"A New Type of Physician" --DMS???

[lkth487]

Interesting.  The couple people I know who do PM&R have a nice call free life. One does mostly pain. I guess it just underscores the variety.    The pain practice my friend works at just has a message saying to go to the ED for emergencies or call back during business hours.

That's why it's a little naive to assume that by being a PA or MD, you'll by its very nature take more or less call.   It's medicine.  Some shit is 24/7.  Someone's gotta do the work at 3AM on Christmas morning.  Sometimes it's going to be you.  

[lkth487]

I've seen said this before but I'm in favor of PAs with a few years experience being able to take STEP exams and applying to residencies with their PA experience counting in lieu of med school years, especially if that experience was in FM/EM or something like that.   And at the end they would be a fully licensed BE/BC physician.  

I WOULDN'T shorten the residency/fellowship requirements.  Im about to finish a pediatrics residency and it is so important to not only have formal teaching but also rotations in the pediatric icu, neonatal icu, heme onc, cardiology, genetics , GI etc etc. if I decided to do just outpatient pediatrics, those rotations are what would make me a complete outpatient physician.  And just as importantly, it's a nationalized and formalized set of requirements that says I MUST do certain amounts of icu, general floors, outpatient, electives, didactics, etc which sets a minimum standard which is vital to make sure that you don't just randomly do whatever and have large holes in your training and knowledge base. 

[ApolloPA]

2 hours ago, lkth487 said:

I've seen said this before but I'm in favor of PAs with a few years experience being able to take STEP exams and applying to residencies with their PA experience counting in lieu of med school years, especially if that experience was in FM/EM or something like that.   And at the end they would be a fully licensed BE/BC physician.  

I WOULDN'T shorten the residency/fellowship requirements.  Im about to finish a pediatrics residency and it is so important to not only have formal teaching but also rotations in the pediatric icu, neonatal icu, heme onc, cardiology, genetics , GI etc etc. if I decided to do just outpatient pediatrics, those rotations are what would make me a complete outpatient physician.  And just as importantly, it's a nationalized and formalized set of requirements that says I MUST do certain amounts of icu, general floors, outpatient, electives, didactics, etc which sets a minimum standard which is vital to make sure that you don't just randomly do whatever and have large holes in your training and knowledge base. 

 Just curious.  Would you be in favor of NPs taking Step exams? 

[lkth487]

I'll defer a little bit because I am not as familiar with NP education as PA education because I've never been at an institution with NP program. Whereas I know pretty well what PAs have to go trough because of friends who did it as well as the fact that I have had PA students rotate on my service every month for the past three years as my institution has a strong PA school.  But I wouldn't, in theory, be opposed if the NPs maybe took a year or two of classes to fill in the gaps, if they exist, and then took the steps. For me, if you can do well, on step 1 especially, you've achieved a certain level of basic science knowledge that's enough of a springboard for you to be able to handle and learn what you need to in the rest of your training.  I don't think we need to hold up medical school as this untouchable sanctuary that's unattainable for anyone else. For me; assuming you can do well on the steps; the residency and fellowship training is definitely more important. 

[CorpsmanUP]

On 2/16/2018 at 10:19 PM, lkth487 said:

I'll defer a little bit because I am not as familiar with NP education as PA education because I've never been at an institution with NP program. Whereas I know pretty well what PAs have to go trough because of friends who did it as well as the fact that I have had PA students rotate on my service every month for the past three years as my institution has a strong PA school.  But I wouldn't, in theory, be opposed if the NPs maybe took a year or two of classes to fill in the gaps, if they exist, and then took the steps. For me, if you can do well, on step 1 especially, you've achieved a certain level of basic science knowledge that's enough of a springboard for you to be able to handle and learn what you need to in the rest of your training.  I don't think we need to hold up medical school as this untouchable sanctuary that's unattainable for anyone else. For me; assuming you can do well on the steps; the residency and fellowship training is definitely more important. 

I very much agree with the residency/fellowship part. Having been embedded in a peds residency, doing the peds surgery, peds cardiology, MFM, newborn nursery, and several additional NICU rotations; the growth as a clinician comes from that structured clinical learning environment, not from more butt in seat academic time.

The common denominator and differentiator in the US is residency training, not where you got your medical education. Have the MD granted to PAs upon completion of residency, and you sidestep the whole World Health Organization, 33 month minimum education requirement.

