New Doctor of Physician Assistant Medicine Program

[didymus]

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.

 

That would be amazing. You could start moonlighting first year, and get your debt paid down that much faster.

[PACdan]

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.

 

I like this thinking. A PA Master's degree can be a end-professional degree to practice medicine or, if one gets the itch, can be used to pursue the doctoral level (MD/DO) of medical practice via efficient bridge programs. PAs interested in teaching, administration, etc. can pursue PhD and DHSc doctorates as a great opportunity for that. But I think that adding a 'DPAM' (Doctorate of Physician Assistant Medicine; horrible title) to a clinical PA will lead us down the road of DNPs. Non-physician providers using the 'doctor' title in a clinical setting, which is unfortunately happening. DNPs who do this can argue ancient etiologies of the word "doctor" all they want, but I feel it's deliberate and negligent misrepresentation of their training based on the common understanding of the word. Even if I were a 'DPAM', I would never introduce myself as "Doctor Hideo" to a patient. The PA training model is meant to allow individuals of sufficient knowledge, experience and schooling to practice medicine at a scope set by their physician partners. I respect that much more than getting a 'doctor' title and feigning doctor-hood.

[cinntsp]

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.

 

Why should a PA have to go to medical school to receive a degree that will open doors in government, research, and faculty positions?  

[EMEDPA]

Why should a PA have to go to medical school to receive a degree that will open doors in government, research, and faculty positions?  

agree- you can already do that with an MS, MPH, DHSc, PhD, etc

[whoRyou]

Makes me want to go to med school!  

Oh, I say go for it, Paula everyone is in debt already. LOL

[blueridge]

It is again time to question, openly, Galen, so to speak.  For the public to more readily accept ,and lawmakers more readily to pen into existence, the realization of the transformed PA to that of an independent practitioner, there must first come blood, sweat, tears, and a set of newly designed and adopted hurdles.  Fine.  Okay.  One possible plan:  Practice medicine as a PA, followed by recertification, a pathway toward physician/doctorate for those who choose such.  One intense year of primarily classroom followed by a one year tailored internship that, when successfully completed, will allow one to practice as a generalist of sorts (family practice) with optional track for a traditional residency and fellowship though perhaps trimmed.  We, as a nation, must not continue to draw doctors from the nations of the world.  As I have stated here before, global health is global peace.  A PA to physician bridge need not be designed as if there was no substantial framework already intact providing support to the competent and willing PA who finds that his or her desire for greater knowledge and skills and scope of practice cannot manifest without first laying a new cornerstone altogether?  

 

If scruffy and potty mouthed Bob Gedolf could convince world leaders to provide greater assistance to Africa during famine (1980's), surely, there is hope for a well organized campaign to redesign how America handles itself regarding business, medical business, on a global scale.  Nice, yes, nice is nice.  Yet, as Bono stated - if they didn't yield to reason, Bob would win them over with spittle, or something like that.  We are "stealing the world's doctors" and often after the respective governments have paid dearly to educate them in hopes that they would stay in their homelands.   

 

The World Health Organization has no authority to grant any form of recognition or accreditation to schools for the training of health personnel. Such a procedure remains the exclusive prerogative of the national government concerned. Consequently, no institution listed in this Directory is recognized or accredited by, or its training programme endorsed by, the World Health Organization. The lists of names and addresses were compiled from data received from, or confirmed by, Member States. The Organization cannot therefore accept responsibility for the inclusion or the omission of the names of any institutions. 

http://whqlibdoc.who.int/publications/WDMS/PRELIM.pdf

 

See the graph on page 6 and behold the need to ready and unleash PAs, even if they are only to be recognized to practice medicine in the United States:

Transformative scale up of health professional education:

http://whqlibdoc.who.int/hq/2011/WHO_HSS_HRH_HEP2011.01_eng.pdf?ua=1

[blueridge]

- rather a pathway having one year primarily classroom followed by one year tailored residency, which may commence after 3 years of practice as a PA already having a master's degree

[Guest Paula]

Oh, I say go for it, Paula everyone is in debt already. LOL

LOL!  By the time I finished pre-reqs (physics), take MCAT, find a school, apply, get accepted, go for 3 years and finish 3 year residency I will be old enough to retire. 

[nazim1st]

Can someone please comment on this....

I have not seen anyone talking about the fact that the foreign graduates holding MBBS degree are allowed to take the USMLE before applying for a residency program. But, American trained PAs with Master's degree who have been practicing medicine for many years can not take the same exam unless they go to medical school.

[Guest Paula]

Can someone please comment on this....

I have not seen anyone talking about the fact that the foreign graduates holding MBBS degree are allowed to take the USMLE before applying for a residency program. But, American trained PAs with Master's degree who have been practicing medicine for many years can not take the same exam unless they go to medical school.

Doesn't seem fair, does it?  We don't have MD behind our names, FMGs do.  

