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Thursday, 1 May 2008
Physician's Assistants
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.
84 comments:
- Kelly said...
Would it be pedantic of me to point out that there are only three S's in "assistant"?
Sorry ;)
- 2 May 2008 at 08:10
- Jobbing Doctor said...
This kind of development is going on everywhere with Physicians assistants in General Practice (playing at Being Doctors) Nurse Practitioners (Assuming the roles of Doctors) etc etc. It is a dumbing down process promoted by Governments.
If you want to do the work of a doctor it's easy: 3 'A'a at A-level, 5 Years at Medical School then at least 7 more years in training.
That should do it.
- 2 May 2008 at 15:36
And where's your union, the so called 'formidable' BMA in all this?
- 2 May 2008 at 17:44
im in my final year at medical school (am in the joyous process of finals at the mo). It really really gets my goat (as a mild understatment). In the 5 since i started medical school i have watched the rise of the noctor - people who are being paid at significantly higher rates than junior doctors - with more exposure to patient care, inflated job titles, preferential treatment and very little accountability.
i will start my job in august (results willing) being a form filling machine whilst people take over roles that doctors have alsways done. Im sure the thrombolysis nurse is very good at what she does but if her patient is really unwell or she isnt sure she will ask some poor sod of a junior doctor who has only seen one guy with a heart attack cos all the rest were done by the nurse specialist. if it all goes tits up who will get dragged across the coals?
i have met noctors who have been on the prescribing course and who are now able to prescibe anything on the formulary. i have done five years at medical school and the thought of prescribing scares the shit out of me.
i am all for people trying to imporve patient care but the way to do it isnt to make nurses into super specialist all singing all dancing nurse consultant specialists. no. its too allow nurses to nurse. in the news over the last few days there have been masses of things about nurses feeling patient care is suffering as they spend too much time doing no essential paperwork.
i appologise that this is a bit of a rant and i appologise if people are offended by its rantiness against nurses. i think nurses do an awesome job under really difficult circumstances, its just that i feel that the medical proffessio as a whole is being gradually eroded and that at some point something is going to snap and patients will die.
it particularly peeves me that the same is happening in anaesthetics as i work bloody hard and that is what i'd like to be when i grow up so dont really want to have to fight tooth and nail for training.
ok rant over
- 2 May 2008 at 18:05
I'm starting my job this year as an F1. I'll be getting something like 20,000 a year, if anything goes wrong, my GMC registration may be in trouble. I wonder why I went through the 5 years (which was really not easy) to get to this life.
- 2 May 2008 at 23:20
- Michael Anderson said...
Kelly – you're absolutely right and I've edited the post. My GCSE English teacher would kill me if she read this!
Jobbing Doctor – There is more and more of this going on. We asked for an OGD on ITU the other day and the consultant turned up with his "Endoscopy Nurse Specialist" and she did the scope. Where was the Gastroenterology junior doctor? On the ward trying to organise discharges and being hassled by the Bed Capacity Manager, that's where.
Anonymous – I've never been a fan of the BMA, they've always seemed a pointless organisation if you ask me and their behaviour last year confirmed this. However, it seems that they are learning their lesson and might actually do something to help their members out (possibly). We shall see…
Rob –Regarding "Non-medical practitioners" in general, I can only talk from my personal experience and they've seemed to me to be bright, driven, hard-working people.
However, whilst previously, Specialist Nurses worked alongside doctors to help the patients (Palliative Care is an example of a field where this works particularly well IMO) it seems, increasingly they are being employed to REPLACE doctors, and I don't see the point of this.
The argument has always been that the non-doctors are the cheaper option, but we're finding more and more that this isn't the case (mainly because, as mentioned, you have to pay the practitioners lots because they're clever and wouldn't so the job for less – they'd so something else) so I'm starting to come round to the view that the powers-that-be just have it in for doctors in general.
Good luck with your finals, I'll keep my fingers crossed for you
Anonymous 2 – Being a doctor is often shit (especially as an F1) but it's often fantastic too. I think if you find your groove and you area of interest, then the good times make it all worth it. I wouldn't worry too much about the GMC. If you're good enough to pass medical finals, you're good enough to be an F1, even if you don't feel that way.
- 3 May 2008 at 21:46
Well, the way I see it, it's just not worth being a doctor these days anymore. To go through 5 years of med school(and this is 5 years of hard work. Not to put down other courses, but hardly any other undergrad course requires the kind of workload that this course does. Even in my 1st year, 5hour lecture days were not rare, while my friends in other courses had something like 5 hours of lectures a week in their 1st year) and come out to find that I could've taken a 3 year diploma course and get paid twice as much!!!
And there is just so little appreciation for the kind of responsibility and stresses you take on as a doctor. This is a job where you literally have to watch every step you make, and just letting your guard down could result in a mistake that can leave you never able to work as a doctor again, not to mention a big blight on your conscience. A large proportion of the public seems to dislike doctors, the government finds it perfectly reasonable to treat us as disposable.
I admire people who still find this a fulfilling career despite everything. But as for myself, I think I've made a huge mistake.
- 4 May 2008 at 16:08
I agree that the dumbing down process is worrying...This sort of thing makes me wonder whether I should even bother going to med school!
I just looked at the job advert: http://www.uclh-jobs.co.uk/uclh/jobboard/JobDetails.aspx?__ID=*5974BC34C3BBC320
It states: "The successful applicants will be expected to possess a Post Graduate Diploma in Anaesthetic Practice and be an affiliate of the Royal College of Anaesthetists."
A postgraduate diploma? Does that mean the candidate needs an undergrad degree first?
If so, then the length of study (say 3yrs undergrad, 2 yrs postgrad diploma) is quite long.
Am I missing something?
Well, given the factors you mention e.g. no on call, nights, weekends etc etc and only 37.5 hrs, really it's not a bad deal.
- 5 May 2008 at 13:50
- David said...
Just wanted to say that PAs have to have an undergrad degree (BSc Hons) in life or health sciences before doing two additional years obtaining the PGDip and then can anticipate at least one or two years internship at the end of that.
PAs are qualified as generalists, although they may undertake additional training to specialise they have to requalify every 5-7 years as a generalist.
- 16 May 2008 at 09:02
In reply to Jobbing Doctor:
I am a current trainee PA (A), I have 9 A/A* GCSEs, 3 A's at A-levels. Unfortunately at the age of 18 I had no clue what I wanted to do for a career, so I went on an achieved a first-class honours science degree and have various other qualifications that I did in my spare time. Unfortunately once I decided what I wanted to do I did not fancy getting myself further into dept by going back and doing a medical degree. This has been a great opportunity for me to do something challenging that I really enjoy and I resent being told that I am part of the 'dumbing down' of the NHS just because MD are not amongst the many letters that I have after my name! There seems to be a lot of misunderstanding about the role and if people actually took the time to educate themselves on the role rather than listen to rumours and hear-say they might understand how we 'noctors' can have an important role to play. I am speaking on behalf of the science graduates that are doing this role but there are also many ODPs/nurses/Sisters on the course too and the experience they have achieved in their careers is obviously not something that a final year medical student will understand!
- 7 July 2008 at 13:24
Perhaps in the UK Physicians Assistants are different than in the United States, but in the US physician assistants are a vital and valued part of the health care system. Physician assistants work in all health care settings, and are becoming increasingly more vital as Baby Boomers continue to age, leaving the health care system stressed. So yes, you can say that the health care system is being 'dumbed-down' without being able to spell the word assistant, but don't blame them when one of your relatives waits in the ER for hours because of lack of professional care availability.
- 26 September 2008 at 03:03
Well said. I think you should get your facts straight. Maybe have a look at the several reputable universities running the new PA courses in this country at present. No offence, but as a UK PA student I would like to point out that the people on these courses at present have 1st class degrees, have already worked many years in the healthcare profession, and to be quite honest shame the 3rd year medical students on the wards within their 1st year in regards to knowledge and insight. These people do not want to be doctors and hence why they have not chosen to do medicine. Spend more time on understanding the role than wasting energy commenting about something you obviously do not understand.
- 4 February 2009 at 19:07
Hmm...I don't think you have any argument to say that you have more knowledge or experience than 3rd year medical students as they are still at a junior level in their training and are accepted to have not developed the knowledge required of a doctor yet. Perhaps FY1/FY2/ST1 docs would make a better comparison since you are filling a role that was essentially a doctors role.
