Adam Skeen
@Adam_Skeen
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GEM student 3/4. Ex-Physician Associate. BMA U.K. Council. MSC Representative. BSc (Hons) Pharmacology. 中文.he/him 🏳️🌈 On a Twitter hiatus.
West Midlands
Joined February 2010
Thank you for highlighting @IncogAssociate . I'm happy to address this publicly. 🧵. It is interesting to note that the tweets you have cherry picked were written a matter of weeks into the course. (1/7).
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I’m a former Physician Associate now at medical school. After 4 years more training, with more responsibility on day 1 of work, I will be taking at least an £11k pay cut from what I’d be earning as a PA. Going from PA to Doctor should be a promotion, with pay to reflect this.
This table shows an hourly pay for doctors and #physicianassociates . Doctors only start to out earn a PA by 5th year post graduation IF they progress through their career without any breaks, but around 80% of doctors do FY3. So in reality, most only start to out earn PA in PGY 6
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I’m a PA now at medical school. You are not doing 5 years of med school in 2.
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This is:. Nonsense. This has everything to do with patient safety, and nothing to do with punching down. PA scope must be clearly defined and appropriate to the minimum standard of a newly qualified PA. Current free rein is unsafe, unacceptable and being exploited by trusts.
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There’s a whole group of us former PAs now at med school, we’d love to be consulted on this stuff. We have valuable insight - use it.
@guidelinexpert @Adam_Skeen could have answered this question much better . But of course they didn’t want to give proper answers, just a jumble of words.
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You have skilfully highlighted that with the additional insight of attending medical school, I have swiftly moved along the Dunning Kruger curve. I’d argue that any PA that goes on to study medicine, would gain the same insights. (2/7).
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@carolvorders @iDrSunny @gmcuk @LBC @TheBMA Hi Carole. I’m an ex-PA now training to be a doctor. I made this choice because I knew PA training was not enough to provide the safe and quality care patients deserve. I’ll be taking £11k pay cut in return for my additional 4 years of training (and 4 years of student debt!).
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@LittlePersonDoc @RCPhysicians Yeah, pretty much. We were told we were covering most of the same clinical content and sitting exams from the same question bank. I now know this clearly was not the case.
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@DrEilidhMaria @ExplosiveEnema I had a degree in Pharmacology before training as a PA. Add in my PA degree and 9 months of clinical practice and I still hadn’t scratched the surface of what we covered in pre-clinical year of GEM. Pharmacology + PA course also doesn’t make me ready to prescribe.
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Lots of rambling, and no clear answer to the question. If the VP of @RCPhysicians can’t figure it out, how on earth are patients supposed to know?.
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You rightly note that my experience should hold some weight. The BMA invited me to the table with open ears. Other key stakeholders might want to start listening too. They can start by reading my article, which you’ve kindly promoted. (7/7).
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The GMC have failed to do this, instead opting to obfuscate the roles and blur lines, which has and will continue to lead to patient harm. This failure has also irreparably harmed the working relations of PAs and Doctors, which could have been harmonious. (5/7).
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You can also note in the last image that I make patient safety one of my priorities - something seldom mentioned by twitter PA advocates & UMAPs. For shame. (6/7).
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This is good evidence that with additional experience and insight that opinions can change. Perhaps the GMC and DHSC would do well to reflect on the information I have presented and consider their position. I’d be happy to discuss with them further. (3/7).
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@LittlePersonDoc @RCPhysicians Unlike many PAs I’m comfortable admitting I had always wanted to be a doctor. Due to circumstance (financial and geographical) I couldn’t. I became a PA. Just weeks into the course I was dissatisfied with the deficiencies of the PA course. It wasn’t satisfying me academically.
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Sounds like the department could’ve benefitted from more doctors.
I’ve worked hard not to be drawn into the PA debate on Twitter, as it’s impossible to have nuanced reflection in limited space. However, as we come to end of the year, I reflect that without the PAs in our dept, service would have collapsed at times. Valued & valuable.
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Can confirm this answer is NONE.
Sorry, how much medical microbiology do PA students do on their course? . They are now essentially working as a microbiology reg.
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I'd recommend speaking to those who have been to both PA and medical school. We'd gladly help you navigate this mess. Fancy a chat? .cc @dx_mighty @TheEMboardround.
We’ll soon be running a consultation to help develop our approach to regulating PAs and AAs. In this, we’ll be asking for views on the detail of draft rules, standards and guidance for PA and AA regulation, covering four key areas:. 🔵education and training.🔵registration.
