The Student Room Group

Why is there so much hate towards the role of Physician Associate in the UK.

Looking online from various sources and discussion threads I get the general impression there seems to be some sort dissatisfaction towards the general role and future of Physician Associates (PA) in the UK primarily from Doctors working in the field.

I genuinely don't understand why this is the case, as, from my understanding, PA's are individuals who have to complete a masters degree and undergo a one year training programme. This is in addition to having already completed a degree in a relevant science subject, required by most universities, and even now we can see some places requiring the UCAT to be sat by applicants wanting onto the MSc Programme.

So why is there so much anger around them? Surely they are qualified enough to work within their designated scope of practise without the need of other professionals in the field having this sort of bias against them, after all their role is to assist doctors by off loading a lot of the less serious cases so that the doctors use their time more efficiently in more serious cases, I dont see why this profession cannot not do this?

This sort of thing is already established in other countries such as the US and other countries around the world are also doing the same so again I don't see why PA's cannot work effectively here either.

Note: I am not saying all Health care professionals have the same attitude but the general portrayal of the profession for now at least seems to be negative by a lot of people.

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I don't know that there's anger, but its still a relatively new role and lots of HCP's don't know about them and what they are/aren't allowed to do. One of my friends is a PA, the only one in her department - doctors think she's a nurse and ask her to do nursey things, and nurses think she's a doctor and ask her to do doctory things. Neither of which are appropriate. The more time she spends there, the more she has been able to carve her own niche.

As time goes on, and the role becomes more established, like every other job in the NHS it will become embedded in the system.
Reply 2
Have you spent much time working in a healthcare environment before? What you'll see is constant pushing of boundaries (scopes of practice) to cope with increasing demands and lack of staff. This is nothing unique to PAs - all nurses and AHPs pushed into doing things we are not 100% of at some point, because you don't want to let patients down.

The alternative is a hard refusal to do something, but you'll (incorrectly) be seen as obstructive, and not a team player, and that will count against you.

The issue with PAs specifically is that with roles being so closely tied to doctors, what is intended to be a distinct line in their role quickly becomes blurred. If a precedent gets set, a new line gets drawn.

The concern is having a new job role consisting of people walking around with stethoscopes around their neck, slowly replacing doctors in front of patients, as poor pay and conditions causes the number of doctors to go down as the number of patients and expectation of 24/7 services gets ever higher.

I hope that makes some sense. It should be black and white, but it never is!
(edited 6 months ago)
Reply 3
There are genuine concerns about scope creep, pay, professional regultion and how people present themselves in the clinical environment. However, it's the internet and because of this (anonymity etc) some of the discourse around PAs is incredibly unpleasant in certain corners of the internet.
Reply 4
Original post by rbc22345
You need to make the distinction between their role on paper (e.g. what we are told their role officially is) and their actual role on the wards in 2023.

In principal, a PA is an excellent idea. They should basically act as little clinical secretaries for their doctor (remember - they were initially called physician assistants). They should document what the doctor wants, take bloods the doctor orders ect. This is what the government told the medical field in the UK 10 years ago. Things are very different know!

However, the mundane nature of this job soon bore down upon the PAs. They wanted to specialise into different areas of clinical medicine and become more engaged in medicine rather than simple administration - because it gives PAs the impression that they are like doctors. PAs have a huge inferiority complex. That is why we always hear of PAs presenting themselves as doctors to patients, or using deliberately ambiguous titles, or by changing their names from assistant to associate. NHS management also actively encourage the increasing scope of practice of PAs simply because PAs are cheaper than doctors in the long run...hence reducing overheads, and compensating for a shortage of real doctors.

They do not have the intellectual capacity or the motivation to deliver patient care equivalent to that of a doctor. If they did, they would not have done a sh*tty PA course at the university of Lancashire. If they did have the competence, they would have gone to Oxford to study MBBS, with an MSc intercalation, and then train in orthopaedics/plastics/ENT and become a real doctor.

PAs do not undergo rotational training. So they spend their whole life in the same crumbling DGH. As such, they begin to identify patterns amongst patients in that particular ward. They simply perform pattern recognition, without properly understanding the medicine behind. E.g. the consultant yesterday gave xxx treatment to Dorris because Dorris has the following symptoms yyy. Dave presented today with yyy, so lets give them treatment xxx like the consultant did yesterday. But applying such an algorithmic thought process requires understanding of the nuances in the flowchart....and PAs don't have the medical knowledge to make those nuances. So when Boris, an anomalous patient, shows up, the PA thinks she knows what she is doing. Look at me look at me im like a doctor, and then fuc*s up. https://www.bbc.co.uk/news/uk-england-manchester-66168798

If you only get AAA in A Levels, let alone a B, you should not be prancing around with a stethoscope on your neck pretending your a doctor. So dont tell me Sharron from Essex, who did a biomedical degree at the University of Colchester after doing 2 BTECs or getting AAB in her A levels, and then spent 2 years surrounded with other Sharrons in PA school, is equivalent to an F2.

