“Raj” Anandarajah | Rajiology
@Dr_Rajiology
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IR SpR / PaedsIR / MedEd / MH - physician, heal thyself. Views my own and probably not worth sharing.
Joined July 2013
I am sure the GMC, in line with their position on MAPs, will let solicitor associates with 20% of the training of a solicitor handle their legal defence. (I am aware an associate solicitor refers to a qualified solicitor, which highlights how farcical the PA/AA situation is).
Today we have responded to the BMA, strongly rejecting the basis on which they have proposed to bring legal proceedings. You can read our statement on our website -
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People mix up Radiologists and Radiographers. All. The. Time. When I explain the difference to patients, it helps that Radiographers have a defined scope & unique MDT role. You know what wouldn’t help? If they changed their name to Radiologist Associates and gained GMC numbers.
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Wait so over 80 paediatric doctor shifts covered by PAs in Torbay?. Do they have any accredited paediatric training? No. But they were making decisions on the care of sick kids. @TheBMA is raise the alarm about replacement of qualified doctors on rotas.
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Utterly shameful that qualified GPs can’t find work whilst there is ringfenced funding for practices to hire non-doctors . A waste of 10+ years of education and training in favour of workers with perhaps 2 years’ accredited medical training… a loss to the taxpayer. Omnishambles.
Qualified GP driving for Uber amid chronic shortage of jobs #GPnews.
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@DrAsifQasim This is the newly-emergent reality in Radiology too. Unnecessary scan requests. Duty radiology phones tied up by queries from non-doctors, who I don’t believe are getting proper supervision. The real cost of Dr replacement will be massive delays to the patients who need scans.
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@JimBethell I want to thank Lord Bethel. After his spirited speech to the Lords, I have found my calling. I am retraining as an #AstronautAssociate. Medicine might be going down, but I’m going up, up and away friends.
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@Xeon4f145d96s1 @MedReddit So, to get this straight: you can work as a PA with the qualification and PANE exam. You can work as a PA without the qualification/PANE. But the only thing that disqualifies you from working as a PA, for better pay/hours? Being a qualified medical doctor apparently.
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Why are student PAs in obstetric theatres assisting in C-sections? Is this an appropriate use of physician associates?. Were there no doctor trainees available to assist and learn?. Do midwives even assist in this procedure, given that they are more experienced in perinatal care?.
There are PAs who do caesarean sections in the UK. (24.00 onwards) . @RCObsGyn did you know this? .@parthaskar @iDrSunny @HelenRSalisbury @carolvorders @natalieben @djnicholl @doctor_oxford @Dr_BellaR @Dr_Done_ @Xeon4f145d96s1 @DrLindaDykes @mmamas1973.
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“You don’t order scans. You request them. This isn’t Nando’s”. - crotchety Radiologists everywhere (and IRMER regulations too). And PAs shouldn’t be doing either.
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A private company makes off with large profits while staff and patients suffer as a result of an NHS cyber attack. Whilst medical students are drafted to deliver blood samples, paying £9k/year fees for the “privilege”. Just the NHS workforce plan in action.
🚨 NEW: Medical students have been drafted onto wards in the wake of the NHS cyber attack. They will work as floor walkers, hand delivering blood tests to and from the crippled pathology labs. Bosses at @GSTTnhs say disruption will last "at least 2 weeks" 1/2
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A wise radiologist once told me: “Medical education means saving lives in slow motion”. Failing to train the next generation of Drs, to the same level of competence as the last, means failing the patients of the future. To those Drs who prioritise Dr training, thank you 🙏.
@stmarnockZ The most privileged thing a Consultant can do (apart from providing good care to patients),is to train the next generation of doctors. If that’s every 4,6 or 12 months repeatedly, then that’s what you do. Training a PA once then sitting back not giving a shit is frankly appalling.
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@DrNeenaJha Not to mention pulling the wool over the eyes of patients to enable this farcical state of affairs. Patients who have a reasonable expectation of medical care delivered by qualified, regulated medical professionals.
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I do not understand how this is a grievance in the @UMAPsUK survey. PAs cannot legally, presently, be IRMER referrers (giving radiologists info to justify CT scans). If this was the Merseyside Hub, I owe one of my fellow registrars a beverage for sticking up for good practice🍺.
