An Alarming Crisis Unveiled: Physician Associate and Anaesthesia Associate Students Facing Severe Bullying and Mental Health Impact

Written by UMAPs Ltd

September 13, 2024

A recent preliminary survey by United Medical Associate Professionals (UMAPs) has revealed a severe mental health crisis among Physician Associate (PA) and Anaesthesia Associate (AA) students. The findings highlight a disturbing trend of bullying within the NHS, exacerbated by negative media coverage fueled by the British Medical Association’s opposition to MAPs. 

Immediate investigation and decisive action is necessary to safeguard the well-being of these dedicated individuals who play a crucial role in patient care.

An overwhelming 86.1% report that their mental health has deteriorated due to the current environment. Sadly, these results mirror our earlier findings among professional MAPs with 92% reporting a decline in mental health, some even requiring medical intervention.  

61.2% of students believe their employment prospects have been adversely affected and 39.4% of students regret their decision to train as a PA, reflecting the profound impact of the hostile environment. 

Bullying During Placements  

64.8% of students have been subjected to negative comments during placements, largely from doctors. Students left tales of their placement experiences, all of which carry a similar theme of humiliation, torment and intimidation. Students are subject to infantile tactics such as name calling and exclusion, one student shared ‘I’m scared for the future. I love everything about being a PA, but I cannot cope with being bullied every day for my whole career.’ Others told “PAs didn’t deserve a salary, they were useless, and deserved the negativity they face”.  

Lack of Support  

Only 55.3% of students reported receiving support from their universities, and with a noticeable lack of public defense from key stakeholders, some students are left without the necessary support leading to devastating consequences.   

The widespread negative environment and hostile comments, compounded by the current media climate, have left many PAs and AAs feeling unsupported and reconsidering their career choices. Immediate and decisive action is necessary to safeguard the well-being of these dedicated individuals who play a crucial role in patient care. 

About UMAPs 

UMAPs is dedicated to providing a supportive community for MAPs, including PA and AA students. Our mission is to advocate for the well-being and professional development of MAPs through comprehensive support and resources. We offer student membership that includes access to free employment dispute & litigation cover. We encourage any student or professional facing these challenges to contact us for support. 

Provisional Statistics for Impact Assessment Survey 

There were 85 survey responses that were verified by university email address. The survey ran from 16th March 2024 to 16th May 2024. All entries were valid.  

The following is a numerical breakdown of the responses 

  • 3 respondents (3.5%) report a positive environment surrounding MAPs. 
  • 13 respondents (15.3%) report a neutral environment surrounding MAPs. 
  • 69 respondents (81.25) report a negative environment surrounding MAPs. 
  • 32 respondents (38.7%) report being aware of the environment surrounding MAPs before starting their course. 
  • 23 respondents (27.1%) report disruption to their teaching as a result of the current environment. 
  • 44 respondents (51.8%) report disruption to their placements as a result of the current environment. 
  • 54 respondents (63.5%) report receiving negative comments while on placement. Further free text entries showed that the majority of negative comments were from doctors of all grades and advanced nurse practitioners. 

Free text entries describing the types of comments received are displayed below; 

