New Doctor of Physician Assistant Medicine Program

[PACdan]

Thoughts?

If you're adding two years to make it "medical school", why not just go to medical school?

 

Once a PA program becomes the same length as MD school, I feel it loses a lot of incentive for people to attend. If I'm going to invest 4 years to come out a PA, DMSc/DCM... I might as well just go for MD/DO and cut the bullsh*t out afterwards.

 

 

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[EMEDPA]

If you're adding two years to make it "medical school", why not just go to medical school?

 

Once a PA program becomes the same length as MD school, I feel it loses a lot of incentive for people to attend. If I'm going to invest 4 years to come out a PA, DMSc/DCM... I might as well just go for MD/DO and cut the bullsh*t out afterwards.

 

 

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yup. there already is a u.s. bridge program that doesn't require the mcat. just do that if you want full practice rights...

[didymus]

If you're adding two years to make it "medical school", why not just go to medical school?

 

Once a PA program becomes the same length as MD school, I feel it loses a lot of incentive for people to attend. If I'm going to invest 4 years to come out a PA, DMSc/DCM... I might as well just go for MD/DO and cut the bullsh*t out afterwards.

 

 

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People are discussing the merit of a doctoral program/qualification in Physician Assistant, so I proposed what I thought would legitimize and actually add value to such a push.

 

The difference would be not having to complete an MD/DO residency. That would be the chief difference. I think the point of adding a doctoral program to any field is to increase the knowledge base of the professionals in that field. Adding the two other years of medical school to a PA doctorate would effectively accomplish this purpose.

 

As has been stated, some PA's don't want to go to medical school/don't want to be physicians. Part of that is the time commitment of not only the extra medical education, but also the time required to finish a residency. I've heard many docs comment on what the major difference b/t them and PA's is being the gap in foundational knowledge in areas such as pathophysiology and pharmacology, among others. The idea above closes that gap. The difference then becomes residency and fellowship training, which PA's would never complete at the same level as physicians.

[PACdan]

yup. there already is a u.s. bridge program that doesn't require the mcat. just do that if you want full practice rights...

 

I hope there will be a few more around after I graduate PA school & practice for 10-15 years. I could see myself going back to school once I know a thing or two.

[EMEDPA]

do it sooner than later. it gets harder the longer you wait. I made several serious attempts to go back, took a yr of physics, genetics, and stats, etc. in 2002 but life happens so it kept getting put off...the bridge started a few years too late for me. if it had started 2 yrs earlier with current no mcat requirements I probably would have been in the first class with primma.

still would consider some kind of residency if I didn't have to move. alternatively when the kids go to college I might follow them and do a local residency where ever they end up....we'll see. looking at lots of options like full time over seas work. I have informally been offered the directorship  hospitals both in Kenya and in Ethiopia as full time clinical staff and director of the facility....who knows...one step at a time. I hope to finish the doctorate next spring (2015) then I will look at some part time local teaching, etc

[PACdan]

People are discussing the merit of a doctoral program/qualification in Physician Assistant, so I proposed what I thought would legitimize and actually add value to such a push.

 

The difference would be not having to complete an MD/DO residency. That would be the chief difference. I think the point of adding a doctoral program to any field is to increase the knowledge base of the professionals in that field. Adding the two other years of medical school to a PA doctorate would effectively accomplish this purpose.

 

As has been stated, some PA's don't want to go to medical school/don't want to be physicians. Part of that is the time commitment of not only the extra medical education, but also the time required to finish a residency. I've heard many docs comment on what the major difference b/t them and PA's is being the gap in foundational knowledge in areas such as pathophysiology and pharmacology, among others. The idea above closes that gap. The difference then becomes residency and fellowship training, which PA's would never complete at the same level as physicians.

 

I like your icon! But not so much the idea. :)

 

The problem of increasing the knowledge base of a PA by adding a doctorate (and 2 years of schooling) to "close the gap" between what a PA is and what an MD is, you increase the cost of becoming a PA, and decrease the benefit.

