Steve Barclay said the Quiet Part out Loud | A Warning to PAs, AAs and SCPs
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- เผยแพร่เมื่อ 20 ต.ค. 2023
- Medical associate professionals, this is a genuine plea to look after yourselves and make sure you are not being placed in situations you are not adequately trained for, or employed in direct substitution for a doctor. Warning signs for that might be being placed on the same rota as your doctor colleagues, or being encouraged to take up locum shifts that would normally be filled by a doctor.
Twitter account referenced: / nandwics
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Great video thanks Ollie. When you talked about scope creep, I did wonder how the traditional training pathways will hold up with educating us to a level where we can progress into leadership roles as you mentioned and supervise PAs. As a midgrade trainee myself, much of my exposure and training is similar to the job role of a PA so in the future I'm not sure what will be the distinguishing factors. It seems the only difference in physician training atleast is the ST4-8 years and membership exams.
Thanks for detailed info, but sadly just as I thought and ultimately very scarey situation for patient safety
Thank you for your measured approach to this topic! Just graduated my PA course, and have been very bogged down with the current news. I hope, despite the press being mostly negative currently, that this will pave the way to making clear cut rules for PA professional practise and scope. I’ve had a lot of thoughts about whether I made the right career choice but I believe that if used safely (and with suitable supervision ) a PA can contribute to the clinical environment.
Congrats on your graduation! Go out there and be a great PA. I agree, what I think is needed more than anything is formal scope definition, and without that, relationships will only get worse. PAs en masse are in the very precarious position of being dependent practitioners, and at the moment an entire generation of doctors is being raisd/trained that will carte blanche refuse to work with, train or supervise them - which is obviously harmful to a PA's career prospects. I suspect this will mean a significant number of currently practising PAs will have their wings clipped a bit in terms of scope, but it might at least provide clarity.
Congratulations! You should be proud - Good luck in your career! I am a 2nd yr PA student and have at times struggled with the negativity and questioned the role. However, it is definitely a valuable role that makes a difference. There is a place for PA's in the NHS :)
Congrats.
I am GP and I have met very good and intelligent PAs
The issue for me personally is not whether theyre safe or not.
I personally believe there all manner of conditions that non doctors can safely diagnose and treat. And they do it well.
And I have total sympathy for the idea that doctors make mistakes and often don't have enough time for patients.
The issue comes when practices are docking doctors wages or refusing to hire them due to PAs being cheaper.
My girlfriend was a PA and I have nothing bad to say about them.
They are very hardworking and certainly a life line to GP practices here in the north where a lot of GPs prefer not to work anyway.
I just don't like that the government promotes and supports them to level where it doesn't support doctors, especially as our training is way longer and there's a shortage of us as it is.
It will only make us less likely to want to work in these disadvantaged areas.
We need definite boundaries do define what pa's can and cant do.
I am an emergency medical technician basic with mental health bias. I would never dream of being that negligent because i am not an idiot. A competent clinician will always double check everything with someone with more experience. I may be a lowly technician but at least i understand my boundaries.
What if there were no supervising senior staff onsite when they should have been? I really think the full story of the PA missing the PE twice is yet to come out as there have been lots of GP practices hiring PAs unsupervised which defeats the whole purpose of their role. There's something significantly missing in that story and it's a really sad case as someone's life is gone
@TheMedicalStrive there is legally required to always have one at least supervising consultant surgeon or doctor present at all times. If that didn't happen then they were not only negligent they could be open to be sued for gross professional misconduct due to severe gross negligence. A consultant is legally required to always be liable for their teams no matter what. To assume otherwise is just plain dangerous and if they had no supervision then they deserved everything they get.
