aprillh Posted May 7, 2012 http://www.ama-assn.org/amednews/2012/05/07/prl20507.htm In response to concerns about nationwide shortages of primary care physicians and rising student debts, several U.S. medical schools are experimenting with programs that allow students to obtain a degree in three years instead of four. Ron Cook, DO Richard Ortoski, DO These programs, which are geared for primary care, would be significantly less costly for students, who in practice can expect to earn less than other specialities. The medical schools condense their courses of study by eliminating breaks and electives and allowing students to begin clerkship training in their second year, a year earlier than the traditional four-year curriculum. How a school condenses 4 years of medical school into 3 Links See related content Many students in traditional programs spend their fourth year primarily doing specialty rotations and interviewing for residency positions. Students who know they want to go into family medicine from the start don’t necessarily need that fourth year, said Robert Pallay, MD, professor and chair of the Dept. of Family Medicine at Mercer University School of Medicine’s campus in Savannah, Ga. “There are many of us in medical education who wonder about the need for the fourth year of medical school,” he said. “The issue here is, ‘What does society need?’ What our society needs right now is a significant increase in the number of family physicians.” In the last five years, at least four schools have initiated or are developing three-year programs: Mercer will begin its three-year track at its Savannah campus in June. Lake Erie College of Osteopathic Medicine in Erie, Pa., started its program in 2007 and launched a second three-year track in July 2011 for certified physician assistants who want to become doctors. Texas Tech University Health Sciences Center School of Medicine in Lubbock began its three-year program with nine students in 2011. Louisiana State University School of Medicine is developing a three-year program at its campus in Lafayette. The first class is projected to start in 2014 or 2015, said Sam McClugage, PhD, the medical school’s associate dean for admissions. “The focus of the program would be to train primary care physicians in an accelerated curriculum designed to encourage more physicians to go into primary care and then hopefully into more underserved areas, such as rural communities, to practice medicine,” McClugage said. Finishing medical school in 3 years instead of 4 could mean $50,000 less in student loan debt. Now a consortium of six schools, including Texas Tech, Mercer and LSU, has applied for $23 million in federal grants from the Center for Medicare and Medicaid Innovation to expand the three-year model to more campuses. Other schools in the consortium are Indiana University School of Medicine, East Tennessee State University Quillen College of Medicine and the University of Kentucky College of Medicine, said Ronald Cook, DO, chair of Texas Tech’s Family and Community Medicine Dept. The innovation center is expected to announce grant recipients soon. Although the schools may follow some similar approaches, each will implement its program differently, Dr. Cook said. “You can’t just have a blanket curriculum,” he said. “Every school’s curriculum is a bit different.” Not a new model The traditional four-year design has been in place at least since educator Abraham Flexner published his influential report on medical education in 1910. It called for students to have two years of basic sciences and two years of clinical training. Though most medical schools have followed that model, three-year programs are not new. Some schools, including the Medical College of Virginia, offered three-year programs during World War II. In the 1980s and 1990s, about a dozen schools offered accelerated programs that allowed students to begin residency training while finishing their fourth year of medical school. In Canada, the University of Calgary Faculty of Medicine and McMaster University Michael G. DeGroote School of Medicine have had a three-year curriculum for all students for years, said Dan Hunt, MD, co-secretary of the Liaison Committee on Medical Education, which accredits allopathic schools in the U.S. and Canada. Some argue that U.S. students should be trained in less than four years. A March 21 article in The Journal of the American Medical Association called for medical education nationwide to be shortened 30% by 2020. “In an era when unnecessary medical services are being intensely examined to reduce costs, similar critical attention should be applied to eliminating waste from medical training,” wrote the article’s authors, Ezekiel J. Emanuel, MD, PhD, and Victor R. Fuchs, PhD. An answer to physician shortages? Nationwide physician shortages are projected to reach 91,500 physicians by 2020, including 45,000 primary care doctors, according to the Assn. of American Medical Colleges. “The major impetus was the recognition that one of the major issues in the health care system is the shortage of primary care physicians and the imbalance between primary care physicians and specialists,” said Steven Berk, MD, dean of Texas Tech’s medical school. “We believe that medical schools need to take part of the responsibility for that imbalance.” The Texas Tech program condenses its medical school curriculum into three years and eliminates eight contact weeks of study. Four-year students get 160 contact weeks, and three-year students get 152. The LCME requires allopathic medical schools