assistants so quite why PAs think they will be operating...
Posted from TSR Mobile
You Don't get HCA first assistants so quite why PAs think they will be operating...
Posted from TSR Mobile
Sounds like they've been sold some unicorns and rainbows story of all the amazing things they'll be able to do (seemingly with a wider scope of practice than most doctors or nurses), and don't have enough actual experience to realise how unrealistic it all sounds to those on the ground.
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Minor surgery to me is something like a skin tag being removed or I&D of an abscess. Certainly not a cholecystectomy or a hernia repair, both of which I saw go massively belly up when I used to work in theatre.
Also, with regards to thrombolysis, how do PAs have the prescribing rights or professional accountability to give these drugs? They're not included in ALS/ILS as far as I'm aware.
It sounds to me that this role has been oversold to the few PAs commenting in this thread, being able to assess and plan the care of a multitude of patients from different specialities on graduation from uni? I severely doubt after two years training and no prior clinical experience anyone would have the confidence to do this without a lot of supervision.
The reality of things are that PAs will be used on the wards or in various areas to do the junior jobs that trainee medical and surgical staff get bogged down in to free up these guys so they can focus on their training instead. There's probably a place for them, however a lot of wards I know are training up experienced nurse practitioners to do a similar role, with years of experience in that speciality, however cost being a likely motivation to employ a PA over an ANP wouldn't surprise me, especially in today's health service.
Also, with regards to thrombolysis, how do PAs have the prescribing rights or professional accountability to give these drugs? They're not included in ALS/ILS as far as I'm aware.
It sounds to me that this role has been oversold to the few PAs commenting in this thread, being able to assess and plan the care of a multitude of patients from different specialities on graduation from uni? I severely doubt after two years training and no prior clinical experience anyone would have the confidence to do this without a lot of supervision.
The reality of things are that PAs will be used on the wards or in various areas to do the junior jobs that trainee medical and surgical staff get bogged down in to free up these guys so they can focus on their training instead. There's probably a place for them, however a lot of wards I know are training up experienced nurse practitioners to do a similar role, with years of experience in that speciality, however cost being a likely motivation to employ a PA over an ANP wouldn't surprise me, especially in today's health service.
Original post by Helenia
Sounds like they've been sold some unicorns and rainbows story of all the amazing things they'll be able to do (seemingly with a wider scope of practice than most doctors or nurses), and don't have enough actual experience to realise how unrealistic it all sounds to those on the ground.
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or they have been told stories about what US PAs with their established state level registration ( and other HCPs in the US including Docs are registered at the State levelk) and legally established rights to prescribe, adminster parenterals etc are doing in the remote and rural areas or the military ...
unconscious incompetence and /or Dunning- Kruger at play here ...
i can see no reason to have PAs over and above Nurse / AHP / Pharmacist expanded and extended roles - and i do;t think that they will be any cheaper over all/
Certain tests and procedures at ward level could be done by RNs/ Physios if the resourcing and support were there (ABGs etc - after all thereare respiratory wards where RNs do ABGs and in critical care areas where peopel have art lines running an ABG is just a common as doing a BM or taking other blood samples) - also we've got loads of experience with purely 'technician' ECG/phleb/ cannula monkey roles at band 3 ...
prn prescribing and rewriting drug charts - existing Independent prescriber (RN or Pharmacist) could do that - as it standards a PA cannot make a valid Direction to administer and i can see very few Doctors or none Medical Independent prescribers just signing off a drug chart written by a PA
i'm still PRSOM for both Helenia and Moonkatt at the minute so have a cookie guys
(edited 8 years ago)
Original post by Sinatrafan
I must mirror that the notion of a lap chole or hernia repair being a minor operation is utterly absurd. My very senior Consultant with registrar at hand had to abandon a lap chole just yesterday because it was such a challenge. He then admitted to me his past 5 lap choles have been extremely challenging. I think I'd rather live with biliary colic than let a PA whip out my gallbladder.
If a surgical trainee with 5 years at medical school and 5 years post-graduate training can't do those operations alone then they are far from minor. With a bottleneck of surgical trainees there is zero need for PAs to be involving themselves in the domain of surgeons.
