Physician Associate or Graduate Entry Medicine?!

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 just fail to see what's so mysteriously spectacular about the PA teaching method that makes them supposedly so much more advanced than medical students in the same or even shorter amount of time. You bang on about the pathophysiology teachings that you received prior to PA training - what on earth do you think medical students were doing during this time?

Also I don't see how anyone can claim to be registrar level when they've never run the take in 20 different hospitals at 3am when the wards and AMU turn into the Alamo. Its this kind of thing that makes you a registrar, not working from the coat tails of a consultant during routine hours.

I just fail to see what's so mysteriously spectacular about the PA teaching method that makes them supposedly so much more advanced than medical students in the same or even shorter amount of time. You bang on about the pathophysiology teachings that you received prior to PA training - what on earth do you think medical students were doing during this time?

Also I don't see how anyone can claim to be registrar level when they've never run the take in 20 different hospitals at 3am when the wards and AMU turn into the Alamo. Its this kind of thing that makes you a registrar, not working from the coat tails of a consultant during routine hours.

It intrigues me how on one hand there's this assertion that PAs are working a registrar level then on the other there's the hiding behind the T&C that they're "not doctors nor do they want to be".

Then I think it's summed up when you say PAs don't want the responsibility, the hours, the clinics and the paperwork but want the cream of medical practice. You can't really have it both ways. Someone has to do this.

My experience of PAs in real practice is that they're there 9-5 colouring by number but when the **** hits the fan or the endless drudgery of medicine rears its head, suddenly the line of "im not a doctor" gets announced. Then who is left to pick up the pieces? Hmm..

The concept and justification of PAs is great. A bit of continuity, someone to help with the TTOs, the cannulas, the basic prescribing. But nobody actually wants to do that job, do they?

I don't think think you addressed the majority of the points made.

Perhaps you have generalised your opinion of PA's.. and almost stereotyped it.

I for one, am more than happy to take responsibility, the saying "we are not doctors" - is simply because we aren't. We are more then happy to complete the same tasks, but we are a NEW type of medical professional. The term doctor is literally, just a term. Hence why we don't call ourselves that. It doesn't mean we can't do similar or the same things.

You act like working a 9-5 job is a bad thing. Wanting a life is not a bad thing at all. I for one, have done many night shifts, and am not scared of alternative shift patterns, but I'm sure you'd agree having some stability in your personal life, I.e Monday-Friday 9-5, is a lovely thing.

You have completely misinterpreted not wanting responsibility. We are more than happy to have it. Just because we want a life, and don't want to sell our soul to a hospital to get somewhere in life, doesn't make us bad people. We can take part in clinics, and lots of other things that consultants do. However, in my opinion there is far too much work load pressure on consultants as it is. I'm not ashamed to say I don't want that.

I would never refuse to do anything, or back off just to be lazy or pass responsibility. It's a shame you have met people like that. I'm more than happy and so are the majority of PA's, to do anything we are trained and confident to do.

You mention cannulas and TTOs like they are a demeaning job. This is the problem with medicine, people focus too much on a hierarchy and look down upon others.
They are jobs that might not be as interesting, but still have to be done.
I would do any job, regardless of how menial you think it is, to care for patients. That goes from simple jobs to the most complicated, if I'm trained to do so of course.
I hope you do meet a PA that can change your rather... negative opinion
Remember we need people that aren't so patronising and rude, to make medicine a more appealing field of study !

- say doing a chest drain - its generally given to the PA not the SHO (as the PA is on the ward for years not months so training them helps the ward more).

And then of course there's the more selfish (but entirely legitimate, as you so eloquently argue) concern that if PAs are so competently staffing the day shift maybe hospitals will take doctors off the 9-5 and give them all the weekends, evenings and nights instead.

except you can just shirk responsibility when you like.

all the boring prescribing. You don't need to cycle through different hospitals in different cities every single year for up to 10 years, doing specialities like paeds or gynae that you have utterly no interest in,

you only work the easy 9-5 shifts, you never have to deal with 12 hours of jetlag four times in 2 weeks or missing friends' weddings because you're working the weekend yet again...

and on top of that you are paid more than a daytime SHO

what the NHS needs and what this role supposedly is - or doctors have just been royally screwed for about the 5th time this decade. If even half of the above is true there's gonna be a lot of doctors wondering why on earth they bothered with med school. Either way: at least some doctors being a little doubtful and/or resentful is hardly surprising is it?