I am a little concerned with the impact the new PA system has on both FY and medical student training. Had a friend recently do a SSM in Anaesthetics and it was honestly the most useless 4 weeks of her life. When any practical procedures e.g. cannulation, LMA's, intubation etc. were needing done, she was cast aside in favour of PA students/ambulance technicians. This is not the students faults but it happened on such a regular basis that I fail to see how this new role cannot have adverse consequences for anaesthetic training. Hopefully, I will be proven wrong in the future.
- 8 February 2009 at 00:56
I have to say, I think you're a real jackass. You and many of the people who've commented on this blog. In my opinion, you're a bunch of know-nothing's (currently) who just can't stand to see someone with less schooling perform as well, if not better in some cases, than you ever could.
I have personal experience with PAs - being the dumb EMT-P that I am.
I remember a gunshot victim: upper-left quadrant. Totally unresponsive, 'cept for a few bleeps on the monitor. An ambulance didn't bring the girl in (her friends did), so she wasn't intubated yet. I ran in the room to see what help I could give, and I was needed, apparently, because I took over compressions while nurses were busy getting a line in her and the doctor was busy setting up his tube-kit. Finally, the doctor had it all set up and went about tubing her. After several failed attempts, he let the PA take a shot at it. And guess what? He got it in on the first try.
Ain't that something? A dumb PA.
Bottom line: PAs go through essentially the same training as doctors. The only real difference is the residency program. It is my opinion that PAs know as much as doctors, but the title[s] of M.D. or D.O. saves them from being pompous asses, in most cases.
Lots of luck, Junior.
- 26 February 2009 at 07:44
I think it is very arrogant of you to assume that people who choose to enter a medical field and not become a doctor must be less clever than you. The PA profession appeals to many (clever) people because the formalized training is much shorter. I studied at Oxford (my degree was a 2.1) and both of my parents are doctors. I want to be a PA because I want to start a family in the next few years and work part-time after that, and frankly, moving all over the country with limited control over my schedule does not appeal to me. I know many others who feel the same.
As for PAs apparently not being good enough to do their jobs (according to you) please remember that although the training course is very short, the main difference between PAs and doctors is not the length of training, but the formality of training.
Please keep in mind that PAs work closely with consultant-level doctors and over a very long period of time (decades) and learn a lot about that area of medicine to the degree that they can and do preform many tasks that were once solely preformed by doctors.
Doctors are not stupid--and PAs work with the very best of them in the USA. PAs in the US teach medical students and junior doctors. Do you really think that so many intelligent doctors would take ultimate legal and ethical responsibility for care undertaken by the PAs that they hire if they didn't truly believe that the PAs were capable of doing it?
I hope that you don't share some of these opinions with the people you'll work with in the future--my feeling is that you'll isolate nearly everyone who doesn't go by the title "Dr." Be careful with that.
- 2 September 2009 at 05:31
So ehm, do PA's get sued if something goes wrong too?
- 6 September 2009 at 09:41
The short answer to that question is yes, PAs can and do get sued. PAs (like any health professional) are responsible for the work that they do, and any negligence on their parts (including doing procedures they're not trained for, etc.). The difference is that the hiring doctor maintains ultimate responsibility for the patient AND responsibility for supervising the PA, so in theory he/she could be sued too. The legal relationship is similar to that between junior doctors and consultants/GPs they train with.
It's worth noting that in an exit survey ( http://www.nes.scot.nhs.uk/documents/publications/classa/UHI_Final_Report_January09.pdf ) following a study on 15 US-trained PAs working in Scotland over 24 months, there were only 2 instances of "minor patient safety issues"--one involved a mixup with patient notes and the other involved a PA advising a patient to change their drug regimen without consulting the supervising GP. It was also found that the doctors generally liked working with PAs and that patients were generally very satisfied with care received from PAs.
- 30 September 2009 at 15:57
Whilst I have the greatest respect for anyone who can complete a medical degree AND survive in the stresses of a hospital environment.
The simple fact is that in many other countries in the world non medical anaesthetists are highly trained and respected by medical anaesthetists, and work alongside and complement each other.
This is not the case in the UK as so many Doctors are so f**king far up their own arses they cant see daylight( Hey its an english class "caste" thing) Why cant you focus on being the best medical practitioner you can and not on others whom you feel should earn less money/respect whatever. Arent you secure enough in yourself to focus on improving yourself rather than criticise others.
These professions have been created due to workforce requirements to meet the needs of a modern healthcare system and due to the WTD provide adequate rest for junior doctors so they are alert enough to be safe (without the use of drugs).
what I was going to say was the education system is so Dumbed down that there are abssolute idiots becoming doctors, albeit doing ther seven years whatever, (hey its really not the hardest degree anymore), so actually judge individuals on their academic and intellectual merit and dont be such wanker (i.e. predujiced) generalists.
I personally have met more than one "stupid" consultant as well as a few brilliant ones.
At the end of the day, PAs are supported independent practitioners but look at the title, it says what thet are, not to denigrate but they are a highly educated healthcare practitioner not a doctor, and dont claim to be.
- 3 May 2010 at 23:56
To the rather angry 'Anonymous' above.
Firstly, the term is spelt prejudice, and the use of offense and ad hominem remark will do you no credit. Furthermore, Medicine today is not only amongst the hardest course to complete, but is systematically becoming more and more competitive to enter into. I speak as a student soon to apply to Medical Schools. It is not the case that there is a 'caste'-based system, and all stand an equal chance based on academic merit and motivation. No-one takes this lightly, and you would be foolish to do so. Please do not for a second claim that you have met 'stupid consultants'. Whilst these people may not be able to tie their laces or make a good cup of tea, no doubt they can speak comprehensively on the chromosomal patterns underlying Ehlers-Danlos syndrome. This, by my measure at least, makes them good doctors. What the article you are talking about aims to put across is that these people are not doctors, they do not have anywhere near the education or possibly even the inclination to be named as such. They are, fundamentally, assistants to the physician. Please do not feel that I mean that they should not be treated with the same level of respect entitled to anybody fulfilling such a demanding role, this is not the case, however, they cannot be viewed as medical equals in their professional capacity. If anything, the role seems to be rather unneccessary and potentially wasteful or dangerous.
- 7 May 2010 at 22:53
I'd just like to point out that I am a qualified PA(A); don't start throwing the tomatoes just yet!
There really has been alot of anger and ranting on this thread (something, I unfortunately have become quite used to). I admit, I don't have the same knowledge as a doctor, even though my knowledge is quite extensive. I did an undergraduate degree in Biomedical Science and completed the 2 year post grad diploma in order to obtain the post I currently hold. It was no easy task coming up against all the controversy. I can understand why alot of people have been very wary of this role but I do NOT see myself as a replacement doctor. Anyone who has ever worked with one of us will understand that. I see myself as someone who can help increase theatre turnover time with my specialised training. In my hospital, alot of people who were "anti PA(A)" can now see how useful we are and will barely do a list without us. Also, we DO work weekends. The hospital I am employed with run fracture lists every weekend and there are no trainees present then. Generally, one case will be finishing up and the consultant will be taking the patient to recovery, meanwhile, I will be drawing up drugs,putting iv in, preoxygenating, generally speeding the whole process up. We always manage to squeeze extra patients onto the list as a result. Even the orthopaedic surgeons have commented on how useful this is. I'm sorry so many people have such a bad impression of us, but I innocently applied for this job thinking I could be good at it (which I am) and thinking I could bring something to the table (which I have). Also, we work very effectively with the trainees in our trust. We certainly don't detract from their training. If anything, it means the consultant has more time to focus on them as PA(A)s can carry on with the more mundane tasks whilst they have uninterrupted teaching and training.
- 7 July 2010 at 15:01
Hi to everyone. I am currently training as a PA(Anaesthetics). All of you have posted some nice and good posts. It is an individual choices and some times different people have different opportunities in their lives. Additionally, it is not a matter of cleverness and un-cleverness. Furthermore, its opportunities and luck. PA are always working with consultants. Sometimes, my cosnsultants are less academic than me. However, they are my consultants. Personally, I have 9 GCSC (All A and B grades), 8 A leverls, A and B grades. Then, Diploma in Nursing, followed by DVM (Doctor of veterinary Medicine) and MPH (Master in Public Health medicine). Nonetheless, now I am training as a PA.
- 18 February 2011 at 09:20
Previous poster:
Give up the badge collecting and get a life!
