More bridge programs?

[PA2O18]

Will there will be more PA to MD bridge programs in the future? Is LECOM the only one so far? Are you for having more bridge programs? What’s your ideal bridge program look like?

[EMEDPA]

hope so. Ideal bridge in my mind would be no mcat, 1 year didactic, 1 year clinical then straight into a residency affiliated with the medschool program, so no having to deal with the match. If you graduate from the program you are guaranteed a spot in an affiliated facility. 

[karebear12892]

LECOM is PA to DO. Nevertheless, I predict more of these programs will start popping up soon. I agree with EMEDPA - 1 additional didactic year + 1 additional clinical year = 4 years total when you count PA school. If it were up to me, I'd also say that PA's with a current CAQ who plan to complete residency in that specialty start out as PGY-2's. The CAQ represents at least 18 months of substantial experience - it should count for something. 

Edited July 11, 2018 by karebear12892

[JOhnny888]

So basically you could become a PA, make 80-100k for 2 years, then reapply without taking the MCAT, get accepted, do another 2 years, get a dedicated spot in residency in your desired specialty (no step1 or match), and then skip PGY-1 lol?

You'd also have to scrap every medical school system in the country shortly after...

 

 

[ProSpectre]

31 minutes ago, karebear12892 said:

LECOM is PA to DO. Nevertheless, I predict more of these programs will start popping up soon. I agree with EMEDPA - 1 additional didactic year + 1 additional clinical year = 4 years total when you count PA school. If it were up to me, I'd also say that PA's with a current CAQ who plan to complete residency in that specialty start out as PGY-2's. The CAQ represents at least 18 months of substantial experience - it should count for something. 

I disagree with the part about shortening residency. Shortening medical school makes sense as long as the Step exams are still taken and passed, but I don't think residency should be shortened, with or without a CAQ.  Practicing as a PA for a year and passing a CAQ is not the same as a year of physician residency (and definitely wouldn't work for specialties like orthopedic or CT surgery where PA practice is not equivalent to physician practice).  

The preclinical curriculum would be important for filling in the gaps in basic sciences curriculum that PAs don't cover in PA school (and for preparation for Step 1), but it's also important for matching into residency to be eligible for board certification as a physician. Shortening residency would 1) lead to resentment among physicians and allow for arguments of inferior training, and 2) could potentially be an avenue for denying the ability to become board certified in a given specialty. 

[JOhnny888]

The whole concept of scrapping 2 full years of medical school will brew resentment. That's basically having a back up plan where you make 6 figures if you fail out (quite different than what medical students like myself currently face if we fail out). I'm all for a bridge program, but if it's going to benefit PA's to the extent suggested above then your going to have to scrap the system, combine PA/MD training, and start anew... 

[EMEDPA]

PA school is 100 weeks in 2 years, med school averages 150 weeks in 4 years. Just saying....We definitely need all of MS1 , but only need parts of MS 2 and 1 year of rotations(we basically have done ms3 already). at my medschool based program ms3/pa2 rotations were scheduled interchangeably. 

[karebear12892]

30 minutes ago, ProSpectre said:

Practicing as a PA for a year and passing a CAQ is not the same as a year of physician residency (and definitely wouldn't work for specialties like orthopedic or CT surgery where PA practice is not equivalent to physician practice).  

Good point. I agree that it wouldn't work for surgical subspecialties, but I would think that 18+ months of full time practice + specialty-specific CME + national board examination would be comparable to an intern year in many medical specialties. 

[Anachronist]

1 minute ago, JOhnny888 said:

The whole concept of scrapping 2 full years of medical school will brew resentment. That's basically having a back up plan where you make 6 figures if you fail out (quite different than what medical students like myself currently face if we fail out). I'm all for a bridge program, but if it's going to benefit PA's to the extent suggested above then your going to have to scrap the system, combine PA/MD training, and start anew... 

A few bridge programs is a good thing, but it shouldn't become commonplace.

And I agree, it would as a whole undermine med schools, and in addition you would have to then allow med school grads (or 3rd years) to take the PANCE at their choosing. Would be a logistical nightmare, make PA programs and MD programs both less appealing in their own right.

PA as a stepping stone to MD would require completely redefining both roles for the benefit of a minority of PA-Cs. I can see how both programs could benefit from some of the other's practices (more residencies for PAs, more clinical experience for med school applicants for instance). But the roles and training are not entirely analogous in my mind. 