 

As you've correctly stated, many individuals with medical experience choose to attend PA school as it is about 2-2.5 years compared to about 7 years of the shortest MD path; a large gap of almost 5 years between completion times. But if you add two years onto the PA schooling, that gap closes to about 2.5 years. Incentive to become a PA drops, as one is in school for two more years (more cost), you come out later into practice (lost income=more cost), and you are still a PA in terms of legal scope of practice (not much added benefit beyond personal knowledge).

 

If you could guarantee higher salaries or full scope practice for a DocPA, then we would have more benefit/incentive. But right now it's just a degree on the table with some possible salary/job title benefit that is still not remotely close to being an MD/DO. As others have said, NPs milked their master's for a lot more than PAs have; so working more for a DocPA doesn't guarantee us significant added benefit for the cost. As EMED has stated, pursuing an MD/DO via a bridge makes more sense at this point in time.

 

As for residencies, those are becoming more common place for PAs. Some have voiced the idea that 12-18 month residencies might become the norm for PAs after graduation, down the road. I could appreciate that after a master’s program, but if you place that at the end of a 4-year PA doctorate, I'm just going to medical school. At that juncture, the difference between the two; including residency time, is only 1.5 years.

 

The closer we get to full blown medical school, the less we want to be PAs, and the more we are vying to be physicians. That's a can of worms (literally). And our encroachment into that territory does not assure us equal reward from a DocPA angle. To keep that in check, I promote the bridge model. Otherwise, IMHO, go to med school off the bat.

[PACdan]

do it sooner than later. it gets harder the longer you wait.

 

I start my 28-month PA master's program this summer. There have been quite a few interesting things since I became interested in the profession a meager three years ago. I am both excited and nervous to see where it goes while I'm in school. I would hope I can be proactive in our profession's future, but I'm fresh as hell & idealistic (ie, dumb). I would, however; enjoy options for upward mobility after I leave school and practice for a time.

[EMEDPA]

I start my 28-month PA master's program this summer. There have been quite a few interesting things since I became interested in the profession a meager three years ago. I am both excited and nervous to see where it goes while I'm in school. I would hope I can be proactive in our profession's future, but I'm fresh as hell & idealistic (ie, dumb). I would, however; enjoy options for upward mobility after I leave school and practice for a time.

at the very least do a residency in your specialty of interest. you make a living wage and get great training which will set you up for the rest of your career.

[mashlee]

 would hope I can be proactive in our profession's future, but I'm fresh as hell & idealistic (ie, dumb). I would, however; enjoy options for upward mobility after I leave school and practice for a time.

 

Man, i feel the same way. On the bright side PAs could be able to practice independently in the near future, or nothing will change. Now going to 2 more years of school makes no sense to me. We would just be adding another $100,000 of debt for nothing. However if a couple extra months were added to allow us to graduate with a doctorate, that would be cool with me, and I feel the upward mobility potential as practitioners (as well as the business side of healthcare ), would for sure improve by having a doctorate as opposed to a masters degree. I'm optimistic 

[Joelseff]

I like your icon! But not so much the idea. :)

 

The problem of increasing the knowledge base of a PA by adding a doctorate (and 2 years of schooling) to "close the gap" between what a PA is and what an MD is, you increase the cost of becoming a PA, and decrease the benefit.

 

As you've correctly stated, many individuals with medical experience choose to attend PA school as it is about 2-2.5 years compared to about 7 years of the shortest MD path; a large gap of almost 5 years between completion times. But if you add two years onto the PA schooling, that gap closes to about 2.5 years. Incentive to become a PA drops, as one is in school for two more years (more cost), you come out later into practice (lost income=more cost), and you are still a PA in terms of legal scope of practice (not much added benefit beyond personal knowledge).

