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    Hello everybody.

    To start, I am a 30 year old male currently on the 2nd year of a Human Physiology course in Portsmouth. While I am averaging a First on my marks, I am starting to think about post-graduate study; I have a few choices but the main two are the Physician Associate and Graduate Entry Medicine at St George's and Kings respectively.

    Since a young age I have wanted to become a doctor, but recently I have thought that perhaps I am just not cut out for the position thus far and so looking for a clinical role that comes close to being a doctor; I am aware of the stigma that Junior Doctors give PAs but I am a person who would rather work up through experience as opposed to just solid education.

    My difficulty is this; I am 30 and do not want to waste any more time, I love the thought of becoming a fully registered doctor but I cannot afford the £3,645 (after bursary) per annum for 4 years on the Graduate MBBS. On the other hand, I like the thought of being in a supportive role for doctors and working as a team.

    Obviously with being a doctor you can further your career and specialise e.g. cardiology, gastroenterology, neurology etc; can you specialise as a PA? Let's be frank, I want to be one of the above 3 specialists eventually, can I do this as a PA and do part-time / distance learning courses?

    I am really stuck in the middle of these two choices; I would also like to do the Space Physiology at King's as one fields I enjoy is the human body in extreme environments.

    I hope I can count on some good quality advice from those who are in the same boat or those from both sides who have done it and perhaps share their experiences.

    Many thanks.
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    What isn't that puts you off GEM? If you can average a first at uni then you would cope with the level of medicine. It's just the sheer content that you are expected to remember.

    Is it something else? The hours, responsibility etc?

    With regards to fees and that, I can't really advise much as things have changed radically since I've been through the system. Would you not have to pay similar fees for PA training?

    Also, PAs are extremely new to this country, so it's difficult to predict their role and progression potential, but I suspect there will be some element of specialisation. I know the PAs I've worked with tended to rotate less and spent more time in one speciality.
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    (Original post by David_Roxx)
    Hello everybody.

    To start, I am a 30 year old male currently on the 2nd year of a Human Physiology course in Portsmouth. While I am averaging a First on my marks, I am starting to think about post-graduate study; I have a few choices but the main two are the Physician Associate and Graduate Entry Medicine at St George's and Kings respectively.

    Since a young age I have wanted to become a doctor, but recently I have thought that perhaps I am just not cut out for the position thus far and so looking for a clinical role that comes close to being a doctor; I am aware of the stigma that Junior Doctors give PAs but I am a person who would rather work up through experience as opposed to just solid education.

    My difficulty is this; I am 30 and do not want to waste any more time, I love the thought of becoming a fully registered doctor but I cannot afford the £3,645 (after bursary) per annum for 4 years on the Graduate MBBS. On the other hand, I like the thought of being in a supportive role for doctors and working as a team.

    Obviously with being a doctor you can further your career and specialise e.g. cardiology, gastroenterology, neurology etc; can you specialise as a PA? Let's be frank, I want to be one of the above 3 specialists eventually, can I do this as a PA and do part-time / distance learning courses?

    I am really stuck in the middle of these two choices; I would also like to do the Space Physiology at King's as one fields I enjoy is the human body in extreme environments.

    I hope I can count on some good quality advice from those who are in the same boat or those from both sides who have done it and perhaps share their experiences.

    Many thanks.
    I dont know very much about the PA role, so I cannot comment much here. But I will say go with your gut.

    I want to draw your attention to your age, not every medical school will accept people over a certain age due to the longevity of your career and whether you will actually make it to a consultant (and whether its worthwhile for the government to fund your training etc.). med school is 4 years graduate entry, plus 2 foundation years then plus 5+ years of speciality training (can be up to 10) and possible years out that makes a minimum of 11 years and a maximum of 16 years. You would be 31 by the time you begin the course (possibly even 32) so that means you would be 42 by the time you exit speciality training and become a consultant at the minimum. Personally I would say thats ample time and you will 100% have chance to give back and have many years as a consultant/GP, but the government seem to think otherwise in some cases. Make sure you check with medical schools regarding this issue.
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    I just want to say I've never heard of unis refusing entry based on age so I personally wouldn't let that put you off. We have lots of "mature" students on our course (oldest is 50 and she is not the only one above 40) so I see no reason why 30 would be a problem. They'll ask you the same questions at interview to test commitment like they would anyone else and as long as you can show you're willing to stick it through I can't imagine anyone not letting you in because of your age- surely that's illegal?

