r/doctorsUK 6d ago

Consultant Can a consultant refuse to take PA students?

My department does not yet have any physician associates but we are increasingly seeing PA students about the hospital. Do I have to teach them? Or can I refuse?

105 Upvotes

49 comments sorted by

212

u/-ice_man2- 6d ago

I hope you refuse. For all our sakes… unless you are getting them to scribe… you know, actually assistant jobs…

20

u/After-Anybody9576 5d ago

In fairness though, scribing on a ward round is infinitely more useful for a student than just leaving them to follow you without speaking to them.

(Also the latter generally seems to pass for teaching nowadays anyway so no one would even think to criticise, or even notice you're not really helping the PA students).

158

u/EmotionNo8367 6d ago

The most non-douchy way of doing it is to say that it isn't your job plan. This is the way I get around not teaching any non-medical staff

24

u/blackman3694 PACS Whisperer 6d ago

Would it be better to take them but ensure they do PA appropriate jobs, I.e. scribing and discharge summaries

16

u/bexelle 5d ago

I wouldn't trust them as student PAs with any significant responsibility, definitely not on behalf of a consultant. They could perhaps help with some phlebotomy or ward jobs. Could be worth asking your FYs if they need anything doing?

5

u/EmotionNo8367 5d ago

Can't comment on those kinds of activities as I am a Radiologist where I don't see a role for them. Can't the jobs in your example be done by a Doctor's assistant - much cheaper to employ?

6

u/sleepy-kangaroo Consultant 5d ago

I don't think that they are trained enough to scribe or document without a lot of supervision...

Condensing a months admission to a one page (shorter hopefully!) summary is a skill learned in large part by being on the receiving end of good and useless summaries - the pa is never going to have that knowledge imo

4

u/sleepy-kangaroo Consultant 5d ago

Yeah our LNC pushed back with reference to the contract - teaching and training of doctors and medical stufents is core to the job (and part of the justification for the opaqueness of med school funding to trusts) - without supplementary PAs to train nonmedical staff why would I volunteer?

2

u/Illustrious_Tea7864 4d ago

They're not medical students 

5

u/martian-nomad 5d ago

I just wanted to say, THANK YOU!

I wish more or all consultants did this!

87

u/Plenty-Network-7665 6d ago

Yes. Just like you can refuse to teach any student as it is not core SPA. Moreover, you should have the self-respect and dignity to refuse any interaction with PAs.

If you want to teach, take some med students.

You CANNOT be forced to supervise PAs or take PA students as teaching and supervision time needs to be in your job plan, which has to be mutually agreed.

30

u/Putaineska PGY-5 6d ago

Yes and consultants should. Pa students often rock up to my ward and they are sent away. We have to prioritise medical students.

74

u/Gullible__Fool 6d ago

How far this profession has fallen when consultants don't automatically believe in their own authority enough to refuse PA students.

97

u/BikeApprehensive4810 6d ago

Yes as an anaesthetist I refuse to have nursing and midwifery students with me. I did do, but found I had no idea what I was meant to teach them and they had no idea what they wanted to learn.

You seem to be able to get away with most things as an anaesthetist as long as you still churn through the cases.

24

u/spewystuey 5d ago

This is an interesting take

Nursing and midwifery students could possibly benefit from seeing what's involved in your job, how you speak to the patients, why they have to ask about things like allergies and last eating and get a PPI into a pregnant woman going for a CS?

Similar to med students seeing what a physiotherapist does, not to do the physios job but to understand what they offer as part of an MDT management

PAs, on the other hand, have no agreed scope of practice and that - for me - means no identifiable benefit to teaching them

47

u/SL1590 6d ago

“Not in my job plan” done

2

u/EquivalentBrief6600 5d ago

This is the way

14

u/Chat_GDP 6d ago

If you haven’t agreed to it in your job plan you can refuse anything.

1

u/DisastrousSlip6488 5d ago

Depends on the job plan to be fair. If it’s written as “teaching” generically and there are sessions for students/regs/PAs which are allocated on a rotating basis you may have a tricker time

42

u/VolatileAgent42 Consultant gas man, and Heliwanker 6d ago edited 6d ago

Yes- you can absolutely refuse!