 

If you could guarantee higher salaries or full scope practice for a DocPA, then we would have more benefit/incentive. But right now it's just a degree on the table with some possible salary/job title benefit that is still not remotely close to being an MD/DO. As others have said, NPs milked their master's for a lot more than PAs have; so working more for a DocPA doesn't guarantee us significant added benefit for the cost. As EMED has stated, pursuing an MD/DO via a bridge makes more sense at this point in time.

 

As for residencies, those are becoming more common place for PAs. Some have voiced the idea that 12-18 month residencies might become the norm for PAs after graduation, down the road. I could appreciate that after a master’s program, but if you place that at the end of a 4-year PA doctorate, I'm just going to medical school. At that juncture, the difference between the two; including residency time, is only 1.5 years.

 

The closer we get to full blown medical school, the less we want to be PAs, and the more we are vying to be physicians. That's a can of worms (literally). And our encroachment into that territory does not assure us equal reward from a DocPA angle. To keep that in check, I promote the bridge model. Otherwise, IMHO, go to med school off the bat.

 

See, this guy (or gal) gets it!

 

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[GetMeOuttaThisMess]

Sorry, but I've got to disagree with you folks.  All this additional coursework and degree creep takes away from the very idea behind why the profession was developed to begin with.  I appreciate that the NP scenario has muddied the waters (since they declined this professional opportunity at the very beginning thank you and are now trying to play catch up) but if I'm going to spend all this time and money I might as well get my medical degree as an M.D. or D.O. (Speaking hypothetically since age makes this prohibitive, as well as desire). As I've stated before many a time, I don't even want to waste my time or money having to upgrade to an M.S. from a B.S.  when it isn't going to do a blanking thing for me in the long run.

[db_pavnp]

The problem of increasing the knowledge base of a PA by adding a doctorate (and 2 years of schooling) to "close the gap" between what a PA is and what an MD is, you increase the cost of becoming a PA, and decrease the benefit.

 

I think your post is solid, but I have some comments.

 

Firstly, I question the logic of avoiding degree creep when it is plainly happening with nearly every clinical profession.  I am sure that this is a debate which has raged on for every profession which is moving to increase the educational requirements.  Who has it right?  PAs as a holdout or everyone else who has upped their game?  My language is loaded.  I can tell you that I am in an allied health profession that has stagnated educationally and I can't acquire raises that cover inflation.  The idea of acquiring anything that appears a "terminal" degree worries me greatly.

 

Secondly, I think you, and many others, have exaggerated this sense that a DMS would simply cause you to be DO instead.  There is still a great advantage to becoming a practicing PA with an MMS who later obtains a DMS.  Now that I think about it, two years of work in the field could even be stated as a requirement for DMS programs.  This is semi analogous to the notion that an RN should really work for a period of time before obtaining an NP.

 

Additionally, if anyone could let PA programs know that y2k was 14 years ago, maybe we could get some part time / online / modern educational methods going and stop making the education itself so prohibitive to participate in.  A DMS should be significantly cheaper than the original MMS (someone expressed fear of another 100k, 2 year commitment - should not happen) and it should be accessible.  That will apparently be a first for PA programs, so no wonder it's so hard to imagine how it could work out.

[PACdan]

Thanks.

 

I guess it's akin to academic lemmings over a doctoral cliff, in so much that once it starts you best just join the herd.

 

I will concede that if the "DMS" is available online, part-time, <$20k, and allows me to work while obtaining it; that is a horse of a different color.

If I would have to stay seated in a classroom or out of the workforce for an additional two years, no, that's not acceptable.

[EMEDPA]

 

Additionally, if anyone could let PA programs know that y2k was 14 years ago, maybe we could get some part time / online / modern educational methods going and stop making the education itself so prohibitive to participate in.

there are several part time pa programs, something like 8 or so at last count(there is a list in the pre-pa area). here is that list. may be out of date as it is several years old:

16. List of part time (2 yrs of classwork in 3 yrs) programs:

According to the Physician Assistant Education Association website there are 7 schools which offer a part time option.