Nurse, Vet, MPH (you can become a Consultant in that now, don't you know)and now PA(A) - what a waste of the public purse.
What you going on to next - medicolegal LLD?
- 27 February 2011 at 20:24
- Rebecca said...
Goodness big debate.. I'm slightly concerned as I was intending on applying to St Georges (UK) this year for the PA Masters.. from my own perspective, yes it would be a great interesting job, good money and all that.. however, I wouldn't feel right about doing it if in fact it is a pointless role if for example, Nurse Practioners basically do the same job.. I want to be of use and really be able to help in the health care system.. otherwise it's meaningless.
Can all you health care experienced peeps help me out and explain if there really is a point to PA's, and if there are some vital differences between them and NP's ??? (and i'm not talking about the education, i'm talking about after graduation, the actual work and care they provide)... it would be much appreciated as I will stop wasting my time on applications! :) please honest, not biased feedback
- 10 March 2011 at 19:27
Yes, there is a point to them.
There are not enough doctors to go round.
New qualifieds flock off to the southern hemisphere and the non-EU doctors that were once the backbone of english on-call rotas aren't allowed in
Pa's can give flexibility to a department but don't provide the answer to all shortfalls, esp on calls.
They are not doctors and are not a substitute for doctors.
Ther work along side them and sometimes train them.
It's a great course and a fasinating career but just bear in mond there are qualified PA's without a job, don't beleive the hype.
Places on courses are drying up and the number of universitys offering the course this October (2011) are dwinddling.
- 21 March 2011 at 11:38
Hi there, I'm an intensive care nurse with 4 years experience and training in critical care nursing. What I find so difficult with a lot of young doctors today is that they see themselves have the "leader" in a healthcare environment and not part of a team. Ive worked with a lot of extremely experienced consultants, nurses, physios and actually a PA A, who comes to our unit to insert PICC lines. The thing is about looking after a patient is that one profession cant work without the other an we all have our on skills. Ive seen several junior doctors who come to intensive care thinking they are god gift to actually find out they know very little about critical care, panic in emergency situations and often are guided by us on what to do. So please open you mind to what healthcare and medicine is all about...
- 31 March 2011 at 15:41
Good call.
it should be about team working.
Just a shame it seems to be about kudos, point scoring and getting a higher banding.
PA's are not the new order, but could help small departments that struggle to recruit.
PA's dont help themselves when the price themselves in the same bracket as doctors i.e. 8B+.
Although same (ex. nurse PA's) can prescribe a PA is not a doctor.
They may have sat in "school" for 5 Years or more but IT IS NOT the same as a medica degree.
It is shorter and yes, more focused, but yuou are not a doctor, go back to school for another 4 years and yes, maybe you will be.
- 4 April 2011 at 00:36
Well!, aren't you all a precious bunch! having done some years training, you now feel that only you are qualified to practice routines on people. Let me bring to your notice that there are a great deal of clever, intelligent nursing staff out there with buckets full of experience, wisdom, and common sense who are quite capable of doing such a role , yes, with only 2 years of training. (I might point out here that I am a medical librarian, not a nurse, so carry no predjudice to one group or another, who deals with the whole variety of hospital staff) . I often see F1's who are so stupid, that I would not let them administer me with a plaster, and I know that there are some Nurse Practitioners who have seen more and done more than you could ever have experienced in your dreams. Stop all of this bleeting and learn to work together as a great TEAM. Value each team member on their individual merits, and value experience above all.
- 31 May 2011 at 16:58
Hey there
I am a UK trained Physician assistant currently consulting in General Practice.
I have a 2.1 with hons degree in Radiotherapy and Oncology and spent 2 extended years at medical school training under consultants under the main area's of medicine, as PA's do 2 EXTENDED years training we actually only have approx 20 weeks less training than a fully qualified doctor who trains on the 4 year entry scheme - which I qualify for.
In addition to this, we have a 1 year internship.
In order to pass the course we sit a 200 x2 medical MCQ paper, sit an in house OSCE with 16 work stations managed by doctors and then sit a national exam which again is examined by doctors at each station. We also have to be signed off by a consultant in each specialist area to state we are able to perform to a suitable level, this includes clerking in patients, performing physical exams and suggesting appropriate managements.
The training is tough.
I am not a doctor, I am a proud Physician Assistant who works alongside the doctoring team at my surgery without rotating so all they invest in me they see the fruits of!
I have worked with many junior doctors and your negative attitudes are not universal, as a whole the FY1s etc have been very pleased to have some help and the PAs are happy that FY1s, FY2s are happy to train them.
Junior doctors on the wards are massively overloaded and once those of you that are coming up to qualification enter the hospital, you will take any help that is offered whether it be a friendly PA or an experienced nurse - one needs to remember - not so long ago, nurses were in a very narrow role, imagine if that was still the case today - doctors would need 8 arms and 5 brains!!
- 1 July 2011 at 15:53
So why didn't you become a doctor?!?
What can a PA bring to the party that a nurse( who has completed and advanced practice Masters programme including independant prescribing) can't?
- 12 July 2011 at 22:38
Nurses with that level of training are invaluable and I am not sure it is fair to make a comparision, these breed of nurses are many many years in training, often with a substantial amount of experience that not many professionals can compare to.
I didnt become a doctor because I became a Radiographer and at this point felt training to become a doctor was to much of a commitment, PAs are not doctors, they are not substitutes for doctors.
As a healthcare assistant is to a nurse, a PA is to a doctor. They are a buddy to the doctor, assisting them with there workload.
They are a permanent member of the team meaning that the consultant does not lose them after 6 months and they are a great source of support to the nursing team when doctors are unobtainable.
I understand there is alot of confusion surrounding PAs but the Royal College of General Practitioners support there integration and have more information on PAs on there website.
I am happy to answer questions on how a PA works etc...
Please feel free to email me
- 26 July 2011 at 16:56
If, as you claim, PA's are a permanant member of the team, why are the jobs currently advertised for a fixed term of 12 months?
Looks like the medics aren't that convinced of your usefulness?
- 30 August 2011 at 23:45
- Anonymous said...
Why are PA's not allowed to prescribe medication in the U.K but are allowed in some states of the US? Can they suggest medications to the supervising physician and prescribe?
What would be the role of a PA in A&E? and what would they're role be?
Are they allowed to work nights?
Thank alot
- 4 October 2011 at 14:34
PA's are offered a 12 month contract as post qualification they are expected to complete a 12 month internship, I have searched the current jobs advertisements for PA's in the UK and they specifically state that they are looking for an intern.
- 10 October 2011 at 13:02
Still on a temp contract!
- 15 November 2011 at 11:01
i know pa who are working in hospital. let me tell u, one of them said they didnt even know why th pa programme started, its not organised. they cannot prescribe , but the pa was grateful for that, as they were working in a busy ward. also all teh schools are closing. uve got graduates who took 2 years studying , doing placements, and then no job. consulatnst even said that teh programmes was simply not thouight of before it made its way to the uk
- 3 January 2012 at 01:33
pa programme has been a total waste. I cannot see the longevity of it. now i am in debt. i also have friends who are unemployed. i would like to sue the stupid people who had this idea. if anybody is thinking of doing this programme , PLEASE DON'T. you will regret it. better off, if you be a healthcare assistant, nurse, or doctor.
- 3 January 2012 at 01:38
The PA programs and scope of practice is the US is MUCH different than that in the UK, at least from what I understand. I just recently finished a 27 month program here in the US, where for 14 months I spent 8 hours a day in the classroom and/or labs and then another 13 months on clinical rotations (just like med students, except we go to school year round instead of having summer and winter vacation time). This was 2.5 years of schooling after completing 4 years of undergraduate study. (I like many of my PA classmates were "pre-med" undergrad students who majors in subjects like biology, kinesiology, bio-chem, health studies, ect). Here in the US, PAs are trained in the primary care medical model are seen as mid-level providers, much like a Nurse Practitioner, who also has 2 or so years of graduated medical training. We work side-by-side with out supervising physician treating patients in pretty much every field of medicine. Starting off, as young PAs, we don't have as much autonomy, but as we become more experienced and as the working relationship between our supervising physicians grow, most PAs end up pretty much working on there own only consulting their supervising physicians when they fell necessary. In most states PAs are allowed to prescribe medications, just as they are able to diagnosis and treat patients. I am not exactly sure what type of training PAs in the UK go through, but I don't think it is as rigorous as here in the US. There are plenty of jobs of PAs here in the US, in fact the profession has won awards in the past few years in titles like "Best Career Outlook," "Top Ten Growing Careers," and "Fasting Growing Career." I also feel that I and the rest of the PAs practicing in the US are very well respected by both patients and doctors, both MDs and DOs, which I don't feel is the case in the UK.
