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This is mad - working at the level of a consultant neurosurgeon and you could be paid £33,790 (12+ years of doctoring + 5/6 years of medschool)
But offering a PA (undergrad + 2 years masters) over £51,000!
You can’t blame doctors for striking it’s beyond a joke.
#nhs
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@Patticus
@usamasyedMD
Wrong. In many cultures they used to wash regularly and use perfumes long before it was popular in Europe. You’re looking at this through a very narrow lens
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Both F1s (docs) and PAs now have GMC licences.
PA can see undifferentiated patients in GP/A&E and do clinics - all of which is too dangerous/unsafe for the doctor to do until years of training. Plus PA is paid 15k more.
Doctors are just calling for some level of equality.
🧵1/3 Last night, the House of Lords approved the anaesthesia associate and physician associate order. Regulation will help assure the public that AAs & PAs have the required knowledge, skills and experience to work safely. It will also help to increase the contribution PAs & AAs
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It took us dumb medical student months for some reason. Who knew you could teach everything GI over a lunch break 🤷🏻♂️
Teaching postgraduate physician associates this lunchtime...going through everything gastrointestinal!
They’re very clever so need to bring my A-game!
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Why does a doctor need the MRCS to get onto a surgical reg rota but a PA doesn’t?
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£68,000 for a PA with 1 year experience. Doctors are criminally underpaid. This is more than a registrar is paid at the highest pay point (ST6+).
Continue to strike.
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It’s actually scary how isolated doctors are in the UK.
These strikes have exposed how only the BMA really has our backs. NHSE has been nothing more than a government mouthpiece. Don’t forget the GMC who are ready to throw you under the bus for claiming a laptop.
#NHSCrisis
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Looking at my payslip I’ve only just realised what a 48hour weekend ENT SPR cover is worth in terms of our contract.. and I wish I hadn’t worked it out 😂
£298.. £6.2/hour 🫠
#nhs
#doctorstrikes
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As a training lead you’d think they’d utilise the PA to help with ward work so the doctors can learn endoscopy. But no - they prioritise the PA to learn endoscopy and the doctors to do TTOs.
Why?
@ExplosiveEnema2
@RCHTWeCare
@FPARCP
@BritSocGastro
@UKGastroDr
@parthaskar
@DrAsifQasim
@DrLKVaughan
@DrSteveTaylor
@AlisonGeorge10
@Dr_Done_
@Doctors_Vote
As the training lead for
@RCHTWeCare
, and having signed off this PA, let me respond.
Non medical endoscopists provide a significant and important contribution to endoscopy procedures in the UK whether we like it or not. They all have to go through a robust certification process
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Context for why PAs being in theatre/clinics annoys doctors:
Doctor: numerous surgical exams, published multiple papers, attended several courses, been to national/international conferences - presented at these conferences, 2 bottlenecks/interview processes.
PA: apply for post.
Med regs don’t save lives; Physician Assistants do.
Sorry what exactly are the paeds surgery doctors doing at
@ImperialNHS
?
Discharges? Making and printing lists? Ward jobs?
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It took 1 year of striking doctors to convince this government to start mediation - what a joke. And what a liar 😂
As Secretary of State for
@DHSCgovuk
my duty is to patients, and I want to pursue all avenues to resolve the dispute with
@BMA_JuniorDocs
.
I’m pleased the Committee has agreed to explore mediation, and I am hopeful that this will provide a way forward.
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A junior doctor was struck off for not supervising a PA “correctly” - what they mention in the tribunal is that this junior doc didn’t RE-examine and Retake the history from the patient.
This is actually insane. We didn’t sign up for this.
A fitness to practise tribunal (MPTS) determines that a PA's history should be repeated by a doctor and a PA's examination should be repeated by a doctor too.
DAUK's report in Pulse explains more 👇
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Why is medical school 5 years in most countries when a PA can see and prescribe for undifferentiated patients after 2 years.
Even after 5 years you don’t see F1s in A&E.. but it’s okay for a PA?
Make it make sense!
This is a complete fabrication
@RCPhysicians
, and you should be extremely embarrassed that you would put something like this up.
- PA does not necessarily have a biomedical science background. False.
