Rob Pain @robpain635 Twitter profile

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Rob Pain

@robpain635

8 months

To everyone pearl-clutching at the idea of doctors asking for +35% pay: the government are massively expanding the Physician Associate workforce. They train for 2 years and start on £43.7k. A doctor trains for 5yrs and starts on £32.4k. The difference? *drum roll* 35%

LBC

@LBC

8 months

'They are there to work alongside doctors not instead of doctors.' Health Secretary Victoria Atkins reiterates 'regulations' on physician associates after the death of 30-year-old Emily Chesterton.

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Rob Pain

@robpain635

5 months

Just google it yeah? I would be a bit sad if any doctor wrote this. But the doctor who wrote this is the director of education and standards at the GMC. It's so bleak. It feels like a medical degree is one of the last high standards left and they've been told it's embarrassing

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Rob Pain

@robpain635

9 months

I was a decent Paramedic. First class BSc. 80 on GAMSAT. Top 3 in first year GEM exams. Another 2.5 years of med school to go, then 2 years of Foundation. Then face competition ratio of 5:1 to access this training. Am I quite bright or very, very, very stupid?

Eilidh 🦀

@DrEilidhMaria

9 months

A genuine question. If the PAs can go to the ACCS training, and be taught the same skills on the ward, and do the same service provision, and they can extend their scope of training to ST6 level… What is actually the point of the training programme?

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Rob Pain

@robpain635

3 months

@parthaskar @RCPhysicians @trishgreenhalgh @iDrSunny @ShrillaB @DrLKVaughan @UKGastroDr @mmamas1973 @doctor_oxford @OrthopodReg @RoshanaMN @DrAsifQasim Prof Kar 'dangerous'? Did a ketone write this?!

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Rob Pain

@robpain635

8 months

Should 4th & 5th year medical students be allowed to sit this exam? Become PAs before becoming doctors? There is no aspect of PA training which will not have been covered by their medical training - so if you've done the training and done the exam.... why not? Protectionism?

ExplosiveEnema

@ExplosiveEnema

8 months

There is a lot of talk about the PA National Exam So here are 6 of the top performing Unis for the written PANE, all achieving a 100% pass rate! Amazing! Nothing strange about that at all…

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Rob Pain

@robpain635

7 months

What is it about a 2 year PA degree that qualifies you for this job? What is it about a 4-6 year medical degree that disqualifies you from this job?

Richard Fitzgerald 💙 🦀

@r1chardf1tzg3r1

7 months

Reading #Kidney Patients #PhysicianAssociates Job Description ⬇️ Risks ? ⁦ @BritRenalSoc ⁩ ⁦ @ERAkidney ⁩ ⁦ @NHSEnglandNMD ⁩ ⁦ @RBNHSFT ⁩ ⁦ @TheBMA ⁩ ⁦ @doctor_oxford ⁩ ⁦ @TheLancet ⁩ ⁦ @TheLawyermag ⁩ ⁦ @LBC ⁩

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Rob Pain

@robpain635

5 months

@FullFact This is the weakest 'fact check' I've ever seen. Also the thing about unpaid overtime is it tends to be unpaid.

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Rob Pain

@robpain635

11 months

@tompeck "snow is falling, the contingency budget of 75 trillion pounds is all gone, and the trains are still living in a shed on their grandma's drive..."

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Rob Pain

@robpain635

6 months

@veggieequallife Every doctor has already done the PA course. Unlike other professions, there isn't a single element of PA training you haven't covered. So the real question is why can't you dual register and apply for PA jobs?

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Rob Pain

@robpain635

6 months

@JimBethell @HelenRSalisbury You criticise the medical profession for being hierarchical then name drop the 3 senior Drs pushing this through with no consultation? Every survey of Drs shows negative impact and safety implications. Patients not asked of couse, because you'd have to inform them first

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Rob Pain

@robpain635

4 months

@ChrisHopsonNHS What makes a physician associate a specialist please?