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Train as generalists but specialise to the point of:.- performing flexi cystoscopies and subdural haematoma evacuations.- working on tertiary paediatric hepatology registrar rotas. Dependent independent practitioners - nothing about the UK’s implementation of PAs makes sense 🤯.
PA’s are being taught they are equivalent to middle grade doctors. No wonder they often act like they are middle grade doctors. “They’re not replacing so doctors”.Yes, they absolutely are! . We are being lied to by Uni’s/govt/gmc/colleges
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@UMAPsUK Do you not think it's a little disingenuous that 50 hours CPD for PAs takes up as much space as 2 YEARS of Foundation training?.
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@LordPhilofBrum 1 doctor takes their life every 3 weeks in this country Lord Hunt. Don’t confuse raising professional concerns with the kind of toxicity that caused this Dr to take her life.
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@JimBethell Ironic, in this interview you call the med profession “hierarchical” & “stuck in their ways”, when those are the only reasons you wield influence as a hereditary peer - didn’t the electorate reject you for the Commons?. And perhaps not the day to champion PAs given recent news….
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I have sympathy for PAs. Their leadership has failed them. Instead of embracing a role as doctor’s assistants, where they could be indispensable to trainees… . Scope creep has set up a bitter turf war as doctors reassert what it means to be a safe medical practitioner. @gmcuk.
Genuine question:. What does a 'pause in expansion' of PAs look like?. Where should the brake be applied?. What happens to current PAs? What about student PAs currently going through training?.
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Being a PA isn’t a protected characteristic under the Equality Act 2010, namely: age, disability, gender reassignment, marriage/civil partnership, pregnancy, race, religion, sex or sexual orientation. How disingenuous to suggest they are victims of “professional discrimination”.
We have recently seen discussions across social media about upcoming graduation ceremonies for our Medicine and Physician Associate programmes. Read our full statement in response to these discussions here:
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Without a shadow of a doubt, the PA expansion hits the most disenfranchised doctors the most: WP and IMG backgrounds. And perpetuating stereotypes of “ha ha all doctors are privileged, rah” just puts working-class kids off studying medicine. This is an unhelpful narrative.
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What on Earth is this Orwellian paragraph from the MAP consultation?. “The workforce will need support and assistance to change to a more enabling culture [for MAPs]”. 87% of doctors have concerns about MAPs, why not address that?. Or will beatings continue until morale improves?
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Imagine trying to mislead a room full of senior consultant physicians…. About statistics…. Including the author of this book…. Like… what did they expect?
I will just leave this table here to do the talking. The @RCPhysicians leadership has attempted to mislead its Fellows at the #RCPEGM. 🔗
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Simply outrageous. PAs have less *accredited* medical training than a 3rd year med student. Why are PAs performing invasive procedures?.Do patients know who is wielding the scalpel?. Would Lord @JimBethell let a PA operate on him?. My deepest sympathy to the family of this man.
Family of film make-up artist call for inquest after treatment by physician associate which led to death. @JanetEastham @TheDA_UK @TheBMA.
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@LBC @TomSwarbrick1 They’re not medically qualified @TomSwarbrick1 and they don’t study medicine. Certainly not in any way that any other country would recognise to mean medically qualified. It’s one big cost-cutting measure at the expense of the UK public’s health.
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I sadly agree with @Xeon4f145d96s1. Constant hoop-jumping has destroyed medical training. It’s all about completing the next WPBA or low-quality audit, not gaining real clinical experience. It is Kafkaesque.It is soulless. We’re doctors, not checklists. I hope this Dr is OK 🙏.
So very heartbreaking. PG MedEd has been designed by a group of educationalists that are so detached from reality people are contemplating suicide because it seems like a better option compared to the hell they’ve managed to create. A system utterly devoid of compassion.
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This reads ominously like the opening witness list in a future public inquiry on the rollout of unregulated PAs and the harm it’s caused patients.
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@ClareGerada @ExplosiveEnema2 @rcgp Dr Gerada, I did med school & 4 months as a GP FY2. If I wanted to see undifferentiated pts in GP - I can’t. It’s unsafe. I accept that. I would need more training. Unsuccessful Dr applicants for GP training also can’t… yet why does RCGP set a different standard for PAs?.