‘- Drs not wanting to teach once finding out you are a PA student rather than medical student. – Negative comments about the role, scope, training etc. 
Junior doctors laughing and making comments such as fake doctors and anaesthesiologist informing the patients about the role and telling them to watch read about the BMA statement regarding 
Belittling comments, laughing at me, pulling faces behind my back, purposely leaving me out, ignoring me 
“How can someone with 2 years’ experience diagnose anything”. Do you know when you quality you’ll be getting paid more than me an ST5 registrar, how’s that fair. She proceeded to ignore me throughout the placement so I avoided her 
That we “go to medical school for 2 years to learn how to half take a history”, that we are stealing opportunities when they’ve declined the examination then we accepted when offered to us, that our job role is pointless, that I shouldn’t have changed from my initial degree’s pathway, that I should do medicine instead 
Referred to the BMA guidelines about the PA role and told me we don’t diagnose patients. Also kept calling me a Physician Assistant. 
It’s often comments such as “what even does a PA do?” In a negative tone or asking why didn’t you just do medicine? Did you not get into medicine? Or questions similar regarding the role, regulation and their lack of knowledge 
Verbal derogatory comments about the profession. Thorough lines of questioning. 
PAs are dangerous, that we are going to kill patients, that we are not wanted 
Most of the negative comments I have been subject to surround being accused of “stealing jobs” from doctors, being told that my role is purely clerical and that MAPs are incompetent and unsafe to manage patients. I have been told that the role is fraudulent. I have spoken to other doctors who have refused to answer my questions or handovers of patients purely because of my role despite only doing this on behalf of seniors I am working with. I have also seen differential treatment of medical students vs MAP students where consultants will exclude MAP students from teaching and going to theatre. 
I was called a Noctor 
Demeaning looks and comments 
Being told I am a wannabe doctor and he won’t supervise me as he doesn’t believe in the profession and I should go ask nurses if I want any teaching 
doctors on the cheap. no need for our profession what I need is an assistant. there is no point in you seeing / learning that procedure as you will never do it 
Rude comments, questions and looks 
Belittling PAs and saying how we are irrelevant and also posting about us online 
That there is no point in pas. Why didn’t I do medicine. That I might not find a job due to funding changing 
About job role and issues with pay 
‘Set up to fail’ ‘ cheap doctors’ ‘ they’ll get rid of the role by phasing it out’ ‘you should write a reflection on the unfair pay of doctors and overpay of PAs’ 
Undermining PAs, emphasising on changing profession, refusing me to shadow them after knowing I am a PA student, no jobs at the moment due to the situation 
Mainly not allowing me to attach on, refusing to give any clerking experience, making me do odd jobs like printing etc whilst med students got clinical exposure 
That PAs weren’t safe as they didn’t know their limitations and that they needed too much supervision. 
I had a consultant refuse me when attempting to join them on ward round. They say that I was a PA student and said ‘what can you do? you can’t even prescribe’ 
Degrading opinions about our roles 
Shift in attitude when highlighting you are a PA student 
Describing the PA role as a healthcare assistant. The PA role is not financially viable in primary care. And so on… 
Stating I was “living an American dream that would fail” “the qualification is unsafe” etc 
Comments/jokes about PAs stealing drs jobs, preferential treatment of med students, some medical students questioning why were there and inappropriately complaining if we were invited to theatres/procedures or timetabled to shadow consultants they were also shadowing. A wide general consensus that PA students were not as intelligent and repeated questions on what our undergraduate degrees were in and what we achieved. Consultants discussing their negative experiences with PAs to students. Widespread poor understanding of what the PA course entails, the entrance requirements etc. 
Ignoring me when I smile and say hello. Not engaging in any conversation whatsoever with me even in a group situation, down to no eye contact, in spite of freely engaging with all other members of the group (none of them PAs) 
The comments were mostly that I had the capacity to become a doctor and that I was selling myself short by becoming a PA, when I explained that it was a well thought-out choice they replied with a shrug 
Dr’s – bring more reluctant to let you take histories/ examine – having a consultant say we are observational only on placement – however this was cleared up 
Saying they will introduce me to patients as a student nurse or doctor as this makes patients feel more “comfortable”. 
The junior doctor commented on the salary of a PA. They also said that doctors work is ‘legal’, ‘hours are all over the place, ‘we have more responsibility’ 
PAs being on the ‘gravy train’ 
Very dismissive of my questions, telling me directly that I am a “Noctor”, telling me not to sit with the doctors and to go sit with the nurses, and telling me to “Move from that desk, because a REAL doctor needs to do some REAL work”. 
Indirect and sometimes direct comments, not providing opportunities because of being a MAP (e.g was unable to do a sign off) 
I haven’t recieved any negative comments but you can see changes in behaviour/ shift in mood when I introduce myself as a PA student 

52 respondents (61.2%) report disruption to their employment prospects. Free text comments on this topic by respondents were as follows; 