@@sabrinamurray I agree as that's my understanding of the law too but it doesn't mean in reality it happens and something's really fishy about this case because no one knows anything about the senior medical staff who's supposed to have been thee supervisor nor of how the practice supervised their PAs. Cover ups going on here. The PA is unknown as well. Very hidden and for them to stop hiring PAs raises further suspicion in my mind that they may have made a mistake somewhere and are trying to cover their tracks
@TheMedicalStrive then I have no sympathy for what they did because care was not provided correctly
@TheMedicalStrive I want to know what idiot prescribed betablockers for undetermined abominable pain and actually signed the script in the first place. It's concerning that someone signed it. I wonder if a nurse or paramedic practitioner signed it. Rather than a doctor. Still one supervising consultant should have been providing appropriate care. If a house officer did it then more than one person seriously screwed it up.
The difference is Doctors hold a masters in medicine and surgery for 5 years and additional 2 to 3 years of foundation training before having the various roles and still very tightly supervised compared to a working PA
PA 2 years after undergrad plus experience of 1-2 years max doctor 5 years 2 years plus 6-8 years specialty big difference 6 years PA docror 13 years plus PA is similar to advanced practioner
No, doctors are doctors during their foundation training too!! Doing indepednet ward cover at night by themselves right from their first month!
MBBS is said to be an undergraduate degree for some reason ? do you mean 6 year intercalation that get an intergrated masters ? :) pls clarify
It's a traditional thing in the UK. It's referred to as a Bachelor's degree, and is indeed an undergraduate degree, but it sits at Level 7 on the relevant framework, considered to be Master's level study. Level 8 would be phd
@@OllieBurtonMed now that makes more sense ! thank you for the reply :)
Is MBBS a masters ? I didn’t know that. I thought it is bachelors level
Level 7 on the UK classification system yes - same as a master's.
I've looked into the whole PAs getting paid more than doctors saga but we need to make it clear that doctors' salaries increase significantly as they train further and they clearly do have a. defined training pathway though PAs start at a higher salary with a masters' degree, that's it really, they're mid level practitioners and can only go so high and tend to remain where they are because they don't have a defined training pathway as doctors rotate due to their training and can go all the way to 6 figures in salary when they become consultants and even before they become consultants, their salaries rise way quicker than PAs. As doctors rotate, the PAs remain so which means when for example, new junior doctors come in fresh from meed school, they're likely to meet a PA who's probably worked on the same ward for example for 5 years, they can learn a lot from the PA in that stage as the PA would then be more experienced on that ward. The junior doctor leaves due to rotation and can return to become that same PA's consultant in the future earning significantly higher than the PA who's salary probably hasn't changed by more than 5k whereas the junior doctor now consultant would have +30k and even more in salary so if anyone is making a comparison, I think really all of the story should be told. Don't just stop at where a fresh graduate's salary is at. They really shouldn't be compared at all. I don't get it? Anyway that's what I've read and is my understanding. I think PAs go through a two year intensive masters degree course and trained to take a comprehensive history, examine, diagnose, treat and manage a patient under the supervision of a doctor because they only have two years training to pick up core common presenting medical conditions still under supervision and to know when to escalate a case to their seniors when it's beyond their scope and they wouldn't miss this anyway as they're already under senior medical staff supervision. So clearly PAs are not doctors and are nowhere near doctors and it's not the first time the NHS has a multidisciplinary team. I'm guessing it's because the profession is not as recognised as in the States? I go to the GP and have been seen by a nurse and they're not trained in the medical model as PAs are. Even if they're training is two years only but that's really their focus and then more training in the clinics right? Just like medicine. Really the training starts on the wards even with some clinical exposure in med school but so do PAs have clinical exposure in their masters and since they only have two years, they work under supervision of doctors who studied 5 years isn't it? Nurses only have 3 years and go into work. I've also seen some universities advertise a 2 years masters course to become a nurse if you already have an undergrad degree like look up queen's university in Belfast. I think PAs get the heat because they're the only other profession that are trained in the medical model as doctors who hold a prestigious degree are. Anyway that's my take from my understanding of both roles.
I don't think anyone reasonable is saying competent PAs working in the scope of their practice aren't useful.
People take issue with the fact that even starting Doctors have more experience and knowledge than their starting PA counterparts. Yet somehow they're paid less than starting PAs that have less experience.