[primadonna22274]

Surely we are all way too mature to think life is "fair"?! Come on, you can do better than that.

Many IMGs have completed a very rigorous course of medicine training not very different from the US way. It's disingenuous to think they all have substandard eduction just because it wasn't done "here". The USMLEs are rigorous, I assure you. Those who pass have jumped the first hurdle and should be eligible for residency. PAs could not pass step 1 USMLE without intense, dedicated basic sciences education--this stuff is NOT taught in PA school and most of it isn't covered in undergrad bio/chem/heavy sciences either. I've done both and I know the difference.

[CorpsmanUP]

Prima, I understand and agree about the material on Step 1, so how is a PA studying the material for a year to three any different than an FMG doing the same thing to be eligible to apply for a residency?

 

While I would agree that the UK, Western Europe, Australia, and a few others have very rigorous MD equivalent education; there are another 100+ countries' that don't even equate to NP training in their med schools.  Yet as long as their country says it's a MD school they can sit for the step exams.

[Guest Paula]

Surely we are all way too mature to think life is "fair"?! Come on, you can do better than that.

Many IMGs have completed a very rigorous course of medicine training not very different from the US way. It's disingenuous to think they all have substandard eduction just because it wasn't done "here". The USMLEs are rigorous, I assure you. Those who pass have jumped the first hurdle and should be eligible for residency. PAs could not pass step 1 USMLE without intense, dedicated basic sciences education--this stuff is NOT taught in PA school and most of it isn't covered in undergrad bio/chem/heavy sciences either. I've done both and I know the difference.

I think I was misunderstood. Agree about Step 1.  The FMGs I have known studied for the step one while they worked in public health or epidemiology or research.  Several worked in my office and once they passed the Step(s) they left for residency.  One is now a psychiatrist, one is a FP physician, one is doing a fellowship in cardiology in Texas while  his wife is doing her residency in New York in internal medicine.

[nazim1st]

I respectfully disagree with those who think that getting a master's degree in Physician Assistant studies isn't as rigorous as getting a MBBS degree from another country.

Primadonna, let me assure you that the PAs are more than capable of understanding the material found in the USMLE steps. In fact, most people from my program studied from USMLE step 1 to prepare for the exam.

All I am saying is that PAs with master's degree plus years of clinical experience should not be subjected to start from first year of medical school if they wish to apply for a residency program.

[EMEDPA]

I respectfully disagree with those who think that getting a master's degree in Physician Assistant studies isn't as rigorous as getting a MBBS degree from another country.

Primadonna, let me assure you that the PAs are more than capable of understanding the material found in the USMLE steps. In fact, most people from my program studied from USMLE step 1 to prepare for the exam.

All I am saying is that PAs with master's degree plus years of clinical experience should not be subjected to start from first year of medical school if they wish to apply for a residency program.

you probably mean step 2. most pas could pass step 2 and 3 but not a chance in hell would they pass step 1, I know I wouldn't and I attended a top program back in the day. also took lots of extra bio courses not required for pa school. MS1 is a full year of BASIC (not clinical) medical science like embryology, etc. Stuff we overview in 1 lecture they spend a semester on in detail. MS1 is really the difference between a pa and an md program. we do much of ms 2 and all of ms 3. MS4 is a joke at many places and is all vacation and time to interview. many schools are doing away with ms4.

[primadonna22274]

Even if PA students memorized First Aid for USMLE Step 1, most would have a terrible time understanding the material tested at the level of minutiae required to answer the VERY sophisticated exam-writing that comprises Step 1, unless they had studied the individual topics in detail, at length, and had a reasonable command of the material. Not saying some extremely smart self-taught types couldn't learn it on their own, but the meat of this test is stuff never taught in PA school. There just isn't TIME in the accelerated pace of PA school to cover these topics in the nauseating detail taught in M1 and even much of M2. And who, already neck-deep in testable PA school material, has the time, energy or motivation to self-teach these concepts?

Step 2, not too difficult for most PA students and probably the majority of PA-Cs who've passed PANCE/PANRE by a comfortable margin. Those who barely skated by, doubtful.

Step 3: stay tuned. Haven't taken it yet.

[whoRyou]

Even if PA students memorized First Aid for USMLE Step 1, most would have a terrible time understanding the material tested at the level of minutiae required to answer the VERY sophisticated exam-writing that comprises Step 1, unless they had studied the individual topics in detail, at length, and had a reasonable command of the material. Not saying some extremely smart self-taught types couldn't learn it on their own, but the meat of this test is stuff never taught in PA school. There just isn't TIME in the accelerated pace of PA school to cover these topics in the nauseating detail taught in M1 and even much of M2. And who, already neck-deep in testable PA school material, has the time, energy or motivation to self-teach these concepts?

Step 2, not too difficult for most PA students and probably the majority of PA-Cs who've passed PANCE/PANRE by a comfortable margin. Those who barely skated by, doubtful.

