Changes in GME funding an opportunity

[LT_Oneal_PAC]

With the IOM report and changes possibly coming to GME, might make a good time to get some of those GME funds for PA residencies.

 

http://www.fiercehealthcare.com/story/iom-report-calls-overhaul-medical-education-funding/2014-07-30

[Gordon, PA-C]

With the IOM report and changes possibly coming to GME, might make a good time to get some of those GME funds for PA residencies.

 

http://www.fiercehealthcare.com/story/iom-report-calls-overhaul-medical-education-funding/2014-07-30

 

 

Mehh.... if we go that route then PA residencies will become required instead of optional.

 

40 years ago there used to be a thing called a "general practitioner."  It was an MD who did a 1 year internship and then could hang up his own shingle without completing a full residency.  

 

In case you havent noticed, that option doesnt exist anymore, and a big reason why is because Medicare/fed govt started shoving money at residency programs, which quickly led to the GP's extinction.

 

Same thing will happen to us if we go that route.  

[LT_Oneal_PAC]

Mehh.... if we go that route then PA residencies will become required instead of optional.

 

40 years ago there used to be a thing called a "general practitioner." It was an MD who did a 1 year internship and then could hang up his own shingle without completing a full residency.

 

In case you havent noticed, that option doesnt exist anymore, and a big reason why is because Medicare/fed govt started shoving money at residency programs, which quickly led to the GP's extinction.

 

Same thing will happen to us if we go that route.

I know what a GP is. One was my doctor before he retired and is still a family friend. No, what led to the end of the GP was insurance and hospital credentialing. GME funding has nothing to do with that. There is nothing legally standing in the way of someone doing an intern year and setting up shop. Heck, there are still FM trained guys doing anesthesia who were "grandfathered in". But if you want to work for a group or hospital nowadays, you have to be BE or BC. That's market forces.

[EMEDPA]

 

Same thing will happen to us if we go that route.  

you say that like it would be a bad thing..... it's the future whether or not we like it. we are walking the same road the docs walked 100 years ago. I think it's actually a good thing given the quality of entering PA students today, which is generally a group with  MUCH LESS HCE than 20 years ago. if every program only accepted medics/corpsmen/nurses/RTs with a BS and a 3.5 gpa there would be no need for that but the horse has left the barn with degree creep and accepting folks with 6 months experience as a candy stripper or scribes so the required internship will be a matter of patient safety sooner than later because we are graduating a lot of folks who have no idea how to deal with pts or recognize pathology. .

[KMD16]

^^ So much in agreement with you E!

 

The landscape has changed drastically. Institution are driven by $ & filling it sit.

 

Not what it us to be anymore. The new face of PAs they call it.

[PACdan]

 

 

PA students today, which is generally a group with MUCH LESS HCE than 20 years ago. if every program only accepted medics/corpsmen/nurses/RTs with a BS and a 3.5 gpa there would be no need for that but the horse has left the barn with degree creep and accepting folks with 6 months experience as a candy stripper or scribes...

What caused the sea change amongst the PA institutions? Surely there isn't a shortage of solid HCE folks.

 

I was a bit disheartened to see that about 30% of my new class listed "scribe" as their primary HCE. We do have plenty of EMS types though, so I'll wait and see how it works out.

 

 

[LESH]

 

What caused the sea change amongst the PA institutions? Surely there isn't a shortage of solid HCE folks.

 

I was a bit disheartened to see that about 30% of my new class listed "scribe" as their primary HCE. We do have plenty of EMS types though, so I'll wait and see how it works out.

Hello PACdan, you might find the answer to your question in these articles: 

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/25336

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/77116

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/25368

The last one basically sums it all up.

[Joelseff]

Slightly off topic but that's never stopped me before-LOL, But I have noticed that programs are longer now as well. Maybe it's to offset the greener applicants filling PA schools seats these days.  My program, which was the shortest (still is I guess) in the country, recently increased the length of the program as well. Most programs now seem to be 3 years in length.

[EMEDPA]

 

What caused the sea change amongst the PA institutions? Surely there isn't a shortage of solid HCE folks.

 

 

money is the answer, what is the question?

[LT_Oneal_PAC]

Slightly off topic but that's never stopped me before-LOL, But I have noticed that programs are longer now as well. Maybe it's to offset the greener applicants filling PA schools seats these days. My program, which was the shortest (still is I guess) in the country, recently increased the length of the program as well. Most programs now seem to be 3 years in length.

Most programs? I would say they are as rare as bachelor programs. Most programs are 27-28 months. Far shy of 3 years.