Doctors are severely underpaid and their starting salary should at least match that of a starting PAs, regardless of the promise of career progression.
@@dante9284 The issue of doctors being underpaid should go to the relevant body rather than complain and compare themselves to another profession which is rather embarrassing considering that doctors have prestige.
If nurses, physios, teachers, PAs feel the same, again, off to the relevant body.
A doctor starting out may have "more experience" than a PA starting out but depending on the PAs background as well, then again, why are they being compared?
I think PAs earn on average, how much a Masters degree holder in the UK earns of course dependent on the field too.
Hopefully doctors don't compare themselves to the AA who only qualified in 2021 and is on $220k and this is with having "assistant" tied to their title. Which is why I don't see why some doctors are campaigning for a title change. It's starting to look as if one profession is bitter over the other.
@@TheMedicalStrive None of what you said helps your case.
The MBBS/MBChB that all medical students in the UK graduate with is a Masters equivalent Degree. The only level of degree higher is a PhD. And undertaking masters level study for 5/6 years, I imagine for just a second, is far more challenging than the equivalent for 2 years. If PAs earn a Masters level wage to start, why don't doctors?
And before you decide to make the point, the promise of future earnings is an incredibly contrived work around for the obvious underpay of doctors right now. You have to work until specialty training begins before you earn as much as a PA starting out, and by then the PA from a lack of rotation has cemented professional relationships on the ward they're based, thereby making consultants less eager to train their specialty trainee colleagues. Even beyond talks of salary, the impact PAs have had on the training & readiness of 'soon' (5 years minimum, even if there is a job waiting at the end of the rainbow) to be consultants is startling.
PAs who've come away with a vaguely science related degree and an 'interest in healthcare' (as advertised on the NHS jobs website) are not as experienced as F1s, who have had clinically relevant training throughout their entire degree (to the depth required of a medical practioner in the core tenets of medicine - anatomy, physiology and pathophysiology), as well as a minimum of 3-4 years on the ward gaining clinical experience. An accelerated programme that does not train PA students to the standard of medical students/doctors (many of whom already gain a clinically relevant BSc/MSc through an intercalated year of study during their degree) should not be used as a justification for paying them 1.5x more than their more experienced colleagues.
And on the point of prestige, it doesn't count for anything. It isn't converted in salary, you can't put prestige down on a deposit for a mortgage, nor does it help in any other monetary domain. And if how doctors were, and still are, vilified in the media despite being lauded as heroes during the pandemic is anything to go off of, prestige is well and truly gone. Ask any younger doctor that is screwed by the current system and you'll find that cultural perception of the career means nothing to them anymore.
The pay review bodies are anything but independent, hence why doctors are striking. 'Off to the relevant body' is not the response you think it is when accepting their recommendations every year since 2008 has gotten doctors to where they are now, where less experienced practioners earn more than them.
Despite all I've said, PAs are worth what they're paid - A clinical practioner that can do what they and F1s onward can, deserve pay reflective of their ability. It is scandalous however, that PA advocates are somehow against proper remuneration for their doctor colleagues, and instead advocate for engaging with the pay review bodies that have gotten them into this mess in the first place.
@@dante9284 I don't agree with your point because it doesn't make sense why, just why do some doctors have to compare themselves to PAs to the extent that they complain about what PAs earn when their degrees and training are completely incomparable that I find the need to even spell it out is embarrassing.
If doctors have a problem with pay, take it to the relevant body but not at the expense of bringing down another profession that is no way near their prestige.
Likewise with nurses, PAs, physios etc can take their pay concerns to the relevant body if they feel underpaid.
It's so uncalled for, to read how some people feel the need to spell out the number of years of training of doctors compared to PAs when we all don't need to be in the medical field to know that doctors are obviously the ones on the top. It looks like a toxic environment is being created for another profession.
What has prestige on a mortgage have to do with anything?
Don't you think non-doctors, need a mortgage too? If that's the issue, what has a PA's pay got to do with that?
If some people don't feel doctors have prestige, then anyone is free to move elsewhere with a prestigious degree to feel valued if they wanted and if they wanted to stay in the NHS then take the pay fight to the right body but not at the expense of belittling another profession that supports us or telling them to change their name etc. The doctor degree counts for a lot still.
Once again, problem with pay? take it to the relevant body, don't compare professions and just focus on how to get a pay rise without bringing another down. These two professions don't need to be compared in the slightest at all.
@@TheMedicalStrive You acknowledge the degrees are incomparable yet the less qualified individuals earn more?
The comparison between the 2 roles is made because you have physician in your name. A title previously reserved for doctors and the rigorous training it implies. We're comparing ourselves because of what PAs are called and the training they're afforded (at the expense of doctors) while also being paid better. The comparison is completely justified.
You're the one who cited/still cites prestige as some sort of benefit for doctors ('doctors on top'), not me. I have wholeheartedly said it means nothing and the only thing that has substance (pay) is given in greater amounts to less experienced individuals.
The PA role exists in its current incarnation, as Steve Barclay mentioned when questioned recently in the commons, to undermine doctors and their union. And I agree it is an acceptable response for doctors to emigrate to countries where they are respected and paid appropriately. Just don't grasp at straws looking for answers when patient safety outcomes worsen due to an exodus of well trained & experienced clinicians out of a system that remunerates individuals will less responsibility & expertise better.
We will not be undermined by the DDRB any longer, hence strike action. For some reason you've still yet to realise no one is asking for PA pay to be brought down. Doctors should be paid more, and we are taking action to get there.
“You guys are vulnerable to being used as a substitute to doctors”. This isn’t a warning to them Ollie, this is what they want. I have seen numerous occasions where PAs have actively misled patients and nurses about their role. If you don’t believe me do a few locum shifts in Reading. It’s one of the highest employers of PAs in England and the degradation of doctor training there to accommodate for PAs and PA students is atrocious. I could give you lots of examples in all the specialities I was in. There is zero respect for doctors anymore, and even less so for foreign doctors. Reading actually have a role called “medical support worker” that are basically foreign doctors not on the GMC register, employed as PAs (sans the PA clinic and theatre time obviously..) but on a band 6 salary. We’ve gotten to a point where trusts are supporting BSS courses for PAs that don’t know what the terms pronation, supination or “Murphy’s sign”mean. At the same time we now have F2s being told that ALS is no longer essential training for foundation years. The whole thing is a joke and the very existence of PAs is making it worse for us.
I was told ALS was not necessary for F1 in 2009, yet I was on the crash team and often the first to arrive overnight. I paid for it myself and completed ALS anyway. The degradation has been going on for years and it’s up to us as a profession to unite against the degradation of care, in order to protect our patients.
@DrRussell als is compulsory for fully qualified emts at tech level so it's mad that doctors don't have to know it
@@sabrinamurray to be fair I’m older now (almost 40) and things have improved since I was a junior, but the whole system needs a re-think. It starts at the top. We have no clear, moral leadership.
No doctor can possibly be used as a PA,you must be graduated from a PA course and have passed the professional exam Independant of the university to even apply for q PA job.Furthermore,there is no PA that wouldnt know exactly what those simple medical terms were.
@@scarred10 Well there definitely are PAs who don’t know what those simple terms are, I’ve worked with them, hence they were given as examples.
I think i might be speaking on behalf of all PAs (based on experience), as PAs, we are going through enough as it is, our course is very intense as it is, many of us have put 100% of our life into completing this course to come out as safe practitioners. But we are constantly being bashed left right and centre (mostly online although some cases in person), you have to have common sense to understand that the bashing we get inevitably will impact us, some of my friends have gained depression and are on medication purely because of the amount of online abuse we get (i wish i was making this up) :(. Please try and keep an open mind about us (PAs).
1)we are humans with feelings
2) we want to work for our patients within the MDT
3) we dont want to take over any ones role, we are not doctors or nurses we are PAs.
thank you (feels better letting it out)
Thanks for your input/perspective. As I've said before (and hopefully came across in this video) - personal attacks and bashing are never appropriate. I think the role/deployment of the role can/will continue to be debated and questioned, which was inevitable since deployment happened before scope and regulation - same will happen with SCPs and AAs, and this was exacerbated by doctors (as in members of the relevant Colleges) not being consulted properly before these decisions were made.
