Associate physicians

steddyeddy

Article from the journal.ie. It talks about associate physicians that will aid doctors in diagnosing illnesses and analysing test results. It says these people will have degrees but in what? I would rather be treated by doctors TBH but I think there needs to be some clarification in this story and the roles of these physicians. There seems to be a lot of backlash against these associate physicians calling them wannabee doctors but what actually are they? I actually inquired from a friend who deals with hiring and firing in the hospital who informed me as a biochemist I'd be overqualified. So what qualification is required?

THE Health Service Executive (HSE) has confirmed that Dublin’s Beaumont Hospital is to become the first Irish hospital to employ Physician Associates.
A Physician Associate is a healthcare professional who supports doctors in their diagnosis and management of patients.
They are trained to perform a number of roles including taking medical histories, performing examinations, diagnosing illnesses, analysing test results and developing management plans.
This is all done under the supervision of a doctor.
It’s not a requirement for the associate to have a medical degree, but a basic degree, generally in one of the health sciences is common.
Beaumont Hospital pilot project
The Royal College of Surgeons (RCSI) said the General Surgery Directorate Beaumont Hospital, in collaboration with the RCSI, is seeking to establish a two-year pilot Physician Associate project commencing in July 2015.

The Department of Health officials are currently engaging with the HSE and RCSI in this regard.

Physician Associates are employed in a number of different countries, including the UK.
However, some doctors have not welcomed the introduction of associates in Ireland, with some stating the Ireland has been “crying out” for more funding and more jobs on the ground for doctors and nurses.
One doctor, who wishes to remain anonymous said:

Instead of offering this the HSE has introduced the new job which appears to be another finger in the dam. They are willing to pay them more than a Non Consultant Hospital Doctors (NCHDs) who may be qualified for two years/three years. It begs the question as to why they can’t use that funding for doctor or nurse who have been trained and have appropriate qualifications.

NCHDs have for years been asking for appropriate assignment of tasks in the hospitals. For years qualified doctors have spent hour upon hour paper pushing and doing tasks that nurses or other staff could be trained to do (ecg, phlebotomy, cannulation, form filling).

For these reasons the new post may take pressure off and help the system, said the doctor, but added that at the centre of the argument has to be the patient.

Who will they want to see. Who will they trust?? They deserve a doctor or appropriate trained nurse. They will have to make sure the new post is not used as an alternative to this.

Another doctor said patients will not welcome the new introduction, saying patients want to see a doctor, not a doctor’s assistant who doesn’t hold a medical degree.
The Irish Medical Organisation told TheJournal.ie that it is currently reviewing the announcement of the new roles.

challengemaster

steddyeddy wrote: »

Article from the journal.ie. It talks about associate physicians that will aid doctors in diagnosing illnesses and analysing test results. It says these people will have degrees but in what?

http://www.test.rcsi.ie/course_details

PA's will have a primary degree in the health sciences, or experience in health science sector - and will have completed a postgraduate diploma in physician associate studies (or a MSc in same). It takes 2 years to get the PG.dip, or an extra semester to get the MSc.

I would rather be treated by doctors TBH but I think there needs to be some clarification in this story and the roles of these physicians.

You'll still be treated by actual doctors. Nothing changes regarding prescribing, administering first doses, patient management, or the contribution from intern through to consultant. All this does is create another rung on the bottom of the ladder, and offloads some of the more menial jobs from doctors to PA's - essentially giving doctors more time to do the jobs they should be doing, not filling out paperwork.

Taking histories, performing basic examinations and analysing test results (ie. blood work) are clearly things anyone can be trained to do, but take up quite a lot of time for interns who's time could be put to much better use. Particularly when you have one intern covering an entire department. Diagnosing illnesses is mostly an outcome of these things. So rather than the actual doctor doing the grunt work to diagnose - it's done by a PA, and the doctor ensures it's correct. It's essentially the same redundancy method that already exists in all hospitals - SHO oversee Interns. Reg oversee SHO. SPR oversee Reg. Consultant oversee SPR.

There seems to be a lot of backlash against these associate physicians calling them wannabee doctors but what actually are they?

A nurses role is management and care, a doctors is primary treatment and prescribing. I'd liken the position to "GP of the hospital" - minus the power to actually prescribe anything. The idea being that they speed up the whole process, and if needed the doctors then can ask the more in-depth/specific questions straight away.

I actually inquired from a friend who deals with hiring and firing in the hospital who informed me as a biochemist I'd be overqualified. So what qualification is required?

Well.... As a biochemist with a PhD you're certainly overqualified. Basic health sciences degree is what's required to get into the PG.Dip. You don't need to cover every base from Anatomy, Pharmacology & Physiology, to in depth drugs and disease treatment/interactions - because the PA will never be in a position to prescribe or treat.

https://www.rcsi.ie/physician_associate_apply

Taco Chips

challengemaster wrote: »

http://www.test.rcsi.ie/course_details


You'll still be treated by actual doctors. Nothing changes regarding prescribing, administering first doses, patient management, or the contribution from intern through to consultant. All this does is create another rung on the bottom of the ladder, and offloads some of the more menial jobs from doctors to PA's - essentially giving doctors more time to do the jobs they should be doing, not filling out paperwork.

