First PA-C to DO bridge program announced

[EMEDPA]

heme- what we really need is ms1 and ms4. unfortunately the way medical licensing in the u.s. is structured your program must be a min of 3 yrs.

 

knightgirl- I don't think waiving the residency is a good idea. I have worked in em for 23 yrs and definitely still would learn things in a 3 yr physician level residency.

[NewtonsApple]

Does anyone think that this or future bridge programs will honor PA residencies? Not that they would omit them fully, but give credit for the year or two spent in training.

[rev ronin]

Too soon to say, NA. The world can change a whole lot in the next decade.

[NewtonsApple]

Very true, this first class will determine a lot. I hope the qualifications are looked at blindly without politics, i.e."a PA residency does not compare to a DO/MD residency." I doubt right now that I will ever bridge, as I am happy with my career choice. However, having the option is always nice.

 

Very exciting times for the profession, especially in light of other professions dismissing the quality of the PA. Someone posted a while ago that the NP would take over family practice with some form of autonomy, and the PA would grab the specialties with an option to bridge to an MD/DO. Whoever called that has some good insight.

[rpackelly]

I wrote about this in ADVANCE for PA awhile back, predicting that it would be a DO program. I had no direct knowledge of LECOM but thought they would be a good guess because of their innovative Independent Study pathways that let people with "significant science background" progress through the MS I and II years in 20 months of sequential study. Fewer lectures, more independent study and evaluation, and they had experience with the "fast track" for primary care.

 

This will break the ice and more innovation will be expected in the future. Not that it is a great thing for most PAs, but eventually I predict that it will lead to more "leveling of the playing field", which will affect all of us positively. ?From a health policy standpoint anything that breaks down artificial barriers to upward mobility is notable.

[rcdavis]

heme- what we really need is ms1 and ms4. unfortunately the way medical licensing in the u.s. is structured your program must be a min of 3 yrs.

 

knightgirl- I don't think waiving the residency is a good idea. I have worked in em for 23 yrs and definitely still would learn things in a 3 yr physician level residency.

 

 

I agree 100%.

 

davis

[EMEDPA]

Does anyone think that this or future bridge programs will honor PA residencies? Not that they would omit them fully, but give credit for the year or two spent in training.

nope, won't happen.

[NewtonsApple]

It makes sense that they don't in reality... how could they reasonably account for what you know than place their name on your certification if they didn't teach you.

[NewtonsApple]

double post

[NewtonsApple]

I agree 100%.

 

davis

I thought that in prior post ms-4 was painted to be an over glorified period to apply to residency programs? Am I confusing something here

[rev ronin]

I think the biggest disconnect in any bridge program is going to be residency. Older, experienced students are generally neither going to be physically as capable as 26-30 year olds of going without sleep, willing to work so long while neglecting families that many traditional-age residents don't yet have, nor work for paltry salaries for the promise of future windfalls that will make all the student loan interest a good investment. What I haven't seen the bridge program proposal address is the "total package" needed to take any midlevel practitioner, PA or NP, to medically licensed competence, such that the public can have strong faith in the competence of the final product. Three years of med school is probably too much, but a PA with lots of experience is not the same as a PGY-1--any solution which treats the two as identical or equivalent is not going to play to PA's strengths.

[NewtonsApple]

Agreed rev., however I think that issue will be more able to be addressed after this class. There is no doubt in my mind many people are anxious to get their hands on grade and performance data relating to the PAs in med school. I honestly believe that if the first class performs remarkably (and maybe a subsequent class for skewed data), than I can see a change to a two year program for future students, or a separate program all together. One that caters to the needs of the PA making the bridge. In regards to the residency, I think the playing field may have some leveling as the frustration and/or insecurity while on a steep learning curve will be cut down for a seasoned PA. This in turn may cut down on the stress exhibited by younger, yet more green med students. Of course this is just my opinion :)

[huskymed]