- there is *nothing* on the PA curriculum, nor has there ever been in the
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If you are in the top 0.1% of your school and looking at the news - why would you apply for medicine?
Entry requirement is as high as it gets plus interviews and extra entrance exams.
The light at the end of the 10-15 year tunnel has been significantly dimmed in recent years.
The next NHS crisis? Fewer teens applying to study medicine. And overseas student applications are down too. But let’s get our country back!!!!
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@Patticus
@usamasyedMD
I just don’t like clickbait titles “body odour is a myth” etc - it’s not
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Has anyone figured out why an FY1 doctor is paid significantly less than their PA colleagues yet?
And is anything being done to rectify the situation?
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@Patticus
@usamasyedMD
No one says it’s healthy to use deodorant. It’s for the betterment of society.
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So what’s the point of medschool if you can just train anyone?
Either you need the 5 years med school, 2 years foundation, 2 years core training and 6 years registrar training - or you don’t.
Can’t have one rule for one group.
Tom Gray, consultant gynae: "... I think a PA could work at almost any grade within medical training, right up to senior registrar level if they're appropriately trained ..."
(timestamp: 15:59)
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If a PA is allowed this level of responsibility with no surgical exams or bottlenecks - what is stopping SHOs having half decent rotas??
Why are doctors being used for service provision and PAs elevated to registrar ranks
Ortho PA:
‘You’ll notice this looks a lot like what a reg or fellow would do, and it is, however I’m not taking anything from the fellows or registrars’
…What about the reg or fellow that could be doing your job instead?
❌ Make it make sense ❌
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F2s can’t locum in GP land but a PA can. Why?
@Cleverclog67596
@ExplosiveEnema2
@rcgp
F2 cannot work unsupervised in PC. They are training grade & largely supernumerary. I would like every Dr , irrespective of end speciality , to spend at least 6/12 rotating through PC from ST1.
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There is no longer an argument to not scrap Foundation and core training.
If PAs can specialise after a 2 years masters degree, then a medical student with 5-6 years should also be given that same respect.
Anyone convince me otherwise?
Truly truly, I could not pick the worst part of this.
I’ve highlighted 3. Thoughts?
I am so fed up of reading this nonsense on a daily basis at this point.
SOMETHING has to be done.
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Medical professional = Doctor. Unless you’re in the UK/NHS.
This will just further blur the lines and confuse the public.
🧵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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The healthcare in the UK is a joke. Imagine other countries looking in - no jobs for doctors after 6 years of training because they’ve allocated slots for a role designed to help them 🤷🏻♂️
Med students/new F1s are being shafted again
See the below email confirming 99 have been put in a ‘placeholder group’ in East of England due to no places
Meanwhile HEE is pushing trusts to recruit PAs to a foundation program - guess where?
THIS IS INCENTIVISED REPLACEMENT
☠️
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@ShafiAhmed5
We need seniors like yourself to speak out against this! This should be brought up in meetings/conferences and rules put into place on what’s acceptable. Leaving it upto local trusts etc will be terrible for patients/trainees
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In which profession does this exist? There are national standards.
If you train to be an orthopaedic surgeon - you can’t then go and perform brain surgery just because your colleagues say they feel like you’d do a good job at it.
A universal one-size-fits-all scope regardless of competence, experience, training and skillset is significantly more dangerous.
Scope should be set by those overseeing the training, CPD and development of the PA.
Not by keyboard warriors.
Scope also evolves with experience.
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This has been one of the driving factors for the hostility in the debate. Why are PAs treated as something better than a junior doctor.
GPs have made it clear any doctor that isn’t a qualified Gp shouldn’t be seeing undifferentiated pts - it’s in their contracts. Why can a PA?
@DrNeenaJha
@parthaskar
@NHSEngland
@NHSE_WTE
@RCPhysicians
@NHSEmployers
@trishgreenhalgh
@mmamas1973
@doctor_oxford
@JanetEastham
@DrAsifQasim
@DrLKVaughan
@RowanHarwood
@UKGastroDr
@AntonEmmanuel2
@rcgp
It’s all ‘slightly’ messy
@DrNeenaJha
There’s a new GP contract that states:
“Supporting guidance will also be issued to clarify that NON-GP DOCTORS should not see undifferentiated patients, and that they continue to be required to operate within their sphere of competence”
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I recon the next set of strikes will be vs the GMC
The GMC continuing to blur the lines between doctors and PAs is no longer tenable. PAs are not doctors and are not medically trained.
