Future of Medicine - A New Educational Model?

[ScienceisAmazin]

After much research, I'm interested in hearing opinions from practicing PAs about my idea for a change in medical education. I am just a pre-PA student, so there's a good chance of me being misinformed on this whole issue, but I'd love to hear others' thoughts and opinions. (Even if it's just to tell me just HOW misinformed I am. :) )

 

It seems to me that medical education is highly segregated when it comes to available educational paths. For example, a PA must "start over" if s/he wishes to become an MD. I've been thinking that a more efficient route would be the following:

 

1. Bachelor's degree (w/ science emphasis) or similar-level healthcare training

2. Master's degree (in PA studies, nursing, or similar healthcare field) to become a general practitioner

3. Doctorate decree in medicine to specialize

 

Instead of making bright, young, aspiring medical providers have to choose between PA or MD, why not send ALL potential MDs through PA school? Then, if they choose to specialize, a few more years in medical school will give them that option. It seems to me that this will fill the gaps where medical providers are needed, give more options for people looking to grow in their careers, and end the MD vs. PA war.

 

I'd love to hear thoughts and feedback.

[ScienceisAmazin]

After much research, I'm interested in hearing opinions from practicing PAs about my idea for a change in medical education. I am just a pre-PA student, so there's a good chance of me being misinformed on this whole issue, but I'd love to hear others' thoughts and opinions. (Even if it's just to tell me just HOW misinformed I am. :) )

 

It seems to me that medical education is highly segregated when it comes to available educational paths. For example, a PA must "start over" if s/he wishes to become an MD. I've been thinking that a more efficient route would be the following:

 

1. Bachelor's degree (w/ science emphasis) or similar-level healthcare training

2. Master's degree (in PA studies, nursing, or similar healthcare field) to become a general practitioner

3. Doctorate decree in medicine to specialize

 

Instead of making bright, young, aspiring medical providers have to choose between PA or MD, why not send ALL potential MDs through PA school? Then, if they choose to specialize, a few more years in medical school will give them that option. It seems to me that this will fill the gaps where medical providers are needed, give more options for people looking to grow in their careers, and end the MD vs. PA war.

 

I'd love to hear thoughts and feedback.

[LT_Oneal_PAC]

This was the same idea Eugene Stead (founder of PAs) had a several decades ago. You see how far it's gotten.

[LT_Oneal_PAC]

This was the same idea Eugene Stead (founder of PAs) had a several decades ago. You see how far it's gotten.

[ScienceisAmazin]

This was the same idea Eugene Stead (founder of PAs) had a several decades ago. You see how far it's gotten.

 

Crap. Well it's good to hear my idea is not original (ie not ENTIRELY unfounded). I will Google him. Thanks for mentioning him.

[ScienceisAmazin]

This was the same idea Eugene Stead (founder of PAs) had a several decades ago. You see how far it's gotten.

 

Crap. Well it's good to hear my idea is not original (ie not ENTIRELY unfounded). I will Google him. Thanks for mentioning him.

[ScienceisAmazin]

didnt you pose this same question over at allnurses in the NP section? so essentially you want to transform medical education into a type of ladder that you can climb, up to the point of being a specialist physician?

 

Nope, not me. But it seems my idea has been thought of before. I'm uneducated on the "nursing model" as compared to the "medical model". I've asked a few MDs and PAs about the main difference, and some have told me there are none, so I'm not sure where to go with that. If you have time to explain, I'm all ears.

 

As for "everyone wanting to be a doctor", I suppose I came across wrongly. I have no intention in becoming a doctor and I expect most PAs feel the same. I just feel those with an interest in medicine could all follow a similar path. Once they're comfortable where they are, whether it be at the Bachelor's or Master's level, they stop their formal education and continue on their chosen career path. I've heard regretful stories of MDs who wish they'd gone the PA route and I feel this model would give that option. And if they regret "only having a Master's", they have options for continuing on. Perhaps I should have left nursing out of the equation. I just wanted to pay them my respects.

[ScienceisAmazin]

didnt you pose this same question over at allnurses in the NP section? so essentially you want to transform medical education into a type of ladder that you can climb, up to the point of being a specialist physician?