[lkth487]

Yeah even as someone going into neonatology, the rotations that help me in nicu are things you wouldn't normally think about:  endocrine, genetics, outpatient clinics, PICU, general hospitalist etc.  nicu is a very self contains specialty that is its own world so people do things their way, but it's nice to have that broader perspective of how things can be done other ways, and more importantly, when things go wrong or are unexpected, you can say, "well we saw this endocrine patient with this type of metabolic derangement, or this rheum patient etc etc".  I completely agree with you - a LOT of structured learning that will make me a complete neonatologist will have come from outside of the nicu, and happened even before fellowship. 

[camoman1234]

2 hours ago, CorpsmanUP said:

I very much agree with the residency/fellowship part. Having been embedded in a peds residency, doing the peds surgery, peds cardiology, MFM, newborn nursery, and several additional NICU rotations; the growth as a clinician comes from that structured clinical learning environment, not from more butt in seat academic time.

The common denominator and differentiator in the US is residency training, not where you got your medical education. Have the MD granted to PAs upon completion of residency, and you sidestep the whole World Health Organization, 33 month minimum education requirement.

World Health Organization, 33 month minimum education requirement. What is this 33 month requirement for? Is that the minimum to become a MD/DO? If so then most PA schools are 24-27 months...just curious. 

[TrekkieByDay]

The idea of a residency for PA's to transition to MD's sounds amazing, but isn't there already a huge problem w/ graduating med students getting a residency? 

[PACrankset]

The 33 month thing doesn't make a ton of sense to me. PA programs for the most part are 24-27 months, however there are multiple 30 month programs and a couple 36 month programs out there now. I will be attending one of the 36 month programs, we do have additional time in both rotations and also in the didactic setting. Do we think the new norm with PA programs will be to go with a slightly longer curriculum to narrow the gap between the PA and MD education?

To clarify I am not going to PA school to be a Physician, nor am I expecting it to be a quicker path to the same goal.

[lkth487]

2 hours ago, TrekkieByDay said:

The idea of a residency for PA's to transition to MD's sounds amazing, but isn't there already a huge problem w/ graduating med students getting a residency? 

No.

There are 21,000 US graduates  (MD and DO) who applied through the NRMP for a residency last year. There were 31,757 first year residency positions last year.  The people who are feeling the squeeze are the IMGs and FMGs.   No one is guaranteed that Neurosurg, integrated plastics or that derm spots, but there are plenty of specialties that are not competitive. 

The scores for specialties where applicants matched with step scores of low 220s (at the 25th percentile) and below are: Anesthesiology, Child Neurology, EM, FM, IM, Neurology, OB/Gyn, Pathology, Pediatrics, PM&R, and psychiatry.  So plenty of choices even if you're not a stellar med student.  There's a nice combination of lifestyle, patient populations, procedures, income, etc etc within the 'not particularly competitive' group so most people can find something they like.  For the record, the average Step 1 score for a US MD graduate is around 233-234 or so.  So these are well within the attainable range for most students.  If we ignore something like internal medicine or peds where you can subspecialize which changes your practice styles significantly (where it can range from below average pay and no procedures to well above average in pay and lots of procedures: i.e infectious disease vs. gastroenterology) and take two relatively well paid specialties (Anesthesiology and EM). A student scoring between 211-220 on the USMLE (a full standard deviation below the average) - you still had 134/138 people who matched for anesthesiology, and 180/200 who matched for EM.  So a medical student who is below average (in terms of step scores) still has an excellent shot at these specialties.

 

Sources:  

http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf

https://www.aamc.org/download/321532/data/factstableb2-2.pdf

[TrekkieByDay]

41 minutes ago, lkth487 said:

No.

 

Thank you. 
Have you seen this, though? It's only one year newer than your stats, and implies roughly 4,000 med students who applied didn't get a match: http://www.nrmp.org/press-release-2017-nrmp-main-residency-match-the-largest-match-on-record/ 

Edit: never mind, I see what you meant! Less competitive fields obviously have plenty of room. :D 

[TrekkieByDay]

42 minutes ago, lkth487 said:

. 

