What should a bridge program look like?

[EMEDPA]

I agree independent practice is a worthy goal. it would likely also need to be tied to a postgraduate clinical program so that folks could have the scope of practice and do the procedures I described above. independence is great, but you also need to be able to perform to the standards of the docs you will be replacing.

[EMEDPA]

I'm ok with a pt being able to view their lab and diagnostic study results, but have to admit I am not a fan of them being able to see my note. I shouldn't have to censor my note to make it palatable for later patient perusal.if I want to say that the pt was dramatic and argumentative and had pain out of proportion to exam finding and I suspect drug seeking behavior I want to be able to write that and not have them read it 20 min later when they get home.

[SHU-CH]

Enahncing a PA to MD bridge will damage the profession.

 

Unless you actualy have data (doesnt exist) over what PA to MD bridge students will do post grad (solve primary care shortage) and unless you understand workforce and patient demand trends do not weigh in on this issue in that manner.

 

Regarding point one above, I am not sure that adding former PAs to the MD workforce would hurt us much. Quite the contrary. Who could have better insight into our training, capabilities and generally woeful under-utilization?

 

Regarding what students will do post grad, I am not proposing a solution to all the world's problems. I am proposing an additional option for people who feel it will be of value to them personally. Additional options are generally good things.

[Joelseff]

I see both perspectives for either furthering PA practice/independence (with or without a doctorate or residency) AND a PA to Doc bridge. I don't see how having more PA turned Docs like Lisa can be a detriment to our profession. I think it is a good option for those who want to go that route.

 

OTOH, I could be looking too much into it, but I can see how it may propagate the notion that we are uncooked doctors which is a popular misconception.

 

I think that the best thing for PA's is for us to stay PA's but expand our scope and independence. But I'm not convinced that bridge programs serve to oppose that.

 

Sent from my S5 Active...Like you care...

 

 

[SHU-CH]

So if a PA becoming a physician hurts the PA profession... does a paramedic becoming a PA hurt the paramedic profession?

[SoCalPA]

I like options. I see value in a bridge program for those who desire to become a MD/DO.

 

Personally I think creating an online DMS degree attached to a 9-12 month residency/fellowship (from an approved list) would be just as important. It would put us on equal footing with NPs in the eyes of many. I'm sure the residency programg directors would welcome this. This is way overdue!! Maybe Seton Hall can be the first. Be forward thinking like Nebraska or St. Francis!!!!!

[SocialMedicine]

if you work in N dakota the govt pays off your loans for you.

I think the way to make this work is tie the bridge to a requirement to do primary care or general surgery + a built in residency and loan repayment program to encourage 5+ years work in underserved areas. make it essentially free. maybe even set it up like the nhsc scholars program so folks get a living stipend wwhen in school....

Good point. NHSC scholor program does not guaruntee a certain location/setting upon graduation last I checked. However, I guess if rural dakota was your goal it would not be a major challenge. I have heard of students in some US small cities not finding a clinical role and having to move through NHSC.

 

 

I like options. I see value in a bridge program for those who desire to become a MD/DO.

 

Personally I think creating an online DMS degree attached to a 9-12 month residency/fellowship (from an approved list) would be just as important. It would put us on equal footing with NPs in the eyes of many. I'm sure the residency programg directors would welcome this. This is way overdue!! Maybe Seton Hall can be the first. Be forward thinking like Nebraska or St. Francis!!!!!

 

I like the idea of what I call PA academic centers of excellence. In my opinion duke and wake forest are doing this. I am sure others are as well and I am just ignorant to that fact. However, absolutely not enough PA academics are addressing important PA healthcare issues. Policy setting groups such as a hospital or medicare rely on data to figure out practice. Two minor examples which do not do the larger issue justice... 1) a surgey department near me that is laying off 2 PAs. Chairman says PAs are the great for his dept. but is unable to capture the worth of PAs because they mostly do non billable procedures. Nothing in medical literature assists him in describing PA worth to mgmt. 2) an ER Chief has lost 2 PAs to medical school in last 7 years. Also many PA's leave after less than 5 years.  The PAs leave because they cannot advance practice in this setting. The chief says PA are great and is fine with them doing whatever procedure they can do safely and legally but cannot find the time to teach/credential because of budget constraints and staffing issues. They thought about a residency but no data exists on what ER PA residency programs produce or guidance on how to set up.  This is a failure of our academic institutions in my opinion. A random email to two PAs who list "residency training of PAs" (through google search by that person) as research interests on faculty profile page yielded no useful information as they did not seem to know much about it. We can do better.

 

So if a PA becoming a physician hurts the PA profession... does a paramedic becoming a PA hurt the paramedic profession?

 

No because a paramedic is a pre hospital care provider who follows protocols looking to practice medicine in a different setting.

These are different professions.

