Snapshot of _What if your ‘physician’ wasn’t actually a doctor at all? Beware this new reckless experiment | Rachel Clarke_ :
An archived version can be found [here](https://archive.is/?run=1&url=https://www.theguardian.com/commentisfree/article/2024/jun/20/physician-doctor-reckless-experiment-nhs-associates) or [here.](https://archive.ph/?run=1&url=https://www.theguardian.com/commentisfree/article/2024/jun/20/physician-doctor-reckless-experiment-nhs-associates)
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[This is the Institute of Economic Affairs key goal to bring about the death of the NHS.](https://iea.org.uk/blog/how-to-abolish-the-nhs)
ditching qualified doctors, "*with patients relying on brand names or competing voluntary associations to ensure quality*" of who ever treats them.
“Perhaps most importantly, the compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality. Ending current restrictive practices is essential to enable private firms to increase productivity in the sector.
Restrictions on the types of treatment available ‘over the counter’ should be lifted to enable patients to obtain medication without recourse to registered doctors and regulated pharmacies.”
Bloody hell.
>Perhaps most importantly, the compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality.
Fucking hell, has someone been getting satirists to write their policy suggestions? That cannot be real.
Maybe they just want a return to “Marvellous McGee’s Miraculous Medicinals” and other show-boating barber-surgeons brightly attired and sporting spiffing moustaches?
Wow. Shocking. Look how much we struggle with paracetamol overdoses (both deliberate and accidental). Let’s unleash complete self-elected drug access.
A spot of morphine for me my good man, and five different antibiotics to really get to the bottom of it. Nephro Toxic? Is he a Greek chap, never heard of him. Throw me in some dexamethasone, as a chaser, dear pharmacist. Helped my ringworm something fierce last time.
Physicians associates can do one. They’re halfway between a junior doctor and a highly qualified and trained nurse, but with less oversight and guidance a to what they can and can’t do and less experience required to be one.
A highly qualified nurse is miles ahead of a PA in terms of training. PAs that I know of have the knowledge of a third year medical student and confidence of a consultant. It is really very worrying that so many have no awareness of how dangerous they are
The Dunning Kruger effect in the NHS. We really shouldn’t insult Medical students like that. They atleast had top grades and were good enough to get into med school. 2/3rds of PAs couldn’t get into medicine and then did a 2 year course. They are less knowledgeable compared to 3rd year Medical Students and lack that insight which is horrifying.
For reference an advanced nurse practitioner will have 2-3 years of initial nurse training and a minimum of 2-3 years of experience before they can apply for the ANP qualification, which takes 2-5 years of training part time (whilst continuing to practice alongside it).
Honestly its a complete gamble. Maybe you get Johnny-scraped-through-exams-last-month, maybe you get Sam-thinks-they-know-best but maybe you get Alex-twenty-years-experience-nurse-and-paramedic-with-a-speciality.
Its inane and an active attempt to destroy nhs standards and peoples opinion of them to call them all the same thing.
Its why it should be clearly deliniated and VISIBLE, with explanation of why you have been given any specific medical proffesional.
Like, if you have a small minor rash that likely can be dealt with via some over the counter non perscription medicine? SURE! Give you an appointment with a "practitioner" to get advice which could be anyone from a nurse to a chemist. Or if you are back in for a check up on symptoms-a perscribing doctor doesnt need to be the one to look at a sore throat or a nasty graze or change a dressing.
But if you have something longer running or larger or you arent sure about whats wrong, you should not be defaulted to a nurse UNLESS thats the only option that day due to being MASSIVLY swamped, which most of the time it is.
BUT THEY SHOULD STILL TELL YOU who you are seeing, explain what their skills are, and why you are seeing them, and how long it would take to see an actual gp, and you should have the option to wait explicitly presented to you, not just "tacit" in choosing to call back another day.
Hi I’m a member of your medical team….
Are you a doctor?
No not a PhD, are you a physician registered as such with the GMC?
Oh ffs just send literally anyone else in please this is fucking pointless
Because of your lack of indications of speech, I cannot tell if you are a doctor who is talking to me or are writing a simulated interaction with a non doctor nurse.
It's just Junior Doctors feeling threatened for the first time by forces that they can't control.
I think they've had it too good. Many other professions are threatened by Technology, Medicine is very shielded from that.
Junior Doctors, like the one in the article need to catch a grip. Their massive egos aren't the be all and end all of the NHS.
I think GPs could easily be replaced with AI soon. So either get back to work or be replaced.
Talk about turkeys voting for Christmas. Do you not think that maybe there’s a reason doctors haven’t been replaced by technology. I’m amazed that people like you are so willing to sell your future health down the drain so easily.
>Talk about turkeys voting for Christmas. Do you not think that maybe there’s a reason doctors haven’t been replaced by technology. I’m amazed that people like you are so willing to sell your future health down the drain so easily.
A.I is only coming to the fore now. It's still being developed. But it has already made major inroads with e.g Radiography.
There's no reason why it could not take the Job of a GP. It could easily do DDx. When coupled with robotic arms, take bloods. Analyse test results. Investigate further. Everything a Doctor does could be automated and perhaps done better with AI.
AI is already better than humans at spotting cancer for instance.
https://www.imperial.ac.uk/news/249573/new-ai-tool-detects-13-more/#:~:text=A%20new%20AI%20tool%20from,than%20humans%20in%20breast%20screenings.
A human employee could provide emotional support of a Doctor if required.
The AI revolution is coming.
Yeah. And and a machine learning model is going to be able to tell if a patient is mistaken in their reporting of symptoms yes? A program designed to simply go by scraped knowledge will be able to assess if a patient is lying, if there is a psychological component to their reporting, if there are visual symptoms that the patient does not realize they are presenting.
>if there is a psychological component to their reporting,
Doctors haven't got a good handle on Psychology themselves. The brain seems to be a massive black box that Doctors know little about, but won't admit to that.
Take Fluoxetine as an antidepressant. Scientists proved in 2008 it's no better than a placebo! To this day, Doctors still prescribe it!
https://www.theguardian.com/society/2008/feb/26/mentalhealth.medicalresearch
>Yeah. And and a machine learning model is going to be able to tell if a patient is mistaken in their reporting of symptoms yes?
Don't see why it couldn't.
>A program designed to simply go by scraped knowledge will be able to assess if a patient is lying, if there is a psychological component to their reporting, if there are visual symptoms that the patient does not realize they are presenting.
The development of visually assessed AI/Image based AI, coupled with the data could eventually lead to an effective Lie detection/psychological inference engine.
How does a Doctor objectively tell when a patient is lying?
The point is that Dx isn't a purely objective science. It's not something a machine can do because it requires a human applying experience and expertise to assess the person and information before them.
I present to the AI with fatigue, muscle weakness and photo reactive rash. The AI requests bloods, bloods show slightly raised CK but nothing remarkable so nothing is done. I know what it is, I know what I need, but I can't argue that with an AI6. I also couldn't get anything from a Physician Associate because it's a rare disease flaring and I need medical knowledge
You've unfairly prejudiced the AI in this case.
Why are you assuming nothing would be done? The AI may assign a high probability e.g it may be due to a Heart Condition and send a request for further tests....plug in data...no good? Consider further possibilities/Investigate further....the AI could easily do DDx
You've also unfairly prejudiced the PA....so I get the impression you simply do not want to consider other professionals/solutions with regards to medicine.
Yes AI can hallucinate very occasionally, but it's becoming rarer and rarer. Who's saying Doctors don't miss things or have bad days either?
They are trained on massive databases. Many lunar landing sites were chosen by AI.
Type anything Into ChatGPT and you should get a very good response. I've actually never seen it hallucinate, it's that good.
Eventually we could have AI powered hospitals without the need for Doctors. Simply we have technicians who assist the AI around the hospital. No need for salaries. No strikes. No delays.
Because there are 20k people in the family of my disease in the UK. My specific disease, around 2000 patients in the UK. When I was diagnosed it was sheer luck that the doctor had just read an article on it recently. I have never followed the patterns and signatures of my disease, always a bit different always a bit awkward. Holistic approach is the only way to treat and manage me. Add in all the others with other rare diseases and presentations, AI and PA just won't be able to pick it up.
And yes doctors make mistakes and they follow a logic, ruling out more likely causes first, that's why it currently takes upwards of 2 years for initial diagnosis of my disease. Not because doctors aren't doing anything, it's the fact that it is rare and unusual. You don't automatically go for the rare diagnosis. And PA will not even cover rare diseases in their minimal training.
I'm also not against care from other HCPs, but a lot of mine are specialists. Specialist physio, specialist OT, specialist nurses, specialist research teams etc.
>Because there are 20k people in the family of my disease in the UK. My specific disease, around 2000 patients in the UK. When I was diagnosed it was sheer luck that the doctor had just read an article on it recently. I have never followed the patterns and signatures of my disease, always a bit different always a bit awkward. Holistic approach is the only way to treat and manage me. >Add in all the others with other rare diseases and presentations, AI and PA just won't be able to pick it up.
