Physician Assistant from RCSI

IPNA

The Royal College of Surgeons here in Ireland is planning on offering the Physician Assistant programme.

link here.

Does anyone have any additional information on this?

Are there people out there willing to look at this as a career option?

Jessibelle

I'd be willing if ultimately my career plans didn't pan out. I've a friend who works as this in the States and finds it to be a very challenging role. The only thing I'd be worried about would be the various nursing unions may see this as interferring with the roles of nurse-practitioners, or that the HSE would use PA's as fodder to fillin gaps in service so they'd be landed all the poor shifts etc

imported_guy

its usually a 2 year post grad programme in the united states (pre requisite is usually pre-med in college), and then theres board certification required (like anesthesia assistants, surgical assistants etc etc) + they have prescription power etc etc, dont know what its going to be like over here

lonestargirl

As part of my course in college I got to see a heart bypass in the Galway Clinic. The assist for the surgery was a PA, she harvested the vein as the surgeon was opening and getting started in the chest. The PA on the day was an American women and I don't know where she trained. I may take a while for the role to become common in the public sector but the private sector will move more quickly.

IPNA

I talked with Emeka Okereke from the RCSI. He said that they are planning on starting the two year Physician Assistant programme for the fall 2011. It will be held at the Stephen's Green campus.

Are there any others out there interested in this?

As a Physicians Assistant you will work as a Junior Doctor throughout Ireland.

lonestargirl

IPNA wrote: »

As a Physicians Assistant you will work as a Junior Doctor throughout Ireland.

I think you are jumping from step A -> Z with that statement. Roles within the HSE are very strictly defined and there is currently no role for PAs, it may even require legislation to create the existence of such a position. Private hospitals may employ who they like. There is also currently no way for licensing PAs, you can't work as a junior doctor if you can even prescribe paracetamol!

IPNA

There is no legislation but there will be eventually. The UK system is also trying to find a place for the PAs. They have designed their PA programme to allow the PA to fill the vast amount of empty Junior Doctor spots.

In the US the PA has prescribing rights. I cannot imagine the PA filling the role without the ability to prescribe.

It is a horse and cart problem. How can you graduate PAs without legislation but then how can you determine what a PA can do without PAs working in Ireland?

After talking with the RCSI director for their PA programme, he thinks that there will be a third year of the programme focused on surgery.

Surgical PAs would be a great benefit for Ireland.

lonestargirl

IPNA wrote: »

There is no legislation but there will be eventually.

I think you are being very naive about how long this legislative change make take to enact. I'd advise you to read up on the RIAI and their campaign to register the profession of architect in Ireland. This started before the foundation of the state and was finally completed with the passing of the Building Control Act in 2007.

IPNA wrote: »

The UK system is also trying to find a place for the PAs. They have designed their PA programme to allow the PA to fill the vast amount of empty Junior Doctor spots.

Just because the program is designed that way it doesn't mean that the jobs will follow. Each and every position in the health service has designated minimum qualifcations and a salary scale attached to it, the role of the PA will have to be created by the DOHC. A given hospital can not just decide to employ a PA in an NCHD role.

IPNA wrote: »

In the US the PA has prescribing rights. I cannot imagine the PA filling the role without the ability to prescribe.

Which would require an ammendment to the Medical Practitioner's Act.

IPNA wrote: »

It is a horse and cart problem. How can you graduate PAs without legislation but then how can you determine what a PA can do without PAs working in Ireland?

You can graduate people all you like, it's just a degree. The professional licensing process is the issue for practising.



Just for clarification can you please state if you are affiliated with IPNA, either in an official or unofficial capacity?

IPNA

Thanks for the information on what needs to happen in order for PAs to start working here in Ireland.
I have sent off an email to the DOHC to find out what they know about it.

Academic institutions are focused on getting students into a programme and not always focused on what happens to them once they finish.

Also, I have no affiliation with the Irish Nursing Association. I am not a nurse, nor have had any contact with any Irish Nursing organisation.