The scores for specialties where applicants matched with step scores of low 220s (at the 25th percentile) and below are: Anesthesiology, Child Neurology, EM, FM, IM, Neurology, OB/Gyn, Pathology, Pediatrics, PM&R, and psychiatry.  So plenty of choices even if you're not a stellar med student.  .

 

 

And I see both of my desired fields in there! (Emergency Medicine & Psychiatry)
I just finished a test, and I'm sleepy & getting over a bug, so my mental acuity isn't so sharp. :D Goodnight all. 

[lkth487]

Remember that number 35000 applicants for 31000 spots includes birth US graduates AND IMG/FMGs so it's misleading.  If the number of US grads increase more than residency spots, it'll be the foreign grads who will be squeezed out.

 You just have to look at the US grads. 

[PA778]

Hey guys, my first post didn't go over so well, so I debated posting this, but here it is. I emailed the sponsoring Senator and he told me the bill had been replaced..... With this - this is a link to the bill http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB1926

After reading it, it seems like they are making a license for no reason, maybe. A PA is already able to do everything they are licensing this "new healthcare practitioner" to do. Maybe someone here will correct my understanding. I welcome your opinions on this.

[Joelseff]

Hey guys, my first post didn't go over so well, so I debated posting this, but here it is. I emailed the sponsoring Senator and he told me the bill had been replaced..... With this - this is a link to the bill http://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB1926
After reading it, it seems like they are making a license for no reason, maybe. A PA is already able to do everything they are licensing this "new healthcare practitioner" to do. Maybe someone here will correct my understanding. I welcome your opinions on this.

They were trying toake new doctorate level practitioner from PAs who want to go through the LMU DMS program. I for one am for any further education/credentialing for PAs who want it. The new profession would allow the DMS to practice near or at the level of a MD/DO. Only thing is the curriculum may not be up yo snuff. I think their first class graduates this summer.

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[PA778]

11 minutes ago, Joelseff said:

They were trying toake new doctorate level practitioner from PAs who want to go through the LMU DMS program. I for one am for any further education/credentialing for PAs who want it. The new profession would allow the DMS to practice near or at the level of a MD/DO. Only thing is the curriculum may not be up yo snuff. I think their first class graduates this summer.

Sent from my SAMSUNG-SM-G891A using Tapatalk
 

That may have been in the original bill, but the new bill that I gave the link for seems not to do much of anything. It certainly doesn't put DMS near DO/MD. Correct me if I'm wrong. http://www.capitol.tn.gov/Bills/110/Bill/SB1926.pdf

[Joelseff]

That may have been in the original bill, but the new bill that I gave the link for seems not to do much of anything. It certainly doesn't put DMS near DO/MD. Correct me if I'm wrong. http://www.capitol.tn.gov/Bills/110/Bill/SB1926.pdf

You're right I think... They changed the language and now it says that a DMS will still practice in collaboration with a physician so it's pretty much OTP with degree creep now... No thanks.

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[Hckyplyr]

We're getting closer, but we'll never be able to top the amount of confusing acronyms NPs put after their name. 

Sincerely, 

     Hckyplyr DMS, PA-C, MS, BS, BA, ACLS, BLS, RSVP, ASAP, WTF

[LT_Oneal_PAC]

1 hour ago, Joelseff said:

You're right I think... They changed the language and now it says that a DMS will still practice in collaboration with a physician so it's pretty much OTP with degree creep now... No thanks.

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3 years of practice, 2 more years or school, and 50k for what we should already have? I’ll pass.

I see some angry students with buyer’s remorse real soon.

[PACali]

The Lynchburg's program is better in my opinion. They take credits from PA residency and it is cheaper and shorter to complete. It is basically like DHsc but with a clinical component. I think doctorate degree is inevitable but I don't agree with the LMU program. The LMU program is basically trying to create a new profession and the law is not there yet. I don't see the point. We should be focusing on OTP and a new professional title. 

[DizzyJ]

7 hours ago, PACali said:

The Lynchburg's program is better in my opinion. They take credits from PA residency and it is cheaper and shorter to complete. It is basically like DHsc but with a clinical component. I think doctorate degree is inevitable but I don't agree with the LMU program. The LMU program is basically trying to create a new profession and the law is not there yet. I don't see the point. We should be focusing on OTP and a new professional title. 