The lived reality is that this is causing significant confusion for patients. (1/2)
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“There have been cases where I’ve scrubbed in and opened a patient surgically and dissected down to a vein and harvested the vein for a bypass procedure.”
Not sure how this frees up surgical trainees 🤔
I think the cat is well and truly out the bag. All thanks to the PA podcast
"A physician associate in neurosurgery told the Physician Associate Podcast that he had “zero training in neurosurgery or neurology” during his course...he now “scrubs in and operates on things like subdural haematomas”
Truly unbelievable🤯🤯🤯
@TheBMA
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BMA vs GMC
Exciting times ahead as our union finally grows a backbone and fights for doctors in the UK. So many wrongs which need to be undone by the failure in leadership we have endured for decades.
The BMA is working well for docs now. The GMC is next.
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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@Matt_L_Nash
@DrHuw
@Matt_ParaACP
@Dr_Done_
@VirtueOfNothing
@FICMNews
This has to be one of the most remarkable statements made.
Why do you need surgeons? You can cut an apple with a knife - what’s so special about the body.
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No formal neonatal training in their 2 year crash course. But straight onto the reg rota with oncall commitments?! Make it make sense.
Neonatal Physician associate on the ST 1-3 doctor on call rota .
At the level of ST 1-8 on the organisational chart
When will this madness STOP🛑
@JanetEastham
@carolvorders
@parthaskar
@Dr_Done_
@NHSEngland
@ExplosiveEnema2
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This gets more wild the more it’s looked into. Doing surgical post grad exams to “show equivalence” ?! You should only be allowed to sit those exams if you are a doctor and went to med school. There’s no shortcut in becoming a surgeon - otherwise what’s the point 🤔
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A slap in the face to all nhs workers who gave their all to this government (and got nothing but claps in return)
How is
@Jacob_Rees_Mogg
mocking social distancing guidelines and boldly stating the police won’t investigate the event??
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“Trained to be generalist practitioners”
So a PA is now a GP (minus the -ist)
This is coming from the top. Confusion by design.
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They really thought they could get away with manipulating data in front of medical consultants - the disrespect is wild. These are highly intelligent professionals who have been forced to learn statistics and publish multiple papers to get to where they are.
Shame.
Following the
#RCPEGM
on the role and regulation of physician associates (PAs), the RCP has now published the full data from its pre-EGM member survey.
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😂😂 agreed. I can’t learn all of gastro in a 30min lunch break - if you can hats off to you - you’d make a great doctor
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This is why people think surgeons should just stick to surgery 😭 how can this be your take on the shambolic situation where we have 800 qualified doctors who have only 1 employer (which is massively understaffed) being left in limbo with 50k+ debt and 5-6 years of med school
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Instead of increasing speciality training numbers that will include oncall cover and lead to a consultant at the end of it - this trust decides to hire PAs - why?
Ophthalmology and interventional radiology aren’t competitive right?
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@UKGastroDr
@RCPhysicians
@FPARCP
I guess the BMA and many doctors felt RCP and co haven’t been clear and required some clarity for its members who will be supervising. If anything’s it’s because of a failure on the RCP end. BMA shouldn’t have had to write it.
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The amount of investigative journalism this pizza account has done will never be appreciated 😂
Uncovering scandal after scandal
I said I would send out an FOI to find out more information and would share when I heard back. (As apparently it’s my job to chase illegal prescriptions and not the CQC’s). Thank you
@JanetEastham
for investing this properly and thoroughly.
A short🧵.
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Disappointed to see
@RCSnews
publishing this. A single SCP has been allowed to perform lap choles on patients as the primary operator.
What is the point of med school, surgical exams, core training and specialty training? All the courses, publications and presentations?
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Hmm.. I wonder who told you to delete your anon account after comments like this..
PA school = Med school
Undergrad in anything science = preclinical med school
PAs being trained in irmer for requesting scans
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The way
@parthaskar
has played a blinder here - from that rigged AGM the RCP organised to finally getting them to call out NHSE.