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Rob Pain

@robpain635

5 months

@LittlePersonDoc @ObserverLaura Definitely! Who generates the up to date info we get on the internet? UK educated doctors should be (and have been) a massive part of setting those standards & guidelines. He seems to say that's now for others to do (internationally?) & NHS medical care is about following

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Rob Pain

@robpain635

5 months

@BBCPolitics Could the health secretary explain what's unreasonable about moving the red line up to meet the blue line? We know it's affordable ~£1bn /year net. So who is being unreasonable?

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Rob Pain

@robpain635

10 months

@BMA_James_Steen HCPC regulates 15 seperate, diverse professions. But GMC aren't fully resourced for +2? Even though the training and scope sit entirely encased by the profession they already oversee?

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Rob Pain

@robpain635

3 months

@Rozewicz @rcgp Even just answering the first part of your Q would be a good start. A 2 year 'from scratch' primer course then 1st point of contact in a GP surgery seeing anything? Anyone with any healthcare experience knows how reckless that is.

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Rob Pain

@robpain635

7 months

@JanetEastham @TheDA_UK @TheBMA The prescription issue is serious but it's almost providing the trust with a convenient red herring here.

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Rob Pain

@robpain635

6 months

@iDrSunny Got to be careful about extrapolating anecdotes & I know this attitude is seen with other new HCPs too. However, I find it astonishing that this is seen as band 7 practice. Elsewhere in the health service B7s are decades in, silver command at major incidents, line-managing dozens

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Rob Pain

@robpain635

8 months

@DyfrigH @DrEilidhMaria The PA course is not always a masters, a 2:1 is not a requirement for all PA courses, and biological sciences is not a requirement for all PA courses. We're you aware of that? (This isn't anything to do with the clip, which I haven't watched, but I have read your thread)

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Rob Pain

@robpain635

1 year

@TomStocks1982 Opens with "We hope we can all agree on the benefits of multidisciplinary practice in healthcare" - of course! But why, specifically, are PAs in GP practices? How can they see undifferentiated patients with '1 year theory and 1 year practice' as their training? Dangerous.

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Rob Pain

@robpain635

5 months

@GradMedic01 I thought having a house and a kid in school somewhere does get you special circumstances for that location? I can't keep up with how they are doing it

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Rob Pain

@robpain635

10 months

@RobLaurensonD4P Steve Barclay's "ladder of opportunity": 2 years training in physician associate studies = £43,742, 37.5 hrs/week 5 years training in medicine = £32,398, 40 hrs/week

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Rob Pain

@robpain635

1 year

@DrDLittle I can't quite believe it's legal to set up a "job share" with one group on £44k (37.5 hr week) and one group on £32k (40 hr week). @thebma

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Rob Pain

@robpain635

1 year

@RoshanaMN @SteveBarclay @wesstreeting Brilliant. The only slip up (imo) is calling an immediate 40% uplift unaffordable - it's completely affordable! Same cost as about 4 miles of HS2...

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Rob Pain

@robpain635

10 months

@ShaunLintern @katlay @thetimes Quote from the NHS at the end is interesting. The public will have an idea of what "work under the supervision of a consultant" should mean, and that's definitely not what's happening. Also "internationally recognised"... yes, the role is, but not the way the NHS is using it.

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Rob Pain

@robpain635

6 months

@BMA_James_Steen @KeeleUniversity The website literally uses general practitioner but wedges some extra words in between.

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Rob Pain

@robpain635

6 months

If UK universities have any concern for the job prospects & future earnings of their medical students (which influence uni rankings), they will put them through PA exam at some point between yr 3-5 of the course and register them as PAs. No extra teaching will be required.

Dr Sandeep Bansal

@iDrSunny

6 months

PA job applications from May 23 Duties: ‘The successful applicants will work on the junior medical rota in the relevant department’ I can respect them for being honest and up front.

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Rob Pain

@robpain635

8 months

@KeeleyMP GP minimum: 4-6 year degree in medicine, 2 years as a foundation doctor, 3 years specialty training. PA minimum: 2 year degree in physician associate studies.

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Rob Pain

@robpain635

5 months

Why would the government increase the number of GPs, if senior GP leaders have spent years telling them that someone with a 2 year MSc is safe to see pts in primary care? Why would a minister think that 10 years+ to train a GP is a worthwhile investment?