There are little to no jobs in the northwest at the moment, especially in secondary care. 
I’m worried about job availability 
Lack of physician associate jobs on the north west region 
I’m scared for the future. I love everything about being a PA but I cannot cope with being bullied every day for my whole career. I’m already going home and crying pretty much every day after placement. Sadly this is making me rethink my career choices, which breaks my heart as I have always wanted to do this 🙁 
Not sure I’ll be able to get a job. There was apparently only 4/5 internships in the whole of North Wales available last year 
“Let’s not talk about your profession” 
There is hardly any jobs in the north west 
Job vacancies were pulled in the trust I’m on placement with because of the backlash 
There are no jobs in secondary care!! 
A lot of places saying they will stop PA recruitment due to the negativity surrounding this subject. 
Not graduated yet, but appears to be limited jobs 
Motion 5 of the recent RCP EGM wants to limit the rollout of PAs. 
Pause in the roll out of PAs via the RCP vote, also the breakaway of the FPA from the RCP meaning we have less protection and stability. Also the continual lack of a framework has impacted the views of certain trusts and GP practices. 
Reduction in jobs available at current 
I can’t get a job despite 4 years previous healthcare experience. I am looking to retrain not because I don’t want to be a PA but I can’t afford to live and I have friends who have qualified as a PA now seeking benefits because of unemployment. 
Some mentioned that it is difficult to hire a PA in hospital due to the situation 
Not sure that current supervisors are keen to hire PAs 
I’ve kept an eye on job vacancies to gauge an idea of what to expect once I do graduate. This has been severely disappointing as every time I have checked there has been <5 vacancies at a time in the whole of Mcr & Greater Mcr. Unsure if this to do with the current environment or is just the case anyway but it seems to have gone hand in hand in terms of timing. 
Less jobs since BMA controversies 
Less jobs out there, I feel less confident applying 
The answer for the above would be “I suspect so – but as I am now concentrating on the finals and not actively looking for work I don’t know” 
There are currently 48 jobs for PAs online currently, when I looked this time last year there were significantly more. Discussing job opportunities with our placements has been encouraged, but the negative press and BMA guidance is making departments unsure about whether or not they’d want to offer us posts in their department. 
I see less job postings for secondary care PA jobs than before 
There appears to be barely any advertised jobs at current, supervisors on placement are not keen to discuss job prospects 
There are not many job vacancies near me. 
There seems to be much less job opportunities 
There may be less PA positions available after 
I havnt started looking for jobs – however am worried about the potential pause in recruitment of PAs 
There aren’t many jobs currently while the cohort above us was already applying for their jobs earlier in the year( this time last year), more areas within trusts have also mentioned not wanting to hire a PA and have actively been replacing some staff with different practitioners after initially unofficially offering roles. 
Some hospitals stopping the preceptorship programme due to backlash from the BMA 
I believe there are less jobs available 

76 respondents (89.45%) report their mental health has been negatively affected by the current environment.  

47 respondents (55.3%) report receiving support from their university in the current environment. 

33 respondents (38.8%) regret their choice to train as a MAP.  

All responses were from PA students, the following table contains the number of responses from each university; 

University Number of responses 
Anglia Ruskin University 
Aston University 
Bangor University 
Birmingham University 
Bolton University 
Bournemouth University 
Brighton and Sussex University 
Buckinghamshire New University 
Canterbury Christchurch University 
Chester University 
Edge Hill University 
Hull York Medical School  
Keele University 
Manchester University 
Newcastle University 
Queen Mary University 
Reading University 
Rosemount University 
St George’s University 
Sheffield University 
Sheffield Hallam University 
Surrey University 
Swansea University 
University of Central Lancashire 
University of East Anglia 
University of Bradford 
University of East London 
University of Portsmouth 
University of the West of England 
Worcester University 

Free Text Comments : The following is the free text comments provided by respondents; 