    I have met some PAs in training and as someone mentioned it's a relatively new programme so it's hard to predict how they'll be utilised in the future. They do all seem quite happy with their lot and they are more financially supported atm (part of the aggro for some doctors). I don't know for sure but it seems unlikely that they would allow you to do distance studying. I've seen some physicians associates threads on TSR too so definitely ask for their view on things too.

    You said you like learning and progressing by doing rather than pure education but PAs still do a lot of theory learning so you won't be able to escape from that completely. Besides from third year in medicine most of your learning is done on clinical placements anyway (as will be your higher specialty training) so I think both courses offer you the chance to learn by doing. Bear in mind that PAs are (supposedly) more service provision than anything so you will hit a wall re progression quite quickly.

    Having interests in a wide variety of areas - extreme physiology, gastro etc. I do think medicine would lend itself more to exploring those options and maybe incorporating aspects of more than one into your eventual practice.

    I'm not going to lie it is financially tough to do this as a graduate and only you can determine if GEM is practically feasible for you and it's something you'll have to be realistic about. It's a bit easier to do part time work in first and second year but becomes harder as you progress. I know people who have sadly dropped out for financial reasons part way through.

    Best of luck whatever you decide.


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    You realise you only pay the £3500 up front in the first year? The NHS covers it for years 2-4 and the rest of your tuition fees are covered by student finance.
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    As a 32 year old male, starting GEM this September, I wouldn't let your age put you off applying.
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    (Original post by Marathi)
    You realise you only pay the £3500 up front in the first year? The NHS covers it for years 2-4 and the rest of your tuition fees are covered by student finance.
    Hi, not sure what you mean by this. W
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    (Original post by Marathi)
    You realise you only pay the £3500 up front in the first year? The NHS covers it for years 2-4 and the rest of your tuition fees are covered by student finance.
    Not sure I understand what you mean, what tuition fees would you have if the NHS covered the years 2-4? Thank you :-)
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    (Original post by _ambermac)
    Not sure I understand what you mean, what tuition fees would you have if the NHS covered the years 2-4? Thank you :-)
    So it works roughly like this, for your tuition fees:
    Year 1 - £3500 up front self-funded, £5500 covered by SFE
    Year 2-4 - £3500 paid by NHS, £5500 covered by SFE. For each year
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    Hi David, I am a Physician Associate student at the moment. I notice you said "Obviously with being a doctor you can further your career and specialise e.g. cardiology, gastroenterology, neurology etc; can you specialise as a PA? Let's be frank, I want to be one of the above 3 specialists eventually".

    I think you've answered your own question here. PAs learn medicine, but in a VERY different way. To put it in the simplest way I can, we focus on medically assessing patients in order to differentially diagnose conditions then we do 3 things. We either:
    1. Treat low risk conditions in their uncomplicated forms.
    2. Help stabilise the patient then consult with the medical team who refer for appropriate senior/specialist support.
    3. Participate in the day to day management of complex conditions that have already been diagnosed and whose management plans have already been established (eg in primary care)

    For this reason, even if you gain experience in a cardiology ward and increase certain practical skill sets through CPD you will always remain a GENERALIST. You will never specialise. We are also dependant practitioners who whilst working semi-autonomously in day to day duties, always work as part of a medical team directly under senior medical staff. So you will never achieve a degree of autonomy and seniority even close to that of a consultant. Considering the above, from the question you asked I don't think you will get the job satisfaction you are looking for if you go down the PA route even though it has a quicker entry route. I hope this helps!
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    (Original post by Marathi)
    So it works roughly like this, for your tuition fees:
    Year 1 - £3500 up front self-funded, £5500 covered by SFE
    Year 2-4 - £3500 paid by NHS, £5500 covered by SFE. For each year
    got you now! thanks! do you know if this is the same for all unis offering grad entry medicine? thanks
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    (Original post by _ambermac)
    got you now! thanks! do you know if this is the same for all unis offering grad entry medicine? thanks
    In England and Wales it is.
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    thought this could be of interest
    Attached Images
  1. File Type: pdf Second degree medicine leaflet.pdf (338.1 KB, 109 views)
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    (Original post by xJessScott)
    thought this could be of interest
    thanks this was really helpful to look at! how much is the NHS bursary/grant per year then?
    Thanks
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    (Original post by Ilir1989)
    Hi David, I am a Physician Associate student at the moment. I notice you said "Obviously with being a doctor you can further your career and specialise e.g. cardiology, gastroenterology, neurology etc; can you specialise as a PA? Let's be frank, I want to be one of the above 3 specialists eventually".