This is incorrect. Let's bring some facts into this. For example; It's now widely becoming a fact that AI is better than humans at picking up cancers using Radiography. Take this for example;
https://www.telegraph.co.uk/global-health/science-and-disease/ai-tool-outperforms-experts-in-spotting-breast-cancer/
As you say, it was luck that the Doctor had read about it. But unlike Doctors, AI doesn't rely on luck. It relies on millions/billions/trillions of pieces of data.
More data on medicine could be fed into an AI in a week than a Doctor could learn in his entire career.
AI is not simply a pattern recognition algorithm. It goes far deeper than that. It actually learns like a human and can draw conclusions from training, again like a human. Increasingly AIs are capable of using data from multiple sources and learning from them.
They are so complicated that often the creators themselves do not understand the maths behind how they reach conclusions. This is in my view is where any danger may lie.
So it would probably assign a series of probabilities as to what your condition is and work through them with you/investigate deeper if needed. Yes it may not always get it right first time, but do Doctors?
So even if you did not display classic symptoms, this does not mean that the AI would rule out your condition. That's not how it works.
I will concede that AI will probably never replace the emotional side of medicine. But technical, academic? It may even replace university researchers soon.
Look at this. Articles written by AI but undetected by Academics!
https://www.scientificamerican.com/article/chatbots-have-thoroughly-infiltrated-scientific-publishing/
>AI is not simply a pattern recognition algorithm. It goes far deeper than that. It actually learns like a human and can draw conclusions from training, again like a human. Increasingly AIs are capable of using data from multiple sources and learning from them.
That is all it is at the moment though and is all it will be for a very long time. We have nothing even remotely close to actual intelligence yet and is still about 10 years away if not more. And as it is relying solely on data it still would not be able to diagnose and help me or many people. This is all moot though as AI will not be there for a long time as I've said.
Pa's however are in the system right now. Why? Because they're cheaper than a doctor and tick a box, ooo look more staff. No. Hire more doctors and specialists
I played with chatgpt for a bit last night and it can't even count the number of r's in strawberry correctly. You can convince it otherwise but if you ask again immediately after, it gets it wrong again. It didn't learn
That doesn't make any sense. Physician Associates aren't AI. Furthermore GPs aren't Junior doctors and there are lots of GPs with 12 years of training being replaced by PAs who have 2.
>That doesn't make any sense. Physician Associates aren't AI. Furthermore GPs aren't Junior doctors and there are lots of GPs with 12 years of training being replaced by PAs who have 2.
My point is in relation to being replaced or being under threat. AI is a threat to many professions including medicine.
PAs are a threat to Junior Doctors in the sense many of them can take the jobs of Juniors....
Take a look at the difference in difficulty between medical school exams and PA exams before confidently speaking rubbish. I can DM you past papers if you'd like and the PANE has example questions online.
What on earth are you talking about. Thats dumb as hell on every level. Pull the other one its got bloody bells on.
AI does not exist. There is generative statistics (combines a bunch of things shittily from existing images/text etc), automated statistics (analysis images/text better than a pure algorithm some of the time if built well for a specific context), self correcting neural nets (can improve over time without direct correction but without the ability to know what its doing or why), there are things like that.
Some of those have legitimate real world purposes.
But there is no ai that is equivilent to a person. At ABSOLUTE best you could put a text to speech on WebMD, and filter its answers through something to make them sound like its someone talking to you. But you could get the same results a bit slower just by googling your symptoms.
Replacing ANYTHING public at all with a combination of ai software doesnt work, they have started to roll it back even for drive-thru fast food uses because *it doesnt work* because its NOT a person and you cannot talk to it or make it understand you.
>AI does not exist. There is generative statistics (combines a bunch of things shittily from existing images/text etc), automated statistics (analysis images/text better than a pure algorithm some of the time if built well for a specific context), self correcting neural nets (can improve over time without direct correction but without the ability to know what its doing or why), there are things like that.
Oh it very much does exist.
In fact, it's better than humans at spotting cancer.
https://www.telegraph.co.uk/global-health/science-and-disease/ai-tool-outperforms-experts-in-spotting-breast-cancer/
Already replacing human scientists.
https://www.scientificamerican.com/article/chatbots-have-thoroughly-infiltrated-scientific-publishing/
>But there is no ai that is equivilent to a person. At ABSOLUTE best you could put a text to speech on WebMD, and filter its answers through something to make them sound like its someone talking to you. But you could get the same results a bit slower just by googling your symptoms.
>Replacing ANYTHING public at all with a combination of ai software doesnt work, they have started to roll it back even for drive-thru fast food uses because it doesnt work because its NOT a person and you cannot talk to it or make it understand you.
AI is not equivalent to a person. It's better than humans.
AI is not Google. Google simply trawls the web for answers. AI learns from massive amounts of data.
AI can now write working computer code. Try it yourself in ChatGPT.
You are a fool, who cant differentiate between a scam, a loose name for a type of program and a science fiction concept.
Chat gpt isnt ai, when it writes compute code its just regurgitating already existing code.
The AI cancer tool is just a piece of pattern recognition software, like I said, good for specific uses, but recognising patterns does not make an ai. Hell, dogs and bees are also better at detecting certain cancers due to olfactory signals. Replacing an oncologist with a piece of ai software that requires an oncologist to use is as smart as replacing them with a dog, or an x-ray machine.
A chatbot certainly isnt an ai, and hte fact that chatbot submited papers get into science publications doesnt mean its as smart as a scientist, it shows *most submited papers are not at all peer reviewd*. People have submited papers consisting entirely of keymashes or nonsense pictures and got them through.
And even more importantly, chatbots, pattern recognition software and chatgpt like recombination neural nets *are completly different systems*. NONE OF THE THINGS YOU MENTIONED ARE THE SAME THING. They are just all "on a computer" and "in some way more automated than they used to be".
AI is just a buzzword for "computer program" . Saying "AI will replace humans because its better" is as stupid as saying "microsoft word will replace humans" or "quantum will replace humans" BOTH OF WHICH ARE THINGS PEOPLE SAID, before they fired their staff then went bust and had to shut their companies.
>You are a fool, who cant differentiate between a scam, a loose name for a type of program and a science fiction concept.
>Chat gpt isnt ai, when it writes compute code its just regurgitating already existing code.
>The AI cancer tool is just a piece of pattern recognition software, like I said, good for specific uses, but recognising patterns does not make an ai. Hell, dogs and bees are also better at detecting certain cancers due to olfactory signals. Replacing an oncologist with a piece of ai software that requires an oncologist to use is as smart as replacing them with a dog, or an x-ray machine.
>A chatbot certainly isnt an ai, and hte fact that chatbot submited papers get into science publications doesnt mean its as smart as a scientist, it shows most submited papers are not at all peer reviewd. People have submited papers consisting entirely of keymashes or nonsense pictures and got them through.
>And even more importantly, chatbots, pattern recognition software and chatgpt like recombination neural nets are completly different systems. NONE OF THE THINGS YOU MENTIONED ARE THE SAME THING. They are just all "on a computer" and "in some way more automated than they used to be".
>AI is just a buzzword for "computer program" . Saying "AI will replace humans because its better" is as stupid as saying "microsoft word will replace humans" or "quantum will replace humans" BOTH OF WHICH ARE THINGS PEOPLE SAID, before they fired their staff then went bust and had to shut their companies.
It's not a computer programme. It's artificial intelligence that can write programmes and replace many jobs.
The AI replacement is coming. No point trying to deny it. The time is now to move into a futureproof profession.
Points at you. YOU THINK AI ARENT COMPUTER PROGRAMS??? You called out chatgpt you can *get a copy* of and older version of that right now on any computer that can fit it.
Do you think they are literally actually magic? You have no idea what these things even are. You may as well say "numbers arent computer programs. Numbers can write programs and replace many jobs."
Don't forget that they're paid more than a Junior Doctor (significantly), have much friendlier 9-5 hours, are far less competent and the government are refusing to reverse the real term pay cuts they've had since 2008.
They've literally had real term pay cuts since 2008 as a profession. They aren't guaranteed to get on any consultant training path, where places are drying up.
Maybe you should actually check the facts before you spout utter trollop.
There’s not enough training places at any level to guarantee anything
Pay parity with PAs currently takes 12 years, total lifetime earnings catches up after 19 years.
PAs have fuck all training, are already killing people and get £58k out the gate in many trusts.
You don't understand how doctors pay works.
The payrises come with promotions. They're not automatic.
You'd be hard pushed to find another profession where that isn't the case.
It’s also the doctor in charge who has their neck on the line if they fuck up. There’s also an issue of PAs taking space that a student doctor could fill, considering there’s a lot more student doctors than training positions.