- 16 January 2012 at 16:11
Hi to comment above
Yes the training is just as tough here in the UK.
We too are expected to have an undergraduate degree in some form of healthcare with some experience.
We then do 2 years INTENSIVE training so also do not get summer breaks etc, we work shifts with the doctors and also do lab and classroom studies.
We then sit exams within the university where we have studies, this consists of a practical exam where we rotate around workstations and see "patients" whilst an examiner marks us, and also a long MCQ paper. IF we pass this exam we are entered for the PA National exam which all the PAs from across the country attend. This is much the same as the uni set exams although marked by the governing body of PAs.
In every rotation we do with the doctors we are marked and have to pass each rotation.
It is a very difficult course to pass.
I work in general practice as a PA and am similar to an advanced nurse practitioner, the combination works very well.
- 19 January 2012 at 09:51
- feline friend said...
Well well well, we do have a bunch of bitter individuals here don't we?
I am a Physicians Assistant in anaesthesia.
I am also a registered nurse.
I also went to college when i finished school so all in all thats 2 years for my A levels, 3 years for my nurse training and 2 years for my PA(A) training. Not to mention the 10 years I've been working in the NHS since qualifying as a nurse. To me all this 'time at uni' nonsense means nothing.
Surely the thing that matters is how well you can do your job and what you can offer to any medical team you are working for?
Who said doctors were God? Who said PA's were a threat to doctors? Who said that unless you go to university for 5+ years you're bound to be thick?
Come on people, be a little open minded here.
Junior doctors are bogged down with countless tasks at the best of times, do you not find it helpful having somebody take the pressure off you so can carry out the tasks you will be doing at the highest of your ability without having to rush and possibly make mistakes?
Nobody doubts that doctors work hard to get where they are but this doesn't make them any better than any other health care professional, be it a nurse, care assistant, physio, radiographer etc. We all have very different roles, each one being important in the delivery of quality patient care.
We shouldn't be feeling threatened by the other professionals we work with we should all appreciate each others role, accept it and just get on with it!!!
- 26 February 2012 at 13:26
Well said!!!
PAs are in their own right - health care professionals and are not cheap doctors just as HCAs are not cheap nurses but valuable never the less.
We do a fantastic job and the Drs that have worked with us would, I am sure, agree.
- 27 February 2012 at 12:51
How many PAs that qualified this year got jobs?
- 4 March 2012 at 21:32
Interesting how the tone of these posts has changed. Now that the opportunistic PAs can't get work, the talk is more of wanting to help with the drudge than work as clinical thinkers. The problem wuth the PA role is that its easier to get into, offered more money and better conditions. Thats OK, but invariably the mission creep set in and these new roles want more money, status, respect. They TAKE it and can do do as they are empowered by politicians with an odd doc bashing agenda. Doctors EARN it. It saddens me that so many folk reallt think they are equivalent to or better than doctors when they are simply not. Wanting to be something is not the same as being it. I wanted to be a doctor. I worked hard and became one. You should try it some time. Of course its a bit easier to weazle your way in through these PA/ Noctor type back doors so you do. Thats human nature, but lets call it what it is.
- 2 June 2012 at 09:03
Totally agree. Its time these pathetic, jumped up 'oh lets call the doctor' whenever the doing gets tough types were exposed for their matchless arrogsnce and inferiority.
- 2 June 2012 at 09:08
Your superiority complex as a dr will be exactly the thing that makes patients favour seeing a PA / Nurse Practitioner over you, thankfully your breed are few and far between.
- 8 June 2012 at 20:38
- feline friend said...
Hmmmm...it really makes me wonder why arrogant doctors go into their profession. They obviously have no people skills at all and their main ambition isn't to make a difference to services offered by the NHS!! It is becoming quite clear that these doctors are in it for the status and the power they feel it gives them. Well that is just wrong!!! Having an attitude like that is dangerous because it means you've got your head so far up your own backside that you're oblivious to the team which are working around you. If you are blinkered it means you're failing to see the bigger picture and i feel that is detrimental to the patients well being. I work with some fantastic consultants who believe the key to quality patient care is team working and respect for those team members. People with arrogance are usually trying to hide something!!!!
- 11 June 2012 at 10:52
I am currently a HCA and have a BSc in medical science. I have applied to Medicine and understand it is a very competitive and intense training course but also career choice and is not a decision I take lightly. Having worked alongside of FY1s, Registrars and Consultants I wonder whether Medicine is what I originally thought it was and whether it is something I want to go into. I have been exploring other professions, PA(A) being one of them.
PAs seem to be a more established role in the US and don't think that it would have been brought over to the UK if it wasn't successful. It seems to be a specialist supportive role rather than an invasion of a doctor's position.
However, it seems that not many universities in the UK are offering PA(A) courses and I wonder how many job opportunities exist post qualification? Is it a day surgery job or is it also seen in the resuscitation department?
Feline friend: I thought your original post was really well written and wondered why you decided to become a PA(A) after having been a nurse?
- 18 June 2012 at 13:08
- feline friend said...
I decided to become a PA(A) because my nursing career wasn't offering me anything new or interesting. I am quite ambitious and want to get the most out of my career and this seemed like a great avenue to go down as I already had an interest in anaesthetics from working in theatre and recovery.
There have been lots of PA jobs advertised lately on NHS jobs. I am just trained in anaesthetics but there's General PA's who work all over, A&E, surgery, medicine, trauma etc. It's a great avenue to go down and it's becoming more and more popular. Anaesthetic PA's were only introduced about 8 years ago so I think it would be unreasonable to expect a huge recruitment drive for this role so early on. Our role is more recognised than ever. I was anaesthetising for a trauma list the other day with a orthopaedic consultant I've not worked with before, he spotted my job title on my ID badge and said 'oooooh a physicians assistant, I want one of those on my team'!!!!
- 18 June 2012 at 14:02
I'm a general PA and work in general practice. I lead the nurses in the diabetic clinic, I am just about to start initiating insulin in primary care. I insert and remove contraceptive implants, run the anticoagulant clinic including taking responsibility for bridging, I also see hypertension, heart failure and chair the palliative care meetings. When I'm not doing the above....I am on call with the GPs. On top of this I can read X-rays,CT scans,MRIs due to being a radiographer prior to being a PA. I read ECGs, Spiro and when on the wards could interpret ECHOs.....I cannulate, take blood and interpret all my own results. Did I also mention I can catheterise both male and females. Shock horror I even done chest drains on the ward! How on earth did I manage seeing as I am just a dumb PA??!!!!
Feline I very much support your comments
- 22 June 2012 at 20:14
Yes Jade
But you still can't prescribe, can you?
(Unless you're also a nurse, in which case you'd have got an ANP MSc qualification cheaper, if not free, rather than paying for your PGDip)
- 13 July 2012 at 12:57
- feline friend said...
We don't need to prescribe. We've just initiated a patient specific directive at our hospital for us anaesthetic PA's to overcome the prescribing issue. It's all going very well I must say and the future for PA's looks very bright indeed.
- 13 July 2012 at 17:29
to the hca, thinking of medicine or pa. please dont do the pa course. all the schools have shut the course except for the one in aberdeen. There arent as many jobs as they said there would be. u will regret it. if u want to do medicine, understand it requires alot of responsibility and hard work. stay away from pa course, thats my only advice
- 20 August 2012 at 23:52
First thing I would like to point out is that there are actually 2 professions being discussed here with 2 very similar names. names put out to consultation and chosen by government, nothing that any of the PAs can do. there are Physician Assistants who work in medical or surgical settings and are trained in the medical model and there are also Physician Assistants (Anaesthesia), who work in theatres etc. I think there has been a lot of confusion between the 2 roles throughout this thread, leading to several myths and animosity towards the roles.
I am a physician assistant, and work in acute medicine. I clerk my own patients, come up with my own differentials, recommend my own treatment plan and present my patients on PTWR. I am working with (and I stress the word WITH, not FOR, not INSTEAD OF) my 11th set of FY doctors, and I help them find their feet when they first get on the unit, keep the take moving while they improve their clerking speed and am the person that they come to for advice when the reg is stuck in ED with a sick patient and the RMO can't get off the phone from primary care referrals. I can't prescribe. I am not a doctor. That does not mean that I do not have a good amount of acute medicine experience and knowledge.
