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Autumn is reshaping the fields. Hedgerows pull back, fence lines emerge, and the countryside braces for winter. Cody and I walk familiar lanes where change is gradual, organic, and earned.
The wind is sharper now, and my thoughts drift. Recent weeks have been a blur of clinics, CPD talks in Hull, Hatfield and Daventry, and online teaching for MRCPsych aspirants. Amid all that, one theme keeps returning: a growing unease among doctors about who we are, and who now gets to be called one.
Conversations keep circling back to Physician Associates — non-doctor professionals now seeing patients independently, joining on-call rotas, and in some places, potentially supervising doctors in training. The debates grow louder: Is it safe? Is it fair? Is it right?
Some say it’s necessary — “There simply aren’t enough doctors.” As if this shortage were fate, not a man-made crisis. Meanwhile, newly qualified doctors struggle to find training posts.
We hear talk of competencies, skillsets, and “task-shifting” — language that sounds modern, efficient, and disturbingly sterile. But medicine isn’t a bundle of tasks to be redistributed. You can’t break it down, assign its pieces, and call it the same.
To be a doctor is to be shaped by long, rigorous, humbling training — not just to gain skills, but judgement, ethics, science and accountability. It takes about 15 years to turn a medical student into a consultant, because it takes time to learn how to sit with uncertainty, to listen to stories that don’t fit patterns, and to make decisions when no algorithm will. This isn’t about protectionism. It’s about standards, safety and trust.
Some call the current shift innovation. One colleague, kindly, called it Jugaad — a Hindi word for workaround or hack. “It is clever,” he said. And yes, Jugaad can be clever. I grew up in India seeing car batteries power fans and broken radios revived with wire and willpower. But medicine is not a broken radio. You can’t hack your way into trust. You can’t Jugaad your way into competence. In healthcare, the cost of a workaround isn’t money — it’s lives, dignity, and quiet harm in unseen corners.
I sometimes wonder if our medical leaders truly see that or whether groupthink has made it easier to stay silent, to nod along, and speak in the language of “systems” and “sustainability,” even when the direction feels wrong. But there is a third way: constructive dissent, clarity without hostility, courage without grandstanding. The Leng Review offers a starting point, a breath of integrity in a muddled debate. But reviews don’t change systems. People do. Course correction will need leaders willing to speak hard truths calmly and clearly, not just seeking a seat at the table, but knowing when to stand.
Cody waits at the bend, patient with my distractions. He doesn’t know about rotas, licences or titles. But he knows this path, its contours and pace. He belongs here. Some paths can’t be improvised. Some journeys remain long.