If a surgical trainee with 5 years at medical school and 5 years post-graduate training can't do those operations alone then they are far from minor. With a bottleneck of surgical trainees there is zero need for PAs to be involving themselves in the domain of surgeons.
exactly
hence the reason the role hasn;t really taken off , primarily because they can't legally do the thing that ties juniors up on wards the most =- prescribing - and that can't be easily sorted by other means ( as Nurse prescribing and band 5 is incompatible and trusts don;t really want to grasp 24/7 band 6/ 7 presence on all clinical areas ).
all the psychomotor skills could be done by RNs or AHPs and in some cases by band 3 HCAs or purely technician staff ( e.g. phlebs)
Original post by zippyRN
And I don't see many surgeons being keen on a PA Assisting vs a Doctor in Specialist Training , a Nurse or ODP advanced Practitioner , a Nurse or ODP First Assistant or a Foundation / core trainee Doctor.
You Don't get HCA first assistants so quite why PAs think they will be operating...
You Don't get HCA first assistants so quite why PAs think they will be operating...
There's no way even a junior SHO is going to let a PA take their spot in theatre to fuel the unicorn and rainbow stories. They'll be told politely but very firmly where to go if they think that they're going to be making inroads on the very limited surgical opportunities that foundation trainees have; not only would their presence be totally unnecessary but it'd also be with little potential return at the expense of the actual trainees...
Original post by Helenia
Sounds like they've been sold some unicorns and rainbows story of all the amazing things they'll be able to do (seemingly with a wider scope of practice than most doctors or nurses), and don't have enough actual experience to realise how unrealistic it all sounds to those on the ground.
PRSOM
Original post by moonkatt
Minor surgery to me is something like a skin tag being removed or I&D of an abscess. Certainly not a cholecystectomy or a hernia repair, both of which I saw go massively belly up when I used to work in theatre.
Also, with regards to thrombolysis, how do PAs have the prescribing rights or professional accountability to give these drugs? They're not included in ALS/ILS as far as I'm aware.
It sounds to me that this role has been oversold to the few PAs commenting in this thread, being able to assess and plan the care of a multitude of patients from different specialities on graduation from uni? I severely doubt after two years training and no prior clinical experience anyone would have the confidence to do this without a lot of supervision.
The reality of things are that PAs will be used on the wards or in various areas to do the junior jobs that trainee medical and surgical staff get bogged down in to free up these guys so they can focus on their training instead. There's probably a place for them, however a lot of wards I know are training up experienced nurse practitioners to do a similar role, with years of experience in that speciality, however cost being a likely motivation to employ a PA over an ANP wouldn't surprise me, especially in today's health service.
Also, with regards to thrombolysis, how do PAs have the prescribing rights or professional accountability to give these drugs? They're not included in ALS/ILS as far as I'm aware.
It sounds to me that this role has been oversold to the few PAs commenting in this thread, being able to assess and plan the care of a multitude of patients from different specialities on graduation from uni? I severely doubt after two years training and no prior clinical experience anyone would have the confidence to do this without a lot of supervision.
The reality of things are that PAs will be used on the wards or in various areas to do the junior jobs that trainee medical and surgical staff get bogged down in to free up these guys so they can focus on their training instead. There's probably a place for them, however a lot of wards I know are training up experienced nurse practitioners to do a similar role, with years of experience in that speciality, however cost being a likely motivation to employ a PA over an ANP wouldn't surprise me, especially in today's health service.
I do get the impression they've been sold a dream of a doctor-light with none of the crap that clogs a doctor's job. Except really what they're being hired for is to... well basically replace the medical students who no longer are around to/allowed to/can be bothered to bleed, cannulate, catheterise, notate, re-write and generally be the ward biatch for the juniors
. They're basically wanted for that clogging crap, quite specifically.There are no shortage of people to assist in theatre, perform procedures and perform ALS. I'm sure they're very good at TTOs, though
They're the victims here, really. Not sure who's been selling them this nonsense with a straight face.
(edited 8 years ago)
What stumps me is why any young person would go for it - many of the universities want a 2:1, it's two years long, the fees are still £9000 per year (and presumably you won't be able to get a loan for it since it's a PgDip). Clearly it's not for people who aren't able to get into gradute medicine, so why not just tack on two more years and a bit more student debt and you're sorted for a job with an actual training pathway and (eventually) the appropriate remuneration to show for it?