IPNA is a bushcraft and remote medicine school located in County Kerry.
More information here.

Ange1Pho3nix

Thanks for all of the information, I am currently wanting to start this course and have looked at the layout and set up within the UK at both Wolverhampton and Birmingham Universities and within the NHS but heard that RCSI was starting the course and have decided to hold out on applying as I really want to study there.

The degree at the end may not be fully recognised as yet, however, it is becoming more prominent and when the prescribing rights are hopefully issued there will be a opening for the job to really help within the medical sector.

Any more information on the course at RCSI would be a great help for me! I've been trying to find out for months what stage the set-up was at and when the course would be starting!

ORLY?

Is there anyone here, nurse or doctor, who can explain what the role of a physician's assistant would be?

As far as I'm aware Ireland has no shortage of people wanting to go into primary care, the opposite almost in fact, but this has been addressed to some degree by the increase in paces on GP training schemes. Things seem to be moving toward multi-gp centers as well, with nurses and physios and phlebotomist on staff etc. Where would a physician's assistant fit in? Is their role in the hospital?

What would they be doing that isn't done by nurses now? Excuse my naivete if that's a stupid question but I'll just be starting the clinical aspect of medicine in August and don't have much knowledge about the inner workings of the hospitals as yet.

On the prescribing thing...if a doctor needs to go through 4 years of medicine minimum, 5 if they have no previous degree, and then a 1 year internship in order to be able to prescribe how will prescribing for physician's assitants be brought in?

On the idea of filling empty NCHD spots, doesn't one need to be a doctor to do that? Medical degrees are designed to train doctors to work as doctors, surely anyone wanting to work in a NCHD role would have to be trained to the same level as current NCHDs.

lonestargirl

IPNA wrote: »

Academic institutions are focused on getting students into a programme and not always focused on what happens to them once they finish.

That's what I'm afraid of, I would hate to see students graduating and finding that there is no possibility of job for them.

IPNA wrote: »

Also, I have no affiliation with the Irish Nursing Association. I am not a nurse, nor have had any contact with any Irish Nursing organisation.

IPNA is a bushcraft and remote medicine school located in County Kerry.
More information here.

Thanks for clarifying this. IPNA looks pretty interesting, if you put a signature with a link in your profile you will be able to raise awareness of what you do and avoid confusion with nursing organisations!

lonestargirl

ORLY? wrote: »

Is there anyone here, nurse or doctor, who can explain what the role of a physician's assistant would be?

I'm not a nurse or a doctor but I am a healthcare worker (and patient) in the US and can share some examples of the roles I see PAs filling here.

• My Ob/Gyn has a PA who I can see for repeat pill prescriptions, she does BP and weight etc and can send me into the doctor if she feels it's necessary. She also is the person who calls and discusses blood test results over the phone with me.
• My husband is a surgery resident here in the US, unlike Ireland residents change rotation every month. At the moment he is on paediatric cardiovascular surgery, something so specialised that a resident on rotation doesn't really know a whole lot about it. This service has a permanent staff of PAs who are responsible for the post-op management of patients and assist the attending and fellows in the theatre.
• There are far more private physicians in the US that in Ireland. If you are private you negotiate operating priviladges with a given hospital and you don't have any residents. Most of these employ PAs to be their assist in theatre.

I do think that there are smaller hospitals in Ireland where it is not appropriate to employ surgeons-in-training. These hospitals simply don't have the depth and breath of caseload to provide adequate training for a surgeon. If procedures in these hospitals are limited to day cases and simple surgeries like appedicitis, hernias and gallbadder removal I can see how there would be a role for PAs in managing these patients and assisting in theatre. Teaching hospitals should of course be staffed with doctors-in-training, how else will we produce the next generation of surgeon?

ORLY?

lonestargirl wrote: »

I'm not a nurse or a doctor but I am a healthcare worker (and patient) in the US and can share some examples of the roles I see PAs filling here.