The complete first and second years? I’m going to have to master Bates’ again? Learn how to interview a patient, go through pathophys for a second time, pharmacotherapy, etc., etc.. I can understand requiring maybe the biochem, embryology, and histology, but to start from scratch? Again, I think this is way to get PAs to go to medical school using the guise of a bridge, when in fact there appears to be no bridge - just a whole lot more debt for us and more money in the pockets of the med schools. Condensed clinicals is all they're really offering - and if you ask me we could skip the majority of those altogether. If you just want the doctor title and the boost in pay, maybe, but to truly address the shortage of physicians by utilizing highly skilled and aptly trained PAs? Don’t get me wrong. I’m a huge proponent of a true PA to physician bridge, but, sadly, this is not the way ...

 

And if this does fly and becomes the norm, where’s the incentive to become a PA?

 

1) bachelors, 27-30 months for PA school, another 34 months for the MD/DO, then residency

 

vs.

 

2) bachelors, 36-48 months for med school, then residency

 

The choice looks clear to me. Choice one puts you near 64 months of medical/clinical training. You’re back to square one. Why choose PA school if the end goal is to be a physician? It doesn’t make sense.

 

I think a much better option would be something like requiring MS1 with the hardcore sciences (or a one year hybrid) and one year of condensed clinicals, then residency (and a shortened one at that). I can hear the argument from SDN posters already - there are no shortcuts. But hell, even with the shortened schemata that I've proposed, that still puts us with more total hours of medical/clinical training than the standard 48 month med school. That's no shortcut, that's punishment. Certainly not a bridge or reward for our previous training and experience. If this is going to happen, they'll need to start thinking outside of the box ...

[EMEDPA]

HUSKY- the issue is that to be accredited as a us medschool grad you must do a min of 3 yrs of school.

we both know that 2 yrs would be fine with 1 didactic yr and 1 clinical yr but that wouldn't result in the ability to take usmle step 1-3.

a format with no mcat, 1 yr didactic and 2 yrs clinical would meet the 3 yr requirement and probably appeal to a broader audience of pa's.

[rev ronin]

a format with no mcat, 1 yr didactic and 2 yrs clinical would meet the 3 yr requirement and probably appeal to a broader audience of pa's.

 

I wouldn't mind the MCAT personally, but if they did 1 didactic, 2 clinical, with the 2nd clinical year essentially being a traditional PGY-1 internship and the ability to be medically licensed (though not board certified, obviously) upon successful completion of the three year program, I'd consider going for it once my kids are all grown and gone. Odds of that happening by then? Probably not too high.

[Doc Savage]

I hope that LECOM makes sure that this program is a big success. If LECOM can make it a hit, other schools will follow! Man ... this is big! GO LECOM! GO! Just think 45 years ( or so ) ago the first PA students were underway at Duke... that went pretty well i think. I can only imagine the details now.

[Ridiculopathy]

id like a 2year didactic....i'd like learning over again in a more indepth fashion... once again, as long as the p.a. can work...i wonder if this program will be available to NP's? will this now create a new flame war between NP's and PA's?

[primadonna22274]

Gosh you guys have been busy since I haven't been able to post the past 2 days. I've followed the discussion by phone but responding is out of the question on my useless Palm. I need a new phone....

 

OK. For the record, I had the benefit of an inspiring and in-depth conversation with Dr Mark Kauffman at LECOM about this on Monday. I think we talked about 40 minutes. His enthusiasm is infectious and with good reason. For those of you who don't know, Dr K is a DO and a PA. This project has been in the works for a very long time, but he stuck with it until it was a "go". So here's the insight he shared with me:

 

1. There is no way to get around the MCAT, at least not for now. No accrediting body will approve a program that waives MCAT, so that has to stay. That said, the MCAT score is probably the least important part of the PA-C-to-DO application--a minimum score of 22 is required, but that's not that hard. I'm not saying it's a fun test--I've taken it twice--but if you had the necessary prereqs for PA school and brush up a bit on the stuff you don't use often (for me, gen chem and physical science) you will do passably.