[ProSpectre]

1 hour ago, JOhnny888 said:

The whole concept of scrapping 2 full years of medical school will brew resentment. That's basically having a back up plan where you make 6 figures if you fail out (quite different than what medical students like myself currently face if we fail out). I'm all for a bridge program, but if it's going to benefit PA's to the extent suggested above then your going to have to scrap the system, combine PA/MD training, and start anew... 

There are currently a dozen traditional medical schools with 3 year programs (most are designed for primary care specialties, but not all of them). So technically, the PA-DO bridge doesn't even shorten medical training any more than what schools already allow students like yourself to currently do. Do you resent people in those programs since they allow students to scrap a full year of medical school? 

Besides, I didn't argue for shortening a bridge to two years;  I have said in the past that I thought a bridge program that lasted 2.5 years straight through could work, which would allow 1.5 years for the preclinical curriculum (some medical schools already do this, by the way) and 1 year of rotations, taking into account that PAs already do 12-15 months of rotations in PA school. This would still be a longer path to becoming a physician than simply going to medical school (27 months average for PA school plus 30 months for medical school = 4.75 years); so aside from planning for failing out and continuing to work as a PA as you mentioned, it wouldn't really benefit anyone to take that path, it would simply allow for those who realized they desired to increase their knowledge and practice independently as a physician the ability to do so by taking their prior training into account. Or keep the bridge at three years, and just implement a few more of them.

Either way, I don't advocate for cutting corners on taking the Step exams or completing a full residency, which are the measures of competency that demonstrate adequate training to practice as a physician, not the length of medical school.   

Edited July 11, 2018 by ProSpectre

[JOhnny888]

1 hour ago, ProSpectre said:

There are currently a dozen traditional medical schools with 3 year programs (most are designed for primary care specialties, but not all of them). So technically, the PA-DO bridge doesn't even shorten medical training any more than what schools already allow students like yourself to currently do. Do you resent people in those programs since they allow students to scrap a full year of medical school? 

Besides, I didn't argue for shortening a bridge to two years;  I have said in the past that I thought a bridge program that lasted 2.5 years straight through could work, which would allow 1.5 years for the preclinical curriculum (some medical schools already do this, by the way) and 1 year of rotations, taking into account that PAs already do 12-15 months of rotations in PA school. This would still be a longer path to becoming a physician than simply going to medical school (27 months average for PA school plus 30 months for medical school = 4.75 years); so aside from planning for failing out and continuing to work as a PA as you mentioned, it wouldn't really benefit anyone to take that path, it would simply allow for those who realized they desired to increase their knowledge and practice independently as a physician the ability to do so by taking their prior training into account. Or keep the bridge at three years, and just implement a few more of them.

Either way, I don't advocate for cutting corners on taking the Step exams or completing a full residency, which are the measures of competency that demonstrate adequate training to practice as a physician, not the length of medical school.   

 

Hey man, I never said I resent anyone, I've got lots of respect for PA's, and I wasn't really directing that response to your post. 

You can't tell me that some of the suggestions made in this entire post wouldn't breed resentment though. A lot of those 3 year programs also dealt with accreditation issues and have required primary care routes (not to mention full residencies still). 

I agree that as long as you can demonstrate competency through the standardized methods then you can practice as a physician. There should also be measures taken to make sure that there are no shortcuts taken that make it unfair for current and future medical students (MCAT, clinical rotation letters and grades, etc.). I can think of a few examples from your post that I quoted where this could become a problem. Which existing schools open up bridge programs? Why do they accept the former PA's instead of a medical applicant? Did they take the MCAT? Were only the grades from the medical rotations accessed on residency applications? Are medical students who have completed 3rd year allowed to take the PANCE if they so choose?

See what I'm saying here ^^^

Edited July 11, 2018 by JOhnny888

[JOhnny888]

1 hour ago, EMEDPA said:

PA school is 100 weeks in 2 years, med school averages 150 weeks in 4 years. Just saying....We definitely need all of MS1 , but only need parts of MS 2 and 1 year of rotations(we basically have done ms3 already). at my medschool based program ms3/pa2 rotations were scheduled interchangeably. 

You probably only need half of M1 imo (that year was rough though as far as studying goes). I'm not saying you haven't done some of the requirements already, but to do what you suggested originally in this post will undoubtedly (and with good merit in my opinion) lead to resentment in many situations. See the questions posed in my response to ProSpectre. 

