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)
On my first full day of FY1, a PA helped me obtain a blood sample from a paediatric patient, and gave me some helpful tips. This was just the first day, there will be many times during this rotation and others where PAs provide valuable contributions to patient care & to the team
Susan hopes to form a union for PAs and likely has leadership ambitions. Someone who behaves like this should never be in a leadership position. I have felt singled out and targeted. My access to professional networks has been restricted. I have been made to feel unwelcome. (8/9)
It is plainly just anti-doctor sentiment. There are others in the groups that have pursued alternative paths after PA and as far as I'm aware, I'm the only person that was targeted and removed from the groups. However, I know the majority of PAs don't think like this. (5/9)
Yesterday evening, without prior warning, provocation or discussion, I was removed from 3 physician associate networking whatsapp groups by the same individual solely because I am now a medical student, despite continuing to work as a PA and remaining on the MVR (2/9)
Despite always having remained an advocate for the PA role. My only crime is that I have gone to the 'dark side' to study medicine. (9/9)
#physicianassociate
Seeing ridiculous comments re: PAs should be paid less. I don’t know how anyone can think that is going to help achieve FPR for Drs. PAs are paid appropriately. Perhaps years of being underpaid has skewed the views of some but no one should be paid less. Drs need to be paid more!
I have a family to consider and therefore if the pay situation does not improve, I am planning to go LTFT once I graduate as a doctor and to locum as a PA alongside this to boost income. My locum pay as a PA is in excess of what my 4 x my hourly rate would be as an FY1. (3/6)
I recognise this decision was made by one (possibly a few) individual(s) but its disheartening to see such contempt directed at PAs who decide to pursue medicine. (4/9)
Great to see the
@FPARCP
publishing guidance on the appropriate ways of introducing and explaining the PA role and language that should/shouldn’t be used during these communications.
I do feel like FPA members deserve to know a little more information here
@FPARCP
Why have there been 4 resignations from senior board members with immediate effect?
Colleagues have sent me private messages of support and some have posted on the group asking why I was removed and if I can be added back but those requests have been ignored. Susan Singleton is a PA Ambassador and founder of
@buddyassociate
,
@associate_uk
and
@ppaaUK
. (6/9)
I have been blocked by the above accounts which are supposedly networks to support PAs. I have also been blocked by Susan's personal twitter
@SwanCArt
despite never interacting via twitter with her until now. (7/9)
I expect you thought this would come across funny but it reads as mocking and insensitive. Also this is being posted from a business account… it is a bad reflection on PAs when organisations that represent our interests are posting like this on social media. Perhaps an apology?
@AWJChadwick
@KeeleyMP
Wow. I’ve just noticed my mortgage reference number is also a seven digit number, calling my mortgage company immediately in case I’ve inadvertently bought a doctor!!
Dammit, I’ve just typed 7654321 into my calculator. Doctors everywhere! Aaah. I’m so confused.
#7digitscare
I had been part of one of the groups since 2019. What makes it worse is that the person who removed me is a PA Ambassador. Throughout my time at medical school, I have remained supportive of the PA profession. (3/9)
If I had stayed working full time as a physician associate, I would expect a salary of circa £50k by this stage of my career. As it stands, when I commence FY1, my base salary will be £29k. (2/6)
However because of purely financial reasons, I will continue dipping my toes into both ponds as I am unable to embrace my new career fully. This feels disheartening. (5/6)
Wow okay anon with 2 followers, I shared a post from a Dr explaining some of the issues affecting them. It’s not my problem if you lack empathy.
This is the kind of rubbish that comes my way as a PA studying medicine. Some in the PA sphere unfortunately let everyone down.
@dx_mighty
Donya literally fuck off and stop perpetuating anti- pa horseshit, you don’t get a free pass simply because you qualified as a pa and used it as a stepping stone to becoming a doctor
PAs now entering the group chats are being asked specifically if they are also medical students. Why are they being asked this if it’s not because the sole admin of the group (Susan) is promoting anti-doctor sentiment?
@Dr_Done_
The response is just wild to me. I would like to think any HCP who has missed something like that would be first concerned about the patient, feel bad for missing something so serious and have a debrief/reflect on the learning points. Not have a go at the GP/complain 🤦🏽♀️
No doubt, opting to go LTFT will prolong FY1 and FY2 for me and delay me entering specialty training. One of the reasons I opted to study medicine was that I felt my clinical progression would be halted at some point as a PA. A decision personal to me. (4/6)
@MikePretswell
I’ve never worked a night or on-call as a PA. My hospital experience as a PA has been in a fairly protected day time setting. Perhaps an unpopular opinion among my PA colleagues but I think it’s right that I need to do foundation training. Just wish the remuneration was better!