 

2. Clinical experience counts for a LOT. Dr K will be personally reviewing each of the PA-to-DO apps and conducting interviews himself. Initial plan is to start with a cohort of 12 PAs in the class entering end of July 2011. Once in, the PA will choose his/her preferred learning pathway (any of the 3 pathways are allowed, but the PA is NOT eligible for PCSP, the 3-year condensed medical curriculum for primary care). Especially for the first class, LECOM is looking for a group of dynamic can-do PAs who have done great things SINCE PA school. An interesting CV will probably compensate for less impressive MCAT and undergrad grades. PA grades and honors matter more. Work experience and responsibility matters more.

 

3. Correct that M1 and M2 remain the same, but M3 and M4 are condensed, giving the PA credit for what s/he has already learned in clinical practice. It is true that by WHO accreditation standards the minimum length of any medical program is 3 years (technically I think 138 weeks? that number sticks out in my head). IMO requiring M1 and M2 and not exempting the PA from any of the basic sciences is a strength because the program will be able to effectively compare how the PAs do with the rest of their medical school classmates using standard measurements and statistical analysis. Don't think there's not a paper in the works here, or three or four or eight or ten. Nothing revolutionary in academic medicine happens without planned publication. Also, from my perspective, I too would like to relearn the things I don't feel I know particularly well. I hate kidneys, for example. I don't like Acid-Base Chemistry. But I need some guidance and affirmation to relearn that stuff that I don't like. Repeating M1 and M2 would not hurt me a bit.

 

4. It is a "bridge" of sorts. You do cut out a year from traditional medical education curriculum, saving a year of tuition and a year of living like a poor student again. Dr K told me he anticipates PAs could work while in this program--not full-time, but enough to get by--and at any rate, the program won't discourage it. Keep in mind that those PAs we know who have done traditional medical school have said again and again that there is little of med school that could be "cut" for PAs--it's all important--but this is the first serious attempt to find out what is feasible. There is a definite minority of practicing PAs who would jump at the chance to attend this program, and I predict competition will be intense, especially after the first cohort gets going and proves we can DO it. :)

 

5. At this time, the program is ONLY for PAs. No NPs mentioned or considered for these slots. I'm not sure whether NPs as a group are specifically excluded or if it was just more practical to create a program just for PAs...and as stated above, Dr K is a PA and DO, so he has some expected preference. As I have stated many times previously, PAs are for the most part a consistent product than NPs, so it makes sense to pick just one group to focus on for this experiment.

 

All in all, I think it's exciting and yes, I'm considering it strongly. I might have reapplied anyway in a couple of years, and in fact had planned to apply narrowly when I did apply--and LECOM has established a reputation of developing innovative educational pathways and producing competent physicians with an excellent board pass rate. It also happens to be one of the least expensive DO programs ($28k/year for out of state, $27k/year in state), so less debt than other programs, and cheap COL in PA. (FWIW, the program will be available in Erie and in Greensburg, but the Greensburg program is only PBL.) I won't take the time here to explain the learning pathways--but you can check www.lecom.edu if you are interested.

[SocialMedicine]

Not a huge fan of this. I do not think anyway. I feel it somewhat discredits PA's and shows us to be a profession of people who couldnt do the MD initially. I would much rather see a way for seasoned/motivated PA's to demonstrate themselves more within the profession and gain more autonomy/skill that way. Such as a way for a PA with 5-10 years experience to complete some coursework and obtain a Senior PA credential. However, I wish the best to the first year class ! It will be interested to follow. Def not for me.