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Rob Pain

@robpain635

6 months

@RCPhysicians @NHSEngland Off doctors' rotas by this time tomorrow then yeah?

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Rob Pain

@robpain635

8 months

@TVRJDC @BucksHealthcare They are calculating that some F1s will do it for £240. They are calculating that PAs won't do it for less than £480. These rates are about how people value themselves - you can't always blame the system.

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Rob Pain

@robpain635

6 months

@DrEilidhMaria @ABarotchi1 Fair enough response, and good to see in writing that you've studied the entirety of the PA curriculum already. So clearly meet standard for registration as a PA. Now let's ask the GMC once they hold both registers, when can doctors dual register? Presumably just a case of paying

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Rob Pain

@robpain635

6 months

@iDrSunny I wouldn't let someone without a registration do a single one of these on me or my family. Are patients being given enough information to make that choice for themselves?

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Rob Pain

@robpain635

5 months

@DrEilidhMaria Putting life/career on hold to maximise knowledge & training shows respect for patients. Ppl accuse doctors of arrogance but to me arrogance is showing up with the bare minimum & expecting patients to be grateful

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Rob Pain

@robpain635

6 months

@JimBethell Person with <1/5th training of GP: 'i saw 30 patients today they were all simple infections, back pain, headaches - didn't need to escalate any of them'. You genuinely don't see the problem there?

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Rob Pain

@robpain635

9 months

@thatsnotmine125 @ExplosiveEnema Apart from when it's a PGDip not a masters? Or when a science degree isn't a requirement for the course? I appreciate the majority of PAs will have a BSc followed by a masters, but even this is not a set standard

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Rob Pain

@robpain635

9 months

@UKDefJournal hmm, not sure how the author can look at current theaters like Ukraine and then propose something as vulnerable as this - I'm not an expert but I think you'd be sending a lot of pilots on one way trips?

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Rob Pain

@robpain635

3 months

@AbbieTBee If those languages students then got employed by the trust while you played the foundation lotto, held positions on foundation & medical rotas for more pay despite their shorter course etc... might you then look back on your shared graduation ceremony with some bitterness? Agreed

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Rob Pain

@robpain635

7 months

A lot of us feel helpless & afraid when a loved one goes under general anaesthetic, whether we show it or not - the thing that stops us panicking is knowing the person doing it has been selected and trained to the highest standards. The government wants that person supervising 3

Royal College of Anaesthetists

@RCoANews

7 months

Our position on the supervision of anaesthesia associates is 2:1 We don't support 3:1

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Rob Pain

@robpain635

1 year

@RCOphth If it's important to stress that, why doesn't your website do so? It says the pilot aims "to set the standards of a PA in ophthalmology, by defining the potential future roles and scope of practice". You're not going to define a role & scope then say it's unfeasible are you?

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Rob Pain

@robpain635

6 months

@drmattuk It's why the erosion of every standard is being sped up. Criminal by yesterday's standards, questionable by today's, normal by tomorrow's

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Rob Pain

@robpain635

7 months

@JimBethell Yes, studying for a decade to safely undertake specialist work is so inflexible, so 20th century. If only we'd known sooner that one year of theory and one year of hospital placements is all you need to work anywhere in healthcare. Can't believe no other country is copying this.

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Rob Pain

@robpain635

4 months

@timricketts_ @amateuradam Applying for Christmas day off, getting told no because there's too many people off. Then sitting on my own in the ambulance station all shift with no crew mate, because there was too many people off...