Really, I can't imagine how annoying it must be for them to be constantly mistaken for doctors by the public and other staff on the wards and to have to always be saying "well actually...". It's a drag as a med student, let alone for the rest of your life.
Really, I can't imagine how annoying it must be for them to be constantly mistaken for doctors by the public and other staff on the wards and to have to always be saying "well actually...". It's a drag as a med student, let alone for the rest of your life.
Hello again, Ii apologise for writing so much but I think you have all given some challenging questions.
Firstly, not every ward wants a PA and they are under no duress to hire one, we are optional. A few people have tried to make me feel useless during my training and belittled my profession. However I am as keen as ever to get involved and help as best I can.
NHS England has set a target of employing 5000 more PAs in the next few years, I call going from nothing to that in a couple years as something. Only byworking will we ever develope a real value.
I get my information mostly from the consultants who have offered me my intern year posts and full time contracts. Also from NHS workforce managers who meet with PA students regularly to keep track of the roles implementation and have no financial gain from my course fees but big HR problems. There are several government, university and hospital studies ongoing into our usageat the moment. We were never in doubt that this a trial of a new role! It's part of what is so exciting about it!
Can I clear up one big complaint you all had, I think this is a semantic problem. I have scrubbed in on a few difficult procedures that here are colloquially called "minor operations".
I have attended MDTs and spoke with consultants to discuss the death of patients during and around minor ops for example AAAs eroding into the duodenum during a knee replaccement! Also a death due to sepsis shortly after a failed converted-lap-chole and I've seen many post op PEs, strokes infections etc over this last year. These things are possible every time you enter the OR and it is terrifying. PAs couldn't save these patients from this and in these cases neither could the surgeons doing the OP currently. But you're probably itching to point out that patients have better odds with a Registrar than a PA. This is going to depend on the quality of the reg vs the quality of the PA. Broadly speaking it may be true I agree. However the evidence is not available for UK PAs, so we can't say for sure that this is a bad direction for our evidence based medicine to take. A quick google gave some links that on glance seem reassuring
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448455/ (small narrow study I know but I have exams to study for
)
This is why the mentoring, monitoring and further training will (if it ever happens) be appropriate and prolonged with supervision much as it is with an ST for several years. I am not naive enough to believe that all this responsibility would be handed to me on a plate or that it would even be a good thing if it was.
There is a lot of evidence showing that american PAs benefit their place of work and we are being modelled on them, we have a long way to go, we are not american PAs and this is not the American healthcare system! http://tinyurl.com/q68ezg6
Almost all feedback I hear from the current PAs and their consultants is positive.
Importantly, I feel we work in very different environments, I am already aware that big hospitals will use PAs very differently from struggling district ones or primary care. In all cases there are advantages, whether a big centre like Birmingham wants a hospitalist to help hold together a busy ward or a tiny rural hospital wants someone to be able to retain some useful skills and run a struggling service for them.
Here there is great demand in many areas and as an employee I would be very open minded with where I work and what I do. Here operating lists are often (once every couple months) cancelled because there is no one available to assist. Here there are clinics run by nurses with no extra training.
Here some wards have had their junior Dr rotations taken from them because of mismanagement. These wards now being manned purely by ANPs and PAs.
PAs do look after the ward and do ward jobs during the day, which can allow the juniors to go to teaching or surgery more often than before the PA arrived 2 years ago.
Breach of waiting times is a huge problem here, with procedures from arthroscopy, knee replacements, endovenous laser ablation, to the aforementioned procedures being over subscribed. Here this often sees patients traveling far and having to continue to travel for follow up. Also applications for the future training in some such procedures has already been applied for but not accepted. Several PAs have been put forward to be enrolled on current PA specific surgical programs. No guarantee I know but it is positive for my profession.
Paradoxically there is no stipulation in law stating that only a Dr can operate, so PAs may even do this before prescribing meds (if we do more than become expert handover sheet managers!).
