PA-MD/DO bridge

[Swole2112]

Now that LECOM (I think?) has established an official PA-DO bridge program, is it reasonable to suggest that the idea will spread across the nation?... of course, depending on how successful the LECOM program is.

[MonikaPA]

That is interesting, I looked it up and the link is below:

http://www.lecom.edu/index.php/lecom-announces-new-accelerated-physician-assistant-pathway/76/0/1919/18477

[EMEDPA]

there is at least 1 other DO school considering a bridge.

[JFarnsworth]

Hmmm, advantages? Drawbacks? Contrarian, where are you?

[EMEDPA]

advantages? 3-4x the salary for 1/2 the work and independent practice in any setting or country with a high level of respect from patients and other medical professionals.

drawbacks? loans and 6+ yrs of no significant income.

[ventana]

$$$ for both sides

 

I am 42

 

3 years of school - loose $100k/yr income

4 years of residency - loose $60k/yr income

 

total loss of $540k plus the stress of being broke and 80+ hour work weeks - PLUS another $200k in loans

 

49 when graduate - $740k behind....

 

Income as Doc - $200k/yr ($100k more then PA as all I want to do in IM and not subspeciality)

will take me 7.5 years to be "even" financially with out any time value of money (interest - also difference between earning interest on my savings versus paying interest in school loan)

 

That places me at age 56.5 to just pull even with the income side..... but will have lost 7 years of retirement savings (5k/yr for Roth and 10k/yr 401k = 15k/yr x 7 = another 100k!)

 

Would have to work well into my 60's to make it work financially - not for me...... But if I was 10 years younger I would really consider it....

[EMEDPA]

But if I was 10 years younger I would really consider it....

 

me too. I have done the same calculation ( I also included price of school). my opportunity cost(lost income +price of school+loans minus residency salary) is around 1 million dollars and the position I would go into as a doc(rural fp/em) would likely make me after expenses basically what I make now so I would never break even. although a 2 yr bridge with no mcat requirement and I would do it.....I seriously considered the 3 yr bridge but studying for the mcat is the deal breaker...kaplan course, repeat several classes, take biochem, etc

[Beorp]

advantages? 3-4x the salary for 1/2 the work and independent practice in any setting or country with a high level of respect from patients and other medical professionals.

drawbacks? loans and 6+ yrs of no significant income.

 

At this point, DOs only have full practice rights in 50 countries according to AACOM.

[EMEDPA]

I think I could keep myself busy in 50 countries....with more being added every yr.....there are "practice rights" and "practice rights in a disaster".

Haiti doesn't license pa's but there were tons of us there practicing full scope medicine(equivalent to md) right after the earthquake....ditto DO's...if you were a residency trained/board certified er doc who happened to be a DO you could go anywhere in the world with a disaster or relief organization...they aren't too picky....

[Beorp]

Absolutely. No argument with any of that, but it is just important to remember that one of the limitations with DO is international practice in non-disaster situations since the DO degree as equal to MD/MBBS is unique to the United States.

[Contrarian]

Hmmm, advantages? Drawbacks?

 

Advantages? ... Able to own and open a practice in 50 states & countries without supervision or "obstruction."

 

Drawbacks? ... These would be based upon individual perspective. For me... Not really any. A few folks above point to the loss of revenue/return on investment as calculated utilizing their personal expectations...

 

Personally, I don't/can't see many folks "retiring" at the traditional age of 65 in 15-20yrs. With the way things are going (economy, investment vehicles, taxes, national debt, aging population shift, socialist ideals, etc.)... most will be working until they "lay-it-down/dirt-nap."

 

Soooo... since the whole "retire at 65" seems to be going the way of the do-do bird...

A 42yr old PA-C returning to school today... for a 3yr bridge and 3yr residency to become a IM Physician by age 50... will still have a good 20-33yrs of physician salary to collect and a HUGE and growing elderly population to collect it from. Of course... this assumes that this persons mental faculties and health remain reasonably intact.