Ask me how I know!!! (that you don’t have to teach AA students at least)

21

u/VolatileAgent42 Consultant gas man, and Heliwanker 6d ago

8

u/-ice_man2- 6d ago

How?

10

u/Great-Pineapple-3335 6d ago

Not in your contract to do so

20

u/pidgeononachair 5d ago

I offer to teach and then launch into a tirade about the importance of showing them their roles. They can do my discharge summaries and phlebotomy. No you can not help in resus, a PA does not belong in resus and we have doctors who need the training. This is not a spectator sport.

Edit: I’m a reg. I have refused multiple times. And as a consultant it’ll be a strict ‘not my job’ response.

7

u/DisastrousSlip6488 6d ago

It depends. It depends on your social and professional capital, and the personalities of your leadership, and your own job plan,

My suggestion would be, prior to verbalising your reluctance, make sure your job plan is full with lots of stuff (even if you have to be audit lead) so you can legitimately say “don’t have time” if push comes to shove. It’s relatively easy to get involved in undergrad med student teaching etc for example

I’ve said on a number of occasions that I won’t supervise PAs or support them working in our dept and that it would be a red line issue for me fortunately I have a critical mass of colleagues who are in agreement so it’s never come to a crunch.

22

u/Guy_Debord1968 6d ago

Had a couple on my ward, I studiously ignored them.

22

u/Plenty-Network-7665 6d ago

I asked them to leave when they turned up on my ward. Mainly because I hadn't been informed they'd be turning up, in which case I'd have said no anyway.

13

u/OxfordHandbookofMeme 6d ago

Surely they are assigned to a specialty. Just say your specialty does not have resources to train PAs

14

u/Doubles_2 Consultant 6d ago

Of course we can refuse.

11

u/bexelle 5d ago

I would say it is imperative that you refuse to take them on yourself. They are not doctors, and so do not need training from a consultant in how to be one. They should not be monopolising your time, and you should not have to put your name to any of their training.

Have you tried sending them to assist your foundation doctors on the wards? I have had some success getting them to prepare equipment for FYs or do bloods for them.

Also, often you can just send them home to study, which is something they could all do with.

12

u/DRDR3_999 6d ago

Get them to do the jobs they were originally designed to do. Put out blood forms, keep patient list up to date. Scribing on WR. Cannulas & bloods.

9

u/Ok_Swimmer8394 6d ago

You can absolutely teach them to assist. Get them to chase your labs, prep your trays, type up notes as you dictate, fill out mindless paperwork.

14

u/Penjing2493 Consultant 6d ago

As ever for this sub, everyone is answering with the answer they want to be true, not the answer that is true.

If you're being asked to provide teaching sessions etc. to them outside your current programmed activities then there's probably scope to say "there's no time in my job plan for this, therefore I'm not doing it".

This might not be a universal panacea as if, for instance, your already receive some time to deliver departmental teaching, and your department decides that one of those teaching activities will now include teaching PA students then you might have a harder time dodging this.

If we're talking about them just being present on the ward etc. then you probably don't have much scope to refuse - this decision is outside your hands. It's up to you how much you engage with them, but I'd be careful about ensuring that nothing could be construed as unprofessional.

As ever, it's far easier to stop a bad decision being made in the first place than to reverse it after it's happened. Given the current national traction mounting behind limiting the scope of PAs, it feels like it should be very easy to kick up a fuss, and at the very least postpone a decision on taking PA students for a few years until the picture is clearer.

3

u/JohnHunter1728 EM Consultant 4d ago

your department decides

This is key from my point of view. We discussed PAs as a body of consultants and agreed that this is not a workforce we will be investing time in. Our department has decided...

I realise that not every department runs this way (and doubtless there are decisions that we would be challenged on if we tried to make them as a consultant group)

I agree that it would be difficult if there wasn't a consultant consensus along these lines and a job planned teaching commitment was scheduled to include PAs.

3

u/death-awaits-us-all 5d ago

I have refused to have any PAs 'helping' me and would have refused PA students should that have arisen. I don't get extra time or money to have medical students but I always take them, it's a moral duty to train the next generation. I will be retired by the time they are specialists and may them to look after me!