If you read this far then thank you, there are problems with PAs currently and we will find how we work best in future. We work very hard in training with no sure promise of a bright future like you may have. So please be open minded when you meet one and if you work with one maybe spend a little time to get to know them and what they can do before you write us off.
Good luck to you all thank you for deciding to spend your working life in service of the ill and infirm!
Firstly, not every ward wants a PA and they are under no duress to hire one, we are optional. A few people have tried to make me feel useless during my training and belittled my profession. However I am as keen as ever to get involved and help as best I can.
NHS England has set a target of employing 5000 more PAs in the next few years, I call going from nothing to that in a couple years as something. Only byworking will we ever develope a real value.
I get my information mostly from the consultants who have offered me my intern year posts and full time contracts. Also from NHS workforce managers who meet with PA students regularly to keep track of the roles implementation and have no financial gain from my course fees but big HR problems. There are several government, university and hospital studies ongoing into our usageat the moment. We were never in doubt that this a trial of a new role! It's part of what is so exciting about it!
Can I clear up one big complaint you all had, I think this is a semantic problem. I have scrubbed in on a few difficult procedures that here are colloquially called "minor operations".
I have attended MDTs and spoke with consultants to discuss the death of patients during and around minor ops for example AAAs eroding into the duodenum during a knee replaccement! Also a death due to sepsis shortly after a failed converted-lap-chole and I've seen many post op PEs, strokes infections etc over this last year. These things are possible every time you enter the OR and it is terrifying. PAs couldn't save these patients from this and in these cases neither could the surgeons doing the OP currently. But you're probably itching to point out that patients have better odds with a Registrar than a PA. This is going to depend on the quality of the reg vs the quality of the PA. Broadly speaking it may be true I agree. However the evidence is not available for UK PAs, so we can't say for sure that this is a bad direction for our evidence based medicine to take. A quick google gave some links that on glance seem reassuring
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448455/ (small narrow study I know but I have exams to study for
) This is why the mentoring, monitoring and further training will (if it ever happens) be appropriate and prolonged with supervision much as it is with an ST for several years. I am not naive enough to believe that all this responsibility would be handed to me on a plate or that it would even be a good thing if it was.
There is a lot of evidence showing that american PAs benefit their place of work and we are being modelled on them, we have a long way to go, we are not american PAs and this is not the American healthcare system! http://tinyurl.com/q68ezg6
Almost all feedback I hear from the current PAs and their consultants is positive.
Importantly, I feel we work in very different environments, I am already aware that big hospitals will use PAs very differently from struggling district ones or primary care. In all cases there are advantages, whether a big centre like Birmingham wants a hospitalist to help hold together a busy ward or a tiny rural hospital wants someone to be able to retain some useful skills and run a struggling service for them.
Here there is great demand in many areas and as an employee I would be very open minded with where I work and what I do. Here operating lists are often (once every couple months) cancelled because there is no one available to assist. Here there are clinics run by nurses with no extra training.
Here some wards have had their junior Dr rotations taken from them because of mismanagement. These wards now being manned purely by ANPs and PAs.
PAs do look after the ward and do ward jobs during the day, which can allow the juniors to go to teaching or surgery more often than before the PA arrived 2 years ago.
Breach of waiting times is a huge problem here, with procedures from arthroscopy, knee replacements, endovenous laser ablation, to the aforementioned procedures being over subscribed. Here this often sees patients traveling far and having to continue to travel for follow up. Also applications for the future training in some such procedures has already been applied for but not accepted. Several PAs have been put forward to be enrolled on current PA specific surgical programs. No guarantee I know but it is positive for my profession.
Paradoxically there is no stipulation in law stating that only a Dr can operate, so PAs may even do this before prescribing meds (if we do more than become expert handover sheet managers!).
If you read this far then thank you, there are problems with PAs currently and we will find how we work best in future. We work very hard in training with no sure promise of a bright future like you may have. So please be open minded when you meet one and if you work with one maybe spend a little time to get to know them and what they can do before you write us off.
Good luck to you all thank you for deciding to spend your working life in service of the ill and infirm!