 

When you consider that a IM physician, utilizing a good EMR on tablet PCs, electronic faxes, and a fuel efficient car.... doing Housecalls out of a homebased-office and doing their own billing can easily make $180k+/yr seeing 10-12 patients/day... coupled with the fact that the population is aging rapidly, then returning to school may be worth it if you are interested in IM.

 

Hell... our Inpatient Psychiatrists get paid a daily rate of $600 (weekday)-$800 (weekend)/day of work. Most days they arrive by 0900 and leave by 1400 and only have to see 3-7 patients. They generally only spend 3-7min with each unless its a admission then they MAY spend 10mins talking with a new admit. Thats a easy $145-$193k/yr sitting and talking with people. Its sooo easy that one psychiatrist works 10 days in a row, 3 off then 10 on again (~$16k/month). So yeah, it may be worth it for some folks to return to school.

 

With that said...

 

I think the LECOM program is a great start and opportunity for some PA-Cs... but personally, I wouldn't do a "bridge" program in its current iteration... not until it was a true Bridge.

 

To me...

A true Bridge means getting rid of the MCAT requirement for PA-Cs and the total bridge program is 24 months long... ~ 21 months (~ 91.25 weeks) when you subtract from actual class/clinical time for breaks.

 

This assumes that the PA-C --> MD/DO bridge student gets:

15 days Christmas break (30 days for both phase I & II)

10 days break between each semester (50 days)

 

The first 1.5 yr of the PA->MD/DO bridge would still be same as the first 1.5 yr of traditional Med School.

 

Phase I:

This covers MS1 & MS2 and is 3 Semesters long. (Sep-Sep)

1st Semester

Anatomy,

Physiology, Pathology

 

2nd Semester

Biochemistry, Behavioral sciences,

,

Microbiology,

 

3rd Semester

Pharmacology,

nutrition, genetics, and aging

The PA-C takes USMLE step 1 at the end of this...

 

Phase II:

3 Semesters of the usual (FP, IM, In Patient, Surgery, EM, Peds, OB-Gyn, Psych, ID-HIV) clinical clerkships (Sep-Sep) ...

 

The PA-C takes USMLE step 2 (CK & CS) during this phase...

 

PA-C is Awarded the DO degree at this point.

This has all been discussed here and here

[mktalon]

I don't really understand the "bridge program" that still requires 3 years of med school and 3 years residency. If a PA has been practicing for 15+ years is that not worth more than 1 stinkin' year of MD residency? I understand that the scope of practice is not the same, but I would think that after 15 years of practicing as a PA, a one year residency could probably cover the difference. If the PA is a newly practicing PA then I would completely understand, but for a seasoned PA that's been practicing in FP for a long time, a 3 year FP residency just seems excessive, especially if the PA has been practicing fairly autonomously.

[mktalon]

I'll clarify by adding that my comment was only intended for those PA's that would be going MD in the same field they had been practicing in for an extensive period. If they were planning on switching specialty then I would say they would need the residency.

[GeneValgene]

I don't really understand the "bridge program" that still requires 3 years of med school and 3 years residency. If a PA has been practicing for 15+ years is that not worth more than 1 stinkin' year of MD residency? I understand that the scope of practice is not the same, but I would think that after 15 years of practicing as a PA, a one year residency could probably cover the difference. If the PA is a newly practicing PA then I would completely understand, but for a seasoned PA that's been practicing in FP for a long time, a 3 year FP residency just seems excessive, especially if the PA has been practicing fairly autonomously.

 

this brings to mind something else for me. if the idea of a bridge were to ever catch on, it would be nice if they put some kind of minimum years of experience requirement. for example, minimum 5-10 years as a PA to even be considered for the program. and maybe even an SP recommendation or endorsement. last thing i would want to happen is that people who can't get into med school start thinking of PA school as a fall back and a back-door way to become a physician.