FOI request shows 50-67% of PA applicants also applied to medicine. Of the 33-50% of PA applicants who didn’t apply to medicine, I believe it is the “life” of a Dr - e.g rotational training, being sent across the country - that will have put them off applying to medicine
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.
Based on some recent conversations, I felt like a thread was needed on some of the issues surrounding medical training, and how they intersect with the long term workforce plan.
Buckle in for a long one
1/14 🧵
Update: my tweets are in no way intended to be disparaging to the PA profession as a whole. I tweeted to highlight unprofessionalism and bullying. I have been professionally ostracised from my colleagues, for no real reason that I can see other than me being a medical student
@SecretPhysician
I knew people would come for me when I wrote the post, you can’t write anything positive about PAs on here lol. PAs were literally created to help the medical team, which is what happened in this instance.
Whilst I don’t think the ITV report was entirely balanced, I agree for the benefit of all parties that the sensible approach right now is to pause PA expansion and resolve the issues instead of pressing on full steam ahead with plans irrespective of concerns.
Every single vote on the issue of PAs and AAs has been overwhelmingly against
The reasonable approach is pause, thorough review of working practices, scope, and safety data, then move
What possible motive could any sensible person have against that?
#TrustDoctors
Others, like me, have gone on to do medicine afterwards when realising the issues within the PA profession due to its infancy e.g scope, regulation and feeling we would reach the “ceiling” of PA after a while and want more
@Adam_Skeen
@TheEMboardround
& more
@Parody_RCGP
I remind you that the idea of primary care having something that looked like SAS doctors resulted in a fairly unpleasant push back.
Not completed GP training? No thanks.
No medical degree? No problem.
* Turning off comments now as MedTwitter has proved yet again we can’t make any positive comments about contribution of PAs and even when PAs are doing what the job was designed for (assisting doctors) there are still issues…*
There was no way of me accessing my colleagues as a whole other than taking what’s happened to Twitter. Susan (and co) are accusing me without proof of leaking information to Twitter accounts that are anti-PA. To clarify - I have NEVER done this.
Interesting thoughts. Having done PA & completed med school rotations (aside from assistantship) it felt like I spent more time on the wards as a PA student. As med student, time in clinical environment constantly cut short by needing to attend scheduled teaching.
I’m putting it out there: I don’t believe it takes 5 years to get a medical degree. And I do believe that you can learn on the job if you already have a clinical role. Doctors should be honest with themselves.
Was every minute of your degree spent in learning/working? Was
Agree not helpful right now from NHSE, however there are many PAs who would go on to become drs if the pathway was more accessible / easier financially. My insta DMs are testimony to this with hundreds of messages from PAs/PA students that are considering/applying to medicine
MedTwitter pls RT: Any qualified PAs (or PA-S2) applying to medicine this year, drop me a DM if you’d like to be added to a closed group with other PAs also applying to medicine, for peer support and encouragement through the application process ✨
You make a valid point. Any qualified PAs applying to medicine this year, drop me a DM if you’d like to be added to a closed group with other PAs also applying to medicine, for peer support and encouragement through the application process.
@Molly2323232323
@LittlePersonDoc
@gmcuk
It’s based purely on finances. The PA locum rate I get is more than rates for foundation trainees in my region. I want to be working only as a Dr and in an ideal situation Drs pay would be at least that of a PA. I wouldn’t remain on register if not working as a PA.
@Adam_Skeen
@TheEMboardround
Actually slight correction to above - “issues within the PA profession due to its infancy” and poor planning from the govt / DoH and NHSE
There are issues to be resolved (i.e regulation, implementation, scope and progression). However I look forward to working with and championing PA colleagues in the future.
If you are a PA or PA student wanting to apply to medicine, I will be hosting a Q&A session alongside other PAs that have gone to medical school. It will be on Monday 19th August at 8pm. To sign up, drop me a DM.