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I get furious every time I see this. Many PA courses are severely deficient in pharmacology and prescribing content - mine included. Prescribing is an integral part of primary medical qualifications and is assessed as such. The downplaying of medical degrees has to stop.
Who is this?. ‘PA/AAs can and must prescribe and unlike med students they are trained in prescribing/safe prescribing’ . Has the whole world gone mad? How can a 2 year course compare with a medical degree?
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@LittlePersonDoc @RCPhysicians The PA course feels intense, and so I think it becomes easy to believe you must be cramming so much in. In reality med school is just as intense and lasts 4-6 years 😂.
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There is no shame in admitting this is the case. Couldn’t get into medical school? It’s hard, loads of great candidates take a few attempts! Can’t afford to keep trying or put your life on hold? Fair enough! But be honest about it. If you’ve settled for PA, settle for the scope.
It really irks me when PA colleagues say they never wanted to be a Dr. We all wanted to be similar to a Dr without the life of a Dr. Some didn’t get into medicine and went for PA instead and are either happy with their decision or have “settled” for being a PA.
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As per the second image, although I no longer think the GMC is the best regulator, I stand by my previous statement that there was an opportunity to clearly define scope/responsibility/accountability for PAs & doctors. (4/7).
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Great to hear that @wesstreeting is listening and now shares our concerns about Physician Associates. Talking to @ShelaghFogarty @LBC he makes clear that PAs must not be used as doctor substitutes, and recognises there is an unacceptable discrepancy in pay. Listen here
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This libellous tweet was shared by .@VishwajeetP4t3l. Deleting does not make this go away. Full withdrawal and apology please.
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@chriscraigCCC @HYBRIDVIGOURMD @Dr_Done_ @veggieequallife @iDrSunny I also did a biomedical degree and got a first. I then trained and worked as a PA. Now I’m at medical school. I concur with this.
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@LittlePersonDoc @RCPhysicians I powered through and got a job I loved in acute medicine. I was well supported by consultants and registrars who I looked up to. I knew I wanted their job. I knew the only way to get there (morally) was medical school, so here I am! (And I mostly love it!).
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Why are we putting doctors through this? YEARS of rigorous exams at med school. At least 2 years post qualification experience. And yet PAs walk straight into any speciality they choose, based on their application and interview.
Incredibly disheartened by my MSRA results as it is pretty much already apparent that (miracle excepting), for a third year running, I won't be able to get a job in the area I want. I'm jaded and disillusioned by the system, our leaders, and my career as a whole. .
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Repeat after me: They're not trainee doctors, they're fully qualified.
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I have no doubt that it is a difficult time to be a physician associate or student PA. Most will go into the role with best intentions to help look after patients and do their best. Some will have been miss sold the role. Some will, like me, want to be a doctor but face barriers.
Is this part of a bullying culture: Those trying 2 keep the system running in impossible circumstances r blamed 2 keep trying? Many #physicianassociates colleagues R doing amazing work #caring 4 patients in places where doctors did not want to work. @civilitysaves #compassion.
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And honestly? Plenty of this is on you guys. Failure to hold accountable those who exploited the lack of regulation for their own career gain. Those who harmed their patients through lack of knowledge and insight. And those who thought this was the easy way to “do medicine”.
The PAs pushing back against this need to stop and reflect on why this offends them?. Surely you want clarity? Defined scope? Regulation done right? . You should be backing this too.
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@LittlePersonDoc @RCPhysicians Gosh, difficult question! It's a very multifaceted issue with a lot of mess to unpick. For this reason, a pause in recruitment to PA programs and roles has to happen. 1) Define scope nationally - has to be based on lowest common denominator given lack of standardisation.
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and to any PAs reading: Sorry if you feel let down. I really didn't appreciate how different medical school was until I did it myself. My advice? If you can, go to medical school, you'll learn a load and it's mostly great. Your patients deserve you as a doctor.
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The PAs pushing back against this need to stop and reflect on why this offends them?. Surely you want clarity? Defined scope? Regulation done right? . You should be backing this too.
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Very pleased to be elected as the University of Birmingham Representative to @TheBMA Medical Students Committee @BMAstudents, having had a successful year as deputy. Thanks @Doctors_Vote for your endorsement! . - Fix Medical Student funding.- End MAP scope creep.- Fix UKFPO.
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@LittlePersonDoc @RCPhysicians And I didn’t feel like it was preparing me well for the role I was working towards. It was essentially “teach yourself the matrix” alongside learning how to go through the motions of examination and history taking. I kept asking for the “how” and “why”, to be told we didn’t need.
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@LittlePersonDoc @RCPhysicians Without wanting to be controversial, we need to consider if what we really need is just more doctors, more nursing staff and better IT and admin support. In which case, does the role need to be phased out in favour of actual assistants?.