[EMEDPA]

Slightly off topic but that's never stopped me before-LOL, But I have noticed that programs are longer now as well. Maybe it's to offset the greener applicants filling PA schools seats these days.  My program, which was the shortest (still is I guess) in the country, recently increased the length of the program as well. Most programs now seem to be 3 years in length.

I think most are now 26-28 months or so with a tendency to add a bit every few years. part of this was to add time to write a MS thesis and do research. my program is still about the same length but has 6 weeks LESS of clinical time to add in research coursework/thesis writing. I think the future for pa school is a 3 yr program based on the USC model with 18 months classroom and 18 months clinical. at some point we will likely have to do an additional rotating internship as well for a year(which will grant a doctorate) and will become the new GPs.

with many medschools now going to 3 yrs and similar requirements in terms of grades/coursework folks will have to think long and hard about which road to take. it used to be the difference was ochem/mcat for medschool and neither for PA school. that factored into my decision in a big way. today if I was starting from scratch looking at the current landscape I would go straight to MD/DO.

[EMEDPA]

http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/25368

The last one basically sums it all up.

read page 5 folks. it pretty much states we had to go to an MS to keep up with the NPs.

I have never seen this document before but suspected as much.

[Joelseff]

Most programs? I would say they are as rare as bachelor programs. Most programs are 27-28 months. Far shy of 3 years.

I never really looked into it but it *seemed* to me that way. Maybe those schools offer a 3 year option but still have a 28 month curriculum. Even so, my program was 16 months and most, if not all the other programs at that time were 24 months. And that wasnt even that long ago.

[LT_Oneal_PAC]

I think most are now 26-28 months or so with a tendency to add a bit every few years. part of this was to add time to write a MS thesis and do research. my program is still about the same length but has 6 weeks LESS of clinical time to add in research coursework/thesis writing. I think the future for pa school is a 3 yr program based on the USC model with 18 months classroom and 18 months clinical. at some point we will likely have to do an additional rotating internship as well for a year(which will grant a doctorate) and will become the new GPs.

 

We can hope. I'm less optimistic. I think it would be worth it, but not if we still have a supervisory relationship. I'm less optimistic about the future.

[EMEDPA]

We can hope. I'm less optimistic. I think it would be worth it, but not if we still have a supervisory relationship. I'm less optimistic about the future.

I think PAs in the future will still have to have an affiliation with physicians but it will be more along the lines of NPs today in "non-independent states" who are required to have a collaborating physician of record. I don't see PAs being fully independent anytime soon.

[Guest Paula]

specifically nurse practitioners (NPs), should be award- ed a master’s degree upon completion of their education.10 In October 2004, the American Association of Colleges of Nursing adopted a posi- tion statement that called for the standardization of the graduate degree for advanced practice nursing (clinical nurse specialist, nurse anes- thetist, nurse midwife, and nurse practitioner) at the doctoral level, specifically the doctor of nursing practice (DNP), by 2015. This posi- tion statement will have significant implications for the PA profession, as the NP profession is considered the PA profession’s major competitor. It is likely that this disparity in educa- tional preparation will work to the advantage of the nursing profession in terms of favorable reimbursement and practice statutes

 

I believe this is the statement EMEDPA is referring to.  SO...PAEA knew all along PAs would struggle  with maintaining our validity in light of the DNP?  What the heck?? I've never seen this document either but now I'm mad and disappointed that PAs have no support from PAEA/AAPA/NCPPA for the clinical doctorate degree for PAs.  Shameful.  

 

I do like the idea of us becoming the next GPs as EMEDPA prognosticates for us. 

[Joelseff]

specifically nurse practitioners (NPs), should be award- ed a master’s degree upon completion of their education.10 In October 2004, the American Association of Colleges of Nursing adopted a posi- tion statement that called for the standardization of the graduate degree for advanced practice nursing (clinical nurse specialist, nurse anes- thetist, nurse midwife, and nurse practitioner) at the doctoral level, specifically the doctor of nursing practice (DNP), by 2015. This posi- tion statement will have significant implications for the PA profession, as the NP profession is considered the PA profession’s major competitor. It is likely that this disparity in educa- tional preparation will work to the advantage of the nursing profession in terms of favorable reimbursement and practice statutes

I believe this is the statement EMEDPA is referring to. SO...PAEA knew all along PAs would struggle with maintaining our validity in light of the DNP? What the heck?? I've never seen this document either but now I'm mad and disappointed that PAs have no support from PAEA/AAPA/NCPPA for the clinical doctorate degree for PAs. Shameful.

