PA to MD-new development

[gleannfia]

Forgive me if I am being evasive here.  But I wanted to let my fellow PAs know about something that has transpired in the past week.  Unfortunately, I have to be very careful about the details I divulge here.  I am asking that you keep this within the PA forum.

 

I have submitted a proposal to the hierarchy in my job.  It involves many aspects that have been discussed here.  PAs taking USMLE step1 and 2, one year residency, granting of MD degree by a third party. 

 

My proposal was received enthusiastically.  I am happy to share details in private messages, but I have to be careful about what I divulge publicly.

 

Feel free to contact me in PM. 

[rev ronin]

I am asking that you keep this within the PA forum.

That'll work well. :-)

[EMEDPA]

sent you a PM.

the crucial factor is if this a us or international med school. an md degree from many international med programs is worthless because you can't match to a u.s. residency.

[KMD16]

I sent you a PM as well. Another crucial factor here is whether one must pass step 1 on first attempt. Step 1 is heavy on basic sciences and I can see many PAs struggling with this exam. Step 2 won't be that bad.

[gleannfia]

I agree, but I think that we can prepare for Step 1 .  I just ordered First Aid for Step one and will study whether this goes through or not.

[gleannfia]

The proposal I put forth was for a local med school for the MD degree or the Uniformed Services Medical School, a federal entity.

[gleannfia]

I agree, Step one will be tough, but I think we could prepare for it.

[Guest Paula]

The proposal I put forth was for a local med school for the MD degree or the Uniformed Services Medical School, a federal entity.

I don't have a uniform (except for the Brownie uniform from second grade) but work for a federally recognized tribe.  Will that qualify?

[bradtPA]

I don't have a uniform (except for the Brownie uniform from second grade) but work for a federally recognized tribe. Will that qualify?

Graduates must serve 7 years in the uniformed services. I would assume the uniformed Public Health Service would qualify, but not GS, VA,or IHS.

http://www.usuhs.edu/medschool/somfaq.html

[Guest Paula]

Darn.   I've spend 7 years as a direct tribal hire.  But then this concept is a concept, interesting one. 

[gleannfia]

True, but this could change to include other govt employees, especially with all that is happening with doctor shortages in the VA.  The government can change things if there is the will.  That's what my whole proposal is about:  looking for non-traditional solutions.  The traditional route will not provide nearly enough primary care docs, as one can guarantee that new docs will continue to avoid PC, unless the way that training is paid for is drastically changed. In Europe and India, they do 5 years right out of high school, then residency.  Much more efficient.  Now of course the US could always increase the number of FMGs that can come here, but I would rather look at home-grown solutions.

 

Anyway, these are just ideas to throw out there.  I am not arrogant enough to think that I am the first person who thought of this; I know I am not. And my apologies if I implied that I think this is something that will happen overnight.  There is too much entrenched thinking to overcome for this to happen anytime soon. But I think it will happen, probably too late for me, but eventually alterative training pathways will develop.

 

What I am kind of excited about is that people in a position to help promote such change are beginning to seriously listen. Years ago, people were very dismissive of this idea.  A number of doctors I have worked with are enthusiastic, at least the ones who can put their egos aside, as one of them put it.

 

Judging from the number of PMs I have received, there are a number of you that would do this.  Heck, a lot of us would have gone on to med school if it wasn't so blasted expensive.  The way I framed my proposal would be for us to continue to work and receive our salaries while completing additional duties, to be determined.  I think it can work, and would go a long way toward producing PCPs, but it is a matter convincing the ones that can make it happen.

[gleannfia]

Oh, and no doubt Step 1 is a b*tch. I have looked at sample questions, and there is where the gap in basic sciences is glaring.  But I figure reading and working on the USMLE First Aid book would enhance my knowledge as a PA.  And I am happy as a PA.  There is not a paper-width's bit of difference between what I do and the docs do in my job.  But if a less painful pathway to MD or DO were to develop, I would jump at it.

[gleannfia]

Haha, I never even made it as a Brownie or Girl Scout.  I've always been a non-conformist.

[Guest Paula]

^^^^^^^ I lasted until 2nd grade.  I am now a non-conformist in a traditional sort of way. 