One last point that I forgot to mention is that our university training is not token, and PAs are proving confident in decision making. We have seen the anatomy, the pathology, the physiology, the biochemistry and the pharmacology.We have put it into practice in real working wards just as a medical student does before graduating. Our OSCEs and training are shorter than med students. We do cover more than you would expect after 2 years and we are capible. Sadly there is no regulation to allow us to prescribe and make us a safer bet for a hospital to rely on our decisions.
I think comparing a medic 6 years after starting training and a PA 6 years after starting training will show some interesting features. This is partly what workforce managers want 6 years from now. Also why they are still keen even though we can't yet prescribe.
Specifically ZippyRN, If you think our value is in our psychomotor skills that a HCA can mirror with a premade admission sheet then you are mistaking us entirely.
I think comparing a medic 6 years after starting training and a PA 6 years after starting training will show some interesting features. This is partly what workforce managers want 6 years from now. Also why they are still keen even though we can't yet prescribe.
Specifically ZippyRN, If you think our value is in our psychomotor skills that a HCA can mirror with a premade admission sheet then you are mistaking us entirely.
Original post by LosPA
Can I clear up one big complaint you all had, I think this is a semantic problem. I have scrubbed in on a few difficult procedures that here are colloquially called "minor operations".
I have attended MDTs and spoke with consultants to discuss the death of patients during and around minor ops for example AAAs eroding into the duodenum during a knee replaccement! Also a death due to sepsis shortly after a failed converted-lap-chole and I've seen many post op PEs, strokes infections etc over this last year. These things are possible every time you enter the OR and it is terrifying. PAs couldn't save these patients from this and in these cases neither could the surgeons doing the OP currently. But you're probably itching to point out that patients have better odds with a Registrar than a PA. This is going to depend on the quality of the reg vs the quality of the PA. Broadly speaking it may be true I agree. However the evidence is not available for UK PAs, so we can't say for sure that this is a bad direction for our evidence based medicine to take. A quick google gave some links that on glance seem reassuring
I have attended MDTs and spoke with consultants to discuss the death of patients during and around minor ops for example AAAs eroding into the duodenum during a knee replaccement! Also a death due to sepsis shortly after a failed converted-lap-chole and I've seen many post op PEs, strokes infections etc over this last year. These things are possible every time you enter the OR and it is terrifying. PAs couldn't save these patients from this and in these cases neither could the surgeons doing the OP currently. But you're probably itching to point out that patients have better odds with a Registrar than a PA. This is going to depend on the quality of the reg vs the quality of the PA. Broadly speaking it may be true I agree. However the evidence is not available for UK PAs, so we can't say for sure that this is a bad direction for our evidence based medicine to take. A quick google gave some links that on glance seem reassuring
So I read the whole of both of your posts and I don't feel the way in which most of us say we would treat a PA will be a problem at all. Personally, from what I've heard the job role described as in most of this thread I'd welcome a PA on the ward.
As a junior, it'd always be a help to have someone experienced and (hopefully) helpful on the ward who can help you and stop you from muddling around too much. I've no doubt the constancy and the experience would be to the benefit of the patient.
However, that paragraph is frankly terrifying. I don't know if it was two separate paragraphs that ran on but taken as one point. . .
You've attended MDTs and scrubbed in? You've discussed surgical deaths? I don't understand - does this mean you will be performing operations in the future?
Are PAs performing operations now in the UK, for us to compare their odds?
With the 6 year comparisons (when we get there) are you saying that a PA is going to get the training a reg is throughout their career? Are we following one PA from start to six years later and one reg from start to six years later?
Your reply in no way seems to adjust or respond to what people have incredulously stated previously? How do you expect to get the training to perform these roles, how do you expect to get the training to match someone on their way to consultancy as they progress?
I'm not attacking you, I'm confused and unsure of your points and hope to hear some clarification.
1) What is your expected progression in the career?
2) How much and what type of training do you expect PAs to receive over the years?
3) What percentage of PAs do you expect to be performing operations?
Original post by LosPA
Hello again, Ii apologise for writing so much but I think you have all given some challenging questions.
Firstly, not every ward wants a PA and they are under no duress to hire one, we are optional. A few people have tried to make me feel useless during my training and belittled my profession. However I am as keen as ever to get involved and help as best I can.
