I’ve heard about Physician's Assistants (previously known as "Anaesthetic Practitioners"), but didn’t really know much about them. These are people who aren’t doctors, but have been on a 2-year diploma course to learn how to give general anaesthetics, and thus work as anaesthetists. There aren’t any such people in my hospital, but one of my friends from uni has worked with them before. I asked him how the Physician's Assistants fitted into the grand scheme of things and the conversation we had was illuminating to say the least.
It seems that someone had a bright idea…
“Gather round people, I have a brainwave. I’ve been spending some time in the operating theatres recently and I’ve seen what happens down there. It seems to me that these anaesthetists don’t do very much. They give a couple of injections, put a tube into the mouth and that’s about it. We have to pay them all this money and I reckon it’s money for old rope. I don’t think you need to be a doctor to give a general anaesthetic. I reckon that you could send people on a diploma course for a couple of years and after they finish, they’ll be qualified enough to give a general anaesthetic. As long as the patients are reasonably healthy, then these people could provide the anaesthetic and do away with a couple of expensive doctors.
“Of course, patient safety is paramount, so there must be a fully trained consultant anaesthetist immediately available should anything start to go wrong and we’ve worked out that one anaesthetic doctor can safely supervise two of these Physician's Assistants at the same time.
“So, here’s the proposition. We could set up the theatre lists so that these Physician's Assistants could have only healthy people on their lists. This means that we run two theatre lists simultaneously with two PAs and one expensive doctor! We get twice the work from a single doctor! It’s genius!”
So far, so good.
The trouble is, giving an anaesthetic isn’t really that simple. In order to give a safe anaesthetic, you need to know a lot of stuff. You can’t train just anyone to do it, especially in only two years. You need clever people.
The problem is, clever people are expensive. The powers that be quickly found out that, in order to attract people to the course who would be bright enough and motivated enough to actually finish it, they had to offer salaries of £35000+. (In fact, The Ferret pointed out this advert offering £42 - £49K for an Physician's Assistant job based on a 37.5hr week.)
Now, in my friend’s hospital, unlike the junior doctor anaesthetists, the Physician's Assistants don’t work evenings, nights or weekends, they only anaesthetise healthy (ASA I and II) patients, they do not anaesthetise anyone with moderate medical problems, they do not anaesthetise children, they do not do epidural, spinal or any other regional anaesthesia, they do not cover emergency surgery, they do not cover trauma theatres, they do not cover A&E, ITU, maternity or the delivery suite and they are not part of the crash team.
In short, they are not employed as “replacement junior doctors” (who would otherwise be working on the healthy patient lists), but they are being employed as “Consultant-Lites”
Let’s look at the simple maths of the comparative salaries for two surgical lists run by the two systems
Consultant Doctor + Consultant Doctor
£90 000 + £ 90 000 = £180 000
Physician's Assistant + Physician's Assistant + Consultant Doctor
£40 000 + £40 000 + £90 000 = £170 000
When you factor in the additional pension contributions involved in employing an extra person, the cost to the NHS is pretty much the same.
So, the big question is, what was the point of training these people if it’s going to work out to be just as expensive as before and when a consultant Anaesthetist can do so much MORE than a Physician's Assistant?
Maybe, the powers that be failed their O-level mathematics papers or maybe, just maybe, it’s not about the money.
My friend spoke about it to one of the Physician's Assistant Trainees and it was telling that the PA said something like, “from a personal point of view, the (diploma) course is fantastic for me. I really like it, it’ll look great on my CV and if I get a job at the end of it, then I’ll get paid well. Looking at the wider picture though, I’m not sure I see the point of it. Don’t get me wrong, I’m not complaining but it seems to me that things would run just as well without us.”
I think it’s not about the money.