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Rob Pain

@robpain635

3 months

This is one of the greatest jobs in healthcare & 100% compatible with being a thriving human as well, depending on what you do with the rest of your time. My toxic trait is thinking could I make this work alongside med school?... (answer = no, unfortunately)

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Rob Pain

@robpain635

6 months

@wesstreeting Okay, but this like doubling the number of RAF pilots and not buying any more planes Training posts Training posts Training posts

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Rob Pain

@robpain635

6 months

@doctor_oxford Would you say "general medically trained practitioners" is even worse? Cos that's on the course website

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Rob Pain

@robpain635

9 months

@actor_joshua @wendyburn @DrEilidhMaria @Xeon4f145d96s1 @Dr_Done_ Depressingly familiar theme at the bottom there too. 'lol we weren't really taught anything about this, but where's the patients lets goooo' (see also neurosurgery, paeds, hepatology etc)

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Rob Pain

@robpain635

5 months

@OrthopodReg @RCSnews @TheBMA @ERunswickBMA @ollieburtonmed @parthaskar @doctor_oxford @RoshanaMN What is it about these 3 modules that lets you step into an operating theatre with a log book?

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Rob Pain

@robpain635

6 months

@djnicholl @veggieequallife @gmcuk I mean imagine someone with their heart set on a particular specialty - could work in it for 2 years without rotating, straight out of med school, a genuine 'physician associate' to a named consultant, then progress from there. Or F3/F4 years stable with opportunity to develop

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Rob Pain

@robpain635

5 months

@TomStocks1982 @RCPhysicians Yep - a med student presenting data to fellow med students in this way would get laughed out of the room. Yet this is from the eminent college?!

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Rob Pain

@robpain635

1 year

@trentconsultant "We couldn't find any data for the places where people are actually going, but trust me bro it's not triple the UK salary like everyone says" - Nick Triggle

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Rob Pain

@robpain635

6 months

@traineENT How about "general medically trained practitioner" instead? That's right, a G(medically trained)P

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Rob Pain

@robpain635

10 months

@TomStocks1982 Is it possible they actually don't know?!

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Rob Pain

@robpain635

7 months

@nialldowney @DrEilidhMaria @RichardDeCrep @Captsully @paulpcullen @healthdpt @bbchealth @roinnslainte @campbellclaret @davidmcw @David_ukan @NHSImprovement I guess with half the crew missing they'd never be in that situation because the plane would never have departed? Healthcare uniquely horrible since patients can't refuse to board a dodgy department and doctors can't refuse to take off in it (I'm mangling the metaphor but you get

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Rob Pain

@robpain635

8 months

@DebsaDelight The whole situation is very concerning

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Rob Pain

@robpain635

9 months

@cannula_service yr5 you'll be on £44k while your fellow (med) students will have another yr of debt. yr7 you'll be on £46k while they'll be on £37k as F2s. Not rotating so you buy a house, start a family. Access to specialist training anyway, "tier 2", no further exams... why do the MBBS?!

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Rob Pain

@robpain635

9 months

@Dr_BellaR The letter also openly admits the plan is to hire +12000 healthcare workers with no curricula/capability frameworks, no CPD/assessment/appraisal standards, and no supervision guidance. Spells out in 4 bullet points why pausing is the only safe option at the moment

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Rob Pain

@robpain635

5 months

@mancunianmedic @drmattuk If GMC does end up holding both registers, surely it should just be a case of paying the additional fee to go on the PA register as well. Not sure the GMC could argue a doctor doesn't meet the standard to register as a PA.

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Rob Pain

@robpain635

10 months

@dgfull @Jo_McGinn @AlisonGeorge10 @veggieequallife @Dr_Done_ @BMA_James_Steen I have a great anti-protectionist idea then. Allow med students to take the PA exam after they've done 1 year of their clinical phase. Since there is no aspect of the PA course they won't have covered, they can then earn b7 in their spare time thru finals and foundation years

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Rob Pain

@robpain635

6 months

@timricketts_ Put it this way, I've got 2 years of GEM to go. If the pay issue isn't resolved by then I'll still work as a doctor. If MAPs are still replacing doctors I will take my medical degree and go back to work as a Paramedic - there's literally no point.

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Rob Pain

@robpain635

11 months

@RCPhysicians Are you talking about routes for non-doctors to specialist registration?

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Rob Pain

@robpain635

1 year

@trentconsultant Don't worry sir, we are blue-lighting you in to see the non-medical consultant within the integrated medicine and patient flow division...