 

Nope, not me. But it seems my idea has been thought of before. I'm uneducated on the "nursing model" as compared to the "medical model". I've asked a few MDs and PAs about the main difference, and some have told me there are none, so I'm not sure where to go with that. If you have time to explain, I'm all ears.

 

As for "everyone wanting to be a doctor", I suppose I came across wrongly. I have no intention in becoming a doctor and I expect most PAs feel the same. I just feel those with an interest in medicine could all follow a similar path. Once they're comfortable where they are, whether it be at the Bachelor's or Master's level, they stop their formal education and continue on their chosen career path. I've heard regretful stories of MDs who wish they'd gone the PA route and I feel this model would give that option. And if they regret "only having a Master's", they have options for continuing on. Perhaps I should have left nursing out of the equation. I just wanted to pay them my respects.

[LT_Oneal_PAC]

I can't remember where I read it, but I remember him specifically saying that the problem of medical education was that is had become a series of ladders. Instead of strafing from nursing to and continue up a medical path, you had to climb down and start from the bottom again.

 

We are far to entrenched in our education to change now. Many Doctors feel like anything other than starting from the beginning is cheating the system. Who cares PAs have done at least the second and third years of medical school. Secondly, it is mandated, I relieve by the world health organization, that any med school must be at least 3 years in length. So that knocks out any idea for a shorter bridge than the one at LECOM for PA to DO.

 

Though you're idea is nice, it just won't ever happen. Trouble enough just changing the name from assistant to associate.

 

If ifs and buts were candy and nuts, we'd all have a merry christmas

[LT_Oneal_PAC]

I can't remember where I read it, but I remember him specifically saying that the problem of medical education was that is had become a series of ladders. Instead of strafing from nursing to and continue up a medical path, you had to climb down and start from the bottom again.

 

We are far to entrenched in our education to change now. Many Doctors feel like anything other than starting from the beginning is cheating the system. Who cares PAs have done at least the second and third years of medical school. Secondly, it is mandated, I relieve by the world health organization, that any med school must be at least 3 years in length. So that knocks out any idea for a shorter bridge than the one at LECOM for PA to DO.

 

Though you're idea is nice, it just won't ever happen. Trouble enough just changing the name from assistant to associate.

 

If ifs and buts were candy and nuts, we'd all have a merry christmas

[Beorp]

This was the same idea Eugene Stead (founder of PAs) had a several decades ago. You see how far it's gotten.

 

Do you have a reference for this? Given that the OP specifically mentions master's degrees for the GPs, we can be almost certain that this is not what Eugene Stead suggested.

[Beorp]

This was the same idea Eugene Stead (founder of PAs) had a several decades ago. You see how far it's gotten.

 

Do you have a reference for this? Given that the OP specifically mentions master's degrees for the GPs, we can be almost certain that this is not what Eugene Stead suggested.

[ScienceisAmazin]

Trouble enough just changing the name from assistant to associate.

 

Jeez, yes. Ain't that the truth?

 

You bring up excellent points in the rest of your reply. Definitely more for me to think about.

[ScienceisAmazin]

Trouble enough just changing the name from assistant to associate.

 

Jeez, yes. Ain't that the truth?

 

You bring up excellent points in the rest of your reply. Definitely more for me to think about.

[EMEDPA]

a PA must "start over" if s/he wishes to become an MD.

actually the first pa to physician bridge program opened last yr. pa's get one yr of credit and do 3 yrs for the degree. see the lake erie college of medicine advanced physician assistant track.

[EMEDPA]

a PA must "start over" if s/he wishes to become an MD.

actually the first pa to physician bridge program opened last yr. pa's get one yr of credit and do 3 yrs for the degree. see the lake erie college of medicine advanced physician assistant track.

[LT_Oneal_PAC]

I thought Mr Stead wanted to use nurses as recruits for the first PAs, but that didn't pan out because NP was an emerging field. Anybody have the story? I thought I read it on here.

 

He offered, they declined, then they decided it wasn't such a bad idea and they created the first nurse practitioner after the first PA.

[LT_Oneal_PAC]

I thought Mr Stead wanted to use nurses as recruits for the first PAs, but that didn't pan out because NP was an emerging field. Anybody have the story? I thought I read it on here.

 

He offered, they declined, then they decided it wasn't such a bad idea and they created the first nurse practitioner after the first PA.