#physicianassociate
How can we expect cohesive/respectful working relations when some Drs actively deciding to use diff (& incorrect) job title for physician associates. Whether we like existing title or not is a diff convo. Refusing to use it is unprofessional, disrespectful & breeds incivility imo
@dx_mighty
@Gc9100
Watch this space
You assist medics so you’re Physicians Assistants
That’s the majority title in the US where this role came from i will be urging my fellow docs to do the same as many are doing right now
@zafarhashim_INR
There are accusations flying around about there being a ‘mole’ and someone leaking info to Twitter anon accounts. I’m the most likely suspect to Susan and co because I’m studying medicine. Hence the “divided loyalties” comment from my understanding. (1/2)
@LittlePersonDoc
@FPARCP
🤷🏽♀️ and I’ve now been told there have been other quiet resignations within recent weeks… right now it’s not clear who remains on the board and the email was signed off as ‘the FPA team’.
Exactly my point. Vast majority of messages I get from PAs/PA students are from women who ideally want to do medicine but are late 20s+ and either have or planning for children soon. Financial impact colossal as GEM isn’t properly funded when you have additional responsibilities
@timricketts_
@dx_mighty
@Molly2323232323
@mrmyb10
@LukeAmos__
I worry that the current system really disadvantages certain groups (women with children and BAME women particularly), and this is a possible way to widen access and level the playing field. Ultimately Donya knows far more about this than me, so I’ll shut up and listen.
@doctor_dru_
Where is the proof of this actually happening? Hospitals responsible need to be named and shamed. There is no way any reasonable PA I know would think a PA should ever be doing that job.
@Xeon4f145d96s1
I don’t think all PA courses were on UCAS until ?2021 (previously applicants applied direct to the university) so the number of applicants to both courses is likely to be higher than the records UCAS hold
@LukeAmos__
Have you ever worked with a PA? They’re absolutely worth that pay. Drs are grossly underpaid. PA salary has been assessed via Knowledge and Skills Framework as AfC band 7. It’s absolute nonsense to argue for lower pay for PAs and it doesn’t help the argument for FPR for Drs.
@BMA_James_Steen
When I’ve introduced myself as a physician associate, I still get called doctor. I correct them & explain I’m not a doctor. Many patient’s don’t understand that the title “physician associate” isn’t some kind of doctor until further explanation (1/2)
@iDrSunny
@1choiceatatime
@drvk14012003
@medicalmodelbri
Thanks Sandeep, that’s given me some food for thought. It’s harder for me to think this way when I’ve worked with some fantastic PAs too. I do understand the points you’re making though and I’ve already said before that expansion and new recruitment should be paused.
@Molly2323232323
@gmcuk
I would welcome some guidance on this matter. I have been told I can register with GMC as both PA and Dr (two registrations, therefore two payments to GMC) but no further guidance/advice for when working as PA whilst also being a foundation trainee.
@noodles_nood
@BellaRoscetti
Is the PA newly qualified? I work as a PA in GP and I’m on 15min appts as are majority of PAs I’ve spoken to. Some more experienced are on 10mins, same as GPs but still get paid a fraction of a qualified GP. Depends how you view it but I think you have the better deal 🤷🏽♀️
@Laracapybara
My tweet wasn’t about pay. It was valuing the contribution of a colleague that belongs to a profession that is constantly facing hostility and calls for the role to no longer exist. I hope you get your band 7 pay.
@ExplosiveEnema
@DocEd
@BMA_James_Steen
E.g I know a colleague who went to a job interview where they interviewed a GP, an ANP and a PA for the same role. Massive red flag 🚩some practices will seek to fill GP vacancies with other roles if cheaper
@sam_bidwell
Was this the BMA stance in 2008 because of training bottlenecks - as in no use producing more medical students if training numbers are not being expanded and doctors can’t get into specialty training?
@SandipP64097927
@Sarah_H_Y
@ExplosiveEnema
Goodness me, this is terrible. Surely anyone working in healthcare knows an appropriate introduction is full name and role?! If you’ve managed to obtain name since you can check if the PA is on the MVR and contact
@FPARCP
as it is concerning if any PAs are doing this
Bit of a delayed post as I’ve been in Wales, celebrating by climbing Snowdon but I am happy to say I passed my Physician Associate National Certification Exams!!
#physicianassociate
#nationals
#fparcp
@NotAdoctor0000
There are approx 3000 PAs and not all work on AfC, some are employed via ARRS scheme in general practice. Please explain the maths as to how dropping a band on AfC would help pay for approx 75000 Jr Drs?