[istat2]

I don't believe the most significant aspect of this is the bridge. With this program and the military doctorate programs, there is a trend developing. You may well in the future see things such as a certification for practice autonomy (such as the NP's are pushing), as well as other novel ideas. It does appear as if the lid is coming off the box, and all concepts are on the table. It a brave new world that's coming. :;;D:

[Mark Kauffman]

Hello Everyone,

Let me try to clear up a little of what is going on with the Accelerated Physician Assistant Pathway (APAP) at Lake Erie College of Osteopathic Medicine. Being a PA myself, I had always heard of a medical school that offered an accelerated program for PA’s who wished to return to medical school. It always turned out to be an "urban legend" so I came to LECOM as a student in 1996. Being a DO and a PA gave me insight into the differences and similarities of the curricula and to design APAP. On May 22nd, we presented our curriculum request to our accrediting body, AOA COCA who officially approved the new pathway. Once approval is obtained, per our governing body, implementation cannot begin for 120 days which puts us past the incoming class in August, meaning our start date will be with the incoming class of 2011. We are approved for 12 slots, six primary care, meaning those accepted into the program will be required to do primary care residencies and six open. This is the lay press release:

Lake Erie College of Osteopathic Medicine announces the approval of an accelerated three-year medical school curriculum for Certified Physician Assistants to obtain a Doctorate of Osteopathic Medicine degree. On May 22nd, 2010 The American Osteopathic Association Commission on Osteopathic College Accreditation approved the Accelerated Physician Assistant Pathway (APAP). The pathway was designed and will be directed by Mark Kauffman DO, PA, MS Med Ed as a response to predicted physician shortages. Physician Assistants are healthcare professionals who work under the scope of their supervising physicians. They undergo rigorous didactic medical curriculum as well as at least one year of clinical rotations to obtain the entry level masters degree for the profession. Debate suggesting a change in the entry-level to that of a doctorate degree resulted in the PA Clinical Doctorate Summit of March 2009. The Summit conducted the 2009 Physician Assistant Doctoral Summit Survey. The results of which recognized that many physician assistants wish to become physicians citing the desire to practice independently, the need for professional growth and development, the need for increased medical knowledge and the ability to do more for their patients as the most common reasons to do so. Currently only 4% of PAs return to medical school noting cost and time away from clinical practice as major barriers.

In 2008, 37% of PAs choose to work in primary care. Growth in demand for primary care physicians will increase by more than 15 percent over the next decade. Dr. Kauffman and LECOM have identified PAs as excellent candidates for medical school as they have demonstrated the ability to successfully complete demanding curriculum, have practiced clinically, and have expressed the desire to increase their medical knowledge. By accelerating the medical school curriculum to 3 instead of 4 years, LECOM will reduce the cost and time away from clinical practice for PAs within this pathway by one quarter. Students will complete the first year of didactic instruction followed by 8 weeks of primary care clinical clerkships. They would then return to the second year of didactic instruction followed by 48 weeks of clinical clerkship training. Applicants to the program will be required to have obtained a minimum of 22 on the Medical College Admission Test (MCAT). The first students would be enrolled in the fall of 2011.

In response to some of the issues posted to the forum

1) MCAT: Medical education literature notes that the MCAT is predictor for the ability to obtain core knowledge in Basic Sciences and perform well on standardized testing. It fails to recognize other areas that make good physicians like empathy and the desire to serve. Unfortunately, our accrediting body does not allow a school to pick out subsets of applicants. LECOM requires a minimum MCAT of 22, the level below which students without prior medical training struggle with the medical boards. PAs that have gone through LECOM already have scored lower on the MCAT as we do not take traditional pre-medical sciences often picking up physics, organic and inorganic chem just to meet the med school requirements and take the MCAT. However, despite the lower MCAT, their performance on the DO COMLEX Boards is superior as is there graduating class rank. Again, the rule applies that what you require of one applicant must be required of all, so even considering lower MCAT scores for APAP is not possible. I am not aware of any US medical school that does not require MCAT. If anyone knows of a school that doesn’t, please let me know. I would like to see how they do on their Boards. Another poster recommended taking a MCAT prep course. Good idea.