I do like the idea of us becoming the next GPs as EMEDPA prognosticates for us.

SMH...... :angry:

[LESH]

read page 5 folks. it pretty much states we had to go to an MS to keep up with the NPs.

I have never seen this document before but suspected as much.

IMHO the other 4 reasons given are just as much,if not more so, important to note. Reasons 1&2 answer (in a way) PACdan's question. Reasons 2&5 seem to support EMED and KMD16 comments.Reasons 3&5 speak to the evolution of the profession. Joelseff and Paula the clinical doctorate is coming. It is actually here just not entry level programs yet. 

[PACdan]

So a dwindling supply of post-Vietnam corpsmen coupled with financial aid restrictions coupled with Colorado University set the current trend for applicants.

 

I will say that reason #3 for a Master's reads quite funny. Programs wanted to provide "appropriate recognition" for work done.... 100+ graduate level credits, still just a Master's degree. :)

[EMEDPA]

AGREE. Dr. Davenport has made a good case here and elsewhere that the # of credits done after a BS should give a doctorate.

[Guest Paula]

I've now had time to review the 3 articles posted.  It is clearly obvious at this point in time the conclusions of the papers are obsolete.   The IOM report on the Future of Nursing has catapulted the NPs into the limelight and PAs are in the shadows.  The statements in the papers that say PAs are not interested in being independent are false and not representative of (my views) and others. I believe the physician lead team is also obsolete and not feasible in today's healthcare climate.  

 

Back to the drawing board. 

 

"Joelseff and Paula the clinical doctorate is coming. It is actually here just not entry level programs yet."     When?  Will PAEA support and accredit programs?  

[EMEDPA]

I think Lesh was talking about the Baylor/army DSc program, which involves 18 months of training and a research project.

also do a search here for the new postgrad DPAM program starting at a civilian school next year.

[gbrothers98]

To direct the discussion back to funding of residencies and GME.....

This is an opportunity to pursue but I would assume a significant uphill political battle that may not be worth what the result is ie a small amount of funds in comparison to overall GME to be focused where and by whom?

Instead I would propose the following:

1. Extension of PA programs to 3 years. 

Rationale: Current PA education model is based upon having significant and intense prior health care experience to provide a base to build upon. As pointed out, this is missing for many current applicants and students. Extension would enable prolonged clinical exposure which should start early in the first year of training and build progressively. More time spent on a specific rotation rather than the current 4-6 wk cycle is paramount for patient exposure and skill development.

2. Start 1 year apprenticeships at every major medical center for PAs in several critical areas: inpatient and outpatient medicine, surgery, ED, psych.

Rationale: The beauty of the PA profession is that it is recognized as producing a provider that can start practicing medicine soon after graduation and whose services can also be BILLED for immediately, unlike residents with the significant supervision requirements that have to be met to be billable.

3. Apprenticeships can benefit from the existing residency and GME infrastructure in place. 

Rationale: Having a PA in an apprenticeship for a year with a service, providing participants with both education and an income/benefits would not overwhelm the current system especially since income can be offset by billing. 

There can still be the current OTJ training that occurs in smaller practices and community hospitals but a 3 yr grad will be better prepared than the current 27 month grad for this challenge. If funds are specified for PA training through govt GME sources then this would be better directed at reducing tuition costs for students across the board at accredited training programs rather than directed at establishing a residency program system that would only benefit a small # of graduating PAs.

More discussion of this is needed and should be a focus by national leadership of our professional organization. 

G Brothers PA-C

[EMEDPA]

GBrothers. excellent post. I like this idea. It's great having you post here on a regular basis. you bring a lot of common sense to discussions.

[primadonna22274]

George, I like your apprenticeship idea, but they must be PAID, and the question is from where does that funding come?

Graduating PA students cannot afford to work for free any more than a graduating physician can. Student loan payments come due 6 months after graduation for all of us.

I am torn on the notion of extending PA training to 3 years when we have more 3-year MD and DO programs all the time. In fact the line between PA and physician training is becoming very blurry. I still maintain that the difference is the residency more than any preclinical curriculum--but I also agree that medicine has grown way too much and too fast for anyone to have a decent grasp on it in just a year or two of clinical clerkships. Students today are much more limited in what they are allowed to do as students--it was pretty shocking for me as a medical student to find how little I was allowed to do compared to my rotations as a PA student 15 years earlier. How on earth are these folks supposed to attain clinical competency without significant OTJ training and/or an internship?