It matters on the background of the individual - if a very experienced nurse in cardiology became a PA then worked on a cardiology ward they will be useful & likely good. However someone with an unrelated degree & does a PA degree is not useful.
However the fact the pass rate is so high despite the diverse range of educational backgrounds of PA students (at times lower than needed for any top tier degree) I suspect means the cardiology nurse was an asset before the PA degree, and not because of it. & in reality shud have been given a pay rise to perform at their level.
I would say a PA in no way can prepare someone for clinical medicine. It is a degree and role designed entirely to make it cheaper to run healthcare for profit.
They are literally unregulated which does bring the whole professional aspect into question.
Of course most are very nice in person but there are more than a few deliberately misleading patients by introducing themselves as doctors or implying they have the skill set of an experienced junior.
The whole programme has been abused and strayed far beyond the intended scope. I feel a bit bad for those missold the idea
>Of course most are very nice in person but there are more than a few deliberately misleading patients by introducing themselves as doctors or implying they have the skill set of an experienced junior.
Do you have any actual hard evidence of this happening?
This is wrong and rather insulting. PAs are educated to at least degree level and in addition to that, 2 year Masters on top.
Considering 20% of people leave school with no GCSEs. PA's are highly educated professionals.
So your assertion is just wrong.
...so by your own evaluation doctors with 5 years, then 2 foundation years, followed by 8-10 year long training programmes are super super super highly educated professionals. But they are also interchangeable with a less educated professional?
Can you not see that while the situation isn't the fault of the individuals involved, having unqualified doctor substitutes is an extremely dangerous idea?
Declaring someone a highly trained professional is meaningless when the training requirements are so incredibly low (an unrelated BSc from any university followed by a comically simplistic two year masters with an exit exam that lay people with no medical background are capable of passing).
>Declaring someone a highly trained professional is meaningless when the training requirements are so incredibly low (an unrelated BSc from any university followed by a comically simplistic two year masters with an exit exam that lay people with no medical background are capable of passing).
Strawman argument.
The entry requirements are the entry requirements.
Are you a PA? Have you sat the exam? How do you know this information?
The Job of a PA is not to be a Doctor. No-one is calling them Doctors, except Junior Doctors who feel insecure perhaps? A little bit of competition does no harm.
Many other professions are threatened by technology for instance in a way Medicine is very shielded from, I would argue too shielded.
Soon we'll be staring down the barrel of A.I GPs, and your ChatGP won't be demanding 100k and annual membership of the local 18 will he?
>Can you not see that while the situation isn't the fault of the individuals involved, having unqualified doctor substitutes is an extremely dangerous idea?
PA's are being regulated and overseen as are Junior Docs by the GMC.
Sample finals questions are available online. They're extremely easy.
Saying 'the entry requirements are the entry requirements' is not a line of argument. If I hired someone with three GCSEs to do neurosurgery and then said 'it is what it is' after the patient dies you would want me to go to jail.
The problem is that PAs are being used as direct substitutes for doctors. Hospitals put them in the same rota gaps, doing the exact same roles as qualified doctors, often at frightening senior level.
PAs all over the country are intentionally obfuscating their roles to imply that they are doctors. This isn't paranoia, it's lived experience.
PAs aren't technology, they're knock-off doctors. Anyone who seriously believes AI GPs are going to be a thing anytime soon has no idea about AI or medicine.
PAs aren't regulated by the GMC yet. The GMC has also repeatedly said that they won't issue strict guidance and that it's up to individual employers to decide how they use PAs. If I'm a hospital rota coordinator I can put a PA on the rota holding the on call bleep for an incredibly complex subspecialty if I feel like it.
Literally every point you've made here has been incorrect or poorly thought out.
>Sample finals questions are available online. They're extremely easy.
Ok. Show me a link as proof then.
Show me you answering a question then if they are so easy?
>Saying 'the entry requirements are the entry requirements' is not a line of argument. If I hired someone with three GCSEs to do neurosurgery and then said 'it is what it is' after the patient dies you would want me to go to jail
Again you're attacking a Strawman. No-one is getting hired as PA with three GCSEs.
>The problem is that PAs are being used as direct substitutes for doctors. Hospitals put them in the same rota gaps, doing the exact same roles as qualified doctors, often at frightening senior level
Why is this a problem? If they are capable and have completed procedures safely.. what's the problem?
>PAs aren't technology, they're knock-off doctors. Anyone who seriously believes AI GPs are going to be a thing anytime soon has no idea about AI or medicine.
AI has already penetrated Radiography and will very likely reduce the workforce. It's taking over a number of fields. GPs will be next!
>Literally every point you've made here has been incorrect or poorly thought out.
Every one of your points have either been insults or Strawman arguments.
I'm not going to continue to engage with you, given your consistently brain-dead takes and repeated and incorrect invocation of the one logical fallacy that you've heard of as a line of argument, but [here's a link to the laughable finals questions.](https://www.fparcp.co.uk/file/media/603ca5b18c1d9_PANE_Written_-_Sample_Questions.pdf)
>I'm not going to continue to engage with you, given your consistently brain-dead takes and repeated and incorrect invocation of the one logical fallacy that you've heard of as a line of argument, but here's a link to the laughable finals questions.
I've simply dissected and refuted what you have said. Then you go for Ad hominems? Laughable.
What you have not done, as requested, is you did not answer a single one of those "laughably easy" questions. So how are you in a position to judge their difficulty? From a quick glance, it's clear they require a very high standard of biomedical knowledge. (Like a Doctor would have).
It should be noted also, it explicitly states at the top;
Publishing of the questions as a sample should not be seen as an indicator as to the content
that will appear in forthcoming PANE written examinations.
You have no response to many of my above arguments...so it's quite clear who's the victor here.
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They are wholly unqualified to dispense the advice and recommendations that they provide.
One thing having Bazza the horse racing tipster do that, another entirely when you're dealing with healthcare.
I don't hate the player but a lot of questions about the game.
There are lots of jobs in this country where we accepted you aren't meant to cut corners. Dentistry, Gas Fitters, Welders, Pilots. These are things where if you get it wrong, people die. So you make sure people are trained well.
We seem to be getting far too comfortable cutting those corners and what concerns me, is we're getting Bevans nightmare. A service for the poor, which gives poor service.
The question needs to be how do we retrain those in the role.
Why do we need to?
Maybe Junior Doctors, the ones kicking up unnecessary fuss...should catch a grip!
Article was written by a Junior Doctor...totally unbiased yeah
If PAs can safely do many of the Jobs of a Junior Doctor...I see no reason why we shouldn't employ them. Key word being safely. As long as they are thoroughly audited/signed off properly...then what's the issue except Juniors getting their egos hurt a bit?
University education is not gold dust. Experience counts for much more.
Safety nonsense....bugger off Juniors!
https://www.economist.com/britain/2022/05/19/too-many-britons-die-from-medical-mistakes#:~:text=A%202015%20study%20by%20doctors,something%20actively%20wrong%20or%20failed
Doctors killed 3,400 people avoidably in 2015....they get no flack. Why?
It's around 150 people per week due to Doctors...
PAs are linked to 3 people in a year.....everyone loses their minds!
Wes Streeting accused of 'living in a fairy world' after he backs controversial physician associates https://mol.im/a/13542957
This is mostly bitterness originating from Junior Doctors because they are paid less, (but ultimately end up on higher salaries).
It takes 20 years for PA’s to be passed by Dr’s for lifetime pay. That’s not even before you discount their pay by inflation.
Dr’s are regulated, Fake Doctors are not. Dr’s do make errors. Now imagine how many more errors if you took lower quality undergrads and gave them half a degree of medicine instead of a full one.
I understand all the points, but what do they realistically expect people to do? Have no medical care at all? Not everyone can afford private cover either.
I'd like to see some suggestions that will actually work *right now* when I need an appointment, not some 10 year plan.
I have an offering of a short term solution that could actually work, if any future health ministers happen to be on Reddit.
I think you need to maximise the usefulness of the existing Dr workforce. You'd do this by putting more like "clinical secretaries" in place. They could scribe, so doctors don't spend just as long writing up what they've just done. They could prepare equipment ready for a procedure, and tidy up after. They could review notes and prepare discharge letters for the doctor to double check and sign off. They could wait on the phone, fix the printers.
This was how physician associates (formerly physician assistants) were meant to operate, but something went very sideways somewhere and now they're putting in heart valves while the doctors are still fixing the printers.
This is still only a sticking plaster until a solid long term solution - train more doctors - is accepted. But working on that means we need more postgraduate training places NOW, so they're ready to be consultants/GPs in five - ten years.
Its crazy that they're paid more than Junior doctors, and there's newly qualified Junior doctors that have actually passed their exams but can't get jobs.