*****ng hell they **** me off.


This view seems to already be full of bias towards the role of PA. The idea that every single PA has "an inferiority complex" is quite odd. Do you know every single PA currently working in the UK? If not then you are very much generalizing every one in the profession.

I feel as if your views are based on the idea that every PA wants to be a doctor. I don't believe that this is case. The whole profession is based of Doctors supervising while you practice and in the vast majority of cases this is how it goes, it can work if done successfully - and in a lot of places across the country it does work.

Also I just want to add the vast majority of medical schools in the UK only require AAA, and a lot of them allow you to reduce grades to AAB or lower depending on circumstances or other subjects taken.

Your views on this subject seem quite outdated and filled with bias towards the role. PA as a profession defiantly needs some re working, but with GMC regulation coming this should hopefully sort things out
Reply 5
In principle it sounds ok, but the fear is that it's a cheaper and less regulated way of providing medical care than employing a real doctor, and it feels to many like the government is just using it to slowly erode the medical profession.

Doctors obviously take a very holistic approach to medical care, combining their wide-ranging training with specialist expertise and experience in order to diagnose and prescribe correctly. But what are PA's really going to be learning here? Who is going to be regulating them? And if they don't have prescription capabilities (which they absolutely shouldn't), then it what sense are they really helping doctors? No competent doctor is going to prescribe anything to a patient they haven't examined, so it's ridiculous to think they'll just sign off prescriptions on the recommendation of a PA.
(edited 6 months ago)
Reply 6
Original post by ate3
This view seems to already be full of bias towards the role of PA. The idea that every single PA has "an inferiority complex" is quite odd. Do you know every single PA currently working in the UK? If not then you are very much generalizing every one in the profession.

I feel as if your views are based on the idea that every PA wants to be a doctor. I don't believe that this is case. The whole profession is based of Doctors supervising while you practice and in the vast majority of cases this is how it goes, it can work if done successfully - and in a lot of places across the country it does work.

Also I just want to add the vast majority of medical schools in the UK only require AAA, and a lot of them allow you to reduce grades to AAB or lower depending on circumstances or other subjects taken.

Your views on this subject seem quite outdated and filled with bias towards the role. PA as a profession defiantly needs some re working, but with GMC regulation coming this should hopefully sort things out


Even AAA is sh*t. Standard should be A*A*A, Too many people get into medical school without having the correct competence. Even more so for PA school.
Reply 7
Original post by rbc22345
Even AAA is sh*t. Standard should be A*A*A, Too many people get into medical school without having the correct competence. Even more so for PA school.


Well take it up with the unis and how is AAA sh*t” ?? AAA is a good set of grades to get only 30% on average get A/A* grades. Have you taken A levels? What grades did you get?
Because doctors are bitter and jealous shipman’s who want all to suffer like them
Reply 9
Original post by HM7777
Well take it up with the unis and how is AAA sh*t” ?? AAA is a good set of grades to get only 30% on average get A/A* grades. Have you taken A levels? What grades did you get?

Yeah lol, 4 A*s in bio, chem, maths and further maths...and not with the COVID grade boundaries as well. An A is sh*t. Sorry to say it. Its not like I worked all day and night. I could have easily worked even harder. And yet I still managed to get 4 A*s. That is saying something....A Levels are too easy bro and have little value.
(edited 5 months ago)
Reply 10
Original post by HM7777
Well take it up with the unis and how is AAA sh*t” ?? AAA is a good set of grades to get only 30% on average get A/A* grades. Have you taken A levels? What grades did you get?

" 30% get A/A* " ....that is exactly the issue.
Would you trust 1 in every 3 people you cross in the street to be your surgeon. I doubt it.
Reply 11
Original post by rbc22345
" 30% get A/A* " ....that is exactly the issue.
Would you trust 1 in every 3 people you cross in the street to be your surgeon. I doubt it.


A levels arent the only deciding factor for entry to med school tho. There are many other sections that you have to pass through to get in
Reply 12
Original post by ate3
A levels arent the only deciding factor for entry to med school tho. There are many other sections that you have to pass through to get in


Most of the other stuff is waffle. You can easily make up scenarios for the interviews, and the personal statements don't count for anything anymore. The big intelligence/motivation indicators in the application process are the A Levels and the admission tests, both of which have thresholds which are too low imo.
Reply 13
(Original post by rbc22345)Most of the other stuff is waffle. You can easily make up scenarios for the interviews, and the personal statements don't count for anything anymore. The big intelligence/motivation indicators in the application process are the A Levels and the admission tests, both of which have thresholds which are too low imo.

