FACT CHECK: Countering the MISINFORMATION from the BMA about Physician Associates

Until relatively recently the BMA was supportive of the Physician Associate role. Then, around the time of the junior doctor strikes, a movement within the medical community called DoctorsVote (now rebranded as Doctors United) took over the BMA and adopted a populist line what viewed PAs as a threat and then demanded a more money for doctors via strike action. The DoctorsVote/BMA has been pushing several false claims against PAs:

PAs negatively impact the training of resident doctors – FALSE. PAs enhance the training of resident Drs

The BMA asserts that training PAs is having an adverse impact on the training of doctors. This is complete rubbish. The numbers simply do not support this idea, there are 96 doctors for every one PA in the UK. When the BMA blames PAs for a lack of training opportunities it is like blaming the curry for the hangover rather than the 12 pints of lager beforehand. In fact, PAs enhance the learning for resident doctors in several ways. PAs typically have in depth knowledge of their area because they are permanently employed and PAs are very happy to pass on this knowledge to resident doctors who are rotating through. Also, PAs also free up hospital consultants and senior GPs to teach resident doctors. With extended skills procedures like lumbar puncture PAs are typically super-skilled and give high quality, formal, standardised training in this procedures.

1st year PAs get paid more than 1st year doctors – FALSE. They get paid about the same

The BMA keeps saying (wrongly) that PAs earn more in their first year than a first year doctor. They do this by being economical with the truth. This issue is discussed in more detail in another article. PAs are paid according to the Agenda for Change pay bands – like the rest of the NHS. Doctors are paid according to their own, separate pay scales. Theoretically a PA can be paid at Band 7 straight from university and this would be slightly more than the basic pay of a foundation year 1 doctor. But the reality is: most PAs do a preceptorship year at Band 6 and foundation year 1 doctors get generous supplements for working nights and weekends which PAs do not. The net effect is that PAs and Drs get paid about the same in their first year. Also, there is good evidence that a first year PA and a first year doctor know about the same – so their value to the NHS is equivalent.

PAs are responsible for a shortage of jobs for Drs – FALSE. PAs fill doctor roles only if there is no doctor available.

This is the classic moan of every populist “they’re over here, taking or jobs”. PAs are typically supernumerary, that means they are there in addition to the doctors. There are situations where PAs fill roles which hospitals and GP surgeries are unable to fill with doctors. Also, PAs are dependent, you cannot have PAs without doctors, they are part of a multi-disciplinary team with doctors.

At the moment there is a problem with some resident doctors finding jobs. This crisis is one of the BMA’s own making. They campaigned for more medical school places, which they got. In turn, this has meant a lot more resident doctors coming into the market but there are not the training placements available to take these doctors forward after their foundation years. Additionally most doctors want to work in London, Bristol or Manchester, leading to a shortage of vacancies in those areas – there are still lots of vacancies outside those areas, if you are prepared to travel to a less popular location. In 2025 there are still 257 unfilled training posts for doctors.

Doctors’ careers definitely need better planning – that is not a problem caused by PAs. PAs are NOT taking doctors jobs.

PAs are misleading patients into thinking they are doctors – FALSE. PAs who want to be doctors go to medical school

The BMA often asserts that PAs are wannabe Doctors misleading patients. This is not the case. PAs go through extensive and rigorous training and are proud of their role. PA school is probably more intense than medical school and certainly more intensive. PAs are proud to be PAs. PAs who want to become doctors go to medical school. I do not know of a single PA who has every tried to pass themselves off as a doctor.

PAs are unsafe – FALSE. There is no evidence that PAs are unsafe, even the Leng review found that

There is no evidence that PAs are unsafe – even the Leng review concluded this. In fact, there is evidence that PAs actually reduce the medico-legal liability that doctors face in the Emergency Department. PAs are safe.

PAs only do two years training – TRUE & FALSE. You cannot become a PA by just doing two years of training…

Doctors attending medical school do a five year course if they are undergraduates which consists of two years in classrooms and then three years on a variety of rotations. PAs spend one year in the classroom and then one year on a variety of rotations. However, the PA degree is a postgraduate (Masters level) qualification, in fact it is the same level of qualification as a medical degree. And your undergraduate qualification has to be something healthcare-related for example biomedical science. PA school uses problem-based learning which is a more efficient method of teaching than the learning method employed by traditional medical schools. PA school is more intensive, it involves 30-40 hours of teaching per week with a good 10-15 hours on top of self-study – that is a lot more than medical school. At medical school doctors learn a lot of things which are completely unnecessary – for example the highly complex Krebs cycle (which has very little application in clinical practice). There is an undergraduate PA course in the UK and it is a four year course. So in terms of equivalence 4 years for PA vs 5 years for Dr is probably a better way of thinking about it. PAs learn the same history taking, clinical examination and clinical reasoning that doctors do. Doctors learn more pathology though, because the focus for PAs is on core common presentations. PAs do pretty much the same examinations at the end of their degrees that a doctor does. And there is good evidence that a first year Doctor and first year PA know about the same.

The BMA is being unprofessional

The BMA is wrong in their assertion that PAs are a threat to doctors. PAs are the one staff group that is most supportive of doctors. And it is simply wrong that the BMA, a union for doctors, is attacking a group of professionals that is part of their MDT. Imagine if Nurses started saying there should not be any physiotherapists or dietitians!? The BMA is guilty of unprofessional behaviour and it is amazing that it appears to be tolerated. The BMA claims to support MDT working – obviously in name only.

Addendum

Check this out, it is the BMA’s position on Physician Associates before the DoctorsVote crew took over. Makes for an interesting read.

Latest:

We have just found out from foundation year 1 doctors that the BMA is actually going around medical schools explaining its anti-PA stance to doctors who are just about to qualify so that when they come into they first jobs they are primed against PAs. In an unprecedented move the doctor’s union is actually priming newly qualified NHS staff to be opposed to members of the MDT they are about to walk into. Incredible!