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@LittlePersonDoc @carolvorders @iDrSunny @gmcuk @LBC @TheBMA If things continue in this direction, such that my medical degree is worth no more than my PA one, or training is accelerated further for PAs, I will be seeking legal advice around loss of earnings and tuition fee burden.
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@LittlePersonDoc @RCPhysicians and certainly GEM is more intense. We had 2 exams around every 8 weeks, and 8 more at the end of the year.
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Donya is PA and a medical student. A PA ambassador has targeted her and removed her from a professional networking group @BuddyAssociate because she is training to be a doctor, thereby isolating her from colleagues. This is unprofessional with strong anti-doctor undertones.
I just want to start by saying I really didn't want to take this to social media and had hoped to resolve the issue privately. But this has not happened and I feel this kind of behaviour from someone in a position of responsibility needs to be called out. 🧵(1/9).
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@LittlePersonDoc @RCPhysicians 2) Improve working terms an conditions for doctors - many PAs are bright people who thought "sod that" when seeing what doctors put up with atm. 3)Fix broken medical education (see above). 4)Improve GEM funding and, once capacity allows, expand numbers.
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They are, in huge numbers. A practice locally advertised a single salaried GP role and got ~30 applications. They’re literally falling over eachother to find stable employment.
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What do you call a vampire who gives anti-coagulants to make blood sucking easier? . DOACula 🧛♂️ .(Sorry, not sorry).
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@csubbe @civilitysaves Then perhaps we should be incentivising doctors to work there? Otherwise we're accepting a post code lottery for our patients and whether they have access to doctors or less qualified Physician Associates (I can say that - I was one).
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@LittlePersonDoc @RCPhysicians 6) PAs unable/unwilling to do so, will remain in the workforce in the appropriate scope of practice. There is no backdoor entry to medicine, and on the job experience cannot = increased scope and responsibility.
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Despite this, I'm here shouting loudly about my concerns with the role. IT IS NOT PERSONAL. PAs have be sold a lie. Leaders have failed to lead, with scope, patient safety, regulation and standards all an inconvenient after thought.
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Thank for apologising and setting the record straight. I have engaged with this issue in good faith, in the hope that with experience of both sides I can help navigate a way forward.
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More leaders like Prof Kar please.
Ok then . I am breaking ranks . As Councillor @RCPhysicians . Open letter to council . Time for senior leadership to consider their positions . Silence is complicity . And that? Isn’t me . Enough. #RCPEGM
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The answer is quite simple. Doctors are highly trained medical experts, skilled in diagnostic reasoning, therapeutics and managing complexity in their respective fields. Physician Associates are not.
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The #RCPEGM result shows that the majority of voting fellows share this concern. This caution in project PA expansion is about fixing the mess created by poor leadership from all involved parties. We’ve all been let down. Patients. PAs. Doctors. Now? We fix it.
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@LittlePersonDoc @RCPhysicians 5) With improved funding for all, PAs willing and able to (entry requirements as normal) should be supported to do GEM locally to them. Or HCP-Med style programs (Edinburgh uni style). Many don't like this idea, but I think it's an important step to get us out of this mess.
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I'm incredibly proud to again be endorsed by @Doctors_Vote in the current election for Medical Student Representatives to @TheBMA UK National Council.
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@LittlePersonDoc @RCPhysicians 7) Alongside this, we need to look at what gap we're trying to fill with the PA role. Based on this, the training needs to be reformed and standardised. This has to be led by the medical profession, as the ones who will be supervising.
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This is perfect. Clearly identifiable registered health professionals should be the standard. @theRCN to follow suit with "REGISTERED NURSE" please.
I’ve had a very special delivery today. Coming to hospitals near you. (yes they’re double sided). #AskForADoctor. @BMA_JuniorDocs
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If people could stop talking rubbish about a topic they know nothing about, that would be grand.
@Microbedoc2 @BMA_James_Steen @FPARCP Again, not earn less. Basic pay is less - they never earn basic pay.
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@LittlePersonDoc @carolvorders @iDrSunny @gmcuk @LBC @TheBMA Hi Jen! The full 4 year graduate entry programme, the same as any other graduate of other disciplines, which is absolutely as it should be. At the point of applying, I often wondered why I couldn’t do just 3. Knowing what I do now, there is no would this would be enough.
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Physician Associates can also be skilled, but they are not expert medical professionals. They have the sort of broad medical knowledge and skills required to support medical teams, but not to see undifferentiated or complex patients. Their job descriptions should reflect this.