Not sure where people studied as medical students, but there has certainly never been a lack of patients to see anywhere that i've worked.
- 21 August 2012 at 21:55
Also - the PA courses have not all shut. 2 of them have doubled in size. There are people who want to be doctors, and being a PA will not satisfy that - these people should become doctors. For others (myself being one of them), being a PA is the right choice. I resent that people say I am "playing at being a doctor". Firstly, I'm not playing. Secondly I am not trying to be a doctor. What I am trying to do is to help to take the pressure from the medical team caused by EWTD, increased population size and hugely increased hospital activity without adding to the competition for more senior jobs (meaning that junior doctors have more chance of getting into the specialties that they want to work in rather than stuck in staff grade posts somewhere else because there are too many SHOs around). I would be interested to know how many of the people that are so negative about PAs have actually spent time with one.
- 21 August 2012 at 22:04
which pa courses have doubled in size?as far as I was aware, there was only one pa programme and that was in aberdeen. I am sure anoymous u do good work as a pa. but i can tell the physician assistant course was a disorganised waste of time, the role was not thought of in more detail. do physicians assistant have portfolios of work they have to fill in like fy1 and fy2. no they dont.and where are the jobs being advertised , cos i have only seen them come up once in a blue moon.
- 26 August 2012 at 00:46
theres quite a few physician assistants who have graduated for over a year who still have not found their first Physician Assistant Job. And so their slowly losing their knowledge. The universities from where they have graduated havent helped them.
- 26 August 2012 at 00:51
- feline friend said...
The University of BIrmingham are still running the Physicians' Assistant Anaesthesia course and they're continuing to have lots of interest from various trusts.
Sheffield are advertising for PAA's at present to add to the team of PAA's they already have. In Dudley we have to keep an an anaesthetic logbook of the cases we do and I also have to keep a portfolio of competences and knowledge just like the CT1 and CT2 anaesthetic juniors have to. In fact, the Royal College of Anaesthetists paper work is what we use for these. I went to the Association of Physicians' Assistants conference a few months ago and the outlook is very bright indeed. Our services continue to grow and our ever growing skills continue to be supported by the Royal College of Anaesthetists. The University of Birmingham is just in the final stages of finishing some bolt on modules so we can branch out into critical care. It's all looking good!!! And yet again I will stress that we are not a threat to doctors we are merely there to lighten the work load and work as part of a team. I hate these arguments about who is the better profession. We all have a valid role in health care. This is just how the NHS is modernising and redeveloping itself. Trust me, I've been working for the NHS for over ten years and so much has changed.
- 26 August 2012 at 16:28
felin friend, I was talking about the physician assistant programme which is different tothe anaesthesia course. the physician assistant course has stopped running cept in aberdeen. and yes tere are still physician assistanst that still havent not got their jobs despite graduating over one year ago. so perhaps for the anaesthetics it looks bright.
- 26 August 2012 at 23:19
St George's train PAs. We have a managed voluntary register and to maintain registration have to meet CPD requirements. I keep a portfolio of what I do and during training you do have a skills work book which has to be signed off before grafuation. There are lots of PA jobs which are advertised through UKAPA our governing body. There are also agencies offering locum jobs for PAs. Us who are employed as PAs are very excited about the future role. Unfortunately as with any course, including
Nursing, not everyone is able to find suitable employment straight from university.
- 27 August 2012 at 16:02
hello,first of all I am a physician assistant and like to add my input. when the previous person said they have a skills workbook which has to be signed off before graduation. I can tell you know whilst I was training I never had a skills workbook. whilst i worked as a pa, I never had a portfolio or a list of practical skills that needed signed off.Infact I then had to devise my own little ticksheet and adapt it from the fy1 and fy2 . But this wasn't that good. I didnt graduate from st georges. which agencies are offering locum jobs to pas? Id like to know, cos I heard from my colleagues that its difficult as pa cant prescribe hence no agencies are interested. Also with nursing u can find some temp work easily, once u get your paperwork, registration and up to date training.
- 27 August 2012 at 23:43
I qualified from UH and had a skills workbook that had to be signed off, not only once but had to be signed to say I had watched the skill then I had safely been supervised carrying out the skill. If you were a member of UKAPA you would see there are many jobs being advertised including locums. I work with many nurse practitioners who cannot prescribe but it doesn't mean they are any less of an asset to the team, in fact on calls in large primary care centres would struggle without nurse practitioners or physician assistants.
- 29 August 2012 at 18:53
I take some responsibility for my practices as a member of a health care team, I keep a portfolio and record patient numbers for any surgical procedure I carry out plus any complex practices such as insulin initiation. I also keep anonymised copies of a variety of referral letters I've sent and a comprehensive record of ALL CPD I do. As a PA I make sure I can demonstrate my worth because it is a new role. My mentor looked through EVERY patients I saw for my first 18 months in practice and I have seen approx 35 patients a day for the past 2 years with Absolutely NO complaints from a single patient and absolutely NO issues with my practice, in fact I have had 2 lung cancers come through my on call in this time and have picked up both the first time I met these patients - despite never seeing them before. I am a competent health care professional who takes my job very seriously and practices medicine to the absolute best of my ability, it is ridiculous to think a PA cant add anything to the health care team, I've had at least 3 practices approach me about a job in the past 2 years so PAs who aren't finding employment need to get out there and show the world what they are about
- 29 August 2012 at 19:08
I have worked with PA's and intially I was apprehensive about their role and being a new breed workforce. But they have surprised me; In Cardiology there are PA's doing Central Lines and when the juniors are unsure about something they will ask the PA. In A&e they essentially do everything from start to finish with a patient and theres a PA in Birmingham City hospital who will see really unwell patients. Some of them can even do their own Fastscans.
I don't think they are out there to take over other people's jobs or roles; they are really friendly people and help their fellow colleagues alot, you can handover patients to them and they will make sure jobs are done etc.
Give them a break.
- 13 September 2012 at 20:55
There are PA's in neuro who are trained to do LP's but from what I know the Doctor's training isn't taken away. FY2's/SHO's have their protected teaching time and as far as I know PA's don't get much teaching, yet they are expected to do a fair amount of work.
They aren't a threat to anyones profession, if anything they are hardworking people from what I've seen.
- 13 September 2012 at 20:59
Poor Doc's on their high horse as usual
- 29 October 2012 at 20:02
I have stumbled across this debate whilst researching, and I have to say that I am astounded at the level of anger! When did being a healthcare professional become all about how many qualifications you have? Surely it is about the best care for patients, that is after all why people are supposed to choose such careers, an inbuilt moral conscience for the greater good. Perhaps I am niave or too idealisitic but after working in an inner London Hospital I can assure you that physician assistants and nurse practitioners do provide a useful service. It is unfortunate that the pressures of targets etc are pushing the NHS to bursting point. Doctors, nurses and physician assistants all have different job specifications and skills, yes some of them overlap, but in general it all works very well to provide the best care to patients in a very difficult and stressful environment. Patients keep on coming in regardless, PAs help. Surely we should all respect each other and appreciate the work each of us do?
- 27 December 2012 at 02:10
p.s to all those angry Doctors who are so irate and viscious towards the PAs and what they do, you should stop being so insecure about your own capabilities and worth. Docotrs are doctors, nurses are nurses and PAs are PAs. If you can't respect and understand your work colleagues and other members of the MDT, then you can't respect and understand your patients.
- 27 December 2012 at 02:19
I have terrible diarrhoea.
- 27 December 2012 at 03:46
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- 23 February 2013 at 02:35
Interesting thread. I agree that teamwork is key in patient care. Feline friend, Ive been looking into pa(a). Would it be poszible to email you to ask more ? Thanks !
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- 14 October 2013 at 07:36
250 k to train a doctor who may well go to Australia, or take a different career path. However I think the NHS needs to find alternatives to expensive doctors when they are not needed and let them do the difficult stuff. The uk isn't made of money.....
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- 23 October 2014 at 15:06
Recently, my consultant won't leave accs and second year reg incharge of the patient. Unless, I was available to relieve him for lunch and toilet break.
So, you can gather how much a PA is knowledgeable and confident.
As a junior doc you will work with PA and you will see our anaesthetic knowledge, practice and experience.