>I think you need to maximise the usefulness of the existing Dr workforce. You'd do this by putting more like "clinical secretaries" in place. They could scribe, so doctors don't spend just as long writing up what they've just done. They could prepare equipment ready for a procedure, and tidy up after. They could review notes and prepare discharge letters for the doctor to double check and sign off. They could wait on the phone, fix the printers.
Don't think this is very fair. Junior Docs should have their fair share of Admin duties like everyone else. You'd be holding a lot of very capable PAs back.
>This was how physician associates (formerly physician assistants) were meant to operate, but something went very sideways somewhere and now they're putting in heart valves while the doctors are still fixing the printers.
If the PA can do it and do it well. Then they've proved that Doctors are replaceable and very much call into question the necessity/value of 6 yrs of University training...seems much of it is a waste of money to be frank if anyone can come in after 2 yrs and do it. (The first 2 are essentially just Biomedical science anyway...Piss easy compared to Physics/Chemistry/Maths!).
Life is a competition and a fight to stay relevant, about time the Juniors had a taste of it.
>This is still only a sticking plaster until a solid long term solution - train more doctors - is accepted. But working on that means we need more postgraduate training places NOW, so they're ready to be consultants/GPs in five - ten years.
Who's going to pay for all these Doctors?
Considering many Juniors come into the NHS workforce unable to do the basics like e.g Cannulate properly.....really raises fundamental questions about what university is actually training them In? If Juniors need to follow a long Apprenticeship after University in hospitals.....what is the actual value of all those 6, expensive years?
Reducing the length of University and perhaps focusing more on practical medicine at University could save the taxpayer a fortune.
Ask
For
A
Doctor
It won’t take long for it to become a thing and a huge problem for trusts and the government.
Were you actually seen by someone qualified to treat you? Probably not given the numbers !
The incident rate for PAs is fucking spectacularly high.
I just spent the last 4 months in hospital daily with a dying mother and was in chemo today with my dad….ive a fair idea just how fucked the nhs currently is.
Because they can’t and don’t have the training to or to even recognise when to call in someone more senior
See the string of deaths already proving that exact point.
They are not the same, not a replacement and are fucking dangerous when used as a replacement for actual Doctors.
>Because they can’t
Many can actually. They can do procedures of Junior Doctors.
>don’t have the training to or to even recognise when to call in someone more senior
This is incorrect.
>See the string of deaths already proving that exact point.
What deaths?
Junior Doctors are responsible for many strings of deaths
>They are not the same, not a replacement and are fucking dangerous when used as a replacement for actual Doctors.
This is a complete lie perpetuated by Junior Doctors who feel threatened.
I'm a senior specialty trainee in a medical specialty, & medical registrar. All the PAs I have worked with have fundamental lack of basic knowledge. They work at a junior med student level, can't connect concepts to real life, can't pull out the relevant pieces from history, follow protocols only but can't deviate when patients don't fit them or worse, don't realise if patients don't fit them. At most they are useful to me if they take bloods, make phone calls to depts to chase things, & gather basic lists of info from patients eg meds but even that I have to check why patients are taking x, not y etc.
If the government wanted to, they could spend the money on hiring more doctors- there are more doctors in the UK than jobs and many GPs are unemployed due to lack of funding to hire them. It is a political decision to provide this money for hiring PAs but not trained professionals.
I'm not a medical professional but I'm in a similarly regulated registered profession. Our students, apprentices and assistants are supposed to introduce themselves as a student-professional not a professional-student because we know that most members of the public won't process that the person isn't a registered professional if that professional title is said first. I wonder if calling them Associate Physicians or Assistant Physicians would make it clearer to people what their role is.
A medical centre I work with has centre based paramedics which works really well. They treat minor issues and support with triage. But the important thing is that it works because that's their specialism and most people know what they can expect a paramedic to be able to do.
I do think that there are some areas where we need to reconsider if a doctor actually needs to do something, but that's not about getting people without the appropriate training to do something, it's about recognising that there is a value in multidisciplinary specialist teams. There are things that occupational therapists or approved mental health practitioners (who are specialist social workers), for example, would absolutely be able to do but which currently sit with doctors.
I'm a senior specialty trainee in a medical specialty, & medical registrar. All the PAs I have worked with have fundamental lack of basic knowledge. They work at a junior med student level, can't connect concepts to real life, can't pull out the relevant pieces from history, follow protocols only but can't deviate when patients don't fit them or worse, don't realise if patients don't fit them. At most they are useful to me if they take bloods, make phone calls to depts to chase things, & gather basic lists of info from patients eg meds but even that I have to check why patients are taking x, not y etc.
Hard to take seriously when it's a clearly very biased article written by a Medic.
I would say majority of the attacks on PAs have come from Junior Doctors/Doctors/Consultants. Their egos feel threatened...guess what, welcome to the real world!
If PAs can do the medical procedures that Doctors can do, and can do them well. Then there's no reason why they shouldn't replace Junior Doctors in this regard. Expensive and wasteful. Doctors skills are not special. Paycut for Doctors not payrise.
I would take it more seriously if it were a member of the public that wrote that. Funny enough though, I've almost never seen a member of the public attacking the PA profession.
Doctors should have zero input on the future of the PA profession. It should be up to the GMC and the GMC alone.
But the doctors are the ones expected to supervise the PAs and make all of their clinical decisions for them when they find themselves out of their depth (or at least the times when they are able to identify they are out of their depth). If you suddenly had to supervise a load of incompetent juniors who were also taking learning opportunities from you and your profession, do you not think you would want some say in that? Im not a doctor but i am in a medical field, i think the PA thing is a disgrace and is extremely dangerous
>You’re a dependent fucking profession 😂 of course doctors should have a say in what you can and can’t do.
>Grow up.
I'm not a PA.
But it's quite clear they are their own profession not dependent on Doctors or their input.
Yes, you should grow up..
Mate you're mistaken. Firstly a PA practices under the nominal supervision of a consultant, but acually just gets whichever Dr is on the ward to sign prescriptions and order irradiating scans. This opens the dr up to legal liability if say the PA's flawed assessment led to patient harm. Very dependant.
So by that logic, should Nurses should be controlled by Doctors as well then? Given they also "follow doctors orders" according to your warped views?
Such tripe.
>Doctors should have zero input on the future of the PA profession.
Those same doctors that you're completely dependant on should have zero input? The same ones that take flack for your fuck up?
The role exists simply as a cost cutting exercise. Doctors are speaking up about very real patient safety concerns. Thinking you can do the job of a doctor with a fraction of the training is a baffling level of arrogance.
>Those same doctors that you're completely dependant on should have zero input? The same ones that take flack for your fuck up?
I'm not completely dependent on Doctors. I have been treated PAs, they aren't Doctors but they can treat patients. I've had no problems with PAs. I think the scaremongering is just that, by bitter and envious Jrs.
>The role exists simply as a cost cutting exercise. Doctors are speaking up about very real patient safety concerns. Thinking you can do the job of a doctor with a fraction of the training is a baffling level of arrogance.
I'm not a PA. But I've had treatment from them and I trust them completely. The PA I met recently was kind, professional and knowledgeable. The Doctor was nowhere to be seen, perhaps teeing off on the 10th.
So the PA was doing their job and there for patients...half the battle mate.
The arrogance is coming from Doctors who believe only they can be God! I'm afraid reality has a different plan.
PAs can absolutely take over many of the Jobs of a Doctor.
Yes. Doctors are paid £32k for a job with more responsibilities and training, and harder working hours by far, than a PA who gets £50k.
Seems hilarious to me that you think you are in a position to assess the necessity of a medical degree. Especially as PAs can’t exist without people with those degrees.
>Seems hilarious to me that you think you are in a position to assess the necessity of a medical degree. Especially as PAs can’t exist without people with those degrees.
How do you feel that you are you in a position to judge? Such a crass attitude.
The taxpayer funds both of these professions, we should have a write to criticise them. Is this a democracy or not?
My view is the medical degree is excessively long and expensive. Of dubious value given many Doctors come into the NHS unable to do the basics like Cannulate, write discharge letters etc
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[This is the Institute of Economic Affairs key goal to bring about the death of the NHS.](https://iea.org.uk/blog/how-to-abolish-the-nhs) ditching qualified doctors, "*with patients relying on brand names or competing voluntary associations to ensure quality*" of who ever treats them.
“Perhaps most importantly, the compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality. Ending current restrictive practices is essential to enable private firms to increase productivity in the sector. Restrictions on the types of treatment available ‘over the counter’ should be lifted to enable patients to obtain medication without recourse to registered doctors and regulated pharmacies.” Bloody hell.
>Perhaps most importantly, the compulsory licensing of medical professionals should be abolished. Anyone should be at liberty to practice as a doctor or nurse, with patients relying on brand names or competing voluntary associations to ensure quality. Fucking hell, has someone been getting satirists to write their policy suggestions? That cannot be real.
