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Radical “bridge” idea


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Today I was thinking about bridge programs and how PAs are competing with nursing. I had several ideas, all of them seemingly absurd for one reason or another but I figured I’d throw them up here. 
 

1) nursing has their own nursing board that makes it easier for them to push for independent practice.  Why don’t PAs get out from under the medical board and create their own boards?

2) the DO profession came out of nothing and is now basically recognized as an MD. Why can’t PAs create their own “medical school” bridge program and create their own internship and real residency programs, following the DO path?

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1) I think a few states have attempted to create own boards, not sure if any have succeeded. 
2) LMU in Tenn attempted a new provider with DMS program. Tried to pass legislationin Tenn, Washington and one other state. Nursing boards fought against it along with medical and some PAs. 
Fact is there are more nurses than physicians, more physicians than PAs and a bunch of PAs that are to simple minded to think beyond being an assistant. My opinion is your only hope is to organize all DMSc PAs and start from there. LMU did not collaborate with other DMSc programs.I’ve looked at some of the various curriculum and while a couple are week, many are solid and produce highly educated providers.
However it takes work, few really want to put in the effort. For every one who has put in effort to progress PA profession(many have for years) there are at least 5-10 more who either fight against them or just don’t care. 
PAs I know, recently gave up on AAPA, PAFT because they ignored a million dollar 2 year research that would have been an easier step toward #1, Instead they chose to remain tethered to physicians.  One north central state has legislation to prevent PAs from ever using title associate  ,  Likely many other states will follow or bar change if attempted. Will AAPA reconsider Medical Care Practitioner? Doubtful because they, nor your HOD care enough about your future.

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3 minutes ago, Hope2PA said:

1) I think a few states have attempted to create own boards, not sure if any have succeeded. 
2) LMU in Tenn attempted a new provider with DMS program. Tried to pass legislationin Tenn, Washington and one other state. Nursing boards fought against it along with medical and some PAs. 
Fact is there are more nurses than physicians, more physicians than PAs and a bunch of PAs that are to simple minded to think beyond being an assistant. My opinion is your only hope is to organize all DMSc PAs and start from there. LMU did not collaborate with other DMSc programs.I’ve looked at some of the various curriculum and while a couple are week, many are solid and produce highly educated providers.
However it takes work, few really want to put in the effort. For every one who has put in effort to progress PA profession(many have for years) there are at least 5-10 more who either fight against them or just don’t care. 
PAs I know, recently gave up on AAPA, PAFT because they ignored a million dollar 2 year research that would have been an easier step toward #1, Instead they chose to remain tethered to physicians.  One north central state has legislation to prevent PAs from ever using title associate  ,  Likely many other states will follow or bar change if attempted. Will AAPA reconsider Medical Care Practitioner? Doubtful because they, nor your HOD care enough about your future.

To add to #2) DMSc PAs should get together nationally and try to pass something at the Federal level. Dos gained more respect and notoriety because military and VAMC accepted them. 

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No one will ever take a profession with the words "Assistant" or "Associate" seriously as a stand alone.  If the profession defines itself in these terms, why would legislatures ever give them more autonomy?  It's exactly why nurses added "Practitioner" to their name and proceeded to steam role us.  The name matters, but who cares anymore...  We had our shot at MCP and the profession chose perpetual servitude until demise over future success.  

I am out in the field every day at different clinics and NP's are destroying us. That is a FACT.

Edited by Cideous
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7 hours ago, LKPAC said:

How about just go to MD/DO school?  Don't become a PA if that's not what you want.

Totally unenlightened response. 

I now work in a different state then my home state because they have most of OTP. 
it is NOT about wanting to be a doc.  It is about practice what we are trained to do with out stupid useless oversight/regulations.  

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As someone going to medical school I agree the answer is not for everyone to go to medical school. For one it’s an insane amount of work. And at least this first semester vast majority has not been clinically relevant, hoping that does change year 2. We need better laws and the ability to practice without SPs after a certain period of time (3 years) and then be able to bill for  100% and not 85% which is a major reason why most hospitals make Docs sign the PA charts from what I’ve been told. I also believe in bridge programs that waive the MCAT for PAs who want to become a doctor, because right now it is very difficult when you have to score the same MCAT score as a 21 year old who is being taught the material on the MCAT and has all the time in the world to study. 

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1 hour ago, newton9686 said:

As someone going to medical school I agree the answer is not for everyone to go to medical school. For one it’s an insane amount of work. And at least this first semester vast majority has not been clinically relevant, hoping that does change year 2. We need better laws and the ability to practice without SPs after a certain period of time (3 years) and then be able to