Wednesday, 25 June 2008

Physician assistants

Apparently American style 'physician assistants' (PAs) are to be introduced to the NHS. This is a rather worrying prospect. A two year course (following a previous degree) and apparently they are ready to do the job of a house officer, senior house officer, or even a registrar (there's a minimum of four years training, for graduate entry to medicine, before becoming a house officer, it makes you wonder why they bother if PAs are so much better) in the primary care and emergency medicine setting (at a rather more generous salary of £39,500 in 2003 compared to an F1 house officer on £21k in 2008*) diagnosing, prescribing, and ordering investigations (although prescriptions or X-rays are supposed to be countersigned by a doctor in the UK at the moment, the experience seems to be that discussion with the doctor are perfunctory at best, and there is likely to be pressure to follow the US model and allow them to prescribe).

Somehow we're supposed to be reassured that a pilot study using US trained PAs (with an average of 11 years experience* as PAs and allied health professionals) found that they worked well. Presumably a study of consultant vascular surgeons would be good evidence for allowing new house officers to carry out AAA repairs unsupervised.

This is absolutely crazy, you cannot create a new paramedical profession de novo and then roll it out across the NHS on the basis of a single study of a highly selected cohort with extensive previous experience. They should at least have evaluated newly qualified US PAs (who, unlike doctors, don't have a probationary year).

Paramedics, nurses, and other allied health professionals jump through a million hoops just to be allowed to do a few extra procedures that doctors can do from day 1. Now we're handing over direct clinical diagnosis and management (and de facto prescribing) to people with minimal knowledge, experience or training. Whatever you think about nurse practitioners, at least they develop their clinical skills in line with their extra responsibilities. The US PAs in this study were a lot closer in experience to UK nurse practitioners than to the newly trained UK PAs that could soon be fucking up our healthcare. Newly qualified junior doctors are scary enough, this is terrifying.

* Hopefully the pay differential is due to the US PAs being highly experienced since otherwise I can see junior doctors going on strike, at this pay rate you could get yourself two newly qualified doctors, or even a single specialist registrar (similar level of training to a GP, likely to have higher qualifications such as membership of the Royal College of Physicians) for this price! According to the Wolverhampton course you can "earn a starting salary of £22,500 - £32,000 at current levels" [my emphasis], brilliant, why go to medical school just to end up earning less and taking legal responsibility for someone else's mistakes, while being told that these people are working at a higher level of competence than you after half the training?


The Shrink said...

Tragically, it is destined to happen. Fortunately, folk are so ruthless in enforcing robust governance frameworks in my corner that it's not going to happen hear.
Hurrah for common sense.

Non-medics undertaking the role of medics? Quack quack. And utter madness.

pj said...

Of course there is a view that the position of the psychiatrist has been relegated to a somewhat peripheral role in the modern CMHT. It certainly seems to be the way Dr Crippen sees it.

Anonymous said...

I'm afraid that is correct where I work.

The psychiatrists refuse even to read our referral letters. They go to some tosser in the CMHT for "triage"


DundeeMedStudent said...

I know it makes me so angry, I battled through a BSc so get into medical school just to be shat upon with all this nonsence, I almost walked out of uni when I saw a PA anaesthetic job advertised at £40- 42 pa! why bother becoming a doctor when I could do an easier job with no actual responsibility and get better wages. Soon the best and the brightest will move on to PA work rather than the grind of medical school which is worrying.

pj said...

Anaesthetics and the proposed surgical PAs scare me even more than the primary care and A&E ones. Sure, it is all easy when it goes right, but who is going to carry the can when it goes wrong? And how much will patient care be compromised? The current rationale appears to be that junior doctors only exist to train to be consultants or GPs, and that all the everyday work of doctors should be done by these super-technicians.

So the logical next step must surely be the whole sale conversion of medical schools to technical colleges where they can churn out these people. Doctors will act much as they do in psychiatry, as titular team heads, carrying liability, and filling out paperwork.