• My Ob/Gyn has a PA who I can see for repeat pill prescriptions, she does BP and weight etc and can send me into the doctor if she feels it's necessary. She also is the person who calls and discusses blood test results over the phone with me.
• My husband is a surgery resident here in the US, unlike Ireland residents change rotation every month. At the moment he is on paediatric cardiovascular surgery, something so specialised that a resident on rotation doesn't really know a whole lot about it. This service has a permanent staff of PAs who are responsible for the post-op management of patients and assist the attending and fellows in the theatre.
• There are far more private physicians in the US that in Ireland. If you are private you negotiate operating priviladges with a given hospital and you don't have any residents. Most of these employ PAs to be their assist in theatre.

I do think that there are smaller hospitals in Ireland where it is not appropriate to employ surgeons-in-training. These hospitals simply don't have the depth and breath of caseload to provide adequate training for a surgeon. If procedures in these hospitals are limited to day cases and simple surgeries like appedicitis, hernias and gallbadder removal I can see how there would be a role for PAs in managing these patients and assisting in theatre. Teaching hospitals should of course be staffed with doctors-in-training, how else will we produce the next generation of surgeon?

Thanks for that. The US system seems so different from the Irish system though. I'm still not sure I see where they could go here. I mean in the GP it's been my experience that nurses are already ready willing and able to do a lot of the routine things like BP, bloods, etc.

On the surgery thing, isn't it the small hospitals that are ideal for training general surgeons though. As far as I'm aware most abdominal procedures can be carried out in these hospitals, which are surely going to be useful to start people off on the surgery ladder. Granted, neuro and cardio-thoracic, paediatric surgery etc. needs a more specialised center but surely all kinds of hospitals have a role in training.

lonestargirl

ORLY? wrote: »

Thanks for that. The US system seems so different from the Irish system though. I'm still not sure I see where they could go here. I mean in the GP it's been my experience that nurses are already ready willing and able to do a lot of the routine things like BP, bloods, etc.

I agree with you totally and that's why I think it's very unfair for the course to be marketed using the example of the US, Ireland has a very different health system.

ORLY? wrote: »

On the surgery thing, isn't it the small hospitals that are ideal for training general surgeons though. As far as I'm aware most abdominal procedures can be carried out in these hospitals, which are surely going to be useful to start people off on the surgery ladder. Granted, neuro and cardio-thoracic, paediatric surgery etc. needs a more specialised center but surely all kinds of hospitals have a role in training.

There's small and there's small. There are a lot of general hospitals in Ireland where the caseload isn't enough for them to have accredited NCHD posts, i.e. there are SHOs and Registrar posts in these hospitals but they are not part of any training scheme, the so-called 'perpetual' registrar posts. These are the posts that seem to be losing out most with the reduction in numbers of NCHDs. There is an argument that these posts are not beneficial to doctors as they don't have any prospect for career progression with them and the new medical register seems to favour having people on the trainee register where possible.

Narkius Maximus

lonestargirl wrote: »

That's what I'm afraid of, I would hate to see students graduating and finding that there is no possibility of job for them.

What about all the medical students who will have no jobs in the future? The numbers in standard entry plus graduate entry over the next couple of years is going to exceed the number of intern places available unless a wholesale change in the direction of the HSE with regards to supressing NCHD positions.

How will Physician Aides help this? I suppose you could argue that they would do the more menial tasks leaving the interns free, well, to do pretty much nothing.

RCSI are a money making, self centred machine , they will charge to the hilt for this course and think nothing of it when it doesn'y come to fruition. They see this as a way of protecting surgeons in the future as NCHDs are leaving training in their droves, coupled to this the embracement of the EWTD means that there will be F*$k all surgical trainees around to do anything.

Medical education and training in this country is a minefield at the moment. We are being bounced from pillar to post with no direction and no grand plan. It is quite worrying.

lonestargirl

I probably should clarify that I have no particular personal desire to have PAs working in the Irish system, I was just pointing out the issues involved in implementing the position in Ireland.