Firstly, not every ward wants a PA and they are under no duress to hire one, we are optional. A few people have tried to make me feel useless during my training and belittled my profession. However I am as keen as ever to get involved and help as best I can.
People with significant clinical experience
Original post by LosPA
NHS England has set a target of employing 5000 more PAs in the next few years, I call going from nothing to that in a couple years as something. Only byworking will we ever develope a real value.
NHS England has set a target of employing 5000 more PAs in the next few years, I call going from nothing to that in a couple years as something. Only byworking will we ever develope a real value.
care to provide a referenced source for this
also it does not address the issues over creating a direction to administer medications or administering medications, both of which are competencies of Junior Doctors and Nurse or AHP advanced practitioners ( and in the case of routine ward work with inthe remit of the indepdent prescriber pharmacist to reive w and represcribe )
Original post by LosPA
I get my information mostly from the consultants who have offered me my intern year posts and full time contracts. Also from NHS workforce managers who meet with PA students regularly to keep track of the roles implementation and have no financial gain from my course fees but big HR problems. There are several government, university and hospital studies ongoing into our usageat the moment. We were never in doubt that this a trial of a new role! It's part of what is so exciting about it!
I get my information mostly from the consultants who have offered me my intern year posts and full time contracts. Also from NHS workforce managers who meet with PA students regularly to keep track of the roles implementation and have no financial gain from my course fees but big HR problems. There are several government, university and hospital studies ongoing into our usageat the moment. We were never in doubt that this a trial of a new role! It's part of what is so exciting about it!
it is a roel which cannot legally function i nthe way you describe it to
Original post by LosPA
Can I clear up one big complaint you all had, I think this is a semantic problem. I have scrubbed in on a few difficult procedures that here are colloquially called "minor operations".
I have attended MDTs and spoke with consultants to discuss the death of patients during and around minor ops for example AAAs eroding into the duodenum during a knee replaccement! Also a death due to sepsis shortly after a failed converted-lap-chole and I've seen many post op PEs, strokes infections etc over this last year. These things are possible every time you enter the OR and it is terrifying. PAs couldn't save these patients from this and in these cases neither could the surgeons doing the OP currently. But you're probably itching to point out that patients have better odds with a Registrar than a PA. This is going to depend on the quality of the reg vs the quality of the PA. Broadly speaking it may be true I agree. However the evidence is not available for UK PAs, so we can't say for sure that this is a bad direction for our evidence based medicine to take. A quick google gave some links that on glance seem reassuring
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448455/ (small narrow study I know but I have exams to study for )
Can I clear up one big complaint you all had, I think this is a semantic problem. I have scrubbed in on a few difficult procedures that here are colloquially called "minor operations".
I have attended MDTs and spoke with consultants to discuss the death of patients during and around minor ops for example AAAs eroding into the duodenum during a knee replaccement! Also a death due to sepsis shortly after a failed converted-lap-chole and I've seen many post op PEs, strokes infections etc over this last year. These things are possible every time you enter the OR and it is terrifying. PAs couldn't save these patients from this and in these cases neither could the surgeons doing the OP currently. But you're probably itching to point out that patients have better odds with a Registrar than a PA. This is going to depend on the quality of the reg vs the quality of the PA. Broadly speaking it may be true I agree. However the evidence is not available for UK PAs, so we can't say for sure that this is a bad direction for our evidence based medicine to take. A quick google gave some links that on glance seem reassuring
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448455/ (small narrow study I know but I have exams to study for
) except of course the US PA is a very different model in a differrent system and came aobut because of different circumstances ( not a last ditch landgrab by fossils egged on by lay managers who think it might be cheaper than the safer options)
Original post by LosPA
This is why the mentoring, monitoring and further training will (if it ever happens) be appropriate and prolonged with supervision much as it is with an ST for several years. I am not naive enough to believe that all this responsibility would be handed to me on a plate or that it would even be a good thing if it was.
This is why the mentoring, monitoring and further training will (if it ever happens) be appropriate and prolonged with supervision much as it is with an ST for several years. I am not naive enough to believe that all this responsibility would be handed to me on a plate or that it would even be a good thing if it was.
which destroys your 'bang for buck' and 'flash to bang' arguments
Original post by LosPA
There is a lot of evidence showing that american PAs benefit their place of work and we are being modelled on them, we have a long way to go, we are not american PAs and this is not the American healthcare system! http://tinyurl.com/q68ezg6
Almost all feedback I hear from the current PAs and their consultants is positive.