2) Stepping Stone: PA’s are an extremely valuable asset to medicine. However, as noted in the press release, once experiencing medicine, some have strong desires to become physicians. The 2009 Summit Survey noted the following four reasons as the most common: Ability to practice independently, Need for professional growth and development, Need for increased medical knowledge and Ability to do more for patients. The program is in no way designed to take practitioners away from one field into another. For those who question why PAs should support those who choose to leave the profession, the answer is; which physicians will be the best supporters of the PA profession, those who are PAs themselves.

3) Barriers to returning to med school include the financial burden and time away from practice. This program is 138 weeks of training and will cut the total cost of medical school by ¼.

4) Twelve slots: When applying for new programs, approval is less hampered if smaller numbers are sought. Though barred from the debate process during our application, apparently it was lengthy. Anytime a new program is developed, assurance of its success must be made. With demonstration of success, advancements can be made. As noted by many forum posters, it is a start and no longer an urban myth.

5) Pre-requisites: Schools do have the liberty to accept some courses in lieu of others. Many applicants will take all of the standard physics, organic and inorganic chem just for the MCAT but you shouldn’t hold your application if you have not had all of these courses. Each application will be assessed individually and other completed courses will be considered and approved as appropriate.

6) Clinical experience: only completion of your PA curriculum and certification is required meaning you have had at least 1 year of clinical experience. You could go directly from PA school to LECOM.

7) Applications for the program are through AACOMAS. If planning to apply, put it your application early and notate your PA training.

Thank you and I hope this cleared up some of the issues. I am sure there will be many more. I will be working on formal publication of this information as soon as possible.

[andersenpa]

Thanks for the update.

 

Perhaps I'm being too picky but it would have been nice to see a higher previous clinical experience requirement; seems this would select for PAs best suited for a "bridge": solid patient care experience and a good working knowledge of the health care system.

[just_me]

So in the application process does the program see an applicant with no clinical experience as being on the same level as an applicant with experience or does experience give you a higher standing in the application process. Is the application point based on different aspects of the application process?

 

Hello Everyone,

Let me try to clear up a little of what is going on with the Accelerated Physician Assistant Pathway (APAP) at Lake Erie College of Osteopathic Medicine. Being a PA myself, I had always heard of a medical school that offered an accelerated program for PA’s who wished to return to medical school. It always turned out to be an "urban legend" so I came to LECOM as a student in 1996. Being a DO and a PA gave me insight into the differences and similarities of the curricula and to design APAP. On May 22nd, we presented our curriculum request to our accrediting body, AOA COCA who officially approved the new pathway. Once approval is obtained, per our governing body, implementation cannot begin for 120 days which puts us past the incoming class in August, meaning our start date will be with the incoming class of 2011. We are approved for 12 slots, six primary care, meaning those accepted into the program will be required to do primary care residencies and six open. This is the lay press release:

Lake Erie College of Osteopathic Medicine announces the approval of an accelerated three-year medical school curriculum for Certified Physician Assistants to obtain a Doctorate of Osteopathic Medicine degree. On May 22nd, 2010 The American Osteopathic Association Commission on Osteopathic College Accreditation approved the Accelerated Physician Assistant Pathway (APAP). The pathway was designed and will be directed by Mark Kauffman DO, PA, MS Med Ed as a response to predicted physician shortages. Physician Assistants are healthcare professionals who work under the scope of their supervising physicians. They undergo rigorous didactic medical curriculum as well as at least one year of clinical rotations to obtain the entry level masters degree for the profession. Debate suggesting a change in the entry-level to that of a doctorate degree resulted in the PA Clinical Doctorate Summit of March 2009. The Summit conducted the 2009 Physician Assistant Doctoral Summit Survey. The results of which recognized that many physician assistants wish to become physicians citing the desire to practice independently, the need for professional growth and development, the need for increased medical knowledge and the ability to do more for their patients as the most common reasons to do so. Currently only 4% of PAs return to medical school noting cost and time away from clinical practice as major barriers.