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Rob Pain

@robpain635

9 months

@Exploding_Heads Love how pre-2023 Jordan Henderson is the only clear point of agreement 😂

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Rob Pain

@robpain635

7 months

@DrEilidhMaria Is this happening now?

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Rob Pain

@robpain635

7 months

@CommonsHealth Patients are "paying the price" for:

13 years of govt failure

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Dr's rejecting bad offer

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Rob Pain

@robpain635

5 months

@OrthopodReg @parthaskar @RoshanaMN @ollieburtonmed @doctor_oxford @trishgreenhalgh @AliJaneMoore @mmamas1973 Same but different: my prediction isn't that they'll work "at the level" - I think the medical act will be changed so they will *be* doctors after MLA. PA brand ditched entirely

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Rob Pain

@robpain635

6 months

@DanBealeCocks The argument feels very basic and beginner-level because it is. There is no nuanced or complicated case needed to argue against non-HCPs getting only 2 years training then seeing undifferentiated pts in GP

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Rob Pain

@robpain635

4 months

@peteturton85 Reckon it's probably just the ones who haven't done a formally accredited course, aren't regulated, don't hold a compulsory registration, might have a masters or might not & might have a life science BSc or might not.

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Rob Pain

@robpain635

4 months

@DrEilidhMaria One of those weird areas of healthcare that any smart HCP could have a reasonable working understanding of with 1-2 days study if they really wanted to, but generally can't be arsed. See also ECGs!

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Rob Pain

@robpain635

6 months

@DrPhilBanfield @thetimes The govt is learning 1 lesson here - they are incentivised to make massive erosions in public sector pay, because the media will then call any redress "outlandish". Perversely if they had only cut doctors pay by a few percent in real terms they would be under massive media

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Rob Pain

@robpain635

10 months

@ATRightMovies Everyone in every scene in this movie!

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Rob Pain

@robpain635

5 months

@DrAsifQasim @AnonRantations @PhilipB44023080 I would welcome this, but I fear the GMC/govt plan is to erode medical education to look more like the PA model. Rather than move everyone to a higher standard they'll look to go lower across the board.

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Rob Pain

@robpain635

6 months

@DrEilidhMaria Pervades all levels too - why did the consultants committee allow support for the LTWP to be included in a pay negotiation? Because the government really wanted to and they were getting quite insistent about it? Please.

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Rob Pain

@robpain635

9 months

@hannahfearn Yet if "pilot associates" were flying passenger planes with no fixed definition of what they can/can't/should/shouldn't do, and no accreditation of their training, I suspect the story would be massive by now!

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Rob Pain

@robpain635

7 months

@davehartin If the titles, qualifications and post-nominals don't have any bearing on quality, competence and skill then they are all pointless. If they do, then there are still some professional boundaries, and it's not the public's job to navigate this. They cannot be put in the position

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Rob Pain

@robpain635

8 months

@Gassed_Off 😬

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Rob Pain

@robpain635

8 months

@PippaK10 I believe PAs do ~1600hrs of clinical placements, so I guess you'd wait until a similar amount had been done by the medical student. Then yes, after that - working as a PA makes more sense that what many med students do (HCA, 111 call taker etc) - better use of skills for pt

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Rob Pain

@robpain635

7 months

@VishalGulati_ How do you think the PA (the one who didn't go to medical school) practiced? How did they become good at it? You're happy to get the 100th LP they've done, great. Would you be happy to get the 1st? The 5th? If not, which patients do you want to go first?

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Rob Pain

@robpain635

8 months

@NJL_Blancq Will it fool payroll into dishing out band 7 is the main question 👀😂

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Rob Pain

@robpain635

8 months

@danny_mercer It's not so much being able to pass the exam that made me suggest 4th/5th yr med students sit it - it's more that at that stage no-one can argue that every single aspect of PA training has been covered, including time on placement.

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Rob Pain

@robpain635

4 months

@doctor_oxford @NHSEngland Foundation doesn't seem to be a serious job for adults, it seems to be NHS bootcamp. Although traditionally you get free accommodation at a bootcamp

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Rob Pain

@robpain635

10 months

@KeeleyMP Thank you. Mr Barclay's response is delusional. He thinks if he says "highly skilled" and "masters degree" enough, it will become safe to employ science grads with 2 years training in GP practices. It won't, it isn't.