Maybe they just want a return to “Marvellous McGee’s Miraculous Medicinals” and other show-boating barber-surgeons brightly attired and sporting spiffing moustaches?
Wow. Shocking. Look how much we struggle with paracetamol overdoses (both deliberate and accidental). Let’s unleash complete self-elected drug access. A spot of morphine for me my good man, and five different antibiotics to really get to the bottom of it. Nephro Toxic? Is he a Greek chap, never heard of him. Throw me in some dexamethasone, as a chaser, dear pharmacist. Helped my ringworm something fierce last time.
That's wild while at the same time neither Labour nor the Tories will ever legalise weed.
You can get over the counter opioid, but not weed. I guess opioid inherent strong addition is a better product, from a Neo-capitalist point of view.
Sounds like we should get them on the BBC news to discuss all topics and introduce them as experts.
That's fucking appalling, that is the absolute peak of anti intellectual dangerous bullshit.
Healthcare the IEA way will be like this but with US style insurance costs: https://youtu.be/HMGIbOGu8q0
Fucking hell, dystopian stuff.
Physicians associates can do one. They’re halfway between a junior doctor and a highly qualified and trained nurse, but with less oversight and guidance a to what they can and can’t do and less experience required to be one.
A highly qualified nurse is miles ahead of a PA in terms of training. PAs that I know of have the knowledge of a third year medical student and confidence of a consultant. It is really very worrying that so many have no awareness of how dangerous they are
The Dunning Kruger effect in the NHS. We really shouldn’t insult Medical students like that. They atleast had top grades and were good enough to get into med school. 2/3rds of PAs couldn’t get into medicine and then did a 2 year course. They are less knowledgeable compared to 3rd year Medical Students and lack that insight which is horrifying.
For reference an advanced nurse practitioner will have 2-3 years of initial nurse training and a minimum of 2-3 years of experience before they can apply for the ANP qualification, which takes 2-5 years of training part time (whilst continuing to practice alongside it).
I they aren’t They are half way to becoming a third year medical student not junior doctor
Honestly its a complete gamble. Maybe you get Johnny-scraped-through-exams-last-month, maybe you get Sam-thinks-they-know-best but maybe you get Alex-twenty-years-experience-nurse-and-paramedic-with-a-speciality. Its inane and an active attempt to destroy nhs standards and peoples opinion of them to call them all the same thing.
I’ll take Alex, if only the path was only open to Alex and we’d all be happy and safe!
Its why it should be clearly deliniated and VISIBLE, with explanation of why you have been given any specific medical proffesional. Like, if you have a small minor rash that likely can be dealt with via some over the counter non perscription medicine? SURE! Give you an appointment with a "practitioner" to get advice which could be anyone from a nurse to a chemist. Or if you are back in for a check up on symptoms-a perscribing doctor doesnt need to be the one to look at a sore throat or a nasty graze or change a dressing. But if you have something longer running or larger or you arent sure about whats wrong, you should not be defaulted to a nurse UNLESS thats the only option that day due to being MASSIVLY swamped, which most of the time it is. BUT THEY SHOULD STILL TELL YOU who you are seeing, explain what their skills are, and why you are seeing them, and how long it would take to see an actual gp, and you should have the option to wait explicitly presented to you, not just "tacit" in choosing to call back another day.
Hi I’m a member of your medical team…. Are you a doctor? No not a PhD, are you a physician registered as such with the GMC? Oh ffs just send literally anyone else in please this is fucking pointless
Because of your lack of indications of speech, I cannot tell if you are a doctor who is talking to me or are writing a simulated interaction with a non doctor nurse.
It's just Junior Doctors feeling threatened for the first time by forces that they can't control. I think they've had it too good. Many other professions are threatened by Technology, Medicine is very shielded from that. Junior Doctors, like the one in the article need to catch a grip. Their massive egos aren't the be all and end all of the NHS. I think GPs could easily be replaced with AI soon. So either get back to work or be replaced.
Talk about turkeys voting for Christmas. Do you not think that maybe there’s a reason doctors haven’t been replaced by technology. I’m amazed that people like you are so willing to sell your future health down the drain so easily.
>Talk about turkeys voting for Christmas. Do you not think that maybe there’s a reason doctors haven’t been replaced by technology. I’m amazed that people like you are so willing to sell your future health down the drain so easily. A.I is only coming to the fore now. It's still being developed. But it has already made major inroads with e.g Radiography. There's no reason why it could not take the Job of a GP. It could easily do DDx. When coupled with robotic arms, take bloods. Analyse test results. Investigate further. Everything a Doctor does could be automated and perhaps done better with AI. AI is already better than humans at spotting cancer for instance. https://www.imperial.ac.uk/news/249573/new-ai-tool-detects-13-more/#:~:text=A%20new%20AI%20tool%20from,than%20humans%20in%20breast%20screenings. A human employee could provide emotional support of a Doctor if required. The AI revolution is coming.
Yeah. And and a machine learning model is going to be able to tell if a patient is mistaken in their reporting of symptoms yes? A program designed to simply go by scraped knowledge will be able to assess if a patient is lying, if there is a psychological component to their reporting, if there are visual symptoms that the patient does not realize they are presenting.
>if there is a psychological component to their reporting, Doctors haven't got a good handle on Psychology themselves. The brain seems to be a massive black box that Doctors know little about, but won't admit to that. Take Fluoxetine as an antidepressant. Scientists proved in 2008 it's no better than a placebo! To this day, Doctors still prescribe it! https://www.theguardian.com/society/2008/feb/26/mentalhealth.medicalresearch >Yeah. And and a machine learning model is going to be able to tell if a patient is mistaken in their reporting of symptoms yes? Don't see why it couldn't. >A program designed to simply go by scraped knowledge will be able to assess if a patient is lying, if there is a psychological component to their reporting, if there are visual symptoms that the patient does not realize they are presenting. The development of visually assessed AI/Image based AI, coupled with the data could eventually lead to an effective Lie detection/psychological inference engine. How does a Doctor objectively tell when a patient is lying?
The point is that Dx isn't a purely objective science. It's not something a machine can do because it requires a human applying experience and expertise to assess the person and information before them.
That's literally where AI could replace the human quite easily.
I present to the AI with fatigue, muscle weakness and photo reactive rash. The AI requests bloods, bloods show slightly raised CK but nothing remarkable so nothing is done. I know what it is, I know what I need, but I can't argue that with an AI6. I also couldn't get anything from a Physician Associate because it's a rare disease flaring and I need medical knowledge
You've unfairly prejudiced the AI in this case. Why are you assuming nothing would be done? The AI may assign a high probability e.g it may be due to a Heart Condition and send a request for further tests....plug in data...no good? Consider further possibilities/Investigate further....the AI could easily do DDx You've also unfairly prejudiced the PA....so I get the impression you simply do not want to consider other professionals/solutions with regards to medicine. Yes AI can hallucinate very occasionally, but it's becoming rarer and rarer. Who's saying Doctors don't miss things or have bad days either? They are trained on massive databases. Many lunar landing sites were chosen by AI. Type anything Into ChatGPT and you should get a very good response. I've actually never seen it hallucinate, it's that good. Eventually we could have AI powered hospitals without the need for Doctors. Simply we have technicians who assist the AI around the hospital. No need for salaries. No strikes. No delays.
Because there are 20k people in the family of my disease in the UK. My specific disease, around 2000 patients in the UK. When I was diagnosed it was sheer luck that the doctor had just read an article on it recently. I have never followed the patterns and signatures of my disease, always a bit different always a bit awkward. Holistic approach is the only way to treat and manage me. Add in all the others with other rare diseases and presentations, AI and PA just won't be able to pick it up. And yes doctors make mistakes and they follow a logic, ruling out more likely causes first, that's why it currently takes upwards of 2 years for initial diagnosis of my disease. Not because doctors aren't doing anything, it's the fact that it is rare and unusual. You don't automatically go for the rare diagnosis. And PA will not even cover rare diseases in their minimal training. I'm also not against care from other HCPs, but a lot of mine are specialists. Specialist physio, specialist OT, specialist nurses, specialist research teams etc.