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This aged like milk. Today it was revealed 3 GPs were made redundant from a practice in Surrey. Ostensibly this is due to “new ways of working”, but it appears they supplanted by ARRS roles. More than enough work for all of us, indeed.
@MSH446 There is more than enough work for all of us, working together and each working to the top of our Licence. Let’s start the new year by accepting PA’s as a valuable member of our teams & try & be more positive and accepting towards all our colleagues.
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@Dr_BellaR I don’t think the public are aware about the road we are treading. When I talk to non-medical friends they have never heard of a PA. They were sold as assistants, then associates, now alternates. If Gov workforce plan goes through, doctor-delivered care in the UK will vanish.
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Detestable Rishi Sunak and his Conservative cronies laugh in the face of a GP passionately defending the right of patients to see qualified doctors. He might as well get the laughs in now, the Tories won’t be laughing come July 4th.
'You cannot employ lesser qualified people instead of GPs. the country is not stupid'. PM Rishi Sunak is challenged on the NHS by a member of the public during a campaigning event in Wiltshire. 📺 Sky 501, Virgin 602, Freeview 233 and YouTube
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Why are locum PAs a thing?. According to the GMC: PA scope of practice is defined locally, between supervising Dr & PA. How can GPs set scope for PAs parachuted in by a locum agency? There’s no QA benchmark. Lower-skilled staff can’t replace GPs. My heart goes out to this patient.
Excerpt of email received from member of public . Presumably meaning “Compression on spinal cord”.She wants me to take it forward. Who should it be? .@gmcuk?.@CQCProf?.@rcgp? . Can another HCP miss this? .Yes but have regulatory bodies . Who for this case?. (Shared with consent)
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We should all fear the dilution of medical training to allow anyone to “have a go” at medicine. Patients and allied HCPs rely on doctors to be competent at what they do - that means lengthy rigorous training and assessment. Doctors - if we permit this, we deserve to be replaced.
So GMC is now proposing to dumb down postgrad specialty medical exams and curtail work place based assessments of postgrad doctors competencies. If UK doctors training so watered down & degraded maybe it will be indistinguishable from PA studies. And not accepted overseas too.
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@Dr_Done_ @RCRadiologists This justifies many fears Drs in IR training have regarding PAs. All of the procedural skills listed have potentially significant complications. I hope patients are made aware during consent that the PA will not be able to manage post-procedural pain, bleeding or request a CXR….
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I used this service when I was at my lowest point. It was a lifeline for me. I am healthier now, and still working as a Dr, thanks to Practitioner Health. This is dangerous. A Dr commits suicide every 2 weeks and many more live in despair. Don’t let them take this away from them.
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The GMC claim they can’t regulate the scope of practice of PAs, leaving it to the colleges. Yet the GDC can do exactly that, clearly, in this document called ‘Scope of Practice’. Why can’t medicine get its house in order?.
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@liamlfc64 @JujuliaGrace You’re right - it’s not some magical skill. But the baseline training for a doctor is not a 5 year degree. It’s a 10-20 year training path with constant assessment. The way PAs are being deployed is like letting people drive with just the theory test and hoping they don’t crash.
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@DrPastry @ASiTofficial @RCSEd @RCSnews @gmcuk @OrthopodReg For every time there’s a PA in theatre there’s an SHO losing out on training time. This is a zero sum game - training time is the scarcest resource there is for doctors.
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Tell me you don’t understand the risks of unnecessary imaging, without telling me. - Risks of cancer.- low pre-test probability affecting sensitivity/specificity.- incidentaloma morbidity. UK rad services already on the verge of collapse and you want to let PAs run wild?.
@iDrSunny @profjimspeaks @gmcuk This proves that US PA’s are being much safer to request CT scan, not to miss out on a diagnosis compared to Drs who can be ignorant think they know it all ‘watch and wait’ or misdiagnose till pt ends up with tumors/cancers like this case
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TW: doctor suicide. An awful state of affairs that 4 doctors have died by suicide at one Trust. Imagine any other employer where that happens - it would be investigated. Not awarded a wellbeing award.
4 doctors have died by suicide. At a hospital trust. That has been presented with a well-being award. I don’t think I can articulate how this makes me feel. Or how disrespectful & dismissive this seems . #NHS.
