Doctors in the UK, USA, India and Australia have commented about finding their roles being taken by much less trained and knowledgeable clinicians. Have the medical educators suddenly realised that all their efforts were in vain? Is medicine actually easy enough for a science graduate to pick it up in two years? Or is something else going on?
The evidence is mixed about whether Physician Associate replacement is cost effective. There are certainly studies that suggest using Physician Associates instead of doctors can meet demand (1). But others find that, in the long run, you get more patients sorted out by spending the same money on doctors (2). That was certainly our experience. The wages, time with patients and supervision time requested by Physician Associates meant it was cheaper and easier to hire doctors.
This is not an attack on Physician Associates. Having help supporting patients with chronic pain, mental health and anxiety would be fantastic. But these people are being deployed to replace first contact doctors, not help them.
So, if medical educators are right and it takes 11 years to train a frontline GP, why are they being replaced by Physician Associates? The answer lies in what is being measured. Services are rated by how easy it is to get an appointment, not how quickly patients get back to the best achievable health.
Health services have been taken over by managers concerned with minimising short-term costs. It is cheaper to fool people with less skilled clinicians, even if long term outcomes are worse. This is happening globally because whether tax funded or insurance or pay as you go, the incentives prioritise availability over lasting health.
1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/
2) https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope