#I'm so envious of people who have actual structured arrangements

[and-his-hands-were-24-crows]

The millennial urge to have 4-5 independent computers running in a single workspace.

[dxmedstudent]

What is your impression/impression of your colleagues towards physician associates, particularly American PAs that come to work in the UK? I'm currently exploring options as my husband can transfer to the UK for his work. We've both always wanted to live abroad for a time. However, as I look more deeply into the interwebs, I get the feeling that PAs, particularly American, aren't well received. Thoughts?

Hello! Long time no see. Sorry for the late reply. I actually went back to forums and had a re-read after getting this ask because I wanted to present the arguments (whether wrong or right) that I saw. I hope it helps, though I want you to remember that not everyone feels this way; people who don’t have any strong feelings just don’t bother debating things like this online. In real life, I’ve heard very little negativity about PAs from other doctors. I think most feel pretty neutral about the whole thing. But I don’t want to sweep things under the carpet. Personally, I’ve only ever worked with doctors’ assistants (more limited duties, mostly helping out with odd jobs, bloods etc, no clerking) but I have no problem with the idea of PAs, as long as their role is clearly defined so that everyone gets what they need. One of my good friends from biomed went to PA school after graduating, and I think she’s having great fun. So I want to approach this with the attitude that PAs are our people, too.  I’ll be honest, the topic of PAs seems to still be pretty be divisive amongst the medical community, from what I’ve seen on the big junior doctor forums. I’d say that there are people who are very pro-PAs, and others who are less enthusiastic. Though the reasons why are complex.