    I think you've answered your own question here. PAs learn medicine, but in a VERY different way. To put it in the simplest way I can, we focus on medically assessing patients in order to differentially diagnose conditions then we do 3 things. We either:
    1. Treat low risk conditions in their uncomplicated forms.
    2. Help stabilise the patient then consult with the medical team who refer for appropriate senior/specialist support.
    3. Participate in the day to day management of complex conditions that have already been diagnosed and whose management plans have already been established (eg in primary care)

    For this reason, even if you gain experience in a cardiology ward and increase certain practical skill sets through CPD you will always remain a GENERALIST. You will never specialise. We are also dependant practitioners who whilst working semi-autonomously in day to day duties, always work as part of a medical team directly under senior medical staff. So you will never achieve a degree of autonomy and seniority even close to that of a consultant. Considering the above, from the question you asked I don't think you will get the job satisfaction you are looking for if you go down the PA route even though it has a quicker entry route. I hope this helps!
    Just thought I would jump in and give an alternative view point. I am in my final year close to qualifying as a PA. At the medical school I attend we learn the same content as the medical students and sit the same exams, so the way we learn the medicine is similar here. We are not doctors and do not want to be. We have many differences however, we must acknowledge that we perform a medical role. The pace of learning is very intense due to our time pressures and requires an awful lot of self directed learning. According to the competency frame work:

    "More specifically, in the medical context, a newly qualified PA must be able to perform their clinical work at the same standard as a newly qualified doctor. And similarly an experienced PA must be able to perform at the same standard as an experienced junior doctor, asking for help from the consultant as needed, in the same way that a junior doctor would."

    The definition of dependence is interesting. All members of the medical team are under the supervision of the consultant are they not? A PA does not get supervised by an FY1. The definition is meaningless in reality, in America entire departments are ran by PAs with a consultant on the end of a phone if required, is this not a high degree of autonomy? Without prescribing and regulation we are more dependant however (this will change hopefully). PAs have to take responsibility for their own medical practice but like all medical staff must refer when appropriate. It is also important to note that PAs do not just manage minor and uncomplicated illness. The competency matrix is the MINIMUM requirement for qualification.

    In terms of generalism vs specialism, It is murky. We have PA's that are very experienced working at Registrar level within their departments (to the extent that they employ one less reg) where they perform highly specialised medicine and surgery. One works in acute stroke and the other in paediatric surgery. The definition of generalism does hold true as we get re-tested every 6 years however that does not mean you will not specialise. Once qualified it becomes more valuable for the department to allow you to specialise and take on more department specific roles.

    This is obviously up for debate but this is the perspective that me and my colleagues share, I hope this helps.
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    (Original post by PhysicianAssoc)
    X
    Out of interest, do PAs sit the same final exams/OSCEs/PSA as medical students do?
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    (Original post by Etomidate)
    Out of interest, do PAs sit the same final exams/OSCEs/PSA as medical students do?
    We sit the same Applied Medical Knowledge exam with a pass mark in our final year that is the same as the 5th year medicine students pass mark.

    We also sit the same OSCE's and ISCE's as the medical students although our ISCE's are slightly different as the medical students are told what system it is prior to entering.

    Our assessments on placement are exactly the same with the same competency sign off booklets. We also undertake the same case based discussions/examinations on placement as the medical students do.
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    (Original post by _ambermac)
    thanks this was really helpful to look at! how much is the NHS bursary/grant per year then?
    Thanks
    Well it's means tested so depends on income etc
    When I was a student nurse my parents were on like £50,000 or so collectively and I lived out and got £400 a month and £500 student loan every time so I presume it's similar however is individual
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    (Original post by PhysicianAssoc)
    We sit the same Applied Medical Knowledge exam with a pass mark in our final year that is the same as the 5th year
    So what's that? Are they the same final exam papers?
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    (Original post by Etomidate)
    So what's that? Are they the same final exam papers?
    Sorry If I was unclear: Yes they are the same
 
 
 
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