Almost all feedback I hear from the current PAs and their consultants is positive.
except iof course the UK legal system does not allow for physician extender models , and Uk medicines legislation prevents PAs from having anything to do meds
Original post by LosPA
Importantly, I feel we work in very different environments, I am already aware that big hospitals will use PAs very differently from struggling district ones or primary care. In all cases there are advantages, whether a big centre like Birmingham wants a hospitalist to help hold together a busy ward or a tiny rural hospital wants someone to be able to retain some useful skills and run a struggling service for them.
Importantly, I feel we work in very different environments, I am already aware that big hospitals will use PAs very differently from struggling district ones or primary care. In all cases there are advantages, whether a big centre like Birmingham wants a hospitalist to help hold together a busy ward or a tiny rural hospital wants someone to be able to retain some useful skills and run a struggling service for them.
i think w hat you are seeing is a very filtered view feed by the medicla 'landgrab' and the belif that PAs are going to be cheaper than recognising the skills of Nurses and AHPS and providing them with the opportunity to get independent prescriber status.
Original post by LosPA
Here there is great demand in many areas and as an employee I would be very open minded with where I work and what I do. Here operating lists are often (once every couple months) cancelled because there is no one available to assist. Here there are clinics run by nurses with no extra training.
Here there is great demand in many areas and as an employee I would be very open minded with where I work and what I do. Here operating lists are often (once every couple months) cancelled because there is no one available to assist. Here there are clinics run by nurses with no extra training.
perhaps becasue peopel are wasting time and money on inventing unneeded roles rather than providing training to existing staff ... it's also becasue RNs and ODPs won;t be bullied into assisting in procedures where good clinical governance says the assistant must have "first assistant" or surgical practitioner skills
Original post by LosPA
Here some wards have had their junior Dr rotations taken from them because of mismanagement. These wards now being manned purely by ANPs and PAs.
Here some wards have had their junior Dr rotations taken from them because of mismanagement. These wards now being manned purely by ANPs and PAs.
however not by PAs solely, becasue the PAs can;t legally do certain things can they ?
Original post by LosPA
PAs do look after the ward and do ward jobs during the day, which can allow the juniors to go to teaching or surgery more often than before the PA arrived 2 years ago.
PAs do look after the ward and do ward jobs during the day, which can allow the juniors to go to teaching or surgery more often than before the PA arrived 2 years ago.
and all of these jobs can be done by technicians or by Nurses and AHPs being allowed to do those jobs ...
Original post by LosPA
Breach of waiting times is a huge problem here, with procedures from arthroscopy, knee replacements, endovenous laser ablation, to the aforementioned procedures being over subscribed. Here this often sees patients traveling far and having to continue to travel for follow up. Also applications for the future training in some such procedures has already been applied for but not accepted. Several PAs have been put forward to be enrolled on current PA specific surgical programs. No guarantee I know but it is positive for my profession.
Paradoxically there is no stipulation in law stating that only a Dr can operate, so PAs may even do this before prescribing meds (if we do more than become expert handover sheet managers!).
Breach of waiting times is a huge problem here, with procedures from arthroscopy, knee replacements, endovenous laser ablation, to the aforementioned procedures being over subscribed. Here this often sees patients traveling far and having to continue to travel for follow up. Also applications for the future training in some such procedures has already been applied for but not accepted. Several PAs have been put forward to be enrolled on current PA specific surgical programs. No guarantee I know but it is positive for my profession.
Paradoxically there is no stipulation in law stating that only a Dr can operate, so PAs may even do this before prescribing meds (if we do more than become expert handover sheet managers!).
if you beleive governance or public opinion is going to allow a glorified HCA to operate you really have been taking something ...
you only need to look at the sagas over RN and ODP Master;s prepared Specialist practitioners working alone in anaesthesia or surgical porcedures ...
Original post by LosPA
If you read this far then thank you, there are problems with PAs currently and we will find how we work best in future. We work very hard in training with no sure promise of a bright future like you may have. So please be open minded when you meet one and if you work with one maybe spend a little time to get to know them and what they can do before you write us off.