I wouldn’t say I wholly regret it, I still want to be a PA. But I really don’t know want to be a PA in the current environment. What I find particularly worrying is that I can’t afford to not have a job when I qualify, the course has been a huge financial commitment, sometimes I regret spending all my savings to train in this role. Also, uni hasn’t directly offered support, they provided a lecture on social media use and a space where we are able to report negative behaviour, but not offered direct support addressing the current environment. 
In some ways. Some days I wish I did medicine as I feel I’d be better supported. Some days I’m happy to be doing this 
Told that getting placement, especially in secondary care (which currently we do not have at all) is difficult because many Trusts have a ‘PA ban’ or would rather not PA students due to negative views held by their employer doctors. 
I don’t regret it right now, but can completely understand qualified PA’s wanting to leave due to years of low level abuse that is now coming to light. It unfortunately definitely impacts your short placement period within specialties, and even hospitals. 
“Do you regret your choice to train as a MAP” yes – and when I graduate I might not stay in the profession, very much depends on the attitude towards PAs in the location that I work & the attitude towards PAs of new consultants. 
In regards to mental health, I ticked yes but only because I feel more aware and sort of on edge whilst on placement and aware that I’m representing PA’s in a sense and it adds extra pressure that I feel medical students/nursing students wouldn’t experience. I feel more nervous about entering a new speciality but only purely from the perspective of how I will be received by the staff for being a PA student. Often many are good and excited about PAs or want to learn more, but it’s the few people that are negative which overshadows the positive experiences. 
I love the profession and believe we are a valuable part of the MDT. 
Sometimes I do as I constantly worry about jobs and negativity from fellow colleagues 
I don’t regret becoming a PA, but if I had known the negative environment surrounding the profession I would not have entered at this time 
I don’t regret the choice to train as a MAP because I am hopeful that some positivity will come out of the current environment but I am saddened by the hostility against MAPs which has made me feel less confident in the role and my job prospects after graduating. 
I don’t regret it because ultimately this is the job role that I wanted to do. My dream. However the negative environment for PAs and PA students at the moment make you feel suffocated. Not only has it given me anxiety but also a lack of confidence in my skills and imposter syndrome. Doctors and Nurses saying that the PA role shouldn’t exist or that we are a danger to patient. Everyday I’m studying from 9am-1/2am in the evening but the negative environment makes my hard work not worth it because everyone thinks our course is super easy. I haven’t started placement yet but even when I worked as HCA and I told people I was going to be a PA. They were negative about the idea and were telling me to do nursing or medicine. I am scared that when I go to placement next month, no one with treat me well because of me being a PA student. And although I haven’t started Placement so I can’t answer the negative comments during placement questions but I have received many negativity online just for existing as a PA student. There seems to be an assumption that we don’t work hard to get into PA school but we do. I have A* in GCSE, A’s in A level, I have a 2:1 degree and I did an entrance exam plus interview to get in but online people just tell you that you’re just stupid and that anyone can get into PA school. And that is simply not true. 
I used to be a medical student before this course and the way PAs and med students are treated on placement is vastly different 
Sometimes I do, but I really enjoy the job it’s just a shame of the negativity and bully of the profession that I try to ignore 
From time to time I think it would have been better to stay well away from healthcare if I wasn’t going to be a health professional that is already recognised within the NHS 
Too early to say re employment, potentially depending how RCP pause rolls out 
Overall, No, as I really enjoy what I’m learning and I truly believe PAs can make a great difference when used appropriately, but I desperately wish the wider situation was significantly better. The false information online and the BMA’s posts especially have been very hard to accept. 
Not started placement yet but currently aware of opinions surrounding PAs from Doctors that are family friends etc. 
I have not started placement yet, My placement was shuffled around a few times and I am suspicious of that being the reason I am training to become a PA, I am due to start in a few days. However I face anxiety before starting due to the current environment surrounding MAP’s and the voices of doctors who are anti-PA 
Yes I do regret the choice from time to time, it happens waves. I’m grateful it provides skills that are transferable to other areas and jobs. It just feels like multiple stakeholders are turning their backs on us really. 
I’m am here to help. I always wanted to be a meaningful part of mdt team – and still do 
I do think this is right degree for me but it makes it hard to stay resilient and motivated to study 
It’s really heartbreaking and has massively affected everyone’s mental health. I regret my choice because I didn’t sign up to work this hard and be ridiculed but if the Pa role was accepted more I’d never think of retraining. 