 

1. University of Maryland Eastern Shore (Maryland)

2. University of Medicine and Dentistry of New Jersey (New Jersey)

3. D’Youville College (New York)

4. Daemen College (New York)

5. Drexel University Hahnemann (Pennsylvania)

6. University of Washington (Washington)

7. University of Wisconsin-Madison (Wisconsin)

I attended one in the 90s(Drexel). the first yr is done over 2 years, allowing you to work, and the normal second yr is done as a full time 3rd yr. here is the set up for my program today: (part time is shown below full time on 2nd half of page).

http://www.drexel.edu/physAsst/programs/physicianAssistant/curriculum/

this was a nice way to do PA school. I worked 30 hrs/week as a medic for the first 2 years and on call the third year if I wasn't at an away rotation. it allowed me to concentrate more on my studies taking 3 classes at a time instead of 6 and I worked a slow station as a medic so often got paid to study. I graduated 3rd in a class of 80 (we graduate with the full time class that starts the year after us). the other nice thing about the part time option was that I ended up on a pathway with only 12 other folks in class. we got to know each other very well and I am still in contact with many of these folks.  I'm a big fan of part time school alongside work. that's how I'm currently doing my doctorate.

[Guest Paula]

I was the first University of Wisconsin  graduate in their distance program in 2004.  It was 3 years with first two years part-time and third year full time rotations.  I was able to work part-time the first two years. 

 

The distance program is still going strong and has expanded.  I was the lonely first grad but now I think they accept 4 or more students. 

[PAROCKS]

I have to say that while I agree with a PA to MD/DO bridge I do not with any other type of doctorate degree for the sake of calling ourselves DR's.  I think this is ridiculous as I do for the DNP's.  Why have we become such initial whores?  I was always proud of the fact that I could pick up a review article or paper written by a PA and only see "Their Name PA-C" and not "Their Name PA-C, MS,BS, FMC, BSN, FNP, MSN YADA YADA YADA"  Really?  Do we need all of this crap when the name of the author takes up two or more lines in initials?  You don't see "Doctor Name MD, BS, MS, FMC, YADA YADA YADA" Simply MD as that is all that is needed.  I for one am of the opinion that PA is all we need! I would like to see us remain PA-C, as the physicians are MD's. I'm proud of being "just a PA" and do not mind explaining to patients that no, I do not need to finish school and be a doctor.  I agree with the previous posters who state that if they want to be called doctor then go to med school and earn your MD or DO.  We are beginning to sound like the Phd's in English lit, or economics or whatever other profession that has a Phd and demands that you call them doctor.  I'm sorry this all makes us appear to be Stu from The Hangover, 

Stu: "Do you mind if I take a look, I'm actually a doctor."

ER Doctor: "Yeah you said that several times last night but really, you're just a dentist."

 

I apologize if I am rambling as it is late and I just hate how we appear to be trying to keep up with the Nursing part of medicine and match the initials and degrees as if the addition of initials at the end of our name is going to make us better providers of medicine.  I've always felt that the important letters on your badge are the letters that spell your name, because THAT is who you are.  The initials after your name should not define you, however simply allow you to practice medicine hopefully in a proper and rewarding way.

[mashlee]

I have to say that while I agree with a PA to MD/DO bridge I do not with any other type of doctorate degree for the sake of calling ourselves DR's.  I think this is ridiculous as I do for the DNP's.  Why have we become such initial whores?  

 

I can only speak for myself, but I am for a doctorate option for PAs, and not because I'm an "initial whore" but because I feel that it is inevitable if PAs want to continue in the future to stay current and respected. Degree creep is a fact and will only continue and I question, as others on this thread have, why is degree creep something to fear? Either we go with it and take a few more classes to stay current and respected or we fall behind. Masters degrees will be a dime a dozen in the near future (just like bachelors degrees are now) and patients over time may feel nervous knowing that the person responsible for their healthcare has a masters degree. I recognize that PA school is roughly double the number of credits as a typical masters, but the patient/ the public doesn't know that. Also whether we like it or not, we are and will be competing with NPs for jobs, and if more and more NPs become DNP, while PA stay a masters, it's possible we may lose jobs to the DNPs. I realize that this is speculative, but in a job interview having a doctorate vs. a masters, can't hurt. Why not add a few more credits or start an online format to get a doctorate and problem solved. That's how I feel, and for me this has nothing to do with titles and everything to do with not falling behind other similar health careers. 