I'm not convinced you would. You're telling me that if a consultant, who perhaps doesn't understand your qualification despite you explaining it, asked you to spend an hour cleaning a difficult incontinent patient with dementia every day rather than attending the ward round, you would not have any grievance with that whatsoever?

You have trained to do something else and were expecting something else and so will feel legitimately frustrated - nothing to do with hierarchy

Thanks you for your highly enlightening response. If the outcome of both courses is indeed similar then would not the onus be on the medical course to justify its inefficiency? Let us first exam this far superior education you feel you have had. In 4 academic years (9months each) a graduate in Arts can become a qualified doctor. So in 36 months that can be achieved. We are taking relevant sciences who have done 27 months of pure academics then adding 21 months to become a PA (assuming the 6 weeks off a year) totalling 48 months in total. Does this now seem an unreasonable timescale to become competent at an FY1 level in medicine. Again let me reiterate, we don't want to be doctors but will not accept the patronising attitude a few people give.

At the end of the day your opinion of the registrar issue is not supported look at the RCP publications supporting the claim that their PAs work at ST3 level. Your opinion does not affect reality of the situation. I hope you realise that this is not a threat to doctors but actually support.

The difference is scope.

Physician associates were created for limited service provision. There might be some crossover between them and junior doctors (foundation doctors, early registrars), but beyond that the professions diverge significantly.

Medical school is the tip of the icerberg. Perhaps the PA course puts you on that tip the same as a medical graduate, but that IS their postgraduate training, whereas as a doctor your postgraduate training will eclipse that entirely.

If as you say it was your dream, I would recommend you do whatever it takes for GEM. You have a good 30-40 year career ahead of you still. If you go down the PA route you'll have reached the apex of your career without entering management in 10.

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

say if someone wanted to do the 5 year undergrad or grad courses but were already a grad, how would financing work as Ive read a lot of contradictory stuff on TSR.


Also my answer to the OP, apply for both or spend 1 year training (/working?) as an associate so that way you can save money to do GEM. but just be aware sometimes if you defer your place at Grad medschool, the programme which you applied for may no longer exist in its capacity or exist at all

Its not about what you want though - there are many anecdotes of consultants having the choice between teaching the SHO or the PA< and choosing the PA as its in the ward's interest.



Well all the other stuff mentioned previously I thought? Or was that all made up?

Doesn't change the fact that there could be a real threat to training opportunities for doctors who actually have to staff the hospital at the difficult hours.



Its the impression given by some people on the PA course and what a lot of criticism/scepticism you get from doctors results from.



Previously definitely not. Now that there's all the resentment from the new contract there's much more of a push to make a fuss about staying late but there's still a lot of pressure from the hospital not to. In reality: you stay late all the time unpaid.



The majority of doctors you will meet for now will have started med school before the PA course existed, so that's not a choice many people had.

I agree that the NHS-enforced nomadic lifestyle of British doctors is poorly publicised.



Really? You rotate every 6 months around a single hospital forever?

I was under the impression that a major point of PAs was that they were outside of the merry-go-round of anti-training doctors have to do.



You clearly have not worked nights as a doctor.



Actually no not really. When many current docs started training you had to work hard and lots of out of hours shifts but when you got to consultant you were set - vast majority working 9-5, with actually a quite low intensity job for that period too. Just 10 years later and consultants are in at all hours, multiple consultants on site at weekends for multiple specialities. And now years after they started there's a new course which promises a very similar role but 9-5 only, potentially displacing doctors to do even more nights and weekends. That is not what many docs signed up for, actually. Perhaps they were naive in not realising that was the way healthcare was going, but doesn't make them any less annoyed.



Not yet, but there are plans to do exactly that.



The NHS is behind, on at least some level, both the training of PAs and current working conditions though. You can be angry that that has happened without being irrational yes.



Lol.



The NHS literally could not care less, especially for point B. And that job is exactly what thousands of junior doctors do in their first year - just telling your consultant that you want to do more is not going to help you I'm afraid.



Honestly - read any threads on here about what being an FY is like. It is entirely expected that for your fist year or two you will use an absolutely minimal amount of the knowledge you've spent 6 years learning because you will be expected to do all the mundane skill-less tasks like bloods, cannulas, discharge summaries and general form filling that the NHS mandates you to do. There is no choice, there is no complaining, and there is no other job to take. If you want to work in the UK you must do the FY years, period. If you don't like it, your only choice is to leave medicine. One of the few things that keeps the idea of 'doctoring' alive through these years is the short periods you're allowed to clerk in new patients. But now the PAs are going to do that instead, it would seem.