- 30 November 2014 at 09:49
It's this level of prejudice and animosity to anyone in an advanced role that doesn't have the title of "dr" that is leading me to quit my job as a physicians assistant in anaesthesia. After 19 years in the nhs a Bsc and 3 post grad qualifications I really can't be arsed dealing with the sarcastic comments from middle class primadonnas who believe that my mere prescence somehow downgrades their qualifications. I never wanted to be a Dr hence never going to medical school. I did however want a challenging career that enabled me to provide excellent patient care as part of a mdt. Obviously I should have known my place and not bothered applying for the post and completing my training. I am I off to work in academia if that's ok with all you bitter and stressed out medics. Unless of course that too is a job that I shouldn't be doing. Don't forget the salaries of PAs stay around 40k for the whole of their career while yours will rise to over double that with an increased pension and the opportunity to gain silver and gold awards to plump up your pension pot still further. If you still think we have the better deal my job will be free later on in the summer so quit your career pathway and apply. If you can't beat em join em!
- 12 March 2015 at 15:03
Very well said. Thank you on behalf of all PAs.
- 31 August 2015 at 06:52
- Shuggy said...
I am neither a doctor or a PA, they're both there to help care for patients though?!To diagnose,treat and help others live healthily?!So what's all the hype about?!As far as I see it,medics choose to study for 5+ years because of the prestige,the power,sense of responsibility (a good thing I guess) and PAs choose the shorter route (could be because of their own time constraints,funding,kids/family or other responsibilities).Either way they save lives-that's a great job-learn to love life,love others.Respect each other.You're on the same side.The winning side.Best side to be :) Shuggy
- 2 February 2016 at 02:48
Goodness. PA from the states here.
In the U.S., the vast majority of attendings (consultants) aren't at all concerned that PAs will "steal their jobs." They are only interested in training PAs to be better medical professionals. So the attendings can take more vacations. Just kidding :p
In short, a medical system supported only by doctors and nurses is not sustainable, particularly with the growing elderly population. I don't know about the UK, but the U.S. cannot afford to staff every single hospital and clinic with attendings and residents (residents = junior doctors), unless we begin requiring both our attendings and residents to work twice as much with half the pay (for comparison, we've already "limited" our residents' hours to 80 hours a week - although we're thinking of removing that limit because of the huge demands for medical care). PAs allow for better continuity of care and for wider access to primary care (because, in the U.S., doctors don't want to go into primary care as it is the lowest paid specialty - this results in fewer and fewer primary care doctors every year).
I've noticed most of the people with negative comments appear to still be in training. Just wait until you get out into the real world. Then you will be crying for a PA to come help you with your massive workload. :p
- 7 April 2016 at 21:34
- Andrew O'Sullivan said...
Hi there to everyone. Firstly I should tell you all who I am. I'm an Irish student studying Adult nursing with a massive drive an enthusiasm for specializing and really learning my stuff. I have always wanted to be a specialist and was planning to become a specialist nurse until a mentor of mine suggested that the newly emerging PA or PA(A) would suit me very well and to consider it as a progression route. Now I may be a young man full of nativity but I work damn hard, I suffered to get where I am and always put my work in, The trust I work in has a wonderful team environment with so many advanced and specialized nurses with PA's both employed and training. The level of bitterness and anger on this thread is alarming and honestly hurts to see. Why is it medicine is all about muscle flexing and throwing your weight and titles around? A doctor is always the clinical lead so why is it that some feel the need to belittle and speaking candidly shit on my goals and aspirations? Now I would be incredibly grateful if any PA's or PA(A) could contact me and just help a young student out? It would be much appreciated!
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text:
Most people would probably agree there is no resource that a society cherishes more than its children so it is hard to fathom how sexual predators manage with such apparent ease to carry out horrendous, undetected assaults on children practically under the noses of their families and others who are charged with their protection.
As horrific as the crime of child sexual abuse is there are no firm estimates of its prevalence because it often goes undetected and underreported, according to agencies that study child abuse. Less than 100,000 crimes of sexual abuse are reported each year because children fear telling anyone, and adults who become aware of the activity are often reluctant to contact law enforcement agencies even though there is usually a legal requirement to do so.
With so many LGBT households now raising children, it is obviously vital that all parents be aware of the tactics used by sexual predators to seduce children without arousing the suspicion of their families -- and of the symptoms victims of child sexual abuse exhibit.
The critical need for sustained intervention into child sexual abuse recently gained national attention following a grand jury's indictment of retired Penn State assistant football coach Jerry Sandusky on 40 counts of child sex abuse involving eight victims over a 15-year period. The victims reportedly came into contact with the now 67-year-old married Sandusky in connection with the Second Mile, a children's charity the former football coach founded.
Although Sandusky denied this week in an NBC interview of engaging in any type of sexual activity with the pre-pubescent boys, he acknowledged showering and "horsing around" with them after exercise. He also admitted hugging young boys and putting his hand on their legs when they sat next to him. His admission shocked viewers and confirmed in many minds what was already suspected – Sandusky is most likely a pedophile who has taken advantage of young boys with the unwitting complicity of their families.
It is a devastating scandal that will likely rival the one that rocked the Catholic Church a decade ago when it became known that untold numbers of Catholic Church priests sexually abused young boys and violated the trust of their families.
If the charges against Sandusky are true the accounts by the victims portray a classic pattern of enticement and betrayal practiced by the former football coach in his pursuit of the young boys. Likewise, the lack of action by those who knew about Sandusky's alleged criminal activity parallel what often happens when the abuser commands power and respect in a community.
Much of the difficulty in combatting child sexual abuse can be attributed to its relative youth in terms of public awareness about the crime. The first studies on the molestation of children began in the 1920s, and the first estimate of the prevalence of the crime was reported in 1948. In 1974 the National Center for Child Abuse and Neglect was founded, and the Child Abuse and Treatment Act was created. Since then awareness about the problem has grown dramatically, and much more is known about deterring the crime and assisting victims of it.
Children's advocates have identified "red flags" to help parents and others protect children from sexual predators. They warn parents to be wary of someone who wants to spend more time with their children than they do, who attempts to be alone with a child, who frequently seeks physical closeness to a child such as hugging or touching, who is overly interested in the sexuality of a child, who seems to prefer the company of children to people their own age, who lacks boundaries, who regularly offers to babysit, who often gives presents or money to children, who frequently walks in on children in bathrooms or locker rooms, who frequents parks where children gather, who makes inappropriate comments about a child's appearance or who likes to photograph children.
Signs of possible sexual abuse in children include a fear of people, places or activities, reluctance to undress, disturbed sleep, mood swings, excessive crying, fear of being touched, loss of appetite, a drastic change in school performance, bizarre themes in drawing, sexually acting out on other children, advanced sexual knowledge, use of new words for private body parts and a reversion to old behavior such as bedwetting or thumb sucking.
Aside from the moral responsibility to protect children and other weaker members of society that all people share, it is essential to intervene in child sexual abuse because of the long-lasting psychological damage it usually causes. The problems can include feelings of worthlessness, depression, anxiety, suicidal thoughts and distorted views of sexuality. Victims of child sexual abuse tend to become sexual predators as adults, making it a crime that begets more crime.
The Sandusky scandal will undoubtedly lead to devastating repercussions for Penn State, for the Second Mile charity with which the former football coach is no longer affiliated and for law enforcement and university officials who became aware of concerns about the former football coach's activities and failed to act on them. It's hard to imagine that Sandusky's future holds anything in store other than a lengthy prison center.
But the real tragedy – if the allegations are true – will be the lasting impact upon the victims.

subset: commoncrawl


text:
Monday, August 11, 2008
Biffle Searching For His TV Role
All season long, fans have been watching Steve Byrnes and the NASCAR Media Group producers try to get a handle on the new This Week In NASCAR TV series.
Despite the best efforts of the entire gang, things took a while to gel. The new program teams Byrnes with Michael Waltrip on a regular basis. The third member of the panel is either Greg Biffle or Chad Knaus. This system has been working-out well for SPEED as Biffle and Knaus split their time in the second chair.
We all know that Michael Waltrip is a lightning rod on TV. Fans either love his personality and excitement or hate the frequent sponsor plugs and tendency to talk-over anyone at anytime. SPEED knows both those reasons cause fans to tune-in when Waltrip is on.