to include a minimum of 130 contact weeks. Texas Tech student Clay Buchanan decided to go to medical school after a career as a lawyer and was trying to decide between family medicine and pediatrics. The chance to be part of the first class of the Family Medicine Accelerated Track helped him make the choice. As a father of three children, he saw that taking part in the program means a lighter student debt load and the ability to begin working again sooner to support his family. He said faculty members ask for feedback from students regularly. “They’re very supportive and very interested in what we have to say,” Buchanan said. “They say we’re the guinea pigs.” In addition to not having a fourth year of medical school, students in Texas Tech’s F-MAT program are given a scholarship in their first year. At Pennsylvania’s LECOM, it’s projected that students will save more than $50,000, including tuition and living expenses, said Richard Ortoski, DO, chair of the Dept. of Primary Care Education at the osteopathic medical school. There has been a lot of interest, with more than 30 students applying each year. “It takes a more mature person to go through this pathway, and go through rotations earlier and more quickly,” Dr. Ortoski said. The new Accelerated Physician Assistant Pathway is approved for up to 12 students, including six positions designated for students who commit to primary care, said Mark Kauffman, DO, PA, LECOM assistant dean of graduate studies. Students work as PAs an average of six years before entering the program. “They’re not going to be disillusioned by what medicine is really like to practice. They know what they’re getting into, and they want it,” Dr. Kauffman said. But accelerated degree programs aren’t for everyone. Perry Pugno, MD, MPH, vice president of medical education for the American Academy of Family Physicians, said many medical students aren’t prepared to start clerkships in their second year. “I’m concerned about pushing students into clinical training before they become sufficiently mature from life lessons to lend context and perspective to those experiences,” he said. The LCME also is concerned about what happens to students who decide midway through a program that primary care isn’t for them. Students have to be given the chance to opt out if they decide to pursue a different career path, Dr. Hunt said. For example, students in Mercer’s three-year program who decide midway through that family medicine is no longer for them would be integrated into the traditional four-year degree track, Dr. Pallay said. “We’re not proponents of three-year medical school for everybody,” Texas Tech’s Dr. Berk said. “There are a lot of medical students definitely who need that fourth year to decide what they’re going to do. If everyone were to do this, it would defeat the purpose of why we’re doing this, and that is to make primary care more attractive.” Back to top ADDITIONAL INFORMATION: How a school condenses 4 years of medical school into 3 The Family Medicine Accelerated Track at Texas Tech University Health Sciences Center School of Medicine enables students to complete a medical degree in three years. F-MAT students have 152 contact weeks of instruction as opposed to 160 in the traditional four-year curriculum. First year Clinically oriented anatomy (11 weeks) Biology of cells and tissues (9 weeks) Major organ systems (13 weeks) Host defense (9 weeks) Early clinical experience (10 months) F-MAT1 (8 weeks; new) Second year F-MAT1 (8 weeks; new) Integrated neurosciences (12 weeks) Multisystem disorders (8 weeks) System disorders I (9 weeks) System disorders II (8 weeks)USMLE Step 1 study and examEarly clinical experience 2 (9 months) Family medicine clerkship/F-MAT2 and geriatrics rotation (new) Third year Two-month clerkships in pediatrics, internal medicine, obstetrics-gynecology, surgery and psychiatry F-MAT3 (new) Integration seminar (new) Expanded F-MAT courses F-MAT1 course: This eight-week concentrated course is taken during the summer between the first and second year and is designed to prepare students for the longitudinal family medicine clerkship. Course content includes an overview of second-year basic science course materials and case-based study of cardiovascular, respiratory, endocrine, musculoskeletal, women’s health/urology, gastroenterology and neuropsychiatry subjects. Students also study clinical and pathophysiology correlations material, focusing on skills for patient assessment. F-MAT2 course: Students participate in a longitudinal family medicine clerkship course their second year. The course includes geriatrics with three weeks of palliative care and inpatient hospital training. F-MAT3 course: This eight-week course is taken during the third year and fulfills the learning objectives for two courses normally required in the fourth year — the subinternship and critical care selectives. Students have four weeks in the intensive care and critical care units, three weeks of family medicine inpatient service and one week of residency program orientation. Source: F-MAT Family Medicine Accelerated Track, Texas Tech University Health Sciences Center School of Medicine (ttuhsc.edu/som/fammed/fmat/) Back to top Weblink “Shortening Medical Training by 30%,” The Journal of the American Medical Association, March 21 (jama.ama-assn.org/content/307/11/1143.extract)
jsfelder0417 Posted May 8, 2012 Novel ideas. We'll see how they work out. Maybe we will also see more PA to MD/DO bridge programs rolling out as well, assuming the PAs at LECOM's APAP experiment do well.