I agree that a PA who wants to own the practice of surgery should consider a MD bridge. And these programs shoudl exist for people like this. However, to state that PD-MD bridge is going to help health workforce shortages is a denial of the reason WHY these shortages exist in the first place. It will not work I bet my career on it.

 

And there is no doubt in my mind that public opinion will be influenced by these programs if they grow. Why would people choose to see me in my office when I didnt do a bridge program and become an MD ? My knowledge must be in deficit bc I do not have that added training. Not true. People choose me because I have amazing patient reviews, publication/speaking record, word of mouth etc. This is helping overcome the stigma of PA and I do not need a bridge program suggesting differences in care.

 

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I set off on this tangent because of how your question was worded. I realise I took some liberties with what you were asking. Seton hall is a top PA program and I am sure whatever direction they go down will be a good one. When someone proposes the question how to navigate opportunities to colloborate with a medical school I syncopize if the only and best answer is a bridge program. Seton Hall may have the opportunity to have some seasoned PA academics gain appointments in this new medical school. They may also have the opportunity to tap into new funding sources and perhaps get 1 or 2 faculty members some funding to start a worthwhile research agenda into PA practice. Interprofessional experiences should be PAs running a primary care clinical experience for the med school ... not trying to convert the "less trained" PA into MD's. best of luck no matter what sounds like a good opportunity. I just hope we can elevate PA research and training since this is truly the key to advancing our practice. And IMO a bridge program sets us back.  

[SHU-CH]

... I just hope we can elevate PA research and training since this is truly the key to advancing our practice...

 

This is a big issue. I am a little encouraged because in academia we are finally starting to see PAs get into higher-level academic posts (like Dean's offices). I hope we follow suit in the administration of medical centers and other healthcare organizations. In most cases PAs who are interested in leadership have to develop the skills elsewhere; PA school is already too time constricted to add much more curriculum.

 

I have zero interest in becoming a physician. But were I to become one, you can be sure I would know the value of PAs and be very happy to advocate for them, hire a bunch and let them work at the top of their license. I know there are a lot of institutions where PA students and MD students take classes side by side and I am convinced we can hold our own with the best of them.

[BruceBanner]

I do not think PAs who have been in general practice >2 years should have to do M3 and M4. It just seems to be redundant and a waste of time and program resources.

 

I think it's fair to have PAs complete 12-18 months of M1 and M2 to cover our didactic gap. Then another 6 months built in for boards/prep/admin purposes. So all said and done 18-24 months and then, provided we passed Step 1 and Step 2, we should have complete eligibility to enter the match.

 

The big catch would be that matriculating PAs would have to have at least 2 years of verified, full-time general practice experience. Otherwise a case could easily be made for making us repeat some or all of the clinical years.

[EMEDPA]

I don't think a PA with 2 yrs experience would have the specialty rotation experience in neuro, ortho, gi, etc that a typical med school grad would have. that is why they need some clinical time in the program, to cover stuff other than primary care.

[rev ronin]

I don't think a PA with 2 yrs experience would have the specialty rotation experience in neuro, ortho, gi, etc that a typical med school grad would have. that is why they need some clinical time in the program, to cover stuff other than primary care.

I'd love an anesthesia rotation, even though I couldn't see doing anything of the sort long term.  Ditto for OB--fact is, I learned more about delivering babies in ALSO--that I took last year as the only PA among 50+ attendees--than I did in my "family medicine with OB" rotation.  And I'd love to have exposure to stuff I got zero of in the first place: inpatient psych, any surgery other than general and vascular, derm, oncology, interventional rads... the list goes on.

 

In other words, while I'm a pretty decent generalist, I'd love to be a BETTER generalist.  If there were a bridge program I'd want it to look at my resume, my rotations in PA school, and work with me to make every rotation something that I don't have or never got before, rather than ignoring my past and shoehorning me into a fixed set of rotations that have a random set of overlap with what I've already done.

[PACdan]

In other words, while I'm a pretty decent generalist, I'd love to be a BETTER generalist.  If there were a bridge program I'd want it to look at my resume, my rotations in PA school, and work with me to make every rotation something that I don't have or never got before, rather than ignoring my past and shoehorning me into a fixed set of rotations that have a random set of overlap with what I've already done.

 

 

Yes, exactly. There should be definite consideration for what rotations a PA did in school and what they did in practice. My program has a dedicated ortho rotation and two electives. I know a second year that just did interventional radiology for one of his electives. Another did neuro. No need to make PAs fit a predetermined mold in the bridge when they may already have experience in that area.

[SHU-CH]

Yes, exactly. There should be definite consideration for what rotations a PA did in school and what they did in practice...

 

This is good thinking, but I fear this may be the death of a practical bridge. There is so much possible diversity in rotations and clinical experience that evaluating candidates for admission would be very complex. I fear that it could be so time consuming that it may be judged not worth the effort.