[EMEDPA]

my "perfect bridge" would look like this:

pa x min of 6 yrs. passed panre at least once. min. prior degree of bs(either bs pa or bs in another field)

no mcat requirement.

1 yr classroom, 1 yr rotations.

then on to regular residency pathway.

[ventana]

My tag line......

The Fine Print- you didn't pay for my advice so please consider this when reading it. I don'tcare about typos so don't tell me I can't type. I vote for a PA-MD bridge program for IMwith 1 yr academic then 3 years residency for IM board cert only.

(agree that there needs to be a time frame of experience in the field ie 5 years.... would prevent people become a MD/DO via PA on purpose..)

[rmathews619]

EMEDPA I couldn't agree more. That would also be a perfect bridge program for me.

[JFarnsworth]

EMEDPA, I'd do that bridge program! So if you can get one started, please let us know ASAP. :)

[ventana]

just another thought that might apply to more PA's

 

What about independent practice for IM with

 

1. NCCPA cert

2. 6+ years experience in IM

3. score over 80th (or some other percentile) on the PANRE

4. Masters level degree (no real clinical purpose to this, but adds legitimacy to it - makes the same level as NP's who can do the same thing.

(could even require a "collaboration agreement" with a physician but still do all you own billing under you PA UPIN and never under a MD/DO UPIN

 

 

Then you can own your own company, set up your own shop, have no supervision requirements......

the Super PA

 

 

 

 

Could even say initially that the only place we could practice in critically underserved areas to "get a foot in the door"

 

 

 

Honestly I don't really care about the degree - I just want the autonomy and to get out from under the control of others.....

 

 

 

 

would require a national level law mandating PA's be recognized at primary care providers and all services provided by PA's must be billed under their UPIN

[MMiller]

my "perfect bridge" would look like this:

pa x min of 6 yrs. passed panre at least once. min. prior degree of bs(either bs pa or bs in another field)

no mcat requirement.

1 yr classroom, 1 yr rotations.

then on to regular residency pathway.

 

This is perfect. As it stands, I'd never do any bridge program that had me studying to take the MCAT first. Waste of time for someone already practicing medicine.

[dm123]

$$$ for both sides

 

I am 42

 

3 years of school - loose $100k/yr income

4 years of residency - loose $60k/yr income

 

total loss of $540k plus the stress of being broke and 80+ hour work weeks - PLUS another $200k in loans

 

49 when graduate - $740k behind....

 

Income as Doc - $200k/yr ($100k more then PA as all I want to do in IM and not subspeciality)

will take me 7.5 years to be "even" financially with out any time value of money (interest - also difference between earning interest on my savings versus paying interest in school loan)

 

That places me at age 56.5 to just pull even with the income side..... but will have lost 7 years of retirement savings (5k/yr for Roth and 10k/yr 401k = 15k/yr x 7 = another 100k!)

 

Would have to work well into my 60's to make it work financially - not for me...... But if I was 10 years younger I would really consider it....

 

Our individual health is an unknown and can't be taken for granted. I worked briefly with a rehab specialist who was a trained surgeon, then developed crippling Rheumatoid arthritis. Never in my wildest dreams would I have anticipated spending 3 days in ICU on a vent in '07 with encephalitis, sequalae MS, and just now getting back in gear. Accidents happen. To go back to school, assume debt, especially with a family assumes risks that shouldn't be taken lightly. Then again, you could marry money and let your spouse pay for your training. Following the if/then to the next step, just skip medical school.

[Superfundee]

It's tempting. I am considering the "bridge-program" in the future.

 

I have nearly 2 years of working in the ED. My first year of being a new grad PA, I hated it. I worked at a small community hospital where PAs are treated like a scumbag by a few private doctors.

I then changed my job to bigger academic setting. Much less autonomy but I still love it and I hunger for more learning.

