stomachulcer
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Which medical/surgical specialities have (for the time being) been least impacted by the rise of PAs and ANPs? I know EM is basically being taken offer and a few related ones are on their way. But which are still on the other end of the spectrum?
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junior.doctor
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The language on your post feels very negative. “Impacted”, “taken over”.

Let me offer a positive perspective. In most neonatal units we have ANNPs. They are an invaluable part of the team, and have a wealth of experience. They are fabulous at teaching clinical skills and educating in general. I have learnt a huge amount from them and they have supported me as both colleagues and teachers in a niche specialty. We have lots of ACPs / ANPs in paediatric ED, who again are excellent and bring a wealth of experience. We increasingly have a few in some paeds departments - again, not taking over - complementing. All the ACPs I’ve worked with have been prescribers, and are fully involved with all team jobs including clerking and TTOs. I know there is sometimes a sentiment that ANPs / ACPs / PAs siphon off the procedures / fun stuff, but that’s not been my experience at all within paeds (or especially within neonates where there are procedures +++)

I haven’t worked with any fully qualified PAs but we have student PAs on placement in paeds from time to time.
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Democracy
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(Original post by stomachulcer)
Which medical/surgical specialities have (for the time being) been least impacted by the rise of PAs and ANPs? I know EM is basically being taken offer and a few related ones are on their way. But which are still on the other end of the spectrum?
Maybe something quite niche and relatively small e.g. clinical genetics? Tbh I am doubtful even about that, but it was the first thing that came to mind.

I'm sure I've said this before, but you can pay an experienced PA/ANP half a consultant's basic salary to do 85% of their work. That is an absolute win from the perspective of a manager or healthcare economist. The point of being a doctor is the other 15% of the job - something the public (i.e. voters) don't realise because they think real life medicine is like House MD. The economists are wise to this lack of understanding

So...I understand where you're coming from but this is just how things are. I wouldn't start changing your plans as a result of it however.
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Chief Wiggum
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(Original post by stomachulcer)
Which medical/surgical specialities have (for the time being) been least impacted by the rise of PAs and ANPs? I know EM is basically being taken offer and a few related ones are on their way. But which are still on the other end of the spectrum?
I think this is a bit of a non-issue. I am not aware of any specialties being "taken over" by PAs or ANPs. I do not think your post is in any way reflective of reality.
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Etomidate
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(Original post by Chief Wiggum)
I think this is a bit of a non-issue. I am not aware of any specialties being "taken over" by PAs or ANPs. I do not think your post is in any way reflective of reality.
I respectfully disagree with this. You only have to look at the USA to see the future with regards to “mid level creep”, whereby you have employees with a fraction of the education and clinical hours now occupying 100% of what were previously physician roles. Anaesthetics is a particular example of this.

Along with this came a strange lexicon to intentionally blur the lines of what a doctor/nurse is, such as “provider, clinician, practitioner” etc, so that patients don’t actually understand who they are seeing. The associated nursing bodies have also gone as far as campaigned to change their titles to what were historically physician only titles (eg nurse anesthetists to be called anaesthesiologists).

Looking at the timeline of how the US arrived at this point and you see history repeating itself in the UK, largely a result of a passive physician workforce which allowed this to happen slowly but progressively over time. Often, this is facilitated by more senior doctors and governing bodies who benefit the most from PAs, ANPs etc, as a result pulling up the ladder behind them for their junior colleagues.

tl;dr - ANPs/PAs don’t exist for your, or your patients benefit. They are a “cheap” (false economy) alternative to employing doctors. Everybody wants to be a doctor, but nobody wants to go to medical school.
Last edited by Etomidate; 2 months ago
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fishfacesimpson
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Are you grouping single disease specialist nurses into the category of ANP? if so that take is way off and they provide the back bone for the care of a lot of people with chronic conditions. PD, stroke, MS.... A lot of these secondary care services would fall apart without specialist nurses and none of them are trying to be doctors nor have anywhere near the same roles.

I don't know if clinical nurse specialists are considered ANP though so maybe not relevant. Do they only deal with undifferentiated or acute issues?
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I have seen lot of PAs on medicine do the donkey work that's done by the FY1/FY2s.
I've never seen them work at the level of IMT3/medical registrar. And I doubt I ever will.
They fill a specific niche in the medical workforce. But there is no career progression from there.
I'm not saying that's a bad thing.

ANPs are a different level altogether, they specialise in just ONE thing, so have to expect them to be an authority on it.
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stomachulcer
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(Original post by Etomidate)
I respectfully disagree with this. You only have to look at the USA to see the future with regards to “mid level creep”, whereby you have employees with a fraction of the education and clinical hours now occupying 100% of what were previously physician roles. Anaesthetics is a particular example of this.

Along with this came a strange lexicon to intentionally blur the lines of what a doctor/nurse is, such as “provider, clinician, practitioner” etc, so that patients don’t actually understand who they are seeing. The associated nursing bodies have also gone as far as campaigned to change their titles to what were historically physician only titles (eg nurse anesthetists to be called anaesthesiologists).

Looking at the timeline of how the US arrived at this point and you see history repeating itself in the UK, largely a result of a passive physician workforce which allowed this to happen slowly but progressively over time. Often, this is facilitated by more senior doctors and governing bodies who benefit the most from PAs, ANPs etc, as a result pulling up the ladder behind them for their junior colleagues.

tl;dr - ANPs/PAs don’t exist for your, or your patients benefit. They are a “cheap” (false economy) alternative to employing doctors. Everybody wants to be a doctor, but nobody wants to go to medical school.
Yeah honestly it's something that does concern me a little bit. Especially since the specialities I'm interested in are the same ones who have been "heavily influenced" (since I can't say anything else) but PAs, ANPs etc. in the USA. Also, it's not as if I'm already any ST6 or whatever so have less reason to be worried. The more I read about what's going on, the more it makes me consider what I want to do. I know there's so much more I need to consider but still, it's a consideration.

It may not be 'reflective of reality' now. But I'd say it more likely will be in the future than won't be.
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stomachulcer
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(Original post by fishfacesimpson)
Are you grouping single disease specialist nurses into the category of ANP? if so that take is way off and they provide the back bone for the care of a lot of people with chronic conditions. PD, stroke, MS.... A lot of these secondary care services would fall apart without specialist nurses and none of them are trying to be doctors nor have anywhere near the same roles.

I don't know if clinical nurse specialists are considered ANP though so maybe not relevant. Do they only deal with undifferentiated or acute issues?
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