I do think there is a role for PAs in the NHS and have written as much in published material online. That's not a universal opinion among doctors, and the implentation of PAs and MAPs more widely has been so botched that it's probably reduced the number of doctors that would be willing to work with, train or employ them. That's not the fault of PAs and lies squarely with government/NHSE. You guys are very much victims of a terribly handled deployment plan, and the motivations for that plan may be coming from a bad place, which is what this video is ultimately about.
@@OllieBurtonMed fair response Ollie. But I dont see why implementing PAs widely is making doctors concerned , from what i read, it sounds like doctors think they are not being valued which shouldnt be the case and it is not the fault of PAs whatsoever. Everyone knows doctors are doctors and 99.9% of the time, people appreciate doctors and respect them. PAs are not new, theve been here for 20 years, i 100% think regulation need to happen quickly, but thats out of PAs control. Ive also seen tweets/opinions re patient safety, IF a PA is working outside their scope of practice, that's the fault of that PA and will be taken off the register (FPA atm), knowing a PA limitation is stressed a lot at PA school and it is expected of a PA to know when to escalate/seek further knowledge if having doubts. Another tweet ive seen is regarding pay. I do agree doctors are not paid near enough as they should be, its sad that after going through med school the pay in the first few years is not enough esp with the current rent/expenses but this is not the fault of the PA profession/advance nursing profession/Clinical paramedic profession (all paid similar to PA).
Hi Ollie - I am currently a PA student + I do appreciate your approach to the discussion. It is rare to see a measured approach to the debate that recognises the challenges on both sides. I completely appreciate the significant challenges and inequality junior Dr's are currently. All health care professionals are in support of pay restoration for all Dr's. I think at times this frustration has been misplaced on PA's. I agree that there needs to be a clearly defined scope of practice for everyone involved - I am hoping through regulation this will be made clear. I do disagree with the BMA creating a scope of practice without involving any of the key stakeholders, as I think this only causes further confusion and division - ultimately reduces patient safety as trust and respect for all colleagues working in an MDT, is a fundamental part of ensuring a high quality of patient care.
I agree - I think the way in which the government has introduced PA's into the workforce has been poor - which has largely contributed to the current tensions. Without clear scope of practice/ supervision guidelines and more awareness about the role - it is understandable concerns are raised by Dr's. I think the manner certain Dr's have conducted themselves on social media and in person to many PA students and colleagues has been shocking - especially as leaders within the medical workforce . However, I do appreciate you are not an advocate for that and have raised entirely valid points, without the need to devalue and target an entire profession - with the main intentions of contributing to helping patients and to assist in delivering high quality patient care.
It has been challenging being a PA student at this time, however I do believe there is a place for PA's within the NHS. I have seen incredibly competent PA's working well with Dr's. During my secondary care placement, I have seen examples of effective supervision, as every case is discussed with registrar. I have also spoken to primary care PA's who are incredibly supported in the GP practices. It is very dependent on the specific team itself. Through this experience, I have seen the value that PA's can add value to the MDT. I 100% agree that there is a need for clarify regarding scope of practice. I think as you mentioned, it is important for PA's to be aware of their limitations.