 

I'm 35. completely debt free. pre-med pre-req over 10 years ago. Have taken many hard-core science courses during my graduate study Biochem/Mol Bio and some public health training.

 

If I really want to go back to med school, I would shoot for Class of 2014. Hopefully I could save $120K or more by then. I'll be 42 by the time I graduate.

Hopefully less than 100K in debt. 3-4 years of EM residency. I'll be 46 when I become ER attending making >200K. hmm do I think it's worth it?? Does this make some economic sense? I don't know. But that bridge-program sounds very tempting. Maybe a great idea if they can just drop the MCAT for requirement. :)

[Superfundee]

It's tempting. I am considering the "bridge-program" in the future.

 

I have nearly 2 years of working in the ED. My first year of being a new grad PA, I hated it. I worked at a small community hospital where PAs are treated like a scumbag by a few private doctors.

I then changed my job to bigger academic setting. Much less autonomy but I still love it and I hunger for more learning.

 

I'm 35. completely debt free. pre-med pre-req over 10 years ago. Have taken many hard-core science courses during my graduate study Biochem/Mol Bio and some public health training.

 

If I really want to go back to med school, I would shoot for Class of 2014. Hopefully I could save $120K or more by then. I'll be 42 by the time I graduate.

Hopefully less than 100K in debt. 3-4 years of EM residency. I'll be 46 when I become ER attending making >200K. hmm do I think it's worth it?? Does this make some economic sense? I don't know. But that bridge-program sounds very tempting. Maybe a great idea if they can just drop the MCAT for requirement. :)

[ventana]

It's tempting. I am considering the "bridge-program" in the future.

 

I have nearly 2 years of working in the ED. My first year of being a new grad PA, I hated it. I worked at a small community hospital where PAs are treated like a scumbag by a few private doctors.

I then changed my job to bigger academic setting. Much less autonomy but I still love it and I hunger for more learning.

 

I'm 35. completely debt free. pre-med pre-req over 10 years ago. Have taken many hard-core science courses during my graduate study Biochem/Mol Bio and some public health training.

 

If I really want to go back to med school, I would shoot for Class of 2014. Hopefully I could save $120K or more by then. I'll be 42 by the time I graduate.

Hopefully less than 100K in debt. 3-4 years of EM residency. I'll be 46 when I become ER attending making >200K. hmm do I think it's worth it?? Does this make some economic sense? I don't know. But that bridge-program sounds very tempting. Maybe a great idea if they can just drop the MCAT for requirement. :)

 

 

dont do it for the money - if you figure out the $$$ side of it if you are not in your 20 or early 30 when you graduate it might cost you money - at 42 I would have to likely extend my career just to break even with out the time value of money (and the amazing stress that school and more likely residency) would place on my wife and I.... no thanks....

[ventana]

It's tempting. I am considering the "bridge-program" in the future.

 

I have nearly 2 years of working in the ED. My first year of being a new grad PA, I hated it. I worked at a small community hospital where PAs are treated like a scumbag by a few private doctors.

I then changed my job to bigger academic setting. Much less autonomy but I still love it and I hunger for more learning.

 

I'm 35. completely debt free. pre-med pre-req over 10 years ago. Have taken many hard-core science courses during my graduate study Biochem/Mol Bio and some public health training.

 

If I really want to go back to med school, I would shoot for Class of 2014. Hopefully I could save $120K or more by then. I'll be 42 by the time I graduate.

Hopefully less than 100K in debt. 3-4 years of EM residency. I'll be 46 when I become ER attending making >200K. hmm do I think it's worth it?? Does this make some economic sense? I don't know. But that bridge-program sounds very tempting. Maybe a great idea if they can just drop the MCAT for requirement. :)

 

 

dont do it for the money - if you figure out the $$$ side of it if you are not in your 20 or early 30 when you graduate it might cost you money - at 42 I would have to likely extend my career just to break even with out the time value of money (and the amazing stress that school and more likely residency) would place on my wife and I.... no thanks....