[Gordon, PA-C]

1 hour ago, karebear12892 said:

Good point. I agree that it wouldn't work for surgical subspecialties, but I would think that 18+ months of full time practice + specialty-specific CME + national board examination would be comparable to an intern year in many medical specialties. 

 

No freaking way.  Intern year is a much, much broader experience than a year or 5 years of "work experience."

Here's a typical schedule for intern year of a PGY-1 in a bread and butter primary care specialty like Pediatrics:

3 months of outpatient peds clinic

3 months of pediatric inpatient wards

2 months of NICU

1 month of PICU

1 month of pediatric cardiology

1 month of pediatric endocrinology

1 month of pediatric nephrology

A PA in pediatrics would only have experience in the peds clinic part of the rotation, and MAYBE some exposure to peds wards.  Everywhere else, the intern would have a much different experience than a 5 year PA who has only worked in the outpatient peds clinic.

Edited July 11, 2018 by Gordon, PA-C

[ProSpectre]

3 minutes ago, JOhnny888 said:

 

Hey man, I never said I resent anyone, I've got lots of respect for PA's, and I wasn't really directing that response to your post. 

You can't tell me that some of the suggestions made in this entire post wouldn't breed resentment though. A lot of those 3 year programs also dealt with accreditation issues and have required primary care routes (not to mention full residencies still). 

I agree that as long as you can demonstrate competency through the standardized methods then you can practice as a physician. There should also be measures taken to make sure that there are no shortcuts taken that make it unfair for current and future medical students (MCAT, clinical rotation letters and grades, etc.). I can think of a few examples from your post that I quoted where this could become a problem. Which existing schools open up bridge programs? Why do they accept the former PA's instead of a medical applicant? Did they take the MCAT? Were only the grades from the medical rotations accessed on residency applications? Are medical students who have completed 3rd year allowed to take the PANCE if they so choose?

 See what I'm saying here ^^^

Overall, I agree with you, and I think we are pretty close on our ideas about this. 

As far as the 3 year medical schools, you're right that most require selection of a primary care specialty, but at least two that I know of allow you to apply to non-primary care specialties (NYU and the University of Wisconsin, if I remember correctly). Besides, I'm not quite sure how other programs would prevent a graduate from later specializing through a fellowship if they chose to (like a family med doc doing a 1-year EM fellowship and working as an EM doc in a Level II-III trauma center, though that would negate the benefit of the shortened program). 

And yes, I agree that some of the ideas you are referencing on this thread are simply untenable. I don't think shortening a bridge program to two years is feasible, or possible -- I've read that there is a stipulation, possibly through AAMC, that medical school education must be at least 134 weeks long to meet international criteria; incidentally, this is exactly how long the University of Wisconsin 3-year program lasts. I also don't think residency should be shortened. But if you convert 134 weeks to years (without taking breaks), it works out to just over 2.5 years.  

You mention that no shortcuts should be taken to make things "unfair" for current or future medical students -- are the current 3 year programs unfair to them? If not, then how is shortening the curriculum slightly for practicing medical professionals who already have pretty extensive training unfair if all standards are otherwise met (especially in the case of keeping any future bridge programs at 3 years)? As to your question about rotations, I would assume that only the medical school rotations would be used for residency applications, just like the 3 year medical school programs currently do (NYU's 3 year program has an early match process for residencies within their system, but still allows students to apply to residencies outside their system if they like, and don't limit students to only primary care). 

Which schools would open bridge programs would likely be dependent on who has experience with current PA education and sees that bright PAs could add further value to the system as physicians; unfortunately, it's not financially prudent for schools to do so since they can currently charge for 4 full years of tuition without any problem filling seats. The current bridge at LECOM does nothing differently than any of the other 3 year medical schools except allow for certain students to not take the MCAT if they meet other criteria (they have to meet GPA requirements and I think PANCE scores may be taken into account too). The MCAT is a barrier to medical school, but so is getting into and completing PA school for those who decide to go to bridge programs (there are schools with BS-MD programs that waive the MCAT requirement for students in those programs; the MCAT is a selection criteria for medical school just like being a certified PA is a selection criteria for a bridge program -- the MCAT itself has no bearing on residency, licensure or board certification).

I doubt much of this will ever come to fruition though, it's just interesting to think about; I think the best that PAs can hope for is the continuation of the current bridge program and maybe 1-2 more eventually opening. 

[JOhnny888]

1 minute ago, ProSpectre said:

Overall, I agree with you, and I think we are pretty close on our ideas about this. 