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Rob Pain

@robpain635

3 months

@DrNeenaJha @StGeorgesUni Why do they list the course name for every other course, but the job title for PAs?

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Rob Pain

@robpain635

9 months

@bmj_latest @aneezesmail "There is also confusion among professionals and patients about role title and limits of the role" Do you think that falsely stating "PAs complete a two year masters in medical sciences" helps with this confusion? Are people embarrassed to say Physician Associate Studies? Why?

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Rob Pain

@robpain635

4 months

@ArmagnacleGrand @doctor_dru_ Luxury. When I qualified as a paramedic we had to parachute out the back of a plane over London & whichever station we landed nearest was where we worked. Slept in the bins out the back. Kept warm by burning testosterone

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Rob Pain

@robpain635

6 months

@traineENT AfC isn't perfect but at least breaks down the elements of your job and recognises education, decision making, exposure to difficult situations etc. PAs hit band 7. F1 salary is just a number plucked out of the air as far as I can tell? A really low number...

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Rob Pain

@robpain635

1 year

@ZubyMusic I can do one set of 10 now, then maybe a few reps to failure in a second set. Better than I could do a month ago!

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Rob Pain

@robpain635

4 months

@DrAsifQasim @gmcuk @RCPhysicians @RCPEdin @NHSEngland @rcgp @drcolinm @drmattuk @DrEilidhMaria I think GMC have been given the specific job of decoupling the UK medical profession from international norms & standards. PAs are not doctors, but they're not far off what govt wants doctors to be in future. Source: that blog post by Prof CM!

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Rob Pain

@robpain635

7 months

@VishalGulati_ It might be marginal but I genuinely believe they are, yes! But more broadly, developing more complete clinicians is better & safer in healthcare when there's finite resources and training time, and the doctors need to develop that.

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Rob Pain

@robpain635

1 year

@SimonC469 @SkyNews Oh cool. So if you apply to med school this year Simon, what will the pay and conditions be in 2029 please?

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Rob Pain

@robpain635

9 months

@SteelCity_ENT Nottingham GEM currently: Anatomy - anatomists & surgeons Clinical skills & comms - GPs Ethics/social - medical sociologist Science - biomed researchers/lecturers Clinical lectures - consultants can't complain! (although there is PBL too which seems to trigger some people 😄)

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Rob Pain

@robpain635

9 months

@thatsnotmine125 @ExplosiveEnema Fair point. It also specifically dictates a PGDip not a masters though doesn't it

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Rob Pain

@robpain635

7 months

@Aidan_Baron This is a great example of something I could (and do) try to think about but would never be eloquent enough to write down, thank you! Still not completely sure I've made the right call but I think my 50-55YO self will thank me & be happier in medicine

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Rob Pain

@robpain635

4 months

@jackgkennedy Don't let the 'mother hen' personality paras see this - Walking in & snatching blankets off people is their signature move 😂

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Rob Pain

@robpain635

6 months

@Hantsprints Agreed!

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Rob Pain

@robpain635

6 months

@timricketts_ Not an expert either - but I feel like a US president is 'constructed' by stakeholders like a billion dollar infrastructure project, so many people invested and so many deals done to get there. Our prime ministers are more like portacabins 😂

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Rob Pain

@robpain635

6 months

@ShaunLintern @nottmhospitals If people are are dying under their coats in waiting rooms - then the army needs to be setting up field hospitals in the car park, execs/ministers need to be on the ground until it's gripped or sacked to get someone else in, massive emergency funds need to be released for

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Rob Pain

@robpain635

4 months

@gmcuk Is there anything that sets out the further regulatory reform you're seeking?

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Rob Pain

@robpain635

6 months

@DrLKVaughan Very high risk/high reward to commit 4 years to this as an undergrad. IMO a non-zero risk that job won't exist in 4 years, at least not in the way it exists now. Potential reward that it could be the golden ticket to any specialty you can think of. Safer play = biomed 3 yrs!

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