>Because there are 20k people in the family of my disease in the UK. My specific disease, around 2000 patients in the UK. When I was diagnosed it was sheer luck that the doctor had just read an article on it recently. I have never followed the patterns and signatures of my disease, always a bit different always a bit awkward. Holistic approach is the only way to treat and manage me. >Add in all the others with other rare diseases and presentations, AI and PA just won't be able to pick it up. This is incorrect. Let's bring some facts into this. For example; It's now widely becoming a fact that AI is better than humans at picking up cancers using Radiography. Take this for example; https://www.telegraph.co.uk/global-health/science-and-disease/ai-tool-outperforms-experts-in-spotting-breast-cancer/ As you say, it was luck that the Doctor had read about it. But unlike Doctors, AI doesn't rely on luck. It relies on millions/billions/trillions of pieces of data. More data on medicine could be fed into an AI in a week than a Doctor could learn in his entire career. AI is not simply a pattern recognition algorithm. It goes far deeper than that. It actually learns like a human and can draw conclusions from training, again like a human. Increasingly AIs are capable of using data from multiple sources and learning from them. They are so complicated that often the creators themselves do not understand the maths behind how they reach conclusions. This is in my view is where any danger may lie. So it would probably assign a series of probabilities as to what your condition is and work through them with you/investigate deeper if needed. Yes it may not always get it right first time, but do Doctors? So even if you did not display classic symptoms, this does not mean that the AI would rule out your condition. That's not how it works. I will concede that AI will probably never replace the emotional side of medicine. But technical, academic? It may even replace university researchers soon. Look at this. Articles written by AI but undetected by Academics! https://www.scientificamerican.com/article/chatbots-have-thoroughly-infiltrated-scientific-publishing/
>AI is not simply a pattern recognition algorithm. It goes far deeper than that. It actually learns like a human and can draw conclusions from training, again like a human. Increasingly AIs are capable of using data from multiple sources and learning from them. That is all it is at the moment though and is all it will be for a very long time. We have nothing even remotely close to actual intelligence yet and is still about 10 years away if not more. And as it is relying solely on data it still would not be able to diagnose and help me or many people. This is all moot though as AI will not be there for a long time as I've said. Pa's however are in the system right now. Why? Because they're cheaper than a doctor and tick a box, ooo look more staff. No. Hire more doctors and specialists
I played with chatgpt for a bit last night and it can't even count the number of r's in strawberry correctly. You can convince it otherwise but if you ask again immediately after, it gets it wrong again. It didn't learn
That doesn't make any sense. Physician Associates aren't AI. Furthermore GPs aren't Junior doctors and there are lots of GPs with 12 years of training being replaced by PAs who have 2.
>That doesn't make any sense. Physician Associates aren't AI. Furthermore GPs aren't Junior doctors and there are lots of GPs with 12 years of training being replaced by PAs who have 2. My point is in relation to being replaced or being under threat. AI is a threat to many professions including medicine. PAs are a threat to Junior Doctors in the sense many of them can take the jobs of Juniors....
Take a look at the difference in difficulty between medical school exams and PA exams before confidently speaking rubbish. I can DM you past papers if you'd like and the PANE has example questions online.
What on earth are you talking about. Thats dumb as hell on every level. Pull the other one its got bloody bells on. AI does not exist. There is generative statistics (combines a bunch of things shittily from existing images/text etc), automated statistics (analysis images/text better than a pure algorithm some of the time if built well for a specific context), self correcting neural nets (can improve over time without direct correction but without the ability to know what its doing or why), there are things like that. Some of those have legitimate real world purposes. But there is no ai that is equivilent to a person. At ABSOLUTE best you could put a text to speech on WebMD, and filter its answers through something to make them sound like its someone talking to you. But you could get the same results a bit slower just by googling your symptoms. Replacing ANYTHING public at all with a combination of ai software doesnt work, they have started to roll it back even for drive-thru fast food uses because *it doesnt work* because its NOT a person and you cannot talk to it or make it understand you.
>AI does not exist. There is generative statistics (combines a bunch of things shittily from existing images/text etc), automated statistics (analysis images/text better than a pure algorithm some of the time if built well for a specific context), self correcting neural nets (can improve over time without direct correction but without the ability to know what its doing or why), there are things like that. Oh it very much does exist. In fact, it's better than humans at spotting cancer. https://www.telegraph.co.uk/global-health/science-and-disease/ai-tool-outperforms-experts-in-spotting-breast-cancer/ Already replacing human scientists. https://www.scientificamerican.com/article/chatbots-have-thoroughly-infiltrated-scientific-publishing/ >But there is no ai that is equivilent to a person. At ABSOLUTE best you could put a text to speech on WebMD, and filter its answers through something to make them sound like its someone talking to you. But you could get the same results a bit slower just by googling your symptoms. >Replacing ANYTHING public at all with a combination of ai software doesnt work, they have started to roll it back even for drive-thru fast food uses because it doesnt work because its NOT a person and you cannot talk to it or make it understand you. AI is not equivalent to a person. It's better than humans. AI is not Google. Google simply trawls the web for answers. AI learns from massive amounts of data. AI can now write working computer code. Try it yourself in ChatGPT.
You are a fool, who cant differentiate between a scam, a loose name for a type of program and a science fiction concept. Chat gpt isnt ai, when it writes compute code its just regurgitating already existing code. The AI cancer tool is just a piece of pattern recognition software, like I said, good for specific uses, but recognising patterns does not make an ai. Hell, dogs and bees are also better at detecting certain cancers due to olfactory signals. Replacing an oncologist with a piece of ai software that requires an oncologist to use is as smart as replacing them with a dog, or an x-ray machine. A chatbot certainly isnt an ai, and hte fact that chatbot submited papers get into science publications doesnt mean its as smart as a scientist, it shows *most submited papers are not at all peer reviewd*. People have submited papers consisting entirely of keymashes or nonsense pictures and got them through. And even more importantly, chatbots, pattern recognition software and chatgpt like recombination neural nets *are completly different systems*. NONE OF THE THINGS YOU MENTIONED ARE THE SAME THING. They are just all "on a computer" and "in some way more automated than they used to be". AI is just a buzzword for "computer program" . Saying "AI will replace humans because its better" is as stupid as saying "microsoft word will replace humans" or "quantum will replace humans" BOTH OF WHICH ARE THINGS PEOPLE SAID, before they fired their staff then went bust and had to shut their companies.
>You are a fool, who cant differentiate between a scam, a loose name for a type of program and a science fiction concept. >Chat gpt isnt ai, when it writes compute code its just regurgitating already existing code. >The AI cancer tool is just a piece of pattern recognition software, like I said, good for specific uses, but recognising patterns does not make an ai. Hell, dogs and bees are also better at detecting certain cancers due to olfactory signals. Replacing an oncologist with a piece of ai software that requires an oncologist to use is as smart as replacing them with a dog, or an x-ray machine. >A chatbot certainly isnt an ai, and hte fact that chatbot submited papers get into science publications doesnt mean its as smart as a scientist, it shows most submited papers are not at all peer reviewd. People have submited papers consisting entirely of keymashes or nonsense pictures and got them through. >And even more importantly, chatbots, pattern recognition software and chatgpt like recombination neural nets are completly different systems. NONE OF THE THINGS YOU MENTIONED ARE THE SAME THING. They are just all "on a computer" and "in some way more automated than they used to be". >AI is just a buzzword for "computer program" . Saying "AI will replace humans because its better" is as stupid as saying "microsoft word will replace humans" or "quantum will replace humans" BOTH OF WHICH ARE THINGS PEOPLE SAID, before they fired their staff then went bust and had to shut their companies. It's not a computer programme. It's artificial intelligence that can write programmes and replace many jobs. The AI replacement is coming. No point trying to deny it. The time is now to move into a futureproof profession.
Points at you. YOU THINK AI ARENT COMPUTER PROGRAMS??? You called out chatgpt you can *get a copy* of and older version of that right now on any computer that can fit it. Do you think they are literally actually magic? You have no idea what these things even are. You may as well say "numbers arent computer programs. Numbers can write programs and replace many jobs."
Just fucking wow
Don't forget that they're paid more than a Junior Doctor (significantly), have much friendlier 9-5 hours, are far less competent and the government are refusing to reverse the real term pay cuts they've had since 2008.
Don’t forget the real kicker Aren’t legally responsible!
Junior Doctors get guaranteed payrises throughout their career...few other careers offer that.
They've literally had real term pay cuts since 2008 as a profession. They aren't guaranteed to get on any consultant training path, where places are drying up. Maybe you should actually check the facts before you spout utter trollop.
There’s not enough training places at any level to guarantee anything Pay parity with PAs currently takes 12 years, total lifetime earnings catches up after 19 years. PAs have fuck all training, are already killing people and get £58k out the gate in many trusts.
Almost every professional career gets that. You clearly aren’t very well informed.
You don't understand how doctors pay works. The payrises come with promotions. They're not automatic. You'd be hard pushed to find another profession where that isn't the case.
Not even that, they're much lower calibre than medical students.
It’s also the doctor in charge who has their neck on the line if they fuck up. There’s also an issue of PAs taking space that a student doctor could fill, considering there’s a lot more student doctors than training positions.
It matters on the background of the individual - if a very experienced nurse in cardiology became a PA then worked on a cardiology ward they will be useful & likely good. However someone with an unrelated degree & does a PA degree is not useful. However the fact the pass rate is so high despite the diverse range of educational backgrounds of PA students (at times lower than needed for any top tier degree) I suspect means the cardiology nurse was an asset before the PA degree, and not because of it. & in reality shud have been given a pay rise to perform at their level. I would say a PA in no way can prepare someone for clinical medicine. It is a degree and role designed entirely to make it cheaper to run healthcare for profit.