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There are a minority of nasty voices amongst the many wonderful, compassionate and hard-working doctors trying to advocate for patients. Yes, we need to stamp that out where we see it, but DO NOT shut down this essential debate as bullying or in the name of #BeKind.
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@ABarotchi1 @ExplosiveEnema Yes this is true. But then 29/30 students on my PA course passed with distinction. The one who didn’t got a merit. Does that suggest rigorous assessment?.
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My PA course had a single afternoon session dedicated to all of pharmacokinetics and pharmacodynamics. This is my bread and butter as I previously studied pharmacology. Most of my colleagues left the session bamboozled, but never returned to the topic as it wasn’t assessed.
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Attention medical students!. I am once again asking for you to vote for me in the election for Medical Student Representative to BMA Council. Please return your ballot papers and encourage your medical student colleagues to vote for me and my fellow @Doctors_Vote candidates.
I'm incredibly proud to again be endorsed by @Doctors_Vote in the current election for Medical Student Representatives to @TheBMA UK National Council.
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@wesstreeting @TheBMA Wes states there is a strong signal that current PA use is not safe for patients. We need an immediate pause on PA recruitment and to set clear national scope ahead of regulation. Vote motion 5 ✅ #RCPEGM.
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This debate doesn't need to be nasty. The issues are as clear as day, and leaders need to stop and listen NOW. The failure to listen to doctors has lead to a boiling over of frustrations and this is on them.
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Medical students of twitter!. Please see the below thread on why I think you should vote for me in the elections for medical student representative on @TheBMA (@BMAstudents) council. Voting packs should be arriving by post this week. Endorsed by @Doctors_Vote.
I'm incredibly proud to again be endorsed by @Doctors_Vote in the current election for Medical Student Representatives to @TheBMA UK National Council.
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I think @ERunswickBMA. shared a great anecdote about microwaves. Something along the lines of no staff microwaves, so asked to use managements microwaves daily. Management got annoyed and bought staff microwaves. Maybe staff need to start asking to use their sanitary bins daily?.
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@DrInsurgent @Bonivorlewis @DrLindaDykes @fiercerabbit2 @jewett6a @iDrSunny Apparently not 100% pass rate. This week we've identified a PA working in Primary Care having failed in the Sept/Oct diet.
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Valuable input from Dru here. Nicely illustrates the significant variance in PA course content and quality between HEIs. This is clearly an argument for regulation and standardisation of PA courses, but unfortunately that ship has sailed, with PAs in the workforce already.
My experience is different to Adam’s here. My PA MSc had 2-3 hours per week throughout the first year of “Pharmacology, Prescribing & Therapeutics” and 5 or 6 half-day prescribing masterclasses in the second year. It was actually probably the strongest part of the course.
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I’m a few years behind Dru but fully agree with this. If you’re considering it, go for it!.
I’ve had a lot of messages from PAs & student PAs recently asking for advice on whether they should apply to med school, whether I am happier as a dr vs PA, how I have found it all etc. There is obviously some nuance to it all, but I would 100% make the same choice again.
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How can we say it’s safe to regulate all existing PAs in the workforce when they’re trained to such varying standards? . How can we in good faith continue to train and qualify more PAs or agree appropriate scope before this is fully resolved? . Vote Motion 5 ✅ .#RCPEGM.
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@deeleyc6 @LittlePersonDoc @RCPhysicians @doctor_oxford @JanetEastham @natalieben @JimBethell @KeeleyMP @wesstreeting Still a med student with lots more to learn. Can call me doctor in August 2026! 🤞.
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@LittlePersonDoc @RCPhysicians But ultimately it was a widening participation issue. If GEM was well funded, I’d have applied to my strengths and not been limited to the North East. Instead I had to strike lucky meeting my incredible other half who was willing to support me through med school.
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Absolutely. That’s a balanced decision GPs can make. But now it’s the case that quiet patches are turning into complete work droughts, with locums now scrambling to find salaried posts that are drying up in favour of well funded PA posts (ARRS).
@Adam_Skeen @AmarHujan True - but locuming comes with reduced job security. You can't have the flexibility and higher hourly rate of locuming, and the job security of salaried at the same time. If you locum, you need to expect and have planned for some quiet patches.
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@AmarHujan Also dislike the implication that qualified GPs are somehow picky if they want locum work while there is a growing market for locum PAs. Doctors deserve flexibility and choice to fit their lifestyle and family needs too!.
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@csubbe @civilitysaves people keep telling us we're silly for worrying about a 2 tier service. If PAs are being use to staff harder to serve areas, is that not exactly what this is?.