[LT_Oneal_PAC]

Do you have a reference for this? Given that the OP specifically mentions master's degrees for the GPs, we can be almost certain that this is not what Eugene Stead suggested.

 

I cannot find the direct quote that I'm referring, but this excerpt HERE from a paper Stead wrote shows his general feeling about how those with extensive experience should be granted some leniency and how medical schools hold a monopoly.

 

"The graduate of a medical school cannot practice his profession until the state awards him a license. Only graduates of approved medical schools can be admitted to the licensure examination. The medical schools have an absolute monopoly. In the best of times, the monopoly admits to the practice of medicine only the best. In the worst of times, it excludes any graduate, no matter how skilled, whom the members of the examining team do not like.

 

The medical schools have a great stake in requiring students to attend four full years. Many studnets seeking adminssion to medical schools have had extensive experience in the medical and scientific world. The schools rarely give the seasoned medical worker any credit for courses taken outside of the medical school or for apprentice experience more extnesive than those of the third and fourth year medical students. Without the four years of college and four years of medical school tuition, admission to the qualifying examination is denied and the school's monopoly is maintained."

[LT_Oneal_PAC]

Do you have a reference for this? Given that the OP specifically mentions master's degrees for the GPs, we can be almost certain that this is not what Eugene Stead suggested.

 

I cannot find the direct quote that I'm referring, but this excerpt HERE from a paper Stead wrote shows his general feeling about how those with extensive experience should be granted some leniency and how medical schools hold a monopoly.

 

"The graduate of a medical school cannot practice his profession until the state awards him a license. Only graduates of approved medical schools can be admitted to the licensure examination. The medical schools have an absolute monopoly. In the best of times, the monopoly admits to the practice of medicine only the best. In the worst of times, it excludes any graduate, no matter how skilled, whom the members of the examining team do not like.

 

The medical schools have a great stake in requiring students to attend four full years. Many studnets seeking adminssion to medical schools have had extensive experience in the medical and scientific world. The schools rarely give the seasoned medical worker any credit for courses taken outside of the medical school or for apprentice experience more extnesive than those of the third and fourth year medical students. Without the four years of college and four years of medical school tuition, admission to the qualifying examination is denied and the school's monopoly is maintained."

[LT_Oneal_PAC]

More interesting excerpts from here:

"Why do I say that an interested accredited medical college can break the monopoly? The key is that once it has been accredited, it has the privilege of deciding how to select and educate a student body which can pass the qualifying examinations. Accordingly. it can accept students for advanced standing and award the M.D. degree whenever the school believes that the student is ready for the qualifying exams. An example from the past shows the art of the possible. About 35 years ago, before the age of space exploration, the market for Ph.D. graduates collapsed while the market for M.D. graduates remained robust. One of the Florida medical schools decided that the first two years of the Ph.D. program covered the sciences which supported medical practice and accepted the Ph.D. students into the third year class of the medical school. In my role as physician-in-chief of Duke hospital I appointed several of these former Ph.D. candidates to the resident staff. They performed as well and in some instances better than the students who had spent 4 years in the medical school."

 

"Medical schools traditionally require 4 years of course work in an accredited college. The colleges sending the most students to medical schools are in fact close allies of the medical school monopoly. The close tie between favored colleges and the medical schools was emphasized to me first by Goodrich White, The President of Emory University. I was his 33 year old professor of medicine and department chair. I had told a reporter of the Atlanta Constitution that the medical school did not need to require 4 years of college work. Two years were adequate. This would allow the students not interested in additional college work to graduate two years earlier and give them time for two additional years of postgraduate study either here or abroad...."

AND HERE IS HIS IDEA FOR A TIERED MEDICAL EDUCATION SYSTEM

 

"The successful accredited medical school will establish an online division that allows its students to take courses at home or at work. The purpose of the online division is to allow Physician Associates and Nurse Practitioners holding a Masters degree to take the courses needed to meet the requirements of the medical school for the M .D. degree. Those up graded students would sit for the qualifying examinations along side of the graduates of the traditional 4 year school. This would allow an easy comparison of the two methods of education. If the percentage of the upgraded students passing the examinations equaled or was greater than that of the traditional 4 year program the online program would be judged to be successful. Past experience shows that older students, knowing why they are in school and anxious to make for lost time, perform better than the younger students. The online medical school will set the requirements for admission. We suggest the following: Physician associates and nurse practitioners who are 27 years of age and have a masters degree whose course of study included one year of the sciences underlying medical practice and one year of student apprenticeship covering the areas covered by the traditional M.D. rotating internship. The final requirement is that the candidate has completed 3 years of practice under the supervision of a practicing M.D. or a group of M.D.'s. willing to write strong supporting letters."