I don’t think the reception is anything to do with people being American, in the sense that i’ve never seen PAs’  nationalities be described as an issue. Despite occasional jibes, Americans are generally well liked here, and I’ve never overheard negative comments about a colleague’s Americanness. Is that a word? Feels like it should be. I’m actually sure US PAs might even be assumed to recevie a more comprehensive one than our own, if only because our own PA profession is very recent; we didn’t have PAs at all when I was younger. US-based training tends to be well-respected, as far as I know. The reasons for tensions between doctors and PAs here are many. First of all, PAs are a very recent invention. They have only been around for several years in the NHS. As such, we have a system that was built without their role, meaning that in order to have PAs at all, we need to make sure to carve out a role that does justice to what PAs can do, without taking away important opportunities from senior nurses/nurse prescribers/ANPs and junior doctors.This means that a lot of hospitals structure the role very differently, hence what a PA at one hospital does might not be the same as what a PA at another hospital does. This means if anyone wants to be a PA in the UK, it’s worth really shopping around, if you can, to see if you can get the most support and best role for you. I’d be really careful to make sure that the role made it clear what support is available for decisionmaking. PAs should have oversight from at least a registrar, ideally. I’ll come back to this later, but if anyone is making clinical decisions, it’s important that they are supported appropriately; I’m against giving nurses or paramedics or PAs or pharmacists prescribing privileges, just enough responsibiltiy to get them into trouble, but not giving people the right support for if they aren’t sure what to do. As a doc, having senior support is a big part of my job, and I think any one of my clinical colleagues deserves this, particularly if the government are trying to save money by getting them to do more doctors’ jobs so they don’t have to hire as many docs. And where PAs have in theory to get more junior docs to sign off on their decisions, lots of juniors aren’t comfortble with that idea. Because you generally have to be a bit more experienced before you can take repsonsibiltiy for others and their work. An FY1 or FY2 ‘supervising’ a PA wouldn’t be appropriate for either. And deep down msot of us docs feel that bringing in more ANPs, bringing in PAs, allowing pharmacists and paramedics and nurses to prescribe, a lot of it isn’t ultimately created with the interests of the clinician in mind. Ultimately the government does everything it does to save itself money, and given what they put junior doctors through in recent years, we are very, very bitter and wary with ANY government scheme. A lot of people worry  that bringing in PAs is just a way of the government trying to provide people to do doctor jobs on the cheap, without supporting them or training them up properly. And given that they’ve structured nurse training in such a way that trusts try to get by with as few senior nurses as possible, because it’s cheaper to have lots of HCAs and lower band nurses, I think all NHS workers have reason to be wary.   I’m going to spend most of this post outlining some of the issues that people have brought up in various threads, which aren’t necessarily issues I myself share, but I feel I have to discuss why some people are still adjusting to PAs cropping up. Not all doctors like the way having PAs works in practice, at least where they have worked. Some people grouse about the pay, because some of the PA slots advertised give a higher salary than you get for the frist several years of being a junior doctor, whilst most of them don’t do nights or oncalls, and have to take less clinical responsibility.  On the surface, it doesn’t seem fair; why should someone working better hours, and taking less legal responsibility be paid more? But I don’t believe in bringing everything down to the lowest common denominator; if anything, it should be an argument for better pay for nurses, doctors, physios, pharmacists etc.  In reality, I suspect they have made a few posts that pay unusually well to entice senior nurses to train up as PAs, and sort of get the ball rolling. The numbers are much smaller than the number of docs and nurses, so they can afford to pay more. Also, my colleagues have a point that that’s a PA’s final salary and that the job role is more limited, whereas junior docs (in our system, at least), get to train up to do different things, and eventually earn more.  Some act like PAs get a bad deal, others are envious; I think both jobs can be good if you’re the right person for that job. I’m sure it’s a better role for some people. Now, a small part of me can see why my colleagues are concerned. When you’re stressing about fulfilling the things you NEED for training, because otherwise your deanery and seniors will totally make out that you’re an inadequate doctor, it puts a lot of pressure on you to get your procedures and cases signed off.  I’ll be honest; medical training as a doctor once you graduate in the UK is minimal; we do our own exams. We have to arrange our own attendance at clinics (which is compulsory), we have to make sure we can get to compulsory teaching. We have to make our own opportunities to do the procedures we need to do to get signed off, see the cases we need, etc. We need to mke our own opportunities for audits, publications, etc. Apart from the occasional nice senior, literally nobody helps you to get all the things you absolutely need to do done. And that’s on top of the usual ward rounds, saving lives, dealing with pts and relatives thing, whilst often being extremely busy and understaffed. And rotating around every few months, so that nobody in the hospitals you work at Junior doctors are genuinely exhausted, overworked, and scrabbling around to get the opportunities they need to get by. Some of my colleagues report working in hospitals where because the PAs were permanent (not rotating) staff, they were given preference for audits, projects, research, procedures, surgery etc to the point where junior doctors felt sidelined and unable to get the training they need. Where they felt that rather than PAs taking on some of the “jobs everyone doesn’t like doing”  on top of clerking, they were given preference for the things both they and docs like doing, but also that docs NEED to do. And I’ve been in situations where I’m tired, struggling to get what I nee to do done, and I can see where they are coming from; I remember having an unpleasant evening, and wondering they were giving a GP trainee a chance to do a lumbar puncture when they’ll never need to do one in their line of work, when there are trainees in the dept that will need to do these procedures independently soon, but never get the opportunity. Of course, I reined in my childish brain, but the reason I felt that way wasn’t really because of my lovely colleague, but because of my stress at the lack of opportunities I got, which the system dictated I needed, but didn’t help me with. I’d never begrudged or been jealous of a colleague before so it was a low moment for me. But I’m sharing it because even generally nice people can feel jealous or let down if the system pits people against each other. And in scenarios like that, it’s not the fault of PAs at all; it should be up to hospitals planning their rota to ensure not only that staffing is well covered, but that trainee docs get enough opportunity to do what they need to do. And that PAs aren’t screwed over. I think blaming other employees is wrong, when the real culprit is a system that pits people against each other or doesn’t give people what they need to get things done. Now, there’s also a bit of rivalry between PA students and med students, more so than grads. Some PA students seem to go into it with the attitude that “It’ll be just like being a doctor, but you graduate faster”, and med students being med students, some of them will treat other clinicians with smug, unearned superiority. I have no time for either of these imposters, personally. Med students who think they are better than everyone don’t make good doctors until they get taken down a peg or two. We’re part of a team, and we can’t do what we do without nurses, physios, pharmacists etc, even PAs if they are part of our team. And people choosing beteeen the two courses shouldn’t think, wrongly that PA school is just the easy way into medicine, or “basically makes me a doctor”, because it’s dangerous to assume a level of competence or practice you don’t have. And because if you don’t understand the role you’re getting into, you may well be disappointed if it doesn’t meet your expectation. I think med students and PA students like this let both sides down, but I hope that real life will knock them into shape. The good news is that a lot of my colleagues on the group report that they’ve worked in places where having PAs worked really well. I think a lot of people would love having more people on the team to help. I’m certainly not against PAs if they are well supported. I think it has a lot of potential, and I’d like to see hospitals develop it properly. Where there were enough opportunities for both, and where PAs . I saw a lot of people say wonderful things about PAs, and defend them when things on the thread got more negative. I have hope for what our PA colleagues will do, I just think we’re still going through a transitional period with its own teething problems. We work well with nurse prescribers, with ANPs and with pharmacist prescribers; I believe we can work well with PAs. I just hope that trusts and the govt will do well by both docs and PAs, and that the relationship we eventually build will be fair to both sides. I suggest doing your research to see the kinds of jobs beingoffered, because they might not be as varied as they are in the US; some places definitely seem to offer jobs for PAs that are mainly paperwork, minor jobs with some phlebotomy, whereas other trusts have scope for clerking or more varied practice. And I would want to make sure that there’s an appropriate level of senior support for decisionmaking.