Views And Reviews No Holds Barred

Margaret McCartney: Are physician associates just “doctors on the cheap”?

BMJ 2017; 359 doi: http://www.libreriabv.com/10.1136/bmj.j5022 (Published 20 November 2017) Cite this as: BMJ 2017;359:j5022

“Undergraduate medical education is dead, long live the physician associates” The governing bodies of clinical education cry!

With Jeremy Hunt and the Royal Colleges heralding the creation of Physician Associates (PA) courses at our universities as a positive step in ‘redistributing the workload’1 (or words to that effect) and the research being published that propose that physician associates can provide care to a certain patient population equivalent to that of a GP.2 I have to ask myself, if I was a that 16 years old again, would I even bother applying to and going through the gruelling medical school application process? Really, what is the point? Is the medical profession on life support?

Some may argue that “PAs can’t prescribe or they can request investigations which involve radiation, but a doctor can!” My response to that is “but, for how long?” with the crowds in Whitehall, Lincoln’s Inns Field, Red Lion Square and St Andrew’s Place joining the bandwagon of the PAs if will not before long that those limitations are removed and the PAs will be in full swing.3 Others might proclaim ‘What about performing operations, delivering a general anaesthetic, doctors will still be needed for that?” Alas, that is not the case either, as specialist nurse and advanced care practitioners are already performing many of those tasks (albeit minor cases) up and down the country, with some junior doctors not getting a chance to learn some critical skills, in the not too distant future PAs will also be joining the ranks, conducting those tasks.

So “really what is the point?” is the future doctor a ghostly being that no patients catch a glimpse of? or if they do is it in an out-of-hours setting in an understaffed, poorly performing hospital that the governing NHS authority is in dire needs to populate with staff to keep the wolf like CQC from knocking on the trust’s door? In all honesty no one, not even the powers that be can honestly paint that scene, with spending cuts and staff shortages and the old broken record that is Brexit looming.

Medical schools cannot rest on the laurels and let the ‘new child’ (the PAs) be the shining star. Medical schools now more than ever as well as practising clinicians (with a medical degree) must stand up and be accounted for and promote the fantastic career that is medicine. The second to none education that a medical degree gives you to understand and apply; physiology, pathology and pharmacology. The craftsmanship of being a clinician, a scientist a therapist and technician all in one sitting.

I welcome PAs into our workforce, but medics and medical schools need to wake up and smell the coffee, for our profession to survive we must rebrand, refocus and rejuvenate the role that makes us unique in the ever-expanding multidisciplinary team.

Thoughts from not a militant or mo?t medic but someone who loves his profession.
References:
1. NHS, NPAEP. The National Physician Associate Expansion Programme. http://npaep. com. ?
2. Halter M, Drennan V, Chattopadhyay K, et al. The contribution of physician assistants in primary care: a systematic review. BMC Health Serv Res 2013;359:223. doi:10.1186/ 1472-6963-13-223. pmid:23773235. ?
3. Royal College of Physicians. An employer’s guide to physician associates. Nov2017. http://www.libreriabv.com/file/7623/download?token=4C7OyR_p. ?

Competing interests: No competing interests

28 November 2017
Luke McMenamin
Academic Clinical Fellow in Intensive Care Medicine
St James's University Hospital, Leeds, UK
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