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Honest question:.How does the @gmcuk feel about Drs working in roles they aren’t qualified for? Seems like it warrants suspension from medical register. What about MAPs being on SHO/registrar/even consultant rotas without med degrees, higher exams etc?.
🧵The updated #GoodMedicalPractice2024 uses the term ‘medical professionals’ as a collective term for doctors, physician associates (PAs) and anaesthesia associates (AAs), rather than listing out each individual role for every reference. We haven't removed doctors from the.
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@pepemac27 Steeped in management-speak. This sounds like appropriate feedback for a flow coordinator, not a resident doctor learning to, you know, treat sick patients.
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I’m believe I’ve met @Anniedroid_; on paper & IRL sounds like she would’ve made a great radiologist (best of luck in Psych!). There’s NO role for IR PAs while training bottlenecks exist. To the bitchy PAs in the thread… wanna list your academic achievements so we can compare?.
Great to know that I couldn't get a job in radiology with a BSc, MBCHB with honours and MSRA score of 573! Wish someone had told me that all I had to do was become a PA. 🤬.
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@Dr_Done_ Why is the GMC referring to a PA as “Dr G” at the MPTS tribunal? Do they have a doctorate?. The only way a diligent registrar could avoid this is either 1:1 MAP supervision (not cost effective) or stopping them seeing undifferentiated patients.
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I wonder if the FY/IMT Dr trainees get such good training in ascitic drains and LPs?. Do patients know who is sticking needles into them?. In IR we see the knock on effects of deskilling the medical workforce. Time to enshrine a “right of first refusal” for trainees.
Listen from 4:50min. Hubris off the scale. ‘ People ask why I’m allowed to do these procedures , well….work is what you make of it. If I see something that I want to do I just ask , if they say no then I ask again . Eventually they will let me do it ‘ .
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@Ask_foradoctor TPD roles can attract “ladder climbers” as it’s a management role in a sizeable organisation. It doesn’t always attract those who truly care about training and trainees. What are the true motives of a non-GP who wants to oversee the training of GPs - why not train nurses/ACPs?.
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Dangerous rhetoric which will lead to patient harm. A saying: all regulation is written in blood. UK Medical practice has been highly regulated for centuries, because the stakes are high. So what is the logical endpoint of deregulating medical practice via doctor-substitutes?.
@parthaskar @pa_StephenNash @ramey999 @Cleverclog67596 @Adam_Skeen It's a complete coincidence that LocumPA who support Mr Nash would benefit greatly from "removing competition from a market [Doctors] monopolise". The narrower the scope, the less of a "market" for PA locum companies to profit from
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@PhilSmithIsBack Aren’t there reports of hundreds of applicants for some JCF medicine jobs? GPs going jobless? . Doctors are having a hard time finding jobs for God’s sake.
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You can’t replace GPs with less-trained healthcare professionals unless you’re willing to pick up the pieces when patients get the wrong treatment @wesstreeting . @carolvorders .@mrjamesob.
A good friend phoned the GP for a bullseye rash (example image) following a tick bite this morning, and they got 'referred' to a pharmacist by the receptionist. They prescribed an antihistamine. I guess this is the excellent state of our primary care, yeah?
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This anon PA concisely demonstrates Doctors’ concerns regarding PA scope. How can the GMC regulate them when their scope is so nebulous?. PA scope is limited only by their hubris and their supervisor’s scruples. How to rein a rogue PA/department with no real oversight?.
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@vinc3h4ll @BBCNews Yeah basically all of medicine is pretty safe until there’s a complication. That’s why we train surgeons who can handle them, and not cholecystostomists.
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This shouldn’t be controversial. The various grades of Dr aren’t interchangeable with other roles (e.g. “ST3-level ACPs/MAPs”), because the training from med school onwards is fundamental to doing the job well. I can learn to play Stairway to Heaven, it doesn’t make me Jimmy Page.
As someone who was a qualified nurse prior to starting medical school, I would not be able to do my job without having done med school. Medicine is medicine, practiced by medics. Even if I’d done a 2 year PA MSc, I would still not be practicing medicine.
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Being extra nice to my FY1 colleagues who ring radiology today - the most under-appreciated workers in the hospital. (And for the record: I think everybody working today to care for patients deserves a pay rise).