I really hope that if you are a doctor that i never get treated by a person with such a negative mindset such as yours. The fact that you think medicine is based on A levels just shows that you're probably one of the doctors that doesn't care about building rapport, showing empathy and all the things that makes doctors have an impact on the patients care and experience. We don't need doctors like this especially if they think like you do. Please rethink your career choice for the safety of your patients. You say PAs have an inferiority complex , please, doctors have an ego problem. Doctors who feel threatened by PAs, whose roles completely differ from that of a doctor, shows how insecure you are in your profession. Please learn to grow up and understand that no one is coming for your job and if they wanted to they would've done a MBBS at Oxford.
Reply 14
Original post by rbc22345
And there is the issue.....The official roles of physician assistants and doctors are different, on paper. I agree with that. But, the reality is that, on the ground, physician assistants are being used as substitute doctors. And PAs get wet dreams from this. If anything endangers patients, its these random ass PAs thinking their 2 years of bullsh*t in Colchester uni is equivalent to a real MBBS.

You claim that, as of the present moment, their roles are different.

If their roles are different, why are PAs examining medical students in OSCEs?
If their roles are different, why are PAs teaching medicals students on placement?
If their roles are different, why are PAs going into theatre and running clinics whilst the poor CST, who's here to do surgery and infinitely more competent, has his training opportunities stolen?

A cub doesn't learn how to survive from a mother goose, but from its mother tiger.

I bet you in 10 years time, physician associates will have access to the same postgraduate training as doctors. Does that seem reasonable? Do you want the local PA, called Susan, who's got her 3 cm acrylic nails and piercings everywhere, on the core surgical training programme, taking the place of an actual *****ng doctor. Because with this bs, that is what is gonna happen. And guess what, the justification for such a decision will be that, "it promotes inclusivity....Susan came from a single-parent household, she's vegan, and in a wheelchair ect. so she deserves widened excess". And the real reason is that NHS trust managers can't be fuc*ed to train actual doctors, and prefer to pocket the money to fund their second home, all while training cheap PAs.

Yes, the physician assistant role is good on paper. But the role has been transformed into something completely different. Once you understand this you'll have made a great step. Until then, I'll never train physician assistants. Or treat them that is. **** them.

What is your issue? Show me on the doll where the PA hurt you ........

For starters, I had an offer for BMBS but after careful consideration, I declined and applied for PA the following year.
I don't want the responsibility of a doctor, I want a decent life/work balance so I can spend time with my family.

I really hope you are not a doctor with that attitude - and I am so happy you never want to train PAs as we don't want you.

Oh and BTW it is Physician associate NOT assistant - so please try and at least get the job title correct before putting it down if you want people to take you seriously.
Reply 15
Original post by Jotenno
What is your issue? Show me on the doll where the PA hurt you ........

For starters, I had an offer for BMBS but after careful consideration, I declined and applied for PA the following year.
I don't want the responsibility of a doctor, I want a decent life/work balance so I can spend time with my family.

I really hope you are not a doctor with that attitude - and I am so happy you never want to train PAs as we don't want you.

Oh and BTW it is Physician associate NOT assistant - so please try and at least get the job title correct before putting it down if you want people to take you seriously.


No actual arguments addressing my questions....just emotions.
Original post by ate3

So why is there so much anger around them?


Well what does their profession add that can't be fixed by there being more doctors? What can a PA do that a doctor can't do?
Reply 17
Original post by rbc22345
No actual arguments addressing my questions....just emotions.


To be fair, your argument is clouded by your obvious bias against people you deem as beneath you based on their uni or whether they have piercings...
(edited 5 months ago)
Reply 18
Original post by rbc22345
If their roles are different, why are PAs examining medical students in OSCEs?
If their roles are different,Yes, the physician assistant role is good on paper. But the role has been transformed into something completely different. Once you understand this you'll have made a great step. Until then, I'll never train physician assistants. Or treat them that is. **** them.


Are you suggesting you would not treat a PA? That's a worrying position to take if that's what you are saying.

There are genuine concerns about scope creep and PAs being used to fill rota gaps, but your argument is dropping in classism and snobbery and it devalues what you are trying to say.
The animosity is borne purely out of the arrogance that is part and parcel of the medical profession. A PA needs a postgraduate degree just to enter the field, making them already far more educated than your average medic who insists on the title of Dr without ever actually earning it. This is why I feel very strongly that medicine should be a graduate degree like it is in the States. There is no need to segregate the profession in such a bizarre fashion, especially when you end up with a situation where insecurities run amok and MBBS discriminates against MSc. I mean, seriously? Grow up.

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