heartsurgerypa Posted May 8, 2012 I hope eventually something like this comes along for surgical specialties too. There is a grave shortage of cardiac surgeons which is only going to get worst. I understand surgical skills take many years to master, however, perhaps eliminating elective rotations and breaks in medical school will expedite the time it takes to begin hands on surgical training.
primadonna22274 Posted May 8, 2012 We are all doing well--haven't lost any of the 7 PAs we started with, although have had a handful of non-PA classmates decelerate. The skinny is that our GPA's are a smidge higher than the class avg and our anatomy shelf exams were about 10%ile higher than class avg. Will be interesting to see how our NBME exams shake out this time next year ;) That said, 2 finals tomorrow, must get back to it. ;)
surgblumm Posted May 9, 2012 Initially this was the deam of Dr. Eugene stead. Yes, he wanted physician associates but years later was excited with the skills and knowledge thata we had and in the late 90's advocated for a bridge program. He knew that we can do it , and I do also. the big question relates why we choose this profesion. It was to care for the sick to be professionals but also because we wanted to raise our families and be at home with them as they grew up. that is the price that most physicians pay for their name. they pay a price to gain a prize. the question is how great is that prize? bob Blumm
jsfelder0417 Posted May 9, 2012 Way to represent PAs Lisa, and I wish you and your classmates continued success.
primadonna22274 Posted May 9, 2012 Bob, you are so right. My eyes are wide open to the sacrifices. I never found the time to have kids as a PA and will be 40 when I graduate. Young at heart, a bit aging in the ovaries though ;) I may be giving up parenthood entirely to become a physician, but I knew that going in. Are the two roles mutually exclusive? No, but I am not one of those superwomen who can do it all.
physasst Posted May 9, 2012 So glad to hear Lisa. You and I, as I noted last time we saw each other at the NCCPA in Georgia took different paths, glad to hear that it is going well. Mike
Ridiculopathy Posted May 9, 2012 what if u dont want to do fm and want to do general IM (which is the same if there is no rounding and no kids), can u still go into these programs?
primadonna22274 Posted May 9, 2012 Half of the slots are primary care, half undeclared. I am undeclared although there is a fair chance I will go IM...but am lately really drawn to neuro, esp geriatric/behavioral neuro...academic medicine track. The other undeclared guys are looking at interventional rads, vascular surgery and CC/pulm with sleep fellowship.
coloradopa Posted May 9, 2012 Half of the slots are primary care, half undeclared. I am undeclared although there is a fair chance I will go IM...but am lately really drawn to neuro, esp geriatric/behavioral neuro...academic medicine track.The other undeclared guys are looking at interventional rads, vascular surgery and CC/pulm with sleep fellowship. I'm curious how this is going to work. I'm presuming you take Comlex in June of your second year (and USMLE step I if you want to go allo). Then you have June through August to do your rotations and then put in your applications in September. So while a traditional student will have a year and change to get LORs etc you will only have three months. Now for FM (especially Osteo) this shouldn't be a problem. Getting a categorical IM at a decent program (decent enough to get pulm/CCM fellowship) is going to be a huge problem. Getting into a decent surgery categorical or IR is going to be even more challenging. Unless I have the math wrong?