Merry Christmas to all those working in the NHS today. Many staff in the NHS are grossly underpaid (even on Christmas day👇) but none more so than Junior Doctors who frequently graduate with >£100k debt. RT to support them & ask government to pay them ALL fairly #PayRestoration
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@gibraltarfx @annemflfc @MariaZander8 @DrEilidhMaria @DannyCass1 I’m a junior doctor. I put in a stent in an artery the other day. I’m also not a cardiologist, but I don’t want to completely blow your mind.
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Let’s call it like it is: the “modernisation” agenda of UK healthcare is actually a race to the bottom. Only 2 healthcare systems are pushing mass deregulation & role substitution: the USA and the Tory-run NHS (soon to be privatised by US interests). Nobody else seeks to copy it.
@Burnt2020 UK had an opportunity to be a world leader in the modernisation of healthcare, & create a workforce suitable for a landscape that will totally transform over the next few decades. It has regressed through poor leadership, lack of resource, reactionary stances & incompetent mgt.
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No Confidence the GMC.Reclaim the Royal Colleges. That is all.
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@theveindoc I’m glad the UK medical profession has shaken off the apathy which led to a generation of devaluation: monetarily, professionally and societally. I’ve never seen such solidarity and camaraderie amongst doctors, and it’s great to see us pitching together to get out of this mess.
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@BMA_JuniorDocs @AoMRC @TheBMA @NHSEngland @gmcuk What a pathetic attempt to freeze out the group of doctors most disaffected by MAPs, namely those in specialty training. Especially since the BMA is the ONLY organisation that has issued guidance on MAP scope of practice. Guidance we will be using to protect patients and doctors.
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@Xeon4f145d96s1 @drcolinm A certain terrifying irony that people are being threatened with referral to their professional regulator for raising concerns about the scope of… *checks notes* unregulated professionals.
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@amapresident @TheBMA A complete and utter farce. A qualified doctor has to risk their professional registration to prescribe for an unregulated individual (physcian associate). Said PA has not been to med school, yet is being prioritised to train in invasive surgical procedures with no real oversight.
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@ClareGerada @Dr_BellaR Dr Gerada, those 10 years are when many of my colleagues get married, buy houses, pay for childcare or parents’ care homes. You cannot placate them with the promise of high salaries in their 50s when they cannot pay their rent, bills or look after their parents or kids RIGHT NOW.
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If only there was a job role that could assist physicians to summarise these case notes?.
The state of training programmes nowadays. I suppose it’s training you for when you’re an ST5 writing discharge summaries.
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On what planet is it safe for PAs to be doing invasive procedures when they can neither recognise nor treat complications. Foundation year doctors aren’t given free reign to do this, and yet far more qualified.
@iDrSunny @NGHnhstrust @CareQualityComm I had to intervene in a situation with exactly this problem. PA misplaced seldinger chest drain, caused tension, was unable to manage or even make the diagnosis. Patient deteriorated, with haemodynamic compromise. We had to do an emergency decompression. PA couldn’t even help.
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@liamlfc64 @JujuliaGrace There’s a saying in medicine: the eye doesn’t see, what the mind doesn’t know. You can’t pick up the rare diagnosis, if you don’t know it exists. That means hitting the books, you can’t learn it all “on the job”. PAs after 10 years won’t be equivalent to a 10-year doctor.
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@DrNeilStone This is a tinfoil hat take given that:.- Numerous polls and surveys by RCP, RCoA, BSIR, ASIT, BMA hover around 8 out of 10 doctors being against PA rollout.- Organisations (Trusts, GMC) are coming down hard on disenfranchised trainees. This forces anonymity. It’s defo not 1 bloke.
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@cannula_service It’s so interesting that the votes are always however around the same ballpark figure:.87% think PAs pose a risk in this poll. 88% of anaesthetists voted to pause AA expansion.90% of interventional radiologists voted to pause PA recruitment . This is not a vocal “minority”.
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“But, but… Drs make mistakes too”. Yes. To err is human. But that doesn’t somehow justify the experiment that is the PA rollout. Some reasons why this isn’t an argument for PAs (gathered from X discussions):.
@LittlePersonDoc @Dr_Rajiology Yes because Drs never cause any harm. Just get rid of everyone. Or shall we judge each case on merit and not overreact?.