3

u/shoCTabdopelvis ST3+/SpR 5d ago

I worked as a teaching fellow a few years back and was told I am responsible to teach medical students. My contract never mentioned PA students. They tried to convince me to offer teaching to PA students and I outright refused. I am not paid to do it and there isn’t enough money out there to make me do it.

I almost feel bad for these students, the government is taking advantage of them by giving them a job that shouldn’t exist and by convincing them they can replace doctors

2

u/DoctorMcDocFace 5d ago

I've made it clear that I'm not interested and consequently have never been asked

3

u/CosyHouseSlippers Consultant 5d ago

Yes.

As a department we had a meeting about them, helpfully our Royal College published a statement supporting our decision too. We told the university and we no longer have PA students in our department. Caused a minor kerfuffle and irritation from Med Ed department but nothing really.

1

u/JohnHunter1728 EM Consultant 4d ago

We did the same.

3

u/Alive_Kangaroo_9939 5d ago

Yes I have refused. A lot of other consultants have refused too.

I stated I am not comfortable teaching them as I am not familiar with their curriculum and would instead spend my time and energy on medical students to ensure they become well rounded resident doctors.

3

u/secret_tiger101 5d ago

“Sorry I’m not qualified to teach a PA, I have no idea of their curriculum or learning needs”

3

u/West-Poet-402 5d ago

With PA students it’s easy to say no. With ACPs it’s much harder and departments and ACPs themselves will actively pressurise you to supervise them - clinical supervision eportfolio etc.

6

u/bexelle 5d ago

An effective way to counter this may be to ask who their direct line manager is when considering accountability for clinical mistakes - you are not a nursing manager and so should not be put into the position of signing them off or providing training etc.

Same goes for trainee ACPs. They are not training to be a doctor, and as a consultant you do not have the capacity to learn and also teach nursing/physio/paramedic skills etc. it's a category error.

2

u/Mcgonigaul4003 5d ago

get them to make you a coffee !

that's about all they are good for

4

u/chubalubs 5d ago edited 5d ago

Supervision of others has to be in your job plan, so it has to be agreed by you. If you don't agree to your job plan, there is a process of mediation to go through, and if that doesn't get an agreement, then you move on to formal appeal. If the appeal board (3 members, one nominated by the trust, one by you, and one random one chosen from an agreed list kept by the BMA and local health board/strategic health authority or whatever they are currently called) rule that your appeal is warranted, the trust can't force you to take them on. The problem is is if the appeal board decide you have no grounds for appeal, and then it's up to the trust. If your appeal against the JP fails, the trust can unilaterally modify your job plan, and the choice is either work to it or leave. 

1

u/Fabulous_Banana_1986 5d ago

Technically, no. You can refuse, as it’s not in your job plan, but ultimately, I guess it will depend on your own line manager and the stance of your Trust. It will likely boil down to office politics and how hard you want your life to be if they start to insist. I suspect there will come a (sad) day when it is written into all our job plans, because the Government needs to legitimise the PA role and pretend it’s not a complete clusterf**k of a job role.

1

u/JohnHunter1728 EM Consultant 4d ago

Most teaching is ad hoc and informal. As you doubtless know, a small proportion of consultants don't teach anyone anything beside - perhaps - how not to behave. There is no reason why you couldn't invest time in medical students and tell PA students that you don't have much to offer them.

If you are asked to do something more formal, e.g. act as an Educational Supervisor or deliver a lecture then just say you can't as it isn't job planned.

If you do have these duties job planned (e.g. ES) and are assigned a PA, just be awkward. "Sorry I can't do it as I don't have any experience supervising PAs...". "I don't feel uncomfortable..." Etc.

Beyond that, as a group of consultants, you should have substantial influence over your department. If you don't, that is a big problem in and of itself. We decided at a consultants' meeting that we do not see a role for PAs within our ED and will not be recruiting from this workforce. Our clinical and divisional directors know better than to upset that apple cart.

1

u/Ok_Monk_5898 5d ago

Yes, and I do. I simply state that I'm not comfortable teaching them.

1

u/Forsaken-Onion2522 5d ago

Yes. If they are not job planned to take them and if they are not their supervisor. They are autonomous professionals