[LT_Oneal_PAC]

More interesting excerpts from here:

"Why do I say that an interested accredited medical college can break the monopoly? The key is that once it has been accredited, it has the privilege of deciding how to select and educate a student body which can pass the qualifying examinations. Accordingly. it can accept students for advanced standing and award the M.D. degree whenever the school believes that the student is ready for the qualifying exams. An example from the past shows the art of the possible. About 35 years ago, before the age of space exploration, the market for Ph.D. graduates collapsed while the market for M.D. graduates remained robust. One of the Florida medical schools decided that the first two years of the Ph.D. program covered the sciences which supported medical practice and accepted the Ph.D. students into the third year class of the medical school. In my role as physician-in-chief of Duke hospital I appointed several of these former Ph.D. candidates to the resident staff. They performed as well and in some instances better than the students who had spent 4 years in the medical school."

 

"Medical schools traditionally require 4 years of course work in an accredited college. The colleges sending the most students to medical schools are in fact close allies of the medical school monopoly. The close tie between favored colleges and the medical schools was emphasized to me first by Goodrich White, The President of Emory University. I was his 33 year old professor of medicine and department chair. I had told a reporter of the Atlanta Constitution that the medical school did not need to require 4 years of college work. Two years were adequate. This would allow the students not interested in additional college work to graduate two years earlier and give them time for two additional years of postgraduate study either here or abroad...."

AND HERE IS HIS IDEA FOR A TIERED MEDICAL EDUCATION SYSTEM

 

"The successful accredited medical school will establish an online division that allows its students to take courses at home or at work. The purpose of the online division is to allow Physician Associates and Nurse Practitioners holding a Masters degree to take the courses needed to meet the requirements of the medical school for the M .D. degree. Those up graded students would sit for the qualifying examinations along side of the graduates of the traditional 4 year school. This would allow an easy comparison of the two methods of education. If the percentage of the upgraded students passing the examinations equaled or was greater than that of the traditional 4 year program the online program would be judged to be successful. Past experience shows that older students, knowing why they are in school and anxious to make for lost time, perform better than the younger students. The online medical school will set the requirements for admission. We suggest the following: Physician associates and nurse practitioners who are 27 years of age and have a masters degree whose course of study included one year of the sciences underlying medical practice and one year of student apprenticeship covering the areas covered by the traditional M.D. rotating internship. The final requirement is that the candidate has completed 3 years of practice under the supervision of a practicing M.D. or a group of M.D.'s. willing to write strong supporting letters."

[LT_Oneal_PAC]

Thanks for explaining.

 

Sts0001 put up a good and more detailed explanation. In reality, the PA was created just a hair (I think about year or two) before NP. PA starting at Duke, and NP over in Colorado with the first being a pediatric NP.

 

I remember reading the nursing response from back then (the ANA president or something) basically saying it would disrespect the heart and purpose of nursing to accept a role in providing medicine. That's why they turned it down.

[LT_Oneal_PAC]

Thanks for explaining.

 

Sts0001 put up a good and more detailed explanation. In reality, the PA was created just a hair (I think about year or two) before NP. PA starting at Duke, and NP over in Colorado with the first being a pediatric NP.

 

I remember reading the nursing response from back then (the ANA president or something) basically saying it would disrespect the heart and purpose of nursing to accept a role in providing medicine. That's why they turned it down.

[chatcat]

and end the MD vs. PA war.

.

 

I'm not aware of an MD vs PA war going on. While there is much discussion on this forum of choosing between PA versus MD training, once training is completed it seems we all fall into place as clinicians in our own professional niche without adversarial

tendencies. Like any other profession, there certainly can be some isolated incidents of conflict but for most of us practicing PAs our relationship with our supervising Docs is a good one.