[EMEDPA]

I'd love an anesthesia rotation, even though I couldn't see doing anything of the sort long term.  Ditto for OB--fact is, I learned more about delivering babies in ALSO--that I took last year as the only PA among 50+ attendees--than I did in my "family medicine with OB" rotation.  And I'd love to have exposure to stuff I got zero of in the first place: inpatient psych, any surgery other than general and vascular, derm, oncology, interventional rads... the list goes on.

 

I would also like to do anesthesia, ent, and a general surgery rotation. I had a great ob rotation in school (ob was required for us) and took the ALSO course in 2011 as well. I did trauma surgery in school , but have never seen an appy or chole performed. I had a great inpt psych rotation(also required).

[db_pavnp]

I'm gonna ask a goofy question and it's based in my ignorance of the topic, but how do IMG's swing the ability to challenge the Step exams and can that backdoor be utilized by PA's in any capacity?  Also, can an argument be made that a working PA is too valuable to tie up with full time Step 1 lectures and the basic sciences should really be offered on a part time, even online, lecture format with proctored exams?

[EMEDPA]

I'm gonna ask a goofy question and it's based in my ignorance of the topic, but how do IMG's swing the ability to challenge the Step exams and can that backdoor be utilized by PA's in any capacity?  Also, can an argument be made that a working PA is too valuable to tie up with full time Step 1 lectures and the basic sciences should really be offered on a part time, even online, lecture format with proctored exams?

IMGs are physicians. they have already had the step 1-3 material, they just need to prove mastery of it by passing the steps.

basic sciences online would be very doable.

[BruceBanner]

This is good thinking, but I fear this may be the death of a practical bridge. There is so much possible diversity in rotations and clinical experience that evaluating candidates for admission would be very complex. I fear that it could be so time consuming that it may be judged not worth the effort.

 

This is why I think any bridge program would either be unnecessarily long (as in the 3 year LECOM thing), or would by design have to pigeonhole PAs into primary care only, using my example of a 2 year GP experience requirement. 

 

There is just too much variety in both PA clinical training and PA careers to have a one-size-fits-all program without it being just too damn long, and expensive. If each individual applicant were evaluated on the diversity of his/her CV and rotations the process would be time and cost prohibitive.

 

And personally I don't see the appeal. A boatload more debt, more time away from living a real life....and for what?? An MD after your name, more autonomy (responsibility) and higher income which you wouldn't even realize until your colossal debt is paid off? Pass.

 

Good work is good work, but work in itself is highly overrated.

[EMEDPA]

Bruce - if it was a primary care program it could easily be tied into loan repayment. say it's a 2 year program. you give folks a living stipend in the program like the NHSC scholars program currently does and have folks commit to 2-3 years working in an underserrved area after graduation from an affiliated primary care residency with loan repayment. voila, debt free and a physician.  I would do this in a heartbeat. 2 yrs school + 3 yr residency= 5 years to be a licensed, residency trained and boarded physician with no debt. then you start a job at a reasonable salary and let the govt pay off your school debt for you. I could live anywhere for 2-3 years to get school paid off. deep south, alaska, north dakota, wyoming, inner city chicago or nyc? bring it.

[BruceBanner]

^ That's a good point. Would certainly make it more appealing.

[db_pavnp]

IMGs are physicians.

 

They are physicians, but aren't they BMMS's or something with 6 years of schooling?  Sounds a lot like a PA.

 

http://en.wikipedia.org/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery

[SocialMedicine]

a study comparing US PA esp those with 1 year IM residency vs IMG would be VERY interesting. US PA training in certain institutions is superior to many country medical school training IMO.

 

I have a tough time envisioning anyone but emedPA sufferring through MD and residency for 5 years and then moving the family to the deep south to hopefully have a funded NHSC in a federally qualified health clinic. I believe you have , but I suspect many people who sign up for that bridge plan have never worked in a FHQC and experienced what that life is like. They would be in for a rude awakening. Meanwhile the amt of money the federal government and health clinic is paying to have that new MD they could have 1.5 PAs seeing patients or more. And I gauruntee 90 out of 100 times if it is a family medicine trained MD in that clinic they are not allowed to do colonoscopy or any of those other procedures due to liability and other limitations

 

I could be wrong but not everyone gets a NHSC program and who knows what that program funding will look like 5 or 10 years from now when the first graduates of a new bridge program emerge.

[FamilyPAC]

I was awarded the NHSC scholarship for PA school, served my 2 years in a rural area, then went back to medical school (currently finishing first year). I feel very fortunate that I was awarded the scholarship again for medical school. It's a different process than the loan repayment program. If anyone has questions I could at least tell you about my experience, and it has been a good one.

[dhageremtp]

EMEDPA I would like to know the program you reference about living in North Dakota and the government pays off your loans.  I live here and work here.  I was funded for NHSC loan repayment but if you know of a program like that we could use it a recruitment tool, I know of no such program.

[EMEDPA]

I was talking about a hypothetical nhsc-like program.

does N. Dakota have a state loan repayment program like those in oregon and washington?

[CandiceParma]

.