In 2008, 37% of PAs choose to work in primary care. Growth in demand for primary care physicians will increase by more than 15 percent over the next decade. Dr. Kauffman and LECOM have identified PAs as excellent candidates for medical school as they have demonstrated the ability to successfully complete demanding curriculum, have practiced clinically, and have expressed the desire to increase their medical knowledge. By accelerating the medical school curriculum to 3 instead of 4 years, LECOM will reduce the cost and time away from clinical practice for PAs within this pathway by one quarter. Students will complete the first year of didactic instruction followed by 8 weeks of primary care clinical clerkships. They would then return to the second year of didactic instruction followed by 48 weeks of clinical clerkship training. Applicants to the program will be required to have obtained a minimum of 22 on the Medical College Admission Test (MCAT). The first students would be enrolled in the fall of 2011.

In response to some of the issues posted to the forum

1) MCAT: Medical education literature notes that the MCAT is predictor for the ability to obtain core knowledge in Basic Sciences and perform well on standardized testing. It fails to recognize other areas that make good physicians like empathy and the desire to serve. Unfortunately, our accrediting body does not allow a school to pick out subsets of applicants. LECOM requires a minimum MCAT of 22, the level below which students without prior medical training struggle with the medical boards. PAs that have gone through LECOM already have scored lower on the MCAT as we do not take traditional pre-medical sciences often picking up physics, organic and inorganic chem just to meet the med school requirements and take the MCAT. However, despite the lower MCAT, their performance on the DO COMLEX Boards is superior as is there graduating class rank. Again, the rule applies that what you require of one applicant must be required of all, so even considering lower MCAT scores for APAP is not possible. I am not aware of any US medical school that does not require MCAT. If anyone knows of a school that doesn’t, please let me know. I would like to see how they do on their Boards. Another poster recommended taking a MCAT prep course. Good idea.

2) Stepping Stone: PA’s are an extremely valuable asset to medicine. However, as noted in the press release, once experiencing medicine, some have strong desires to become physicians. The 2009 Summit Survey noted the following four reasons as the most common: Ability to practice independently, Need for professional growth and development, Need for increased medical knowledge and Ability to do more for patients. The program is in no way designed to take practitioners away from one field into another. For those who question why PAs should support those who choose to leave the profession, the answer is; which physicians will be the best supporters of the PA profession, those who are PAs themselves.

3) Barriers to returning to med school include the financial burden and time away from practice. This program is 138 weeks of training and will cut the total cost of medical school by ¼.

4) Twelve slots: When applying for new programs, approval is less hampered if smaller numbers are sought. Though barred from the debate process during our application, apparently it was lengthy. Anytime a new program is developed, assurance of its success must be made. With demonstration of success, advancements can be made. As noted by many forum posters, it is a start and no longer an urban myth.

5) Pre-requisites: Schools do have the liberty to accept some courses in lieu of others. Many applicants will take all of the standard physics, organic and inorganic chem just for the MCAT but you shouldn’t hold your application if you have not had all of these courses. Each application will be assessed individually and other completed courses will be considered and approved as appropriate.

6) Clinical experience: only completion of your PA curriculum and certification is required meaning you have had at least 1 year of clinical experience. You could go directly from PA school to LECOM.

7) Applications for the program are through AACOMAS. If planning to apply, put it your application early and notate your PA training.

Thank you and I hope this cleared up some of the issues. I am sure there will be many more. I will be working on formal publication of this information as soon as possible.

[GeneticAnomaly]

I still don't see why a PA would not do a residency instead....

[primadonna22274]

I've considered a PA residency several times. Bottom line, I would still be a PA. All of the things that Dr K mentions above--desire for more knowledge, autonomy, to do more for patients than I can do as a PA--would be met by becoming a physician. It boils down to can I spend the rest of my career--easily another 30 years--as a dependent provider? Lots of PAs have made their peace with this. I never have. And I agree with the sentiment, who better to advocate for and promote PAs than a physician who has been a PA?