Proof that you can always make a difference
It’s taken a lot of effort from many to get here
Yet,we are here
@RCPhysicians
formally now calling on
@NHSEngland
to review PA workforce & querying the LTWP re Training posts
“The RCP will now advocate for a limit to the roll-out of the PA role”
Link:
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So we no longer need anaesthetists to intubate - “intubation is the same as putting in a cannula” 😐
What other specialties can we get rid of with this attitude?
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There’s just way too many sections which are outrageous.
First few lines mention how the SCPs are trained to “perform” surgery such as carpel tunnel decompression - no supervision.
This should only be done by a surgeon. If you want to operate on people go to medical school.
‘SCPs are part of the junior doctor’s on-call rota. This was important to justify their salary and
cost of training as it’s possible to train surgical assts, who only worked in theatre, at less cost than an SCP and have existing extended scope’
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This is shameful
@MFTnhs
- core surgical training is incredibly difficult in most trusts as you’re used as just another sho. I’d be fuming if I worked there. You need allocated theatre time to progress to the next stage but no one cares. Normally You have to fight for it.
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I don’t agree with this one. We are just not paid enough. It’s never a race to the bottom.
For comparison, £51,000 is the salary for an ST3/4/5 doctor. (7 years after med school)
Upto £9000 LESS than this advert for a PA.
This is just another reason why we are striking.
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Completely inappropriate for a PA to be head/deputy of examining medical students. If you haven’t done the course/exams how can you be leading in teaching it?!
Also using the title of Dr in this scenario, when he has PhD in fungal infection in fruits, is extremely misleading.
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My reply to the post below
Ahead of the
@RCPhysicians
extraordinary general meeting, president
@DrSarahClarke
explains why there is a role for physician associates in the NHS
@bmj_latest
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We live in a crazy country when this needs to be explained by the RCS. Surgery should only be performed by surgeons. Call me protectionist but I think there needs to be some standards
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@MetroUK
There is no way they would have treated a Jewish MP like this if there were racist mobs burning down synagogues and Jewish businesses. The hierarchy is real and fully on displace in all aspects of British society.
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For me the whole tone was set at “Dear Phil” - when he addressed NSHE it wasn’t with first names etc. Phil is a professor and should be addressed with respect in official communications.
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So when you get PAs telling you they went to med school and practice medicine - it’s because this is being fed to them from the very top.
Leaders of
@FPARCP
again comparing PA studies to a medical degree…
Presentation given to hospital managers to encourage them to employ PAs
Is this appropriate for an arm of
@RCPhysicians
?
Doctors are being replaced
Source:
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Why is it always the super specialist hospitals that trainees are dying to get experience at - let along trust grade doctors.
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@iDrSunny
Apparently enough work to go around 😂 so much robotic surgery that no one wants to assist so PAs have to do it.
F1s just want more edn ward time.
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I don’t understand why london hospitals which have the highest competition ratios for any specialty don’t just increase the number of training posts for anaesthetic registrars.. it costs the same and surely would be more beneficial for the public in the long run?
Epidural anaesthesia is a common form of pain relief in labour. While it is very safe in experienced hands, complications can occur.
Similarly, most LSCS are uneventful.
Both of these procedures have serious risks. Labour ward is not the place for AAs.
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Almost begs the question why a GP needs 5 years minimum after 5-6 years of med school to see undifferentiated patients
We’re taught a bit of everything therefore we are generalists which makes us perfect for seeing undifferentiated patients in GP ‘
@rcgp
is this safe ?
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Just checked taskrabbit for an electrician and the prices ranged from £49/hr (very little experience) to £170/hr (10 years experience) - day time hours.
The comparison just shows how ridiculous this situation is.
*£27.5/h* for a doctor to be working in the middle of the night in a last minute fashion.
Rising to £52/h for likely the most senior doctors working onsite at night. In an emergency call out way.
Any specialists would be happy with this rate? In the MIDDLE OF THE NIGHT! 🤣
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This is the head teacher who thought to defend a ban, in court, on pupils taking 5mins at lunch to pray - which involves kneeling and standing silently.
To me, this goes to show the insidious Islamophobia that is rife in our educational system under the guise of secularism.
My statement regarding the verdict on our ban of prayer rituals at Michaela.