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@JimBethell @DrAsifQasim If maintaining high standards of professional training and defining clear scope of practice before letting people loose on unsuspecting patients is snobbery… then I’m a snob. But I’m not an enabler. What is the role that PAs fulfil that cannot be performed by Drs? Be specific.
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Enlightening thread. UK med training infantilises med students and Drs by making us jump through hoops for our mostly performative appraisals & portfolios - these things detract from real doctoring. And yet those same Drs are held to impossibly high standards by employers & GMC.
Facebook (I open it now and again to keep tabs on/cringeread what my boomer relatives are posting) reminded me that 5y ago today, I finished my elective/subinternship in critical care medicine, at Pennsylvania Hospital!. The experience was as painful as it was formative. (1/n)
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@veggieequallife Because the PA role, as it exists in the UK, is designed to disrupt the model of Dr-delivered care that has existed since the formation of the GMC. This drives down both the wage budget, and the overall influence of doctors. Steve Barclay admitted as such - standards be damned.
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@IjsSmith @TheBMA @RCPhysicians “The wider medical profession”? . Honestly it appears that PAs have unilaterally dictated the their expansion - including co-opting terms like “generalist practitioners”, “medical model” and now “wider medical profession” for the purpose of blurring lines. Pushback was inevitable.
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@Matt_L_Nash @DrHuw @Matt_ParaACP @Dr_Done_ @VirtueOfNothing @FICMNews I am pretty shocked by such a cavalier attitude by a neonatologist. Your mum taught you to drive but you still had to sit a driving test (theory & practical). You’re essentially advocating for the deregulation of medical training into the hands of any old trainer, to what end?.
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@DrNeenaJha I am grateful that the BMA issued guidance on PA scope of practice, whilst every other organisation (GMC, RCs) dithered and delayed. I will be using it. UK Doctors have worked too long and hard to jeopardise their professional registration, at the hands of less-qualified staff.
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@ollieburtonmed GMC/DHSC/RCs have destroyed industrial relations between PAs and Drs (read:future consultants) for decades. Imagine they had defined scope/proper regulation from the start. Imagine they weren’t surreptitiously added to Dr rotas while GMC/RCs took “funds” instead of leading. Shame.
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@ClinOncDoc @drcolinm @gmcuk Spot on. Doctors are becoming deskilled many ward-based procedures like ascitic drains and LPs. Most of these are offloaded to non-Dr HCPs these days. You can’t become overqualified in something unless you do enough of them to become qualified. The buck always stops with a Doctor.
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@DrEilidhMaria People forget, and look down on, FY1s for only doing the basics…. The basics are the basics because they are “high yield” interventions for saving lives. A to E assessments, recognizing worrying ECG changes or initiating sepsis treatments and CPR are time-critical and vital.
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Institutional propaganda: the medical profession refers to being a qualified medical Dr, and always has. Someone who has been to medical school (and not a short course in a med school). NHSE will tell you up is down with a straight face but I, for one, won’t be gaslit on this.
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@DrNeenaJha It’s the opposite of elitism. It’s about ensuring that even poor areas have access to the same quality of medical care, delivered by highly-trained and regulated doctors, as rich people do. It’s about standing up to an agenda pushed by US private health, the IEA, and Tory donors.
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@DanielSokol9 @gmcuk The GMC appear to prefer issue guidance on Doctors’ use of social media to silence them …. Than provide guidance on the scope of Physicians Associates, whom 87% of surveyed doctors consider to pose some risk to patients, despite claiming to soon regulate them. Dubious motives?.
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@DrEilidhMaria It’s a false equivalence. I asked a family member who did undergrad physiology, then dentistry. Early modules on evolutionary biology and fungal life cycles don’t translate to med/dentistry. It’s not the same as targeted med school basic science required for clinical practice.
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Is it just me, or have certain Consultants well-versed in PA apologetics been real quiet since #rcpegm dropped?.
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@Dr_Done_ Can someone post an MSRA pharmacology question for comparison?. It’s interesting that this is the level of prescribing knowledge expected of a PA, and they soon walk into a £45k GP/EM job. But an aspiring rad trainee needs to sit MSRA w/ more pharm, 10:1 ratio, and starts on less.