Exactly!  I don't agree with trying to create a new provider by requiring a specific degree and making the PA profression the stepping stone to this new provider.  We should focus on OTP and gaining independence in certain specialities with several possible routes.  Routes could be length in practice and having a physician sign off, completing an approved residency program, or (maybe) obtaining some fancy doctorate degree.  The degree association should not be the only route.  

[ProSpectre]

11 hours ago, PACali said:

The Lynchburg's program is better in my opinion. They take credits from PA residency and it is cheaper and shorter to complete. It is basically like DHsc but with a clinical component. I think doctorate degree is inevitable but I don't agree with the LMU program. The LMU program is basically trying to create a new profession and the law is not there yet. I don't see the point. We should be focusing on OTP and a new professional title. 

I may be looking at this the wrong way, but why do you think the Lynchburg's program is better? Shorter and cheaper sound nice, but not at the expense of failing to add anything new to your clinical skills toolbox, especially when we're talking about doctorate level education. With the exception of the 3 fellowship courses and maybe the disaster medicine course, most of the classes seem weak on actual medical science (especially for a degree with the title "Doctor of Medical Science"), and heavy on policy and administration coursework. 

The LMU DMS curriculum is longer, but has more training in the advancement of clinical skills, which I believe is what a doctorate for PAs should be tailored toward. This isn't to say the training PAs already have is deficient, but doctorate level training should bring more to the table. The LMU curriculum revisits advanced anatomy and physiology, and has blocks on point of care ultrasound, advanced immunology, neurology, cardiology, hematology, infectious disease, etc. It seems much more rigorous and more grounded in the medical sciences, and in my opinion, a more respectable option for a clinical doctorate (key word "clinical"). Isn't all of the extra "fluff" one of the issues with many DNP degrees? 

This may come down to what you intend to get out of a doctorate, but in my humble opinion, the LMU seems to be the more favorable model for advancing PA education if the profession goes the route of the doctorate. I still favor residency over a doctorate for post-graduate PA education, however. 

[PACali]

3 hours ago, ProSpectre said:

I may be looking at this the wrong way, but why do you think the Lynchburg's program is better? Shorter and cheaper sound nice, but not at the expense of failing to add anything new to your clinical skills toolbox, especially when we're talking about doctorate level education. With the exception of the 3 fellowship courses and maybe the disaster medicine course, most of the classes seem weak on actual medical science (especially for a degree with the title "Doctor of Medical Science"), and heavy on policy and administration coursework. 

The LMU DMS curriculum is longer, but has more training in the advancement of clinical skills, which I believe is what a doctorate for PAs should be tailored toward. This isn't to say the training PAs already have is deficient, but advanced training should bring more to the table. The LMU curriculum revisits advanced anatomy and physiology, and has blocks on point of care ultrasound, advanced immunology, neurology, cardiology, hematology, infectious disease, etc. It seems much more robust and more grounded in the medical sciences, and in my opinion, a more respectable option for a clinical doctorate (key word "clinical"). Isn't all of the extra "fluff" one of the issues with many DNP degrees? 

This may come down to what you intend to get out of a doctorate, but in my humble opinion, the LMU seems to be the more favorable model for advancing PA education if the profession goes the route of the doctorate. I still favor residency over a doctorate for post-graduate PA education, however. 

The DMS degree at Lynchburg has an agreement with Arrowhead orthopedic PA residency. Basically, 18 months of residency training will get you a DMS degree from Lynchburg. No additional tuition necessary but of course you are working at a resident salary.  

https://www.orthosurgerypafellowship.com/ospaf-new 

Same thing with the Arrowhead emergency medicine PA fellowship. 18 months of residency training and you get a DMS degree from Lynchburg at the end. I think just a matter of time, Lynchburg will work with PA residencies across the country.  

I think this is a better model, just like the military PA DsC degree.  This is definitely better than the DNP model. 

 

 

[KMD16]

The Lynchburg's program is better in my opinion. They take credits from PA residency and it is cheaper and shorter to complete. It is basically like DHsc but with a clinical component. I think doctorate degree is inevitable but I don't agree with the LMU program. The LMU program is basically trying to create a new profession and the law is not there yet. I don't see the point. We should be focusing on OTP and a new professional title. 

Will enroll this summer instead of doing the DHSc program.

[ventana]

University of Nebraska needs to come out with this at a far reduced tuition....