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I didn't do A&E but I've heard it's a lot more hands on and requires you to learn a lot more.

Medicine & surgery are usually just scut-fests. Even on calls, you're just filling in a clerking proforma, no time to think about the patient just fill it in ASAP then move on to the next one.

That wasn't really my experience of medicine or surgery either - in both I learnt an awful lot about the practicalities of managing a wide variety of conditions (admittedly in between the scut work). I guess things might vary from hospital to hospital - I was in a middle sized DGH and I wouldn't be surprised if your hospital was either a teaching hospital or a busy large DGH based on your experiences.

It might have been just how your hospital worked. That seems very odd to me.

In those I have worked in for medicine or surgery, you have to clerk, do all the tests and then present a finish piece of work to the consultants either in a post take round or a handover meeting to the team.

I have never heard of fy1 filling in a clerking proforma then waiting for a senior to initiate a plan. Surely if the patient came as a referral from a&e there is no point clerking without doing a full management and investigation plan ? Seems a bit odd to me.

You misunderstood, phleb do bloods only where I am
There are nurse practitioners in various specialties, most are very useful and appropriate like asthma nurses or diabetic nurses
Surgical nurse practitioners depend on the specialty but cardiothoracic surgery for example they will pre op and harvest leg veins in theatre
They do nothing on the ward and also do not do anything like the junior doctor role

This plan will never ever work

in a previous hospital i have worked at, just as i was leaving, they were cutting ortho sho jobs and replacing them with physician assistants on the wards. these PAs were expected to do the work of the ortho SHO. bearing in mind that in ortho you were basically meant to just get on with things by yourselves - do your own ward round and the jobs. your regs/consultants would only see their patients once a week. how can someone who hasn't been to medical school do this?! another problem is they can't prescribe, which means they had to get in a prescribing pharmacist. i don't fully understand how someone can prescribe a drug if they haven't assessed the patient medically.

i heard there was a death in a young man from multi organ failure sepsis after coming in with a closed fracture at a weekend a PA was covering. nothing is one person's fault, but it interesting to think that if they had a medically trained junior doctor on the wards, would the scenario have been different?

i do see the potential benefits of PAs, especially in surgical specialties where patients aren't too 'medically' unwell. They probably will not rotate as often and will be able to learn all the nuances of that specialty and the consultant's preferences, but they still aren't medically trained, and anyone can develop a medical problem whilst in hospital.

Wow, genuinely awful stuff. I really hope you reported these concerns as untrained people should not be on sho rota especially if they are causing death through negligence. I am surprised your orthopods tolerated this.

in a previous hospital i have worked at, just as i was leaving, they were cutting ortho sho jobs and replacing them with physician assistants on the wards. these PAs were expected to do the work of the ortho SHO. bearing in mind that in ortho you were basically meant to just get on with things by yourselves - do your own ward round and the jobs. your regs/consultants would only see their patients once a week. how can someone who hasn't been to medical school do this?! another problem is they can't prescribe, which means they had to get in a prescribing pharmacist. i don't fully understand how someone can prescribe a drug if they haven't assessed the patient medically.

i heard there was a death in a young man from multi organ failure sepsis after coming in with a closed fracture at a weekend a PA was covering. nothing is one person's fault, but it interesting to think that if they had a medically trained junior doctor on the wards, would the scenario have been different?

i do see the potential benefits of PAs, especially in surgical specialties where patients aren't too 'medically' unwell. They probably will not rotate as often and will be able to learn all the nuances of that specialty and the consultant's preferences, but they still aren't medically trained, and anyone can develop a medical problem whilst in hospital.

If such a case went to court, which it would if it were my relative, the hospital will be liable to a heavy negligence claim.

I would just leave surgery ASAP mate. Dying specialty. Radiology you get much better training and you will never have to deal with this.

I never even considered surgery as a career. Never ever ever ever ever ever. It was always a never option.

This is not the point, however bad the training the fact they have replaced SHO surgical housemen with untrained professional is something very worrying, especially when they are filling oncall gaps or leading ward rounds independently. This is just dangerous.

I would be interested if anyone knows the legal position on this and how this is allowed.

The attending physician is responsible for PA's in the US so I assume PA's will have a named consultant in the UK who would be ultimately accountable for them within reason?

I know some NICUs have ANNPs on the SHO or even reg rota! But I get the feeling that's a lot more procedural and protocolised than a surgical ward could ever be. I would not want a member of my family cared for by a PA.

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What is NICU and ANNP ? Nurse practitioner as itu registrar ???

I really do not think an orthopod is going to take accountability for clinical errors made by a PA. It must be the PA that will be responsible for their own mistakes or the trust for employing untrained professional to senior positions.

I really do not think an orthopod is going to take accountability for clinical errors made by a PA. It must be the PA that will be responsible for their own mistakes or the trust for employing untrained professional to senior positions.

On a similar note, there a nurse practitioners with their own theatre lists e.g. ortho have them doing carpal tunnels unsupervised, with the consultant next door if there are any problems. The consultant would be held accountable for anything, same as if the registrar were to do the list alone.