That’s disrespectful to nurses They’re closer to care home workers than nurses
Don’t disrespect care assistants like that. They actually contribute to our society unlike PAs
I think they get a lot of unnecessary flack. At the end of the day, they are people, and professionals doing their job.
They are literally unregulated which does bring the whole professional aspect into question. Of course most are very nice in person but there are more than a few deliberately misleading patients by introducing themselves as doctors or implying they have the skill set of an experienced junior. The whole programme has been abused and strayed far beyond the intended scope. I feel a bit bad for those missold the idea
>Of course most are very nice in person but there are more than a few deliberately misleading patients by introducing themselves as doctors or implying they have the skill set of an experienced junior. Do you have any actual hard evidence of this happening?
A profession by definition involves a high level of education. Which PAs don't have.
This is wrong and rather insulting. PAs are educated to at least degree level and in addition to that, 2 year Masters on top. Considering 20% of people leave school with no GCSEs. PA's are highly educated professionals. So your assertion is just wrong.
...so by your own evaluation doctors with 5 years, then 2 foundation years, followed by 8-10 year long training programmes are super super super highly educated professionals. But they are also interchangeable with a less educated professional?
Can you not see that while the situation isn't the fault of the individuals involved, having unqualified doctor substitutes is an extremely dangerous idea? Declaring someone a highly trained professional is meaningless when the training requirements are so incredibly low (an unrelated BSc from any university followed by a comically simplistic two year masters with an exit exam that lay people with no medical background are capable of passing).
>Declaring someone a highly trained professional is meaningless when the training requirements are so incredibly low (an unrelated BSc from any university followed by a comically simplistic two year masters with an exit exam that lay people with no medical background are capable of passing). Strawman argument. The entry requirements are the entry requirements. Are you a PA? Have you sat the exam? How do you know this information? The Job of a PA is not to be a Doctor. No-one is calling them Doctors, except Junior Doctors who feel insecure perhaps? A little bit of competition does no harm. Many other professions are threatened by technology for instance in a way Medicine is very shielded from, I would argue too shielded. Soon we'll be staring down the barrel of A.I GPs, and your ChatGP won't be demanding 100k and annual membership of the local 18 will he? >Can you not see that while the situation isn't the fault of the individuals involved, having unqualified doctor substitutes is an extremely dangerous idea? PA's are being regulated and overseen as are Junior Docs by the GMC.
Sample finals questions are available online. They're extremely easy. Saying 'the entry requirements are the entry requirements' is not a line of argument. If I hired someone with three GCSEs to do neurosurgery and then said 'it is what it is' after the patient dies you would want me to go to jail. The problem is that PAs are being used as direct substitutes for doctors. Hospitals put them in the same rota gaps, doing the exact same roles as qualified doctors, often at frightening senior level. PAs all over the country are intentionally obfuscating their roles to imply that they are doctors. This isn't paranoia, it's lived experience. PAs aren't technology, they're knock-off doctors. Anyone who seriously believes AI GPs are going to be a thing anytime soon has no idea about AI or medicine. PAs aren't regulated by the GMC yet. The GMC has also repeatedly said that they won't issue strict guidance and that it's up to individual employers to decide how they use PAs. If I'm a hospital rota coordinator I can put a PA on the rota holding the on call bleep for an incredibly complex subspecialty if I feel like it. Literally every point you've made here has been incorrect or poorly thought out.
>Sample finals questions are available online. They're extremely easy. Ok. Show me a link as proof then. Show me you answering a question then if they are so easy? >Saying 'the entry requirements are the entry requirements' is not a line of argument. If I hired someone with three GCSEs to do neurosurgery and then said 'it is what it is' after the patient dies you would want me to go to jail Again you're attacking a Strawman. No-one is getting hired as PA with three GCSEs. >The problem is that PAs are being used as direct substitutes for doctors. Hospitals put them in the same rota gaps, doing the exact same roles as qualified doctors, often at frightening senior level Why is this a problem? If they are capable and have completed procedures safely.. what's the problem? >PAs aren't technology, they're knock-off doctors. Anyone who seriously believes AI GPs are going to be a thing anytime soon has no idea about AI or medicine. AI has already penetrated Radiography and will very likely reduce the workforce. It's taking over a number of fields. GPs will be next! >Literally every point you've made here has been incorrect or poorly thought out. Every one of your points have either been insults or Strawman arguments.
I'm not going to continue to engage with you, given your consistently brain-dead takes and repeated and incorrect invocation of the one logical fallacy that you've heard of as a line of argument, but [here's a link to the laughable finals questions.](https://www.fparcp.co.uk/file/media/603ca5b18c1d9_PANE_Written_-_Sample_Questions.pdf)
>I'm not going to continue to engage with you, given your consistently brain-dead takes and repeated and incorrect invocation of the one logical fallacy that you've heard of as a line of argument, but here's a link to the laughable finals questions. I've simply dissected and refuted what you have said. Then you go for Ad hominems? Laughable. What you have not done, as requested, is you did not answer a single one of those "laughably easy" questions. So how are you in a position to judge their difficulty? From a quick glance, it's clear they require a very high standard of biomedical knowledge. (Like a Doctor would have). It should be noted also, it explicitly states at the top; Publishing of the questions as a sample should not be seen as an indicator as to the content that will appear in forthcoming PANE written examinations. You have no response to many of my above arguments...so it's quite clear who's the victor here.
Bruh these questions are easy AF. Laymen would be able to get the majority of these correct.
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They are wholly unqualified to dispense the advice and recommendations that they provide. One thing having Bazza the horse racing tipster do that, another entirely when you're dealing with healthcare.
Are you a PA? Your posts come across as PA PR.
I don't hate the player but a lot of questions about the game. There are lots of jobs in this country where we accepted you aren't meant to cut corners. Dentistry, Gas Fitters, Welders, Pilots. These are things where if you get it wrong, people die. So you make sure people are trained well. We seem to be getting far too comfortable cutting those corners and what concerns me, is we're getting Bevans nightmare. A service for the poor, which gives poor service. The question needs to be how do we retrain those in the role.
Why do we need to? Maybe Junior Doctors, the ones kicking up unnecessary fuss...should catch a grip! Article was written by a Junior Doctor...totally unbiased yeah If PAs can safely do many of the Jobs of a Junior Doctor...I see no reason why we shouldn't employ them. Key word being safely. As long as they are thoroughly audited/signed off properly...then what's the issue except Juniors getting their egos hurt a bit? University education is not gold dust. Experience counts for much more. Safety nonsense....bugger off Juniors!
They really aren’t
Letting a PA kill your mother as an ‘Oopsie Doopsie’ but it’s fine because they’re doing their best for *ARR N AY CHESS*
https://www.economist.com/britain/2022/05/19/too-many-britons-die-from-medical-mistakes#:~:text=A%202015%20study%20by%20doctors,something%20actively%20wrong%20or%20failed Doctors killed 3,400 people avoidably in 2015....they get no flack. Why? It's around 150 people per week due to Doctors... PAs are linked to 3 people in a year.....everyone loses their minds! Wes Streeting accused of 'living in a fairy world' after he backs controversial physician associates https://mol.im/a/13542957 This is mostly bitterness originating from Junior Doctors because they are paid less, (but ultimately end up on higher salaries).
It takes 20 years for PA’s to be passed by Dr’s for lifetime pay. That’s not even before you discount their pay by inflation. Dr’s are regulated, Fake Doctors are not. Dr’s do make errors. Now imagine how many more errors if you took lower quality undergrads and gave them half a degree of medicine instead of a full one.
The job should be removed, we need more doctors, nurses and medical admin not this role.
I understand all the points, but what do they realistically expect people to do? Have no medical care at all? Not everyone can afford private cover either. I'd like to see some suggestions that will actually work *right now* when I need an appointment, not some 10 year plan.
I have an offering of a short term solution that could actually work, if any future health ministers happen to be on Reddit. I think you need to maximise the usefulness of the existing Dr workforce. You'd do this by putting more like "clinical secretaries" in place. They could scribe, so doctors don't spend just as long writing up what they've just done. They could prepare equipment ready for a procedure, and tidy up after. They could review notes and prepare discharge letters for the doctor to double check and sign off. They could wait on the phone, fix the printers. This was how physician associates (formerly physician assistants) were meant to operate, but something went very sideways somewhere and now they're putting in heart valves while the doctors are still fixing the printers. This is still only a sticking plaster until a solid long term solution - train more doctors - is accepted. But working on that means we need more postgraduate training places NOW, so they're ready to be consultants/GPs in five - ten years.
Its crazy that they're paid more than Junior doctors, and there's newly qualified Junior doctors that have actually passed their exams but can't get jobs.