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The more I’ve thought about it - the main issue I have with this is that for a doctor going through medschool and the traditional route - to get regular weekly clinics / theatre sessions you have to be ST3+
If this is possible within 2 years - doctors should have this option.
I’ve had it.
We need to shut this down.
Surgical trainees, what do you think of this nonsense?
Why are you giving up your lives whilst this is happening?
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@RCSEd
Some clarification regarding who can and cannot operate their own theatre lists/clinics would be nice. If he doesn’t need exams/publications/courses etc to do this then we need to reevaluate the whole system surely?
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Outrageous/criminal that a PA can be performing surgery independently with their own assistant - no surgical exams or bottlenecks again
Again. If a PA is being allowed this, why are doctors made to jump through numerous hoops/courses and exams?!
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@cannula_service
I’ve been told that PAs are doing tonsils and grommet lists in Plymouth for years now 😬 not sure which patient would agree to that!
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Not asking to remove the role. Just to regulate it and create national guidance. It shouldn’t be up to local trusts to decide how far they can go.
Also I think it’s important to ask what will the difference be between doctors and PAs once they are able to prescribe/order scans?
No matter what your stance is on PAs, the NHS is not just going to get rid of the role.
I’ve described an example of what I experienced a good use of the role was and received backlash.
Either you can get angry and create divide, or you find a way to make it work for everyone.
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@drkeithsiau
@ExplosiveEnema2
@RCHTWeCare
@FPARCP
@BritSocGastro
@UKGastroDr
@parthaskar
@DrAsifQasim
@DrLKVaughan
@DrSteveTaylor
@AlisonGeorge10
@Dr_Done_
@Doctors_Vote
Funny that in your time when training I’m sure you didn’t have to fight with non-doctors to get endoscopy lists. Ladder pulling at its finest. If there was a lack of doctors who wanted to up skill then I’d get it. But that’s not the case at all.
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Consultant pay now is equivalent to SHO pay from the past!
Regrettably I will be striking from 0700... in real terms, I earn roughly the same - after 18 years as a consultant - as I did towards end of Registrar training (Band 2A/sometimes Band 3 rotas). Newly appointed consultants on equivalent of not much more than I had as Yr 5 SHO.
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We also need to train on the more simple cases so we can identify the complex ones
I am increasingly hearing rhetoric from politicians and NHS managers about the need to remove “simpler patients” from doctors; thereby allowing them to focus on “complex patients”. But for doctors, seeing an unending stream of complex patients is professionally very challenging.
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Another British doctor lost - wish him all the best!
If we don’t fix our nhs this will only continue and I don’t blame them at all
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This doesn’t even take into consideration the fact that the doctors have done 5-6 year of medical school + additional degrees, been moved all over the country and been a doctor for over 4 years prior to having these responsibilities that PAs are being given.
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This post is indistinguishable from a doctors post. Either you need med school or you don’t. Can’t have it both ways.
I have looked at this job plan
And I am sorry - but the leadership
@NHSE_WTE
@PrimaryCareNHS
have lost control over issues around competence in the zeal to tackle GP ‘gaps’/ locums
Please stop
‘Associate Physician’
This is not a typo
It’s deception
@rcgp
start calling it out
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@uroCESR
Then why are they on the reg rota? Tbh even SHO rota/oncall isn’t what they’re there for. They aren’t meant to be taking referrals are they?
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Imagine the competition if they said you can have a paediatric surgical job in St Mary’s imperial where you have clinics/theatre - this is better than the london core training jobs 😂 the whole thing is a joke. Not to mention they would be paid more!!
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Not replacing doctors eh? Not taking away opportunities from trainees. Not working independently.. hmm
I have heard of a NW Gastro dept that has a PA who is:
JAG certified in OGD, providing independent lists incl. 2WW
Does 2 clinics/wk
On the in-reach rota
Answers GP A & G requests
Works autonomously under “indirect supervision” of a
Consultant Gastroenterologist
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@Anniedroid_
They don’t just comment on every war. Only when it’s related to its members. Theres been an unprecedented number of medical and humanitarian staff murdered in Gaza - there’s many convoys from the UK that go there to help and hence why it’s spoken about. Important imo
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@iDrSunny
When you mention independent operating multiple times you know it’s someone who shouldn’t be operating independently 😬
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@iDrSunny
@UHP_NHS
@gmcuk
@CQCProf
@RCPhysicians
So GMC and NHSE have said PAs are to be regulated by the individual NHS Trusts - the NHS trust has not a single document outlining what this group of healthcare staff can (and more importantly can’t) do?!