Chad Knaus looked as if he needed either Valium or a hug when he first ventured into "Mikey Land" this season. Despite the best efforts of Byrnes to be the referee, Knaus was simply not ready for the powerful presence of Waltrip on the program. Bear in mind, Waltrip has been in that chair for over ten years on SPEED.
Then, a funny thing happened. Knaus figured it out. All he had to do in order to deal with Waltrip was totally ignore him. The results were hilarious. Knaus began to offer his own detail-oriented answers to questions from Byrnes and Waltrip just stared in disbelief. Eventually, Waltrip began to get it. Knaus was the new Ken Schrader.
Since that time, Waltrip and Knaus have had a blast on TWIN and the viewers have been eating it up. We have been comparing them to "The Odd Couple" TV show with Knaus as the detail-oriented Felix and Waltrip as the free-spirited Oscar. Any way you look at it, this duo has figured it out.
That leaves this week's second panelist Greg Biffle. Last season, when the show had three panelists, Biffle had someplace to hide. This year, he has had no such luck. Everytime he turns around...Waltrip. Everytime he tries to speak...Waltrip. The look on Biffle's face on the program this week was simply one of pain.
Byrnes gets credit for pushing this program to develop and his ability to direct TV traffic in tough circumstances is well-known. On this Monday, Byrnes was put to the test as Waltrip had several agendas to advance in-between the highlights.
NAPA was back and Waltrip told the tale of a one-year deal that mandates performance to renew. Waltrip's driver David Reutimann had spun early at The Glen and had another tough day. He is currently in 27th place in the season point standings and remains winless. Waltrip updated Reutimann's issues.
Michael McDowell was involved in the big crash and Waltrip was very clear in his opinion that David Gilliland caused the entire thing. Waltrip said on national TV that Gilliland tried to hook McDowell and crash him because McDowell has just passed him. As the replays rolled, Byrnes talked with Waltrip while Biffle stayed quietly out of the issue. There is no doubt that Waltip's comments will get the Internet message boards rolling.
A review of the Watkins Glen highlights and a preview of the upcoming weekend at Michigan again worked well in that order. Byrnes gave Biffle a chance to shine as he described racing at MIS. No doubt Biffle is excited to return to a track where his team has a solid record. He seemed to also be excited to finally get a word in edgewise.
This program now has a personality and a generates a lot of fun. When Biffle decides to stand-up for himself on this show as he does on the track, perhaps the final piece of the TWIN puzzle will fall into place.
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29 comments:
- Newracefan said...
Poor Greg, Mikey would toss it to him and snatch it back two sentences later. Steve has gotten use to Chad handling Mikey himself and forgot to rescue Greg. I would have a big problem Mikey's version of the wreck but I heard Randy say the same thing on NN.
- August 11, 2008 at 9:17 PM
- D said...
I actually thought Greg did better tonight.... Michael even asked Greg his opinion a few times to try to get him involved.... I do love Chad & Michael though..... it definitely works....and I for one never thought it would... Greg is starting to "get it"... I enjoy the show! Love how they keep making reference to how its all in order now... three weeks in a row...
- August 11, 2008 at 9:23 PM
- Daly Planet Editor said...
You should see my emails...hilarious!
TDP readers helped to push that change down the road.
- August 11, 2008 at 9:25 PM
- Anonymous said...
The funny thing is Sunday night on the NASCAR Now race review, Randy LaJoie held the same view as Waltrip that Gilliland's failed attempt at retaliation caused the wreck. I haven't gotten to watch my Tivo of today's show to see if he said the same thing again.
- August 11, 2008 at 9:33 PM
- TexasRaceLady said...
I, too, had to laugh at the comments about "all in order, now."
Had a great time watching the show. Kept me on my toes awaiting what was going to happen next.
- August 11, 2008 at 9:39 PM
- Daly Planet Editor said...
That was a big email issue, how could ESPN go off the air and never really say what happened?
Guess MW filled us in.
- August 11, 2008 at 9:40 PM
- Anonymous said...
Waltrip might have wanted to push his agenda on the 00/38 issue - but I think it was his right. Over on ESPN they tried to make it sound like McDowell's fault, but I think Waltrip is dead right - after some tough bumping, the 38 tried to hook/spin the 00 and didn't get what he was expecting. The replays clearly show him trying to hook the 00's bumper.
Waltrip's viewpoint on this affair is definitely biased, but he is not afraid to let out a strong opinion, and I think that is great. Over at NASCAR Now, they talked about the accident, and you got the feeling that everyone on that panel - if you pressed them off the record - would tell you what they REALLY thought about the incident. But on the air they're just a bit too diplomatic. On TWIN, you get a more unvarnished, honest opinion. It may be biased, but it is real, it is something to think about, and it is better television.
- August 11, 2008 at 10:11 PM
- Matt said...
I guess it's hard for the fans to determine who was at fault for the big crash since we never got replays of the previous lap, but watching what was shown, it's pretty clear the 00 bumped the 38 going into turn 11.. so to completely put it all on Gilliland is a little much. Even if others have the same view, obviously MW has some bias since it's his driver involved.. and that's not the first time we've seen that.. so that kinda bothered me, especially when he setup the situation by saying the 38 moved the 00 and then cut him off..
Otherwise, the show was great. I agree that Chad and Mikey work better, but today was still good.
I also laughed hysterically at the weather and Robin Meade comments.
- August 11, 2008 at 10:13 PM
- HarpAmy/Amy in FL said...
Once they got the order fixed, the whole show just seems fun and exciting. Love how Mikey seems to be enjoying the correct order.
I agree that Greg needs to either lighten up or figure Mikey out and learn to play off of him. Maybe he needs to talk to Chad and Kenny to get lessons.
Mikey is not afraid to tell it like it is. I think that he would be honest and let us know if one of his drivers started a wreck and it was their fault.
This show just keeps getting better and better. Hope that SPEED sees that and keeps the show for a long time to come. They also need to keep Mikey as he just makes the show awesome.
- August 11, 2008 at 10:36 PM
- Sophia said...
One of the things that cracked me up were the little ongoing comments the show is finally an engine going in the right direction or something like that.
AMEN! They better keep the format as it is much more enjoyable. too bad Biffle can't be more talkative but he needs to tap Mikey on the arm more. He seemed to be a little off tonight compared to previous shows.
I can't believe I am saying this but I really MISS CHAD!! (If you all knew how I felt about Chad in past years, you'd realize them are strange words for me to say) Also I missed NP last weekend so I missed my dose of Chad
Our stupid digital box keeps rebooting and messing up so I finally hope to write BIGGER NOTES to watch NP next week.
I liked the comments about Robin Mead (but I had to google who she was) and laughed at the end when they promoted Robin Miller as co-host on WT (RM will be my only connection to IRL next year...thanks for not getting Versus)
The boys had fun tonight and thanks to the show being orderly, just ENJOYABLE to view now.
:) :) :) :)
- August 11, 2008 at 10:54 PM
- Dot said...
Like Mikey or not, you gotta give him props for his NAPA comments. Fish or cut bait. Now I'm thinking the Ganassi merger just might happen.
That's why I believe him about the 00 and 38. I can't believe there is no tape of that prior lap incident. I don't like wrecks that take out the innocents, but that barrel hit by Sam H was spectacular.
Three weeks in order and counting. Great show.
- August 12, 2008 at 12:13 AM
- Anonymous said...
A week ago.I said the TWIN show was the best of the season. Last night's show was not anywhere as good. It seemed dis jointed with Mikey rambling all over the place. Biffle is better this year, but he's just not a 'talker' and like most folks on the show, seems reluctant to point blame. I'm no Vickers fan, but Brian was very articulate compared to Biffle.
- August 12, 2008 at 3:23 AM
- KoHoSo said...
Tonight was the first time I had a chance to see the "all in order now" TWIN since seeing the reports here that the previous format had been dumped. As I stated here many weeks ago, I wasn't going to watch again even off of my DVR until I heard that there were improvements.
The show overall is indeed greatly improved since I bailed out. However, I still have a feeling of emptiness over it. I know it's stupid to feel that way over a TV show, but it's still like I lost a good friend.
TWIN is still all rush-rush-rush, hurry-hurry-hurry, and I hunger for at least one program anywhere on TV (aside from the Sunday morning political shows) where people can at least occasionally expand on an issue or go on a tangent without being "marshaled" almost immediately into the next topic. I used to walk away from IWC/INC feeling that I had really learned something even if it was only a peek into an inside joke. While tonight's TWIN was by no means an unpleasant way to spend an hour...well, I am still basically sticking to what I have been saying since February.