From my understanding, this is already a role that is very well covered by advanced nurse practitioners. Departments with ANPs will typically have them in the role of ordering bloods, tests, writing charts and covering referrals/discharges. ANPs often work in outpatient clinics seeing routine follow ups under the consultant in conjunction with his team This works well in surgery for example because it free up the NCHDs to get more structured time in theatre. Yes this is creating another rung on the ladder but it's a duplication of a role that is already covered well by skilled ANPs with many years of clinical work and education. I suspect this is because at €45,000 per annum the HSE is trying to save on the cost of employing a well trained ANP with clinical experience.

Taking histories, performing basic examinations and analysing test results (ie. blood work) are clearly things anyone can be trained to do, but take up quite a lot of time for interns who's time could be put to much better use. Particularly when you have one intern covering an entire department. Diagnosing illnesses is mostly an outcome of these things. So rather than the actual doctor doing the grunt work to diagnose - it's done by a PA, and the doctor ensures it's correct. It's essentially the same redundancy method that already exists in all hospitals - SHO oversee Interns. Reg oversee SHO. SPR oversee Reg. Consultant oversee SPR.

This is where I see a problem with a role of the PA. Performing histories and physicals is the bread and butter of a training doctor. It's the foundation upon which medical students, interns, SHOs etc... learn the trade. Why are PAs being introduced with scope of practice in this role when it will directly interfere with important parts of medical training? If this was a position where the administrative aspects of the job that interfere with clinical training were being covered then that would be one thing. It's laughable to think that someone can do a quick 2 year course and perform the role of a junior doctor.

A wider issue is that career structure and medical training in Ireland could do with a serious overhaul. The pathways have been reformed and stream lined in areas like surgery, anaesthetics and EM and this needs to be rolled out across all training schemes. We need more training posts, less time wasted on non clinical, non educational service jobs that only exist to keep the doors of some hospitals open. This is where PAs could be useful but I have misgivings.

I'll be blunt, this strikes me as a total money exercise. HSE make savings by employing less skilled workers at lower wages. RC$I hoovers up tuition fees for another postgraduate course that I'm sure they will create plenty of non EU, full fee paying places for. Who are the ones directly impacted? Patients receiving care from less well trained PAs instead of junior doctors and ANPs. Junior doctor jobs being taken over, no increase in training positions. A lazy way to increase the workforce without implementing the changes that are needed.

Dingle_berry

Taco Chips wrote: »

I'll be blunt, this strikes me as a total money exercise. HSE make savings by employing less skilled workers at lower wages. RC$I hoovers up tuition fees for another postgraduate course that I'm sure they will create plenty of non EU, full fee paying places for. Who are the ones directly impacted? Patients receiving care from less well trained PAs instead of junior doctors and ANPs. Junior doctor jobs being taken over, no increase in training positions. A lazy way to increase the workforce without implementing the changes that are needed.

Couldn't agree more. The HSE already has qualified staff and grades willing to take on these duties, with excess graduates every year. Why not use them instead of creating a whole new profession?

his_dudeness

Taco Chips wrote: »

It's laughable to think that someone can do a quick 2 year course and perform the role of a junior doctor.

Unfortunately, for the amount of actual medicine that the most junior of docs practice, a 2 year course is probably about right.

Initially, I was very sceptical about this role, but there could be some positives. Ideally, the PAs could free up NCHD time to allow for more training. The (i presume) permanancy of this staff grade would allow better planning of the services, and potentially, NCHDs could become surplus to the actual service delivery, allowing them to actually learn and get teaching. However, if the PAs have to turn to a doc every time to duplicate work, then there's no extra benefit to them.

This Q+A on the Lifehacker website gives quite an interesting insight to the role and definitely softened my impression of them.

Taco Chips

his_dudeness wrote: »

Unfortunately, for the amount of actual medicine that the most junior of docs practice, a 2 year course is probably about right.

Initially, I was very sceptical about this role, but there could be some positives. Ideally, the PAs could free up NCHD time to allow for more training. The (i presume) permanancy of this staff grade would allow better planning of the services, and potentially, NCHDs could become surplus to the actual service delivery, allowing them to actually learn and get teaching. However, if the PAs have to turn to a doc every time to duplicate work, then there's no extra benefit to them.

This Q+A on the Lifehacker website gives quite an interesting insight to the role and definitely softened my impression of them.

I'm still not convinced there is a role for them in taking histories and doing physical exams as mentioned in the article. Doing run of the mill clerking and form filling sure but not the rest. In the US medical students are much more involved than they are in Ireland. They would tend to do a lot of the test ordering, blood drawing etc... Why can't that scope be expanded over here?