As far as the 3 year medical schools, you're right that most require selection of a primary care specialty, but at least two that I know of allow you to apply to non-primary care specialties (NYU and the University of Wisconsin, if I remember correctly). Besides, I'm not quite sure how other programs would prevent a graduate from later specializing through a fellowship if they chose to (like a family med doc doing a 1-year EM fellowship and working as an EM doc in a Level II-III trauma center, though that would negate the benefit of the shortened program). 

And yes, I agree that some of the ideas you are referencing on this thread are simply untenable. I don't think shortening a bridge program to two years is feasible, or possible -- I've read that there is a stipulation, possibly through AAMC, that medical school education must be at least 134 weeks long to meet international criteria; incidentally, this is exactly how long the University of Wisconsin 3-year program lasts. I also don't think residency should be shortened. But if you convert 134 weeks to years (without taking breaks), it works out to just over 2.5 years.  

You mention that no shortcuts should be taken to make things "unfair" for current or future medical students -- are the current 3 year programs unfair to them? If not, then how is shortening the curriculum slightly for practicing medical professionals who already have pretty extensive training unfair if all standards are otherwise met (especially in the case of keeping any future bridge programs at 3 years)? As to your question about rotations, I would assume that only the medical school rotations would be used for residency applications, just like the 3 year medical school programs currently do (NYU's 3 year program has an early match process for residencies within their system, but still allows students to apply to residencies outside their system if they like, and don't limit students to only primary care). 

Which schools would open bridge programs would likely be dependent on who has experience with current PA education and sees that bright PAs could add further value to the system as physicians; unfortunately, it's not financially prudent for schools to do so since they can currently charge for 4 full years of tuition without any problem filling seats. The current bridge at LECOM does nothing differently than any of the other 3 year medical schools except allow for certain students to not take the MCAT if they meet other criteria (they have to meet GPA requirements and I think PANCE scores may be taken into account too). The MCAT is a barrier to medical school, but so is getting into and completing PA school for those who decide to go to bridge programs (there are schools with BS-MD programs that waive the MCAT requirement for students in those programs; the MCAT is a selection criteria for medical school just like being a certified PA is a selection criteria for a bridge program -- the MCAT itself has no bearing on residency, licensure or board certification).

I doubt much of this will ever come to fruition though, it's just interesting to think about; I think the best that PAs can hope for is the continuation of the current bridge program and maybe 1-2 more eventually opening. 

 

Because many FM docs that specialize in EM won't be allowed to work in level II areas that are high demand living areas and may also get paid less. Pretty sure for NYU you would have to switch out of the 3 year track that matches only to an NYU residency and complete the 4 year program,proceed through the match to the competitive specialty (aka get more letters, pubs, etc). I'm not 100% sure on which specialties this applies to though, so maybe EM would work. 

In regards to the fair aspect, I'm not saying that you can't change things at all, but some of the suggestions in this entire thread go way beyond. Ultimately, it would just lead to a complete overhaul in favor of that new, easier system (Think No PGY-1). 

NYU is a bad example though, because if you switch to a competitive specialty you will likely need some of that fourth year (think derm and the fact that 50% of matches took a whole year off for research). 

Yeah your MCAT point is valid. My thoughts were that if this scaled to a high level, then we would be talking differently about the MCAT screening being a valid complaint. 

[wookie]

On 7/10/2018 at 9:11 PM, JOhnny888 said:

So basically you could become a PA, make 80-100k for 2 years, then reapply without taking the MCAT, get accepted, do another 2 years, get a dedicated spot in residency in your desired specialty (no step1 or match), and then skip PGY-1 lol?

You'd also have to scrap every medical school system in the country shortly after...

 

 

I agree.. This is all wishful thinking. Shortening medical school by half-maybe, but I wouldn't want to lose out on a whole year of structured learning as a resident. 

[lkth487]

On 7/10/2018 at 9:58 PM, karebear12892 said:

Good point. I agree that it wouldn't work for surgical subspecialties, but I would think that 18+ months of full time practice + specialty-specific CME + national board examination would be comparable to an intern year in many medical specialties. 

Will never happen under any circumstance.  The board specialties will never approve it.  EVER.  In the past 5-10 years, they've actually gotten rid of a lot of practice pathways and combined programs.  They want a standard, structured pathway to board certification.  You are much more likely to get lessening of medical school requirements rather than residency requirements.