I think more bridge programs are fine, but that won't help the PA career out at all, instead it will make the career a stepping stone for students considering medical but who aren't ready to commit 8 years yet or who want to skip the MCAT.

[eddoc]

People seem to be confusing what, to me at least, are two different issues.  I am in an academic setting and I see my colleagues disenfranchised because of the lack of a "D" after their name on a routine basis.  For these folks, the development of a meaningful, targeted degree is of more immediate importance. 

 

First the needs of the clinically practicing PA who is not in an academic setting.  Do you need a doctorate?  Probably not at this point but that landscape will change considerably over the next 5 - 10 years as our nursing colleagues have DNP's after their name, as others have stated.  To me the question then is what additional education creates added value for the PA and for their workplace/employer?  What are the areas where we need PA expertise to be added to the mix?  For 50 years PAs have concentrated on being damn good clinicians but alas, the marketplace no longer values just being a good clinician.  In the academic setting PAs need to be integral to the clinical research being conducted and few currently have those skills.  They need to have the credentials to sit at the administrative tables that decide how they and their colleagues will be used and what they will be credentialed to perform.  Alas while that happens in some places, it is far from uniform. 

 

What are the things that we can  "own?"  We have preached (sometimes screeched) that we practice in teams.  We know about teams yet we neither teach or train the dynamics and mechanics of team based practice.  Or what about the clinical end of "clinical and translational research?"  Theoretically current graduates are supposed to be able to read and evaluate the legitimacy of current medical literature.  Sorry - one biostatistics course simply isn't going to do it so kick it up a notch and "own" CQI and clinical applications.

 

On that note I am off to another meeting in my academic medical center discussing how APP's (our new acronym) will be incorporated into our PCMH.

[bobsquit3]

Much of these concerns seems to be the result of people being uneducated about the PA model before getting involved. If you wanted to practice medicine independently and be called "Dr", you should have gone to medical school. It's just that simple.

[JohnnyM2]

I can only speak for myself, but I am for a doctorate option for PAs, and not because I'm an "initial whore" but because I feel that it is inevitable if PAs want to continue in the future to stay current and respected. Degree creep is a fact and will only continue and I question, as others on this thread have, why is degree creep something to fear? Either we go with it and take a few more classes to stay current and respected or we fall behind. Masters degrees will be a dime a dozen in the near future (just like bachelors degrees are now) and patients over time may feel nervous knowing that the person responsible for their healthcare has a masters degree. I recognize that PA school is roughly double the number of credits as a typical masters, but the patient/ the public doesn't know that. Also whether we like it or not, we are and will be competing with NPs for jobs, and if more and more NPs become DNP, while PA stay a masters, it's possible we may lose jobs to the DNPs. I realize that this is speculative, but in a job interview having a doctorate vs. a masters, can't hurt. Why not add a few more credits or start an online format to get a doctorate and problem solved. That's how I feel, and for me this has nothing to do with titles and everything to do with not falling behind other similar health careers.

I think more bridge programs are fine, but that won't help the PA career out at all, instead it will make the career a stepping stone for students considering medical but who aren't ready to commit 8 years yet or who want to skip the MCAT.

My question is this: If PAs want to increase their employment opportunities and their autonomy, are they better served by getting a doctorate or advanced training. For the DNP, it seems courses are required with no practical, hands-on experience. Isn't the idea, really, to get advanced training? If PAs want more of the autonomy that DRs have, they will need to get it from the docs who are more likely to be impressed by skills and knowledge than someone with title envy. Wouldn't you think?

