No neurosurgery training? No worries!

4 minute read

The UK’s physician associates are just practising to the top of their scope.

Anything we can do, the UK just has to go and do better.  

Take our current “scope of practice” movement, in which community pharmacists in several states are being given the ability to diagnose limited conditions and prescribe the drugs they also sell.  

Allied health is also set to be “unleashed”, and nurse practitioners have been promised more freedom to prescribe and bulk bill by 2026.  

At the same time, cosmetic “surgeons” have had to be brought into line and the title restricted to those properly qualified to wield a scalpel.  

“Hold my beer,” says Britain, whose physician associates have been unleashed on patients’ brains, limbs and digits, according to The Telegraph.  

“The non-medical staff have been operating on skulls and brains, amputating limbs and toes, and removing patient’s tonsils in British hospitals, among other procedures,” the newspaper reports

One physician associate is quoted as saying that despite having “zero training” in neurosurgery, he regularly performs lumbar punctures and subdural haematoma evactuations. Another performs toe amputations under supervision and co-operates on major limb amputations.  

We’re not sure if this beats on-the-job medical training for apprentices without degrees.  

According to the NHS, physician associates have “a generalist medical education” and work in teams alongside doctors and surgeons. Their scope includes:  

  • taking medical histories from patients 
  • carrying out physical examinations 
  • seeing patients with undifferentiated diagnoses 
  • seeing patients with long-term chronic conditions 
  • formulating differential diagnoses and management plans 
  • carrying out diagnostic and therapeutic procedures 
  • developing and delivering appropriate treatment and management plans 
  • requesting and interpreting diagnostic studies 
  • providing health promotion and disease prevention advice for patients. 

But not 

  • prescribing 
  • requesting ionising radiation imagery

The Back Page doesn’t see anything in there that involves scalpels, unless lopping off a limb comes under the anodyne term “therapeutic procedure”.  

But note that prescribing is still a bridge too far

The Telegraph story says physician associates are confusing for patients, as they do not always clearly identify themselves as not-quite-a-doctor.  

The BBC reported in July that a young woman had died after twice seeing a physician associate she mistook for a GP. She had presented with calf pain and was diagnosed with a sprained ankle rather than the blood clot she actually had.  

“At a second appointment, she was given anxiety medication after reporting further symptoms of a swollen leg and shortness of breath. She collapsed later that day and died in hospital in November, three weeks after she first sought medical advice,” the BBC reported. 

The British Medical Association has called for the PAs to be renamed “physician assistant”, since, as the woman’s heartbroken mother pointed out, “Physician associate sounds grander than a GP”.  

Anything does, it seems, and maybe that’s what makes radio and TV broadcasters think they could do a GP’s job with no further training.  

As RACGP CEO Paul Wappett tweeted in response to Dr Hamish Blake’s flippant comments at the weekend: “I invite you to spend a bit of time with one of our GPs in a GP practice to understand what a hard job it is, what an important job it is, what an undervalued job it is, and how hard a job it is.  

“I’ll set it up if you’d like. And, in return, I’ll promise to not try to host my own TV show and charm the mums of Australia.” 

Physician associates were introduced in the UK 2003 but are not yet regulated. They will finally come under the purview of the feared General Medical Council late next year, and the NHS plans to increase their numbers to 10,000 by 2037 to help deal with its health worker shortage.  

And we shouldn’t sneer. Maybe that’s better than relying on brain drain from other countries to make up our workforce deficits.  

Send story tips to and charm the mums of Australia.  

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