I think with an increasing population and increased waiting times - the wider implentation of PA's with appropriate supervision and scope of practice can be very useful. There are PA's with over 10+ years of experience within the same department, who are effectively and safely escalating any concerns to senior Dr's. I think there has been alot of misinformation about the role, which has lead to toxicity within the professions, as it is still a relatively small profession, not many Dr's have actually worked with a PA. Some perceptions are based on twitter feeds, which aren't reflective of all PA's. I understand PA's do also need to held accountable for their actions. Regulation is a much needed step forward! At the end of the day, all health care professionals are working towards the same goal :)
I've always wondered why we only heard about the PA who misdiagnosed the PE twice and not a word about the supervisor who signed off on the script which is what the PA role is about. Also any organisation hiring PAs should ensure adequate supervision or else don't hire one. There was a BBC documentary about an organisation who hired PAs and in reality, not a supervising doctor on site which is appalling and the PAs themselves exposed this but really they too could have raised this as they would be working beyond their scope of practice or did they raise it but were ignored? Not everyone can decide to just quit their job because they need to pay bills and live. I'd love to hear about the supervising doctor on the patient's 1st and second visit, how the practice ensures supervision and how it was run before, during and after the PA was fired as well as any other PAs working in that practice because it's odd that the patient saw the PA twice and a script was signed off twice. Was this PA used as a scape goat? Really odd that no one else but the PA seemed to have been blamed for this case. I think the practice have also decided not to hire any more PAs maybe it's because they know that they didn't provide adequate supervision as well and have not been doing so to cover their tracks. The full story never came out.
!!!!!!!
i will never understand doctors bashing on their colleagues online
it's very weak-minded
Obviously a controversial take, and I'm not in a MAP myself, however it feels like there's a lot of patronising material out there targeting medical associate professions out of damage to doctor's egos..
At the end of the day whilst not doctors, they are professionals that are trained to diagnose and treat many common medical conditions, including those that cause associated abdominal pain. I have met a few very intelligent and highly effective PAs in the hospital that I work at, and many socially inept/generally incompetent doctors.
Having gone to medical school may make you legally more responsible for these patients, but doesn't necessarily make you more intelligent or better equipped to deal with these sorts of issues.
Whilst not doctors, we need to actually put some faith into MAPs that they are able to do the job they're employed/trained to do, and stop dumping on them simply for not being doctors
It's a fair point to take, I do disagree on the idea of not making doctors more able to deal with undifferentiated issues - our training is broader and deeper for that very reason, a first principles focused approach so we can work out what might be going on when it's not obvious. If we weren't by definition better equipped to deal with uncertainty, I think that would be a pretty dire indictment of medical training.
The RCGP's own position on this (recently published) is that PAs should not diagnose patients with undifferentiated symptoms. I don't know how this will be formalised, but I suspect it may become the case that PAs have to have a selected or pre-triaged caseload.
@@OllieBurtonMed Maybe I worded my comment poorly, I don't disagree that doctors have a greater depth of training and of course, will generally be better equipped to deal with these more complex cases.
Its important to remember though that for most PAs, the two years postgraduate training they receive is not their first exposure to medicine, and arguably some of the undergraduate degrees possessed by PAs (primarily biomedical science as far as I am aware), go very deep into the pathophysiology of common, and actually a few rare diseases.
I'm just wondering who would be responsible for pre-selecting or triaging the caseload to determine if a PA is suited to treat an undiagnosed patient that presents to ED, rather than the PA simply recognising that a presenting patient is beyond their scope themselves (which any healthcare professional should be able to do) and escalating it
@@milhouse1405But most GEM entrants have a degree in biomedical sciences or similar, with exposure to the same diseases do a 4 year postgraduate medicine degree, compared to 2 for physician associate. Not only that, but even after the 4 year gem degree, doctors still have to undergo a minimum of 5 years training to become a fully fledged gp (the shortest pathway), whereas pas are then able to go straight into GP practices and see patients
@@milhouse1405What’s your job role and in what context have you met all these amazing PAs and shit doctors?
@@milhouse1405 The problem is that there is significant overlap between the skills required to diagnose a patient, and the skills required to recognise when a patient is beyond your expertise. Medical school and postgraduate medical education focus substantially on training doctors to do both, for thousands of hours beyond PA education. It's almost the opposite scenario - more highly skilled practitioners should be seeing patients upstream, and differentiated patients with known problems would be more suited to seeing practitioners with narrower scopes of practice. This works well on hospital wards where patients have already been seen at the front door and on post-take rounds, but the situation becomes more challenging in general practice (though perhaps could be modelled in line with the use of NPs in general practice).