The program was not broken because of the old format. It was broken because Dave Despain was not the right man to be the host and moderator (a position that shouldn't have been changed in the first place).
All of that being said...with how TWIN has now become a more sensible program, I hope that more changes for the better are in store. I will start watching more regularly again, but with a wary eye.
- August 12, 2008 at 4:00 AM
- Anonymous said...
Chad is alittle stronger co-host than Biffle is. Replays, like it or not do show the 38 pushing the 00 against the wall, but many racers have their "moments". They even discussed that issue, drivers losing their tempers. Good show, honest opinions and some facts and humor thrown in for good measure. I had no clue that the 55 had made it back out, congrats to his team for doing that and BOO to ESPN for not letting us know what goes on with the cars that finish 12-43, unless your Jr or Jeffy.
- August 12, 2008 at 7:27 AM
- Vicky D said...
I think MW will tell anyone within earshot, that if you want to make comments about the race or anything else, get your own show! Great show and I think GB is having a better time now although it's hard keeping up with MW.
- August 12, 2008 at 7:30 AM
- majors house said...
I cannot stand Michael Waltrip and this is the reason that I do not watch TWIN. He thinks he knows more than he does and it is a shame that Biffel will not stand up for himself when he is with Mikey. I think if Mikey will look at the tapes, he will see that it was his driver that started that mess and he must have learned how to drive or not drive from Waltrip. I am surprised that NAPA is not making Waltrip pay them for their sponsorship because they definitely deserve better than waht they ahve been getting.
- August 12, 2008 at 8:00 AM
- Deborah said...
Even as a big fan of Michael/MWR I didn't really agree with Michael's assessment of the incident between McDowell and Gilliland - even if Gilliland was trying to wreck McDowell, you have to ask what happened between them to get Gilliland that angry? In some ways Michael's in a no-win situation because some are upset that put the blame on Gilliland, but if he had blamed McDowell, some would think that being openly critical of his own driver is wrong too. IMO, it's a good thing that Michael is willing to stand up for and support his driver even if he's expressing an unpopular opinion.
I have to agree with those who like Chad and Michael together better - I didn't enjoy the show as much this week as I did the past couple of weeks when Chad was on. I like Greg but I don't think he has the same kind of rapport with Michael that Chad does and the show doesn't flow quite as well as a result.
- August 12, 2008 at 8:29 AM
- HarpAmy/Amy in FL said...
What do you mean about the Ganassi merger happening? Are you saying the Ganassi is buying Mikey out or the reverse? I kind of think that if a merger happens, it will be Mikey buying Ganassi out. JMHO.
Sorry if off topic, I just wanted to get Dot's response on her statement. I wanted clarification.
I do admire Mikey for saying on tv his comments about NAPA.
I thought that I left the show feeling like there was some sort of inside joke/look between Steve and Mikey. Last night on the show, Steve and Mikey were talking about something and it seemed as if producers were talking into their heads about moving on or something and Steve gave Mikey a look and Mikey said that he knew what the look meant. I wanted to know what it meant.
SPEED, please keep this show in this order and keep Mikey and Chad and Steve together for a long time. They are great together.
- August 12, 2008 at 9:41 AM
- Anonymous said...
J.D. I think your comment "Speed
knows those reasons cause fans to tune in when Waltrip is on" should
have been tune in or tune out.
Tks.J.D. Ron Il.
- August 12, 2008 at 10:51 AM
- Anonymous said...
I am surprised that NAPA is not making Waltrip pay them for their sponsorship because they definitely deserve better than waht they ahve been getting.
Depends on what you think they're not getting. Waltrip's fans are very loyal to NAPA and his TV commercials are very well known.
As long as NAPA makes money from the sponsorship, it doesn't matter if the car wins.
- August 12, 2008 at 11:09 AM
- Anonymous said...
I miss when this show had 3 on the panel. Ken Schrader and Johnny Benson were very cool to listen to and put Michael in his place. Allen Bestwick was also #1. Yesterday, there were a lot of akward moments of silence and Michael Waltrip would cut off Greg Biffle in the middle of his sentence so he could hear himself talk. As is, we got to hear Michael to his usual sponsor plug-ins and useless info that had nothing to do with the show. At the end we got the "thrill" of watching Michael put his leg behind his head, Greg looking at him uncomfotably and a very sloppy goodbye.
- August 12, 2008 at 12:07 PM
- Sophia said...
i caught the end of the repeat of this show last night...when the show went OFF the air, the ending was tv for another moment.
I don't remember Biffle attempting to lift his leg like Mike in an attempt to put it behind his head.
I like Biffle but the chemistry last night was lacking. Chad and Mikey are fun, last night, the show was not as smooth.
SO, with it just TWO panelist, if the other half of the Odd Couple is missing it seems to throw the show off.
So yea, last night was not as fun as the previous two but still huge improvement with the fixing of the order.
- August 12, 2008 at 12:16 PM
- Dover fan said...
- This comment has been removed by a blog administrator.
- August 12, 2008 at 3:16 PM
- Daly Planet Editor said...
Dover fan,
Please re-phrase your comment. Thanks.
- August 12, 2008 at 3:23 PM
- Anonymous said...
This show is FINALLY fun again.
- August 12, 2008 at 3:46 PM
- Dot said...
To Harpamy in FL,
I've been readng the rumors on Jayski about Ganassi & Waltrip.
My personal opinion is Dodge is not long for the automotive world.
My apologies, just being polite in answering Harpamy. If you "remove by blog administrator", I understand.
- August 12, 2008 at 9:23 PM
- Anonymous said...
JD - You wrote "SPEED knows both those reasons cause fans to tune-in when Waltrip is on." Let me offer an opposing view.
I was following NASCAR long before MW came along. I saw him appear on the scene and develop as a driver, move on to ownership, and become a TV personality. I view him in those three different roles. As a driver, I have no feelings one way or another. I think of him as one of the best restrictor plate drivers and mediocre at best anywhere else. As an owner, I admired what he accomplished as an owner/driver in the Busch Series some years back. As a cup owner, I think his days as an independent owner are numbered. It's a tough business, and I think he's headed for a merger or oblivion.
When I first saw him as a broadcaster, I had no particular feelings. He was flaky, but it didn't really bother me. I think the approval of loyal fans worked on his ego, and he let his worst characteristics get out of hand. His broadcaster persona got more and more extreme. He now reminds me of a rude, spoiled child who always has to be the center of attention. I do not care for that behavior in children and find it offensive and boorish in adults.
My general reaction to MW the broadcaster has been comparable to developing an allergy. At first there was little or no reaction. As time went on, it began to grow into a noticeable irritation. Eventually it grew into a violent reaction, and I can no longer tolerate any exposure. I have completely stopped viewing INC. I read your posts to keep track of the show. On the rare occasion when MW misses a show, I will tune in. I enjoy the truck series racing, and I usually tune in to the start of a race. The first time I hear MW's voice, I am gone for good.
I understand MW has many fans, and SPEED and NAPA have made economic choices. However, the polarizing behavior of MW does have its consequences. I used to patronize NAPA shops first among the many auto parts stores available to me. Now NAPA is the store of last resort, and I haven't been in one in two years. SPEED loses me as a viewer as soon as I hear his voice.
I recognize that I am in a minority, but I suspect that I am not alone in my reaction. Generating strong feeling on both sides does not automatically mean people on both sides tune in. Some of us just tune out. Like an allergy, we do our best to avoid the cause of our violent reaction.
Michigan fan
- August 13, 2008 at 3:46 AM
- Anonymous said...
TO Mi.fan at 3:46am. great post I felt we were the only ones had the same feelings, and do the same thing.Thanks
Tks.J.D. Ron Il.
- August 13, 2008 at 8:09 AM
- red said...
anonymous said...
TO Mi.fan at 3:46am. great post I felt we were the only ones had the same feelings, and do the same thing.Thanks
Tks.J.D. Ron Il.
agreed as well, altho' i think i'm just more feeling the effects of the allergy meds (to continue the analogy): i'm just so very tired of him. yes, he can sometimes be amusing but even those moments happen b/c he's working to be center stage.
he exhausts me and, rather than continue to take the needed medicines in order to tolerate the allergy, i, too, have just removed myself from it all together.
- August 14, 2008 at 10:54 AM


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