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Sometimes it felt personal. It felt like because people had concerns about the role, or didn't see its value, that I wasn't good enough. I imagine there are many PAs out there now feeling exactly the same as I did, if not worse, as the debate grows louder and louder.
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@InvCoriolis Hard agree. Fund and expand GEM numbers, making it accessible to those able and willing. PAs can do it properly, like several of us already are. Only concession I’d consider is partnership between trusts and local medical schools to facilitate entry locally, like WP initiatives.
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After this, the only pharmacology and prescribing was algorithmic learning of “for this condition the first line is ____ and second line is _____. A commonly examined side effect is ___” on repeat. Minimal understanding required.
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There are many, MANY problems with the PANE and PA project more generally. We need not be sensationalist to highlight this. This is not an accurate representation of how the PANE is run (unless things have changed significantly since I sat it online in 2021). Stick to facts.
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IMPORTANT. Statement of concern regarding the @RCPhysicians EGM occurring tomorrow. Please read and share, including with RCP fellows not on twitter.
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@lewisthughes Not that I or any of my PA to Dr colleagues are aware of. Would love to hear from anyone who knows otherwise!.
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For me the issue is the lack of repercussions. It is within @FPARCP power to prevent this individual from joining the register in future, and prevent future joining of statutory register. But they won’t.
A PA that is working in primary care at a GP surgery without having cleared the national exam and without registration on the PAMVR was brought to my attention. I emailed the @FPARCP, her employer and @CareQualityComm . Here’s the response from FPA . If I’m a PA I would be upset
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@Treasure_2222 @Mary_Tom11 @medicalmodelbri @MJA9622 @TheBMA Scope is the job of the GMC? You should tell them that, because they’re currently neglecting to set this. As for the BMA? They have no trouble understanding what PAs study and do, and as former PA now on BMA council, I am available to support them with this.
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Being a PA student in 2019-2021 was challenging enough, with questions about the role starting to appear as the PA project expansion accelerated. I often felt a bit hopeless and demotivated by online anti-PA sentiments or subtle comments made to me on wards.
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@t0uchgrasss @Burnt2020 @iDrSunny @Molly2323232323 There are even PAs who describe themselves as “pre-registration” while working having FAILED the PANE.
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Part 2. @wesstreeting states he is ready to discuss this with @TheBMA after the general election. Why not talk to us now? There is a lot to unpick and at pace. We need to start NOW.
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There may be some assessment on how to transcribe a drug from the BNF onto a paper drug chart. Fluid prescribing did not consider anything about fluid physiology or appropriate assessment of fluid balance.
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@DrEilidhMaria @mmamas1973 My paeds teaching as a PA was completing the “spotting the sick child” course, and a very short placement. I think I joined a couple the 3rd year paeds teaching sessions at my placement too. Not much at all, and not safe to then work in paeds or primary care seeing paeds.
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@DrDMcGregor @UMAPsUK It’s amusing that their posts are so absurd that you say with such confidence it’s a doctor run parody and “pathetic”. In fact it’s the official account of what MAPs hope will be their trade union.
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@DrDMcGregor @UMAPsUK I know one of the PAs behind it. They’re partnered with the locumPA agency. They have a registered company and are accepting money for membership.
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@Bonivorlewis @fiercerabbit2 @jewett6a @iDrSunny Do you not see how absurd it is that there isn't a clear answer to this question while there are 4500 of you out there treating patients?.
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Picture on the left was taken in my first week on the course. I was a representative for the Postgraduate School, not the PA course. I fought with senior faculty on the appalling standards of teaching. To be clear, I have not been in receipt of payment from BMA. Withdraw.
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After 5 years of hard work to qualify as doctors, being called a "trainee doctor" is downright offensive. The use of this terminology by a hosptial education department is unforgivable.
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How does this hospital think this at all ok? A employer failing to provide the most basic sanitary equipment for their staff is unacceptable, even worse to see this from a healthcare service.
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@DrEilidhMaria Hardly anything to my recollection. Theory/underpinning pharmacology - 2 lectures in PK/PD. Told not examined, so did people bother to learn? .Then nothing beyond “give x for y”, some side effects, and written skills bit of “transcribing” a drugs/fluid chart, which was assessed.
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@t0uchgrasss @Burnt2020 @iDrSunny @Molly2323232323 The PANE is categorically not a legal requirement to work as PA in U.K. There is no statutory regulation to necessitate this. I was offered work pre-PANE when I first qualified, and there are many employed in PA roles without PANE currently.
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@cannula_service Talks about elitism of wanting an office, but couldn’t possibly have the title or uniform of her blood taker….
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