 

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[cinntsp]

If PAs want more of the autonomy that DRs have, they will need to get it from the docs who are more likely to be impressed by skills and knowledge than someone with title envy. Wouldn't you think?

 

No...tbh we need to get away from the idea that docs should be the ones to "give" us anything.

 

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[CorpsmanUP]

Prima, after going through the LECOM program I have seen you state over and over that the biggest difference is Step 1 and the first year sciences.  So what would you think of a one year program that focused solely on the sciences and offered a Doctorate upon completion?  As I would bet on a large majority of US trained PAs being better trained than FMG MDs I think it could be an option for the same chance they get which is sit for the 3 steps and then apply for a residency.

[primadonna22274]

No way. I have learned valuable stuff above and beyond step 1 and through clinical rotations. The REAL difference I think will be residency, with its structured curriculum and graduated responsibility.

 

Now, I do think all of the worthwhile stuff I learned in med school could have been compressed into 2 yr. There is a significant amount of redundancy and waste in each system where we rehash the basic sciences for each system. That could be cut. But it won't be most likely because the schools operate on tradition and "this is how we teach medicine". Will our class be able to recommend some positive changes for future APAP generations? I hope so, But there is still that pesky detail of the WHO mandating 132 weeks of medical school.

 

Once you finish the core rotations there is a lot of overlap. I took step 2 after just 5 mos of rotations (oops, a little earlier than I was supposed to) and killed it. Barely studied. Did some test banks and reviewed the OMM I don't do every day that always shows up on an NBOME exam. But I do believe the extra bit I learned in M2 systems and in rotations made the difference between just passing it (which I think any PA could do less the OMM) and rocking it. Case in point: I had to recert my PANRE in Sept of M2. Didn't study, took it the afternoon of my cardiology final. Scored an 800. Turns out my exam was VERY heavy cardio :) but also plenty of the other major systems. I also think I just became a much better test taker.

 

I'm quite tempted to take step 3 the week before graduation and starting residency (I get one week off! Eek!!) but I haven't decided on that yet.

[Guest Paula]

No way. I have learned valuable stuff above and beyond step 1 and through clinical rotations. The REAL difference I think will be residency, with its structured curriculum and graduated responsibility.

 

Now, I do think all of the worthwhile stuff I learned in med school could have been compressed into 2 yr. There is a significant amount of redundancy and waste in each system where we rehash the basic sciences for each system. That could be cut. But it won't be most likely because the schools operate on tradition and "this is how we teach medicine". Will our class be able to recommend some positive changes for future APAP generations? I hope so, But there is still that pesky detail of the WHO mandating 132 weeks of medical school.

 

Once you finish the core rotations there is a lot of overlap. I took step 2 after just 5 mos of rotations (oops, a little earlier than I was supposed to) and killed it. Barely studied. Did some test banks and reviewed the OMM I don't do every day that always shows up on an NBOME exam. But I do believe the extra bit I learned in M2 systems and in rotations made the difference between just passing it (which I think any PA could do less the OMM) and rocking it. Case in point: I had to recert my PANRE in Sept of M2. Didn't study, took it the afternoon of my cardiology final. Scored an 800. Turns out my exam was VERY heavy cardio :) but also plenty of the other major systems. I also think I just became a much better test taker.

 

I'm quite tempted to take step 3 the week before graduation and starting residency (I get one week off! Eek!!) but I haven't decided on that yet.

Makes me want to go to med school!  

[didymus]

After thinking about it further, those on here who are not in favor of the PA doctoral track are actually right on target. The doctoral level of PA is MD/DO. Nurses, PT's, SLP, and others who have added a clinical doctorate to their respective fields didn't have a doctoral-level offering until they expanded the scope of these fields. PA's have, essentially, a masters degree in medicine. There already always has been a doctorate in medicine. So if that is the certification a PA wants, then he or she needs to enter one of the doctoral programs in medicine that already exist: MD or DO.