Moderator EMEDPA Posted May 9, 2012 Moderator I think these folks are "encouraged" to only apply to DO residencies if I read the lecom site correctly. Application Requirements Applicants to the program must: Be Certified Physician Assistants. Have obtained a minimum of 23 on the Medical College Admission Test (MCAT). Have a minimal GPA of 2.7. Complete an osteopathic residency
coloradopa Posted May 9, 2012 I think these folks are "encouraged" to only apply to DO residencies if I read the lecom site correctly. Application Requirements Applicants to the program must: Be Certified Physician Assistants. Have obtained a minimum of 23 on the Medical College Admission Test (MCAT). Have a minimal GPA of 2.7. Complete an osteopathic residency Thats one of the issues. ACGME has a proposal out that after 2014 to enter an ACGME fellowship you have to have completed an ACGME residency. So if you did an osteopathic residency you won't be able to participate in fellowships. There are (as far as I can tell) no Osteopathic Vascular or IR programs and eight Pulm/CC programs (although some appear to be dormant). So you are looking at pretty long odds to do anything but primary care.
primadonna22274 Posted May 9, 2012 The osteopathic residency requirement was added AFTER we matriculated and in fact we successfully argued to have it waived for our class (it was not what we agreed to and wasn't in our handbook). Looks like it will stand for subsequent classes though. David, you have the math right. I am concerned about that too. There is very little room in this curriculum for auditions and elective rotations. I am hoping to capitalize on connections from my prior PA life and I take some comfort in having taught at a major health sciences center ;) Yes, next May will be busy...COMLEX and USMLE Step 1. I know it's expensive but would rather not be limited by not taking the test. I've been doing board review since January ;) also my PANRE is due by the end of this year. I plan to wait until after we hit cards & pulm in the fall before I sit for it. Not too worried as I have probably taken about 50-60 big exams this year (!) but still want to do well. If anyone has ideas for rotations and/or suggestions for neuro & IM residencies, I'm all ears. Would like to stay in the south as much as possible but will go anywhere. My husband is a HS history teacher and wants "right to work" states only, no unions ;) I told him I would try :)
primadonna22274 Posted May 9, 2012 Exactly our argument. The vascular surg guy is set on a particular allopathic program and has made inroads into making it a reality. The IR guy wants to do a direct-entry pathway which is not available osteopathically. The pulm guy was concerned about fellowship options later on. My beef was so few osteopathic residencies are in the south and west, the 2 places I want to live. We won for our group but it may stand for those to follow. We hope not. Thats one of the issues. ACGME has a proposal out that after 2014 to enter an ACGME fellowship you have to have completed an ACGME residency. So if you did an osteopathic residency you won't be able to participate in fellowships. There are (as far as I can tell) no Osteopathic Vascular or IR programs and eight Pulm/CC programs (although some appear to be dormant). So you are looking at pretty long odds to do anything but primary care.
Moderator EMEDPA Posted May 9, 2012 Moderator any idea why they raised the mcat requirement from 22 to 23? I was hoping it would go down , not up, or go away entirely....
primadonna22274 Posted May 9, 2012 I think it was across the board but we are still working on getting rid of it.
Moderator EMEDPA Posted May 9, 2012 Moderator I think it was across the board but we are still working on getting rid of it. if they get rid of it I may still apply when done with my DHSc....although I am interested in rural fp so not too worried about the DO residency requirement.
Moderator ventana Posted May 10, 2012 Moderator I think it was across the board but we are still working on getting rid of it. oh no....... rid of MCAT and fast track to primary care (IM for me) and I have lost all me reasons to go......
primadonna22274 Posted May 10, 2012 oh no....... rid of MCAT and fast track to primary care (IM for me) and I have lost all me reasons to go...... All of your reasons NOT to go Ventana? ;) no lie, it's REALLY HARD. :)
eewee Posted May 10, 2012 Just out of curiosity, why is the MCAT requirement so off-putting? I can see how, if the program wanted a 30 or higher, it might be difficult to obtain. But it seems like anyone intelligent enough to be a PA could get into the mid-20s with some studying.