National scandal
@wesstreeting
good luck
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How has it been 8 months and he still doesn’t understand the
@BMA_JuniorDocs
@TheBMA
position?? We aren’t asking for 35% all this year - we are asking for a multi year deal to restore the pay that’s been lost.
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@profjimspeaks
@Dr__Sarmy
This is awful. You behaved in such an awful way that people remember it years later and confront you with it - only for you to say you don’t even remember.
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@iDrSunny
They’ve been sold down the river - the project was always about replacing doctors with ‘cheaper and less skilled workers’ but it has been more expensive as they have a higher base rate pay than many doctors 🫠
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GPs will be used for “indirect supervision”, ordering scans and writing prescriptions. Oh and taking the blame for mistakes as they should have been supervising 🤷🏻♂️
The lack of insight is truly scary.
How many non GPs would it take to replace 3 GPs and deliver the same patient outcomes and care.
According to Timmy here its 3...
So why do we need GPs at all?
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@ollieburtonmed
If there’s no difference then let anyone operate 🤷🏻♂️ why do we have one set of rules for doctors and another for AHPs.
One has to sit exams/rotational training/tough interview process/foundation/core/specialty training and more exams + courses.
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@implausibleblog
First 3mins weren’t bad from an NHS point of view - reduce tax for doctors, pay off student debt and talk about paying staff more to retain them.
Probably the most sensible on the nhs staffing crisis I’ve heard from a politician.
Everything else was disgraceful as expected 😂
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2 years in the making but finally published some original research in Clinical Otolaryngology. Looking at head and neck cancer and the need for more localised triaging systems. We looked at the 3 most common systems used.
#cancer
#headandneck
#ent
#otolaryngology
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@ClareGerada
Really poor take on this. Look at the cancer diagnostic/treatment/wait times in the last 10 years - the results are horrendous. To blame the strikes is a joke. The fault lies squarely on the government who has wrecked the nhs
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Exam prices increased in line with inflation.. if only junior doctor salaries would also increase by inflation. Just keeps getting worse.
The Federation of Royal Colleges of Physicians of the UK has announced a change to the fees for the MRCP(UK) Part 1 and Part 2 exams.
Read the full news item here >
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@TheSalariedPA
This is what doctors were sold but the sad reality is in practice we aren’t seeing this. Many PAs being trained over rotating staff to make life easy for the department etc
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Like we’ve been saying - non clinical staff and management will substitute doctors with PAs.
And now it’s happening
Patient: I would like to see a doctor please
Appointment given with a PA
Patient: this is with a PA, could I have it with my GP please?
Receptionist: ‘they are doctors… they do the same thing’
Other patients also completely unaware
This is a huge problem.
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@DecentraliseP
@SkyNews
The fact that hand hygiene is almost unheard of in the UK. Majority of people don’t wash their hands after using the bathroom 🤷🏻♂️
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What was the point of the meeting. Why can’t they be transparent?? If they’ve accepted loads of money from the government to roll out PAs just say so.. why is it all so shady
Ex RCP bod. "We are legally obliged to not pause"
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@tb_doc
They’re smarter than that Dw. We work the majority of the hours “off site” so they’ll only include a few hours of work on the official system as a generic average. That way it’s compliant 🤷🏻♂️
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They don’t represent you. They represent your supervisors - The people in charge of defining scope.
This is very welcomed by all doctors.
Not sure where the gmc/nhse/rcp have been for the last 20 years.
You do not represent us.
Why are you writing guidance for PAs.
You have consistently belittled, undermined, disrespected, and advocated for the eradication of our profession.
Now, you draft guidance for us, still diminishing our role by referring to us as assistants.
Grow⬆️
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The far right complain about Muslims not integrating.. then a Muslim candidate wins a mayoral election through a democratic vote and they’re still not happy.
Is the message then to Integrate but not too much?
🤷🏻♂️
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@sk_weeks
Not saying they’re unable to. I’m saying priority should be given to train doctors to do it.
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