[primadonna22274]

For any PA interested in deepening their knowledge of pathology and understanding the minutiae that makes up step 1, I HIGHLY recommend Pathoma. Self-guided modules with narrated power points and a very helpful book with lots of images to annotate. Anyone can subscribe--don't need to be a med student. Dr Sattar is the BOMB. Www.pathoma.com

[KMD16]

I agree, but I think that we can prepare for Step 1 . I just ordered First Aid for Step one and will study whether this goes through or not.

First Aid for step 1 is great. Would advise supplementing with other study materials. Absolutely, a starting point. I have a copy in my collection of books.

 

 

 

 

[primadonna22274]

First Aid is great--as is Pathoma--but they are review books. Not meat and potatoes. If all you did was memorize these 2 sources you may have some advantage on step 1, but the test is VERY cleverly written...very very few straight recall questions. Almost entirely 2nd and 3rd order questions. You would have to UNDERSTAND the material and be able to interpret it to come up with enough correct answers to pass.

[physasst]

Unfortunately, I cannot see this working. As much as many of us would like to see something like this, there are accreditation issues here. I cannot see any US medical school that is accredited being permitted to do something like this.

[db_pavnp]

I just can't imagine doctors allowing people to become doctors without jumping through the traditional hoops.  They have zero motivation to increase their ranks beyond the bare minimum.  Zero reason to ever make allowances for any other profession to enter their realm.  A quick glance at the lecom bridge and it strikes me that it is hardly a bridge at all considering the "accelerated" 3 year med school is becoming a thing.  The PA step of that bridge looks nearly redundant (not necessarily a bad thing, but still redundant).  There is discussion on here about the failures of IMGs challenging the PANCE and so forth, no one is going to allow PAs to challenge anything.

[EMEDPA]

the commonly heard wisdom against any kind of bridge or reciprocity is that " it's the training, not the test".

even if this worked these folks would still need the clinical year suggested , followed by a residency. what residency would take one of these folks over a traditional medschool grad? and if the gioal is more primary care providers there is really no benefit in kicking out more docs as an experienced PA/NP can do the md/do outpatient pcp role well already.

I agree with Physasst. I just don't see this getting off the ground.

I think the only way to ever make something like this work is to dually accredit PA courses for MD/DO credit at an institution that has both a pa and a med school program. The pa who then wants to go back would take 1-2 years of coursework to finish their md/do.  The downside to this is that any medschool student could then also take a few pa specific courses and challenge pance.

[primadonna22274]

I too am concerned about the residency options. You can't get credentialed anywhere without being at minimum board eligible if not board certified these days.

[PACdan]

The downside to this is that any medschool student could then also take a few pa specific courses and challenge pance.

Would that be a terrible thing?

 

In that case the PA profession could say "look we have med students in medical school who decide at point X to become/practice as PAs". It seems to bolster PAs in that regard.

 

I don't think you'd have a ton of US MD students doing that, as among other things, ego would hold many back. But it seems like PAs get more of a brand recognition and takeaway from the co-credit opportunity.

 

And on another note, doesn't the WHO set the minimum # of months in program to be considered a medical doctor and US med schools meet or exceed that? Seems like PA credit hours would HAVE to be counted as med school hours plus some completed later to meet that international standard.

 

 

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[EMEDPA]

basically, this option would allow any med student who didn't match(say the bottom 5% of each class) to go take a few courses specific to PAs (probably only 2-3 courses doable over 1 term) ,  take pance and practice as PAs.

also WHO requirements don't mean much in the U.S., what's important is the US org that accredits med schools. lots of folks from WHO accredited med schools, even folks who have passed usmle 1 and 2, can't get residencies in the US. SDN is full of these folks. fortunately, the option discussed above would not allow these fmgs to become PAs.

[PACdan]

Good point. I wasn't thinking about the med student who graduated and didn't match. I was thinking of a current student deciding (for whatever reason) to go PA.

 

 

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[KMD16]

Unfortunately, I cannot see this working. As much as many of us would like to see something like this, there are accreditation issues here. I cannot see any US medical school that is accredited being permitted to do something like this.

Agreed. Thought of that too. LCME accreditation.