Moderator ventana Posted May 10, 2012 Moderator All of your reasons NOT to go Ventana? ;) no lie, it's REALLY HARD. :) well at least the big one's......... that and about 3/4 million dollars I don't doubt that it is REALLY hard - I clearly remember 16 hour study days and exams after exams (and the total lack of a life that I had durning PA school) I previously took MCAT's - before taking o-chem even (stupid) and had about a 29 (think I had 11-12 in the two sections and then a 7 in ochem) - just remember it as being a tough experience and that was after taking all med school pre-reg's at the same time as being Active Duty in the USAF and working 40-50 hours a week on overnight shifts on the flight line so I could go to school during day.) Then never got into med school as I was a 29 yr old white male and did not have a 33+ on MCAT's and was AD military (I think the schools I applied did not think this was a good thing...) The thing that gets me is that their are so many barriers to entry to med school and yet I am doing the EXACT same job as the 12 doc's in my practice now and this clearly is not taken into consideration in the current system. I function identically as a doc, and honestly have a similiar knowledge base to many of them as far as the applied knowledge goes. Sure a new grad doc has A LOT more knoweldge then me, but the day to day is just the same. It would be really nice to think I would not have to give up $750,000 and 6 years to go back and be a Doc. The MCAT and need to do all the speciality level care knowledge and rotations just do not benefit me other then getting an MD/DO after my name. They talk about more access to care, and preserving the Doc pay rates (which by the way are sort of contradictory in a business sense) and then handcuff PA practice ownership with having to get an SP and the world is not a clean place. Then you combine this with the relative lack of knowledge that FMG come into our system(have worked with many many FMG in the past as residents and they are less then impressive compared to US trained doc's). Who then come into our system and small towns and find it exceptionally hard to gain patient panels as you can not understand them and the patients prefer not to see them. I really beleive that a PA that did well in school, has continued to read and stay up to date on the IM literature is on par if not better then most FMG (at least in my local hospital system). What I really would like is a advanced practice designation that allows for essentially independent practice of highly experienced PA's - ie 5 years exp in IM, letter of rec from SP's, and then completition of a short academic program to allow attaining the level of doctor - not saying has to be an MD/DO but something better then 'asssitant' where se have to have all this supervision..... just not that simple of an issue for me. My immediate solution - open my own practice and hire a doc.... Maybe a speciality level exam for IM (just like 5 out for other specialties) that allow PA's in practice with much more independence.... but that is another topic all together....
navyflyPAC Posted May 10, 2012 Isn't the PA bridge program at LECOM a redundancy? Why is it any different then the existing 3 year PCP track for new students? Is the curriculum different?
Moderator EMEDPA Posted May 10, 2012 Moderator Just out of curiosity, why is the MCAT requirement so off-putting? I can see how, if the program wanted a 30 or higher, it might be difficult to obtain. But it seems like anyone intelligent enough to be a PA could get into the mid-20s with some studying. it would be more than "some studying". it would be taking a bunch of courses, a kaplan course, and studying several hrs/day for several months. I got straight A's in physics when I took it over a decade ago but all those formulas are gone. I would have to relearn them. and chemistry? even farther gone, we're talking 2 decades since I have taken a chem course. honestly, I could start med school if I could just step in and start but I can't work full time(++) and study for and do well on the mcat. lots of folks who take it cold get scores like 18-20.
primadonna22274 Posted May 10, 2012 Different. Only half of the PA slots are primary care and the other half undeclared. Also we do 2 rotations in between MS1 and MS2 then do ALL of 2nd yr, then take Boards and do one last year of rotations. PCSP is required to do primary care, can come in from any background and leave lecture in March of 2nd yr to start rotations.[ QUOTE=navyfly73;341581]Isn't the PA bridge program at LECOM a redundancy? Why is it any different then the existing 3 year PCP track for new students? Is the curriculum different?
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