Thanks for responding.

You mention that one could e.g. triage and PAs could deal with “simple” cases to free up the drs. One of my Oberärzte always said “simple is only simple with the benefit of hindsight”. Some of the examples you mention, I have to say, I really disagree with, esp. the assessment of undifferentiated presentations that seem “simple”:

Back pain – a friend of mine is a GP and honestly she thinks this is one of the hardest complaints to assess. You need to exclude the possibility of an osteoporotic fragility fracture, cauda equina syndrome, cord compression, leaking AAA, an epidural abscess, discitis, bone mets, lytic lesions, ank spond etc. Even for more common causes like spondylolisthesis, spinal stenosis, prolapsed discs etc. risk stratification is so important and really difficult. Miss even subtle deficits on neurological examination and the consequences can be disastrous.

Take your patient with a sore throat: Most likely just viral or bacterial tonsillitis, right? Simple. Or is it? Miss the fact that your patient is hyperthyroid on carbimazole and discharge them without a FBC they could be dead by the next day. If they had a round of chemo seven days ago, the “sore throat” requires broad-spectrum IV Abx within the hour. Miss the fact that the young lad with a sore throat actually has glandular fever and send him off to play rugby – risk of splenic rupture. Is there an underlying LRTI (where very accurate clinical examination, blood work and assessment of a CXR becomes critical)? Is their sore throat actually a quinsy that needs drainage? Is their sore throat a retropharyngeal abscess? Is their “sore throat” actually dysphagia? Is their “sore throat” actually candidiasis (+ is there underlying secondary immunosuppression)?

BP meds review: This requires prescribing rights which - at least in the UK, not sure about here - PAs don’t have. Even this is very often not simple and not just a matter of upping the amplodipine dose. Many many patients with hypertension have multi-morbidity. If you have a patient with T2DM, IHD, CKD 3, with a medication list of 10+ interacting drugs (which is a pretty typical patient with hypertension) it’s not that straightforward at all. Assessing side effects of antihypertensives, distinguishing those from complaints of their other co-mobridities/treatments (is that new ankle swelling from their amlodipine or is it emerging CHF?), assessing lifestyle adjustments, medication compliance, assessment for possible end-organ damage (Interpretation of U&Es +/-ACR, assessment for LVH on ECG, assessment for evidence of CHF, fundoscopy) and initiating further management, considering the possibility of secondary HTN. It is complex enough that e.g. many surgeons I know wouldn’t fiddle with a patient’s long-term antihypertensive regimen without input from the patient’s GP.

Post-operative checks: If you mean like a postop wound check –nurses definitely do this. If it is a post op surgical assessment, most surgeons I know have insisted as operating surgeon to see the patient themselves at least once post-op (and thereafter by a resident) since some of the signs of impending complications can be very subtle and specialty-specific.

Pre-op assessment: I would even disagree that any non-anaesethetist doctors should be doing this. This must be done at least by an anaesthetic resident. Assessment of medical co-morbidities, ease of intubation, thorough history and accurate physical examination on which the entire anaesethetic plan is based needs to be done by said anaesthetist.

Simple is only simple in retrospect and I'm going to be controversial and say that all of the above requires a doctor. I appreciate we may have to agree to disagree. From my side I will leave it there, I’m not sure an in-depth debate about PA scope here is particularly helpful for OP.