I am very concerned about my future career prospects. I am not applying for jobs yet so don’t know what impact this may have. The university have not offered support but it seems as though no one knows what is going to happen. 
I started this course with high hopes & genuinely felt proud of the fact I had gotten into it. However I am now at a stage where I am constantly having to question my choices. This is due to the grossly negative opinion that is held on PA’s but also the absolute lack of jobs available. It’s hard at the moment to see the point in carrying on. 
I don’t wholeheartedly regret however there are times where I feel like feeling like I am worthless in a clinical environment or questioning the amount of money and effort that is being put into this 
I started this degree to work and contribute in care. That goal has not changed. I have to be fair to the colleagues, nurses doctors, consultant, teaching liaisons and everyone involved with the delivery of the course. The vast majority have gone above and beyond their remit to help me learn and achieve my goals. There are, as everywhere, a few lost (mainly due to ignorance) cases but overall, I am happy with the carrier choice and hope to be able to complete it and join an active workforce. 
I not directly have been a victim of negatively during my placements as far as I am aware HOWEVER I have first hand witnessed unfair treatment towards other PA students/qualified PAs. Also, due to the current climate it has been difficult for me to truly and confidently be proud to express my role as a student PA due to the uncertainty of how I may be treated 
I feel a lot of this negativity towards PAs come from a lack of understanding of the curriculum and feel that if what we are taught it properly communicated to other healthcare professionals, there would be less room for them to criticize us. Additionally, quite a few of us have been placed on “patient bans” and have not been allowed to see patients on placement. This has all greatly affected my mental health and made me feel incredibly sad that I’ve invested so much time, money and effort into a career that has resulted in being a victim of bullying both online and offline and feeling uncomfortable in the workplace. 
Our university is not providing as much reassurance as I would like. They keep just saying ‘stay strong’ it will pass etc but this is not how we feel as a cohort 
As far as im aware there havent been any issues to future jobs but i have not yet applied. The BMAs comments and attitude as well as the social media aspect has had a significantly negative impact on my mental health. I feel like i have wasted over 20k in savings, lost 2 years or earning potential to look forward to a hostile work environment and am concerned about the availability of future jobs and training opportunities. The course is intense enough and i feel as though the current climate has created a working environement where i am under constant scrunity and having to explain my credentials and prove myself as a PA student rather than focus on learning. I dont feel like im able to safely learn as any mistake or uncertainty will translate as a judgment against all PA students and practising PAs. The whole point of placement is to learn in a supportive environment. While most drs and medical students have been supportive and welcoming, the experience overall has been tainted by the negative. I feel very uncertain about the future and concerned about the opportunity for growth and progression. 
I wasn’t expecting hostility from registrars, I thought F1&F2 drs would feel this way as they are underpaid and overworked but instead they were fine with me on placement and actually enjoyed the fact that we could share their workload with them by clerking, examining patients and doing discharges. I had a ST3 actually tell me she thought MAPs career is pointless as we can’t work autonomously and it’s more work for them to ‘babysit’ us without bring paid to supervise us! 
I do not regret training to be a PA – however due to the current climate I have felt anxious/ have previously questioned whether I have made the right choice – due to fear of working in hostile environments and being under appreciated 
I still enjoy what I am doing and couldn’t see myself doing anything else, therefor I would say no. However it has still been very hurtful to read all the comments over the past few months in the media and on social media. We are made to feel ashamed for being a PA instead of proud for all our hard work and dedication. 
The environment is extremely hostile and it feels like very little has been done to stop it getting this far. The bodies and trusts involved are only now starting to do something about it, but it almost impossible to start putting out a fire when its been burning for so long! 
I will always and have always been happy that I chose a career as a PA, it fits exactly what I require and I have seen the impact PAs have had on healthcare. The current situation is something that I hope will pass by as we have been told that similar trailblazer careers have gone through similar situations, we just need to stick by it and stand strong. We got this! 
If I was aware of how much my mental health would be affected by the fact that I have worked so hard to get to where I am, with very little job opportunities, I would never have enrolled on this course 
Although it’s very negative in the media, I am glad to be doing the PA course 

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