I will genuinely call out poor practice and issues of patient safety where I see them. I have no qualms about saying PAs should not be working beyond the intended scope. However some claims being made sound ludicrous and there is such thing as people jumping on bandwagons. (1/2)
@hkg294
@Adam_Skeen
Hi Heather, would you be able to describe what your course was like? I can also identify with Adam’s description of the course and we studied at different universities. I know there is huge variation so would be interested to hear from someone who had a different experience
A very interesting thread. As someone with experience as a physician associate and now studying graduate entry medicine, I would largely agree with what has been said. It’s important we have these conversations.
I'm not going to comment on the tragic PE case directly, but I do think it is important to debate how PAs are supervised and regulated. Lots of interesting comments and threads about it, although too many filled with unnecessary polarisation and vitriol.
1/x
@zafarhashim_INR
Susan (and co) could have just asked me outright though and I would have told them the truth. I have never messaged an anon account to leak any info. (2/2)
A thread worth reading. We should all be amplifying voices like Heather’s. Regulation is a good start and a long time coming but there is still plenty of work to do.
Don't get me wrong, I'm glad regulation is happening and going forward. But I don't feel like this is a victory or a celebration. I think, as PAs, we need to recognise that a lot of the things that have come to light recently are pretty awful.
@Adam_Skeen
I think leadership has a lot to answer for but honestly I do think vast majority of our PA colleagues just want to do their jobs and have naively trusted leaders, with little power to change things themselves
The consequence of scope being locally defined. Re: PAs - Not saying everything PAs should be able to do is inc in 2yrs at uni, there will be specialty-specific additional skills learnt on the job BUT there needs to be defined scope in each specialty area agreed on national level
Thank you for those sending to me video of
#Nursing
Associates taking on full ITU care
@uhbtrust
its clearly out of NAs scope to do full nursing process
The really negative issue is how the senior nurses view nursing practice and how the NAs are being exploited.
@BACCNUK
@DrEilidhMaria
Thank you. I will need to iron out the details and it is subject to change when GMC regulate PAs but as it stands don’t need to log hours worked as a PA but I do need to log 50hrs CPD each year and do an annual reflection. CPD gained whilst working as a doctor should count.
@iDrSunny
Yes if medicine was more accessible, easier financially as a graduate with potential additional responsibilities and doctors were treated better by the system, then yes I feel we'd be looking at > 90% of existing PAs that would want to go on to become doctors.
Obv a lot more additional content in medicine compared to PA. But just my thoughts re: the way medicine is taught and how potentially could be done in less time if focus more on the clinical experience and learning through seeing patients rather than so lecture heavy
@hkg294
@Adam_Skeen
Thank you for your reply and I’m glad your experience was better. Did you study at a uni that also runs a medical course? We had an A&P module but it was poorly taught and only when I started studying medicine did I realise how little anatomy we were actually taught in PA
Confirmation that it’s not PAs themselves or their GP employers deciding on PA scope of practice. In fact their GP employers are being told to utilise them in this way in order to access ARRS funds.
Many people learn better in practice rather than via lecture teaching. I found learning experience easier during PA as a student with SpLD. Perhaps ‘on the job’ aspect of PA helps accelerate the learning? May be why Drs struggle to understand how PA could learn so much in 2yrs
@DrEilidhMaria
My bad, I thought we were hoping for FPR and I wasn’t aware that would still be less than the salary of a day 1 PA. To be clear, an FY1 doctor should always be paid *at least* what a newly qualified PA is.
@Frankli07435432
That is a whole thread in itself! I will cover fully at some point but in simple terms greater breadth and depth in medicine. However certain practical aspects e.g clinical skills, clinical reasoning were taught better on the PA course in my view.
@ExplosiveEnema
@fascinatorfun
@doctor_dru_
I also hope any PA colleagues wanting to progress further clinically consider applying to medicine rather than working beyond scope. Shortcuts risk patient safety.
@rutheberry86
@Lawrenc28443726
I’m a qualified PA and now current 3rd year med student…we have other HCPs such as nurses examine our summative OSCEs for stations involving procedural skills, they obviously wouldn’t have a GMC number but are of course competent in the procedure they are examining
@danny_mercer
@noodles_nood
@nobbysolano123
I just find it quite inflammatory how people keep questioning PA pay specifically when there are many other roles that are also paid band 7. For example, in many trusts trainee ANPs get paid band 7 and band 8a when they can prescribe. 1/2