Step 3: stay tuned. Haven't taken it yet.

Fingers crossed for you Lisa ... Keep us posted

[primadonna22274]

Haha. I'm tempted to take it in my 4 days off between graduation and starting residency orientation, but not sure if they'll pay up front for that before residency actually starts...and would rather not be quite so poor before I start pulling a regular paycheck in July lol

[whoRyou]

Haha. I'm tempted to take it in my 4 days off between graduation and starting residency orientation, but not sure if they'll pay up front for that before residency actually starts...and would rather not be quite so poor before I start pulling a regular paycheck in July lol

July is just around the corner ...

[gleannfia]

We are in the catbird seat.  There is an extreme shortage of primary care docs in the US.  Those of us with 10+ years experience can easily do what an MD does.  I work in the VA.  There is not a bit of difference between what the 3 midlevels ( me, and two NPs) do, and what the three MDs do. We do not even have supervising physicians anymore.  We are collaborating.  I disagree that a reasonable intelligent PA/NP could not prep for/pass USMLE step 1.

 

I cannot think of a more efficient way to add primary care physicians to the system than taking experienced NPs/PAs and allowing them an expedited path to MD.  I am not interested in the LCOM program.  No offense to DOs, but I am not interested in becoming one, and it is ridiculously expensive.

[PACdan]

We are in the catbird seat. There is an extreme shortage of primary care docs in the US. Those of us with 10+ years experience can easily do what an MD does. I work in the VA. There is not a bit of difference between what the 3 midlevels ( me, and two NPs) do, and what the three MDs do. We do not even have supervising physicians anymore. We are collaborating. I disagree that a reasonable intelligent PA/NP could not prep for/pass USMLE step 1.

 

I cannot think of a more efficient way to add primary care physicians to the system than taking experienced NPs/PAs and allowing them an expedited path to MD. I am not interested in the LCOM program. No offense to DOs, but I am not interested in becoming one, and it is ridiculously expensive.

I think the point is that even MDs who have been out in clinical practice for years would have a very hard time coming back to the core sciences of Step 1. The first two years of med school intensely prepare for that exam, before moving on into applied clinical focus.

 

As for a bridge to physician-ship for PAs, if DO schools capitalize on these already highly trained professionals, all the better. It's a stronger bond between PAs and DOs and PAtoDOs. Our circle gets bigger.

 

No matter how much a select few MDs want to be seen as superior to DOs, that's not the case. Only this word matters: Physician.

 

 

Sent from the Satellite of Love using Tapatalk

 

 

[gleannfia]

On second thought, after looking at sample questions for the USMLE, some of you are right!  LOL  I would have a tough time with it.  I do not disdain DOs.  I just have no desire to learn/do OMT.  My family doc growing up was a DO.  Best doc I ever had.  However, DOs are still not well-received in many areas of the country.

[primadonna22274]

OMT is a pretty useful skill. I struggled learning it. I wanted to be a natural and I wasn't. But I kept trying. I have a decent toolbox of techniques that I do well and I use those.

Had a lady at the free clinic Wed am. Young woman, has 5 children. Stands all day at work in food service. Woke up 3 wk ago with a sore back, no known injury. Over the course of a week had become almost incapacitated with severe spasm and left sciatica that was disabling. Had missed 3 days of work because she couldn't stand. This is not a woman who misses work casually. Went to the ED last Monday. Got a shot of Decadron and Toradol and was better for a few days but right back to miserable and couldn't afford to lose any more work.

She came in limping. Couldn't straighten up. Severe spasm on the left LS and exquisite TTP left central buttock, radiating pain down the left lateral to the anterior and medial thigh. Intact neurovascular exam and no other red flags. I treated her with simple muscle energy techniques (basically you take the muscle groups into their position of ease, then have the patient gently press against your (mild) force into the restriction. Repeat 3-4 times, then one last passive stretch, then back to position of comfort. It hurts but it resets the muscle spindles that are tight and forces them to relax. Extremely simple, quick, and effective.

I fixed her left tight piriformis in about 90 seconds. After 3 weeks of disabling sciatica, she could stand almost straight and walk without pain. She was amazed and so was the receptionist who had offered to bring her back in a wheelchair.

So yeah, it's pretty awesome to have that extra tool.

[Guest Paula]

^^^^^ you might disagree with this statement....but primadonna's description is what my Dad did as the local wrestling team's chiropractor when I was growing up in the 60s & 70s.  He is long retired and was the best therapist using those similar techniques.  

 

I would do DO in a heartbeat with my view of chiropractor and my background in dietetics if I was about 15 years younger.  A perfect blend of medicine, therapy and nutrition. 

[KMD16]

Nice work primma. An extra tools indeed. You didn't comment on the patient LE motor strength. Sorry, formal neurospine PA here. Anyway, you did the right thing. Best of luck in training.