Narkius Maximus wrote: »

How will Physician Aides help this? I suppose you could argue that they would do the more menial tasks leaving the interns free, well, to do pretty much nothing.

I don't think it's appropriate at all for physcian assistents to work in training hospitals or replace current NCHD training positions.There may be a role for them in the private sector or in public hospitals that aren't suitable for training surgeons.

Narkius Maximus wrote: »

RCSI are a money making, self centred machine , they will charge to the hilt for this course and think nothing of it when it doesn'y come to fruition. They see this as a way of protecting surgeons in the future as NCHDs are leaving training in their droves, coupled to this the embracement of the EWTD means that there will be F*$k all surgical trainees around to do anything.

My issue is that there will be naive 18-year old leaving cert students who will be sucked in by RCSI marketing the PA course when it is entirely possible that there will never be legislative provision for the post in Ireland.

IPNA

It was my understanding that there was an intense shortage of Junior Doctors here in Ireland. The PA role was to relieve that shortage.

Secondly, the PA were to reduce overall costs. The HSE could hire a few of PAs for the same cost of a full fledged doctor.

I am not certain that the PA would handle major surgeries or clinical work. The PAs that I worked with in A&E in the US did minor suturing, ortho injuries and the general GOMERs. (Get Out of My ER)

They relieved the attending physician of the minor stuff in order for her to focus on the big medical cases.

lonestargirl

IPNA wrote: »

It was my understanding that there was an intense shortage of Junior Doctors here in Ireland. The PA role was to relieve that shortage.

There is a shortage of posts, not necessarily a shortage of people to work in them. Especially now that we have graduate programs for medicine. Some hospitals always have a recruitment problem, usually because their posts are not accredited for training.

IPNA wrote: »

Secondly, the PA were to reduce overall costs. The HSE could hire a few of PAs for the same cost of a full fledged doctor.

Intern salary is €33,619
SHO varies from €38,839 - €54,746

I doubt you would get a PA to work for less that this - never mind a few for the price of a doctor. Bear in mind that a clinical nurse specialist salary scale is €47,089 - €55,852 and I would imagine that PAs would see themselves at this level. One similarity between the US and Ireland is that doctors-in-training are probably your best value employees in terms of the work/responsibilty for the pay they receive.

ORLY?

lonestargirl wrote: »

There is a shortage of posts, not necessarily a shortage of people to work in them. Especially now that we have graduate programs for medicine. Some hospitals always have a recruitment problem, usually because their posts are not accredited for training.



Intern salary is €33,619
SHO varies from €38,839 - €54,746

I doubt you would get a PA to work for less that this - never mind a few for the price of a doctor. Bear in mind that a clinical nurse specialist salary scale is €47,089 - €55,852 and I would imagine that PAs would see themselves at this level. One similarity between the US and Ireland is that doctors-in-training are probably your best value employees in terms of the work/responsibilty for the pay they receive.

Hadn't even thought of that. PAs would be less cost efficient than doctors. Now I really don't see the point.

So PA's can prescribe after 3 years? Am I reading this right? Hell doctor's need 5 years to prescribe.

IPNA

Let's compare apples with apples.
The PAs in the states do save a tremendous amount of money for doctors and HMOs.

In the US the PA can assist the cardiovascular surgeon. She will arrive before the surgeon, harvest the vessel from the leg and start the chest surgery. The surgeon will then arrive, attach the vessel during the bypass operation and let the PA close.

The doc makes from 200-500k per year. He can either pay another surgeon to do the work or pay a PA 80-120k per year. It is a lot cheaper to hire the PA.

Additionally, in the general practice, a GP can let the PA do a lot of the minor procedures, followups, arguing for payment with the insurance companies etc. He can either take on another doctor as a partner and pay him 150-180k per year, or hire two PAs at the same cost.