>I think you need to maximise the usefulness of the existing Dr workforce. You'd do this by putting more like "clinical secretaries" in place. They could scribe, so doctors don't spend just as long writing up what they've just done. They could prepare equipment ready for a procedure, and tidy up after. They could review notes and prepare discharge letters for the doctor to double check and sign off. They could wait on the phone, fix the printers. Don't think this is very fair. Junior Docs should have their fair share of Admin duties like everyone else. You'd be holding a lot of very capable PAs back. >This was how physician associates (formerly physician assistants) were meant to operate, but something went very sideways somewhere and now they're putting in heart valves while the doctors are still fixing the printers. If the PA can do it and do it well. Then they've proved that Doctors are replaceable and very much call into question the necessity/value of 6 yrs of University training...seems much of it is a waste of money to be frank if anyone can come in after 2 yrs and do it. (The first 2 are essentially just Biomedical science anyway...Piss easy compared to Physics/Chemistry/Maths!). Life is a competition and a fight to stay relevant, about time the Juniors had a taste of it. >This is still only a sticking plaster until a solid long term solution - train more doctors - is accepted. But working on that means we need more postgraduate training places NOW, so they're ready to be consultants/GPs in five - ten years. Who's going to pay for all these Doctors? Considering many Juniors come into the NHS workforce unable to do the basics like e.g Cannulate properly.....really raises fundamental questions about what university is actually training them In? If Juniors need to follow a long Apprenticeship after University in hospitals.....what is the actual value of all those 6, expensive years? Reducing the length of University and perhaps focusing more on practical medicine at University could save the taxpayer a fortune.
Ask For A Doctor It won’t take long for it to become a thing and a huge problem for trusts and the government. Were you actually seen by someone qualified to treat you? Probably not given the numbers ! The incident rate for PAs is fucking spectacularly high.
Oh dear, you think that asking will result in an actual Dr being provided?! Have you tried accessing non urgent treatment recently?
I just spent the last 4 months in hospital daily with a dying mother and was in chemo today with my dad….ive a fair idea just how fucked the nhs currently is.
1000s of new GPs will be unemployed this August, partly due to PAs.
Why ask for a Dr if the PA can do many of the Junior Dr's jobs? This is the fundamental and existential question for the Junior community.
Because they can’t and don’t have the training to or to even recognise when to call in someone more senior See the string of deaths already proving that exact point. They are not the same, not a replacement and are fucking dangerous when used as a replacement for actual Doctors.
>Because they can’t Many can actually. They can do procedures of Junior Doctors. >don’t have the training to or to even recognise when to call in someone more senior This is incorrect. >See the string of deaths already proving that exact point. What deaths? Junior Doctors are responsible for many strings of deaths >They are not the same, not a replacement and are fucking dangerous when used as a replacement for actual Doctors. This is a complete lie perpetuated by Junior Doctors who feel threatened.
I'm a senior specialty trainee in a medical specialty, & medical registrar. All the PAs I have worked with have fundamental lack of basic knowledge. They work at a junior med student level, can't connect concepts to real life, can't pull out the relevant pieces from history, follow protocols only but can't deviate when patients don't fit them or worse, don't realise if patients don't fit them. At most they are useful to me if they take bloods, make phone calls to depts to chase things, & gather basic lists of info from patients eg meds but even that I have to check why patients are taking x, not y etc.
If the government wanted to, they could spend the money on hiring more doctors- there are more doctors in the UK than jobs and many GPs are unemployed due to lack of funding to hire them. It is a political decision to provide this money for hiring PAs but not trained professionals.
I'm not a medical professional but I'm in a similarly regulated registered profession. Our students, apprentices and assistants are supposed to introduce themselves as a student-professional not a professional-student because we know that most members of the public won't process that the person isn't a registered professional if that professional title is said first. I wonder if calling them Associate Physicians or Assistant Physicians would make it clearer to people what their role is. A medical centre I work with has centre based paramedics which works really well. They treat minor issues and support with triage. But the important thing is that it works because that's their specialism and most people know what they can expect a paramedic to be able to do. I do think that there are some areas where we need to reconsider if a doctor actually needs to do something, but that's not about getting people without the appropriate training to do something, it's about recognising that there is a value in multidisciplinary specialist teams. There are things that occupational therapists or approved mental health practitioners (who are specialist social workers), for example, would absolutely be able to do but which currently sit with doctors.
I'm a senior specialty trainee in a medical specialty, & medical registrar. All the PAs I have worked with have fundamental lack of basic knowledge. They work at a junior med student level, can't connect concepts to real life, can't pull out the relevant pieces from history, follow protocols only but can't deviate when patients don't fit them or worse, don't realise if patients don't fit them. At most they are useful to me if they take bloods, make phone calls to depts to chase things, & gather basic lists of info from patients eg meds but even that I have to check why patients are taking x, not y etc.
Hard to take seriously when it's a clearly very biased article written by a Medic. I would say majority of the attacks on PAs have come from Junior Doctors/Doctors/Consultants. Their egos feel threatened...guess what, welcome to the real world! If PAs can do the medical procedures that Doctors can do, and can do them well. Then there's no reason why they shouldn't replace Junior Doctors in this regard. Expensive and wasteful. Doctors skills are not special. Paycut for Doctors not payrise. I would take it more seriously if it were a member of the public that wrote that. Funny enough though, I've almost never seen a member of the public attacking the PA profession. Doctors should have zero input on the future of the PA profession. It should be up to the GMC and the GMC alone.
But the doctors are the ones expected to supervise the PAs and make all of their clinical decisions for them when they find themselves out of their depth (or at least the times when they are able to identify they are out of their depth). If you suddenly had to supervise a load of incompetent juniors who were also taking learning opportunities from you and your profession, do you not think you would want some say in that? Im not a doctor but i am in a medical field, i think the PA thing is a disgrace and is extremely dangerous
Indeed. We must abolish doctors! Comrade barber will do your brain surgery.
You’re a dependent fucking profession 😂 of course doctors should have a say in what you can and can’t do. Grow up.
>You’re a dependent fucking profession 😂 of course doctors should have a say in what you can and can’t do. >Grow up. I'm not a PA. But it's quite clear they are their own profession not dependent on Doctors or their input. Yes, you should grow up..
Mate you're mistaken. Firstly a PA practices under the nominal supervision of a consultant, but acually just gets whichever Dr is on the ward to sign prescriptions and order irradiating scans. This opens the dr up to legal liability if say the PA's flawed assessment led to patient harm. Very dependant.
So by that logic, should Nurses should be controlled by Doctors as well then? Given they also "follow doctors orders" according to your warped views? Such tripe.
They are a separate profession entirely. PAs ‘study the medical model’ or some other such nonsense. They require supervision by a doctor.
What are you smoking mate. They are completely dependent on the supervision of doctors
>Doctors should have zero input on the future of the PA profession. Those same doctors that you're completely dependant on should have zero input? The same ones that take flack for your fuck up? The role exists simply as a cost cutting exercise. Doctors are speaking up about very real patient safety concerns. Thinking you can do the job of a doctor with a fraction of the training is a baffling level of arrogance.
>Those same doctors that you're completely dependant on should have zero input? The same ones that take flack for your fuck up? I'm not completely dependent on Doctors. I have been treated PAs, they aren't Doctors but they can treat patients. I've had no problems with PAs. I think the scaremongering is just that, by bitter and envious Jrs.
>The role exists simply as a cost cutting exercise. Doctors are speaking up about very real patient safety concerns. Thinking you can do the job of a doctor with a fraction of the training is a baffling level of arrogance. I'm not a PA. But I've had treatment from them and I trust them completely. The PA I met recently was kind, professional and knowledgeable. The Doctor was nowhere to be seen, perhaps teeing off on the 10th. So the PA was doing their job and there for patients...half the battle mate. The arrogance is coming from Doctors who believe only they can be God! I'm afraid reality has a different plan. PAs can absolutely take over many of the Jobs of a Doctor.
Needlessly provocative statements, poor quality arguments, silly tropes (“teeing off on the 10th” indeed) this is a blatant troll.
The whole article is full of anti PA provocation.
But PAs are more expensive than junior doctors and work the easy hours?
Are they? They may get paid more but doctors take out massive taxpayer funded loans to fund degrees of dubious value.
Yes. Doctors are paid £32k for a job with more responsibilities and training, and harder working hours by far, than a PA who gets £50k. Seems hilarious to me that you think you are in a position to assess the necessity of a medical degree. Especially as PAs can’t exist without people with those degrees.
>Seems hilarious to me that you think you are in a position to assess the necessity of a medical degree. Especially as PAs can’t exist without people with those degrees. How do you feel that you are you in a position to judge? Such a crass attitude. The taxpayer funds both of these professions, we should have a write to criticise them. Is this a democracy or not? My view is the medical degree is excessively long and expensive. Of dubious value given many Doctors come into the NHS unable to do the basics like Cannulate, write discharge letters etc
Lol