Good luck to you all thank you for deciding to spend your working life in service of the ill and infirm!
If you read this far then thank you, there are problems with PAs currently and we will find how we work best in future. We work very hard in training with no sure promise of a bright future like you may have. So please be open minded when you meet one and if you work with one maybe spend a little time to get to know them and what they can do before you write us off.
Good luck to you all thank you for deciding to spend your working life in service of the ill and infirm!
unfortunately you've been sold a story , a role which if it does take off will be little more than a glorified phlebotomist unless and until you get prescribing powers, and it;s taken Paramedics 16 years so far to get to the consideration of prescribing , from State registration becoming Mandatory.
I'm still struggling to get my head around this surgery thing. As it stands, surgical trainees are chomping at the bit to get theatre time, so much that we've employed ANPs to staff the wards doing previously junior doc jobs so they get theatre time. On top of this, there's not enough hours in the day (as far as EWTD is concerned) for them to get as many hours as it stands on top of ward time. While waiting lists are a concern, wouldn't it make more sense to use these PAs on the wards so that the trainees hours could be rotated more flexibly to meet both the needs of the service and their training needs together?
Also, the AAA graft going through someone's duodenum while they had a completely unrelated knee op has nothing to do with the minor vs major surgery thing. A cholecystectomy is NOT what I or many others would define as a minor op, be it laparoscopic or open.
The other side of this is that there may be space for training some PAs in scrub to work as first assistant, however, if you're a consultant looking for people to train up to do this as a non trainee role, who do you go for? The PA with two years experience as a trainee PA revolving throughout all sorts of different specialities or the scrub nurse/ODP who has 5-10 years + of solely periop experience in the theatre environment training as a surgical care practitioner, a role that's well established in a lot of cardiothoracic teams (and many others) already.
Also, the AAA graft going through someone's duodenum while they had a completely unrelated knee op has nothing to do with the minor vs major surgery thing. A cholecystectomy is NOT what I or many others would define as a minor op, be it laparoscopic or open.
The other side of this is that there may be space for training some PAs in scrub to work as first assistant, however, if you're a consultant looking for people to train up to do this as a non trainee role, who do you go for? The PA with two years experience as a trainee PA revolving throughout all sorts of different specialities or the scrub nurse/ODP who has 5-10 years + of solely periop experience in the theatre environment training as a surgical care practitioner, a role that's well established in a lot of cardiothoracic teams (and many others) already.
(edited 8 years ago)
Original post by LosPA
Paradoxically there is no stipulation in law stating that only a Dr can operate, so PAs may even do this before prescribing meds (if we do more than become expert handover sheet managers!).
This is mental. There is a reason why surgeons have to go through an eight year postgraduate training programme. In your fantasy world, are PAs also going to sit the MRCS/FRCS? Or does your two year postgrad diploma exempt you from that?
Even podiatrists have to go through more rigorous training than PAs before they get to do minor foot surgery. And in this case, the word "minor" is appropriate; a cholecystectomy is never a minor operation - this is not semantics, it is medical fact!
PAs in my hospital have been proven to be better than doctors. They take years to learn whereas we only learn important things. In my hospital after a couple of months we are able to minor procedures such as performing anaesthesia, operating and doing endoscopies. We can do these all to better abilities that doctors as our training is so intensive that we our better.
Currently I work on my own surgical list where I anaesthetise all my patients and operate on them as well. I have junior doctors to assist me. Next week, I am doing a course so I can run the air ambulance service single handedly. Also we will replace ANPs as they only have defined roles whereas PAs can work everywhere and do everything. Also they are not as good as us as they have not learnt on the 'medical model'.
Lead the crusade. Be a PA.
Currently I work on my own surgical list where I anaesthetise all my patients and operate on them as well. I have junior doctors to assist me. Next week, I am doing a course so I can run the air ambulance service single handedly. Also we will replace ANPs as they only have defined roles whereas PAs can work everywhere and do everything. Also they are not as good as us as they have not learnt on the 'medical model'.
Lead the crusade. Be a PA.
(edited 8 years ago)
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