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Sometimes in IR/US a patient will tell me how clever their doctor was for spotting a pathology on a scan. My inner monologue: But I reported your scan and got to the diagnosis, and yet I toil in obscurity 🙁. Cite your radiologist folks. Tune in for more tales from the dark room
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Hot take: UK trainee portfolios and ARCP processes divert energy and time away from us being better doctors. We fill out increasing volumes of pointless tickboxes, while in the real world IMT trainees can’t do LPs confidently any more. Thanks meducationalists.
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@alrightPET Using admin staff to fill in requests should be considered inappropriate too, and I assume they are basically dictating verbatim at the request of a doctor. I do think this incident at Leeds needs very close scrutiny by @CQCProf to ascertain what was happening here.
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@doctor_oxford @gmcuk @TheBMA The GMC actions on PAs aren’t consistent with an organisation that aims to protect patients and regulate doctors. They want to regulate PAs under their umbrella, and collect their fees, but have abrogated their duty to create a scope framework by which to regulate them.
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@DrEilidhMaria Gaslighting. Remember FY1s, you need to accept worse working conditions than any other similarly-qualified professional group, or else it’s a moral failing.
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Q: let’s say PA rollout was a non-inferiority drug trial. Dr-delivered care is gold standard. PA-delivered/Dr-led care is novel & under evaluation, which comes with great scrutiny of PAs. If there were concerns of unintended harm - do you press on? Or pause & re-evaluate?.
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@XelenX1 @thomaswoodcock Agreed. There’s a bizarre narrative that PA’s are an oppressed minority, or drawn from a poor subset of society. Many PAs are the children of doctors who didn’t get into med school. It’s a narrative that undermines the work of widening participation into medicine….
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@mstotty88 I went LTFT to have a more normal work-life comparable to my non-medical partner. What we call FT is not normal, especially when you factor in the “unpaid extras”: exams, portfolio and so on. It will become the new norm.
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@DrNickTwit There’s a wider debate about role substitution here. I work with great dialysis ANPs, who have a focussed remit to signpost care - it works. The issue most people have is the use of ACPs etc as Dr-equivalents (eg “ST3 level in EM”), despite a gulf in formal training between them.
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I value the MDT. The value Drs bring to the MDT stems from rigorous training in the science of health+disease. UK med schools must either preserve the integrity of a medical degree…. Or we dilute med ed until we’re indistinguishable from MAPs, at which point we’re replaceable.
The whole of biochemistry, microbiology, virology, infectious diseases, pathology and oncology in 4 weeks. It’s the same. 🤡
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Great piece by @Adam_Skeen explaining the stark difference between PA and doctor training. This bit stuck out - Drs need a grounding in the science of health & disease to do the job. Anything less is not “practicing medicine”. Patients deserve better.
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@drcolinm @theSAScollect If all this furore has taught me anything, it’s that a great many “medical leaders” are anything but.
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AI will change the face of Radiology. Radiologists should embrace it as a tool to make us better at patient care. I don’t fear AI, but I do fear bureaucrats who buy the hype and see AI as a cost-cutting intervention (like PAs in primary care). We’re still here @geoffreyhinton
"There's no question that real-life clinical radiologists are essential and irreplaceable, but a clinical radiologist using insights from validated AI tools will increasingly be a formidable force in patient care.". Our President @halliday_kath on AI's potential in diagnostics 👇.
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@ShaunLintern @jarottingen @wellcometrust The NHS doesn’t reward, and in many ways disincentives, doing anything above and beyond. Research, developing patents, education and training initiatives. Is it such a surprise nobody wants to jump through hoops any more?.
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@cannula_service Incredible how close the numbers are:.88% of anaesthetists voted for an AA pause and 90% of IRs agreed.90% of doctors think PA deployment is a risk (BMA survey).71% of surgical trainees report negative impact of PAs. Some people really want to bury their head in the sand though.
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The end point of this line of thinking is playing out across the NHS…. Resident doctors are de-skilled at simple procedures because the easy ones are done by non-rotational non-doctor staff during the daytime (with consultants around to help). So who does the tricky ones at 3am?.
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@DrAsifQasim Yes - I read a paper from the US that suggested PAs request imaging at 5.7x the rate of Drs. Not necessarily leading to more diagnoses made. We have too few radiologists, and amongst the lowest availability of scanners per capita in the developed world. Disaster in the making.
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