[lkth487]

The real question people should ask is what is the incentive for medical schools to offer something like this and go through the hassle of administering it, approving it and running it all the while missing out on extra years of tuition?  If schools were hurting for qualified med students, it's one thing....but the number of applications to spots is quite high and med schools have a very rigorous criteria to be accredited so spots are always going to be limited (unlike some other fields where it is easy to open up a school).

 

i am not saying it won’t happen.  But there are forces working against it and for it to happen at any large scale, there has to be a compelling reason for schools to do this. 

Edited July 22, 2018 by lkth487

[lkth487]

ANOther thing that I am starting to hear which might impede these programs is some PA programs seem to not be as standardized as I had initially thought.  There is a reddit thread about PA students and some are complaining that they are finishing their schooling with barely any inpatient experience and not knowing anything about IV meds and things.  That’s a little worrisome. 

At my institutions where I’ve taken trained, most PA-2 and MS3 rotations were essentially interchangeable. I thought this was universal, but maybe it is not?

[LT_Oneal_PAC]

25 minutes ago, lkth487 said:

ANOther thing that I am starting to hear which might impede these programs is some PA programs seem to not be as standardized as I had initially thought.  There is a reddit thread about PA students and some are complaining that they are finishing their schooling with barely any inpatient experience and not knowing anything about IV meds and things.  That’s a little worrisome. 

At my institutions where I’ve taken trained, most PA-2 and MS3 rotations were essentially interchangeable. I thought this was universal, but maybe it is not?

I agree that this is a weakness of PA programs not giving a proper IM or FM inpatient rotation. I had one, but I set up that rotation.

 I think weak rotations can be a problem of med schools as well. I know a certain med school that does a OB GYN rotation where they pretty much don’t do anything and spend 90% of their time sitting at a desk reading. 

However, if a PA student doesn’t have knowledge of IV meds that’s partially on them since many are required knowledge for PANCE.

This is why Residency is so important. It is the great equalizer.

[lkth487]

That’s horrendous.  You (or one of the students) should email the LCME - that school would get into big trouble. 

Edited July 23, 2018 by lkth487

[LT_Oneal_PAC]

3 minutes ago, lkth487 said:

That’s horrendous.  You (or one of the students) should email the LCME - that school would get into big trouble. 

I had encouraged the students to bring it up. Not sure what came of it.

as far all this bridge talk, I agree that residency should remain unchanged. I think medical school should remain relatively unchanged, but eliminate any undergrad or MCAT requirements. Rather focus on grad GPA and PANCE scores

[PAtoMD]

9 hours ago, lkth487 said:

ANOther thing that I am starting to hear which might impede these programs is some PA programs seem to not be as standardized as I had initially thought.  There is a reddit thread about PA students and some are complaining that they are finishing their schooling with barely any inpatient experience and not knowing anything about IV meds and things.  That’s a little worrisome. 

At my institutions where I’ve taken trained, most PA-2 and MS3 rotations were essentially interchangeable. I thought this was universal, but maybe it is not?

Just came across that thread on reddit. Can confirm. I'll have no inpatient experience when I graduate. 

[lkth487]

That's insane.  How can they get away with that?  Maybe PA programs should also be accredited by the LCME, with similar requirements to MD schools for their PA-2 years...?

Edited July 23, 2018 by lkth487

[MT2PA]

10 hours ago, lkth487 said:

ANOther thing that I am starting to hear which might impede these programs is some PA programs seem to not be as standardized as I had initially thought.  There is a reddit thread about PA students and some are complaining that they are finishing their schooling with barely any inpatient experience and not knowing anything about IV meds and things.  That’s a little worrisome. 

At my institutions where I’ve taken trained, most PA-2 and MS3 rotations were essentially interchangeable. I thought this was universal, but maybe it is not?

It would be impossible for this to be universal.  Not all PA programs have an MD program nearby (let alone under the same school).

While my program was affiliated with a med school, the MD students got priority for a lot of rotations.  They were also bound by different...laws? (I can't remember exactly what agency this stipulation fell under) so they had FEWER options for where to rotate.  I.e they HAD to rotate at hospitals affiliated with the school.  The PA kids did not (this was a huge advantage for us actually).  

I know PA schools where students essentially do all primary care rotations - no OB/gyn or psych specific.  Apparently that still meets ARC standards somehow...but definitely leaves something to be desired for countless reasons.

Edited July 23, 2018 by MT2PA