It makes financial sense to hire PAs.

I know things are different here in Ireland. I did read The Bitter Pill about how horrific the HSE is.

It is doubtful that the PA programme will ever take off here but it would be a great option for cost cutting measures without loosing healthcare coverage for the people.

I still don't understand how you could be trained in three years?

tallaght01

It'll be the same old balls we see with the nurse practitioners. Trained up in a protocol, without the knowledge or authority to be able to deviate. They'll be hired as everyone will think they're cost effective, whereas junior docs are as cost-effective as it gets.

They will be able to tick a load of competency boxes, but won't do half the stuff that a good junior doc will do, that's not always measurable.

If it comes in it will be part of the insidious dumbing down of medicine that we're already seeing in the med schools. They're very unlikely to be cheaper than medics, but individual departments will love them, as they'll be hassle-free once they're trained, and will get trained in all kinds of things at the expense of med student training.

lonestargirl

Deleted User wrote: »

So PA's can prescribe after 3 years? Am I reading this right? Hell doctor's need 5 years to prescribe.

Currently PAs with prescribing rights don't exist in Ireland.

lonestargirl

IPNA wrote: »

The doc makes from 200-500k per year. He can either pay another surgeon to do the work or pay a PA 80-120k per year. It is a lot cheaper to hire the PA.

This statement is only true for surgeons in private practice who don't have access to residents. General surgery residents in the US earn $42,000 - $55,000 a year - way less than PAs.

Edit:when I say private it doesn't mean the same as it does in Ireland. It means a self-employed surgeon who pays a hospital for use of their facilites rather than one who is an employee. In both cases the patient still pays for the service.

ORLY?

IPNA wrote: »

but it would be a great option for cost cutting measures without loosing healthcare coverage for the people.

How? They'd be more expensive and less trained than doctors.

IPNA

When I learned minor suturing while serving as a medic in the army, we had a four hour class and then was sent to the A&E. We watched a few and then started suturing. As we progressed through the months of training we learned advanced techniques. The doc would come and check on each of our patients before discharge.


Now, one of the docs could have sutured a minor laceration. He would have had the four years of training to understand Langer lines and the finer nuances of the procedure. But the end result was the same as our suturing.


So, do you pay a medic to do the easy stuff or just hire loads of docs? A doc is not needed to start a cannulation, plaster a fracture, debride and close a minor wound, blood draws etc. She needs to be there to monitor, yes.

Our doctors are overworked here in Ireland because they are not allowed to delegate tasks. The patient should be in the care of a competent doctor who has a team of professionals at her disposal.

The Physician Assistant programme was created forty years ago to make the job of doctoring easier for the physician.

Why is there such a tremendous resistance to change?

tallaght01

I don't think anyone minds a purely procedural service, such as the cannule service in some hospitals here in Oz.

But there will be a surplus of young docs pretty soon, who are very likely to be more cost effective, and need those basic skills too.

Plus virtually all medics will have seen the "mission creep" with the nurse practitioners in Ireland and abroad. Once PAs get bored with doing ECGs and cannulas and suturing they'll push for prescribing rights and "minor illness" diagnostic authority.

We're at the stage in the UK where my GP mate rang up to admit a patient, and he didn't get the reg, he got the nurse practitioner, who tried to refuse the (very legit) referral.

It's not resistance to change. It's a desire to do things properly.

ORLY?

IPNA wrote: »

So, do you pay a medic to do the easy stuff or just hire loads of docs? A doc is not needed to start a cannulation, plaster a fracture, debride and close a minor wound, blood draws etc.

No, a doctor is not really needed to do those things. But why hire a PA when they'll cost the same as a doc anyway? Also, a doc will not ever bang on about certain things not being in their contract etc. A doctor is obliged to see to it that whatever the patient needs to get done gets done.

2Scoops

Hypothetically, could a doctor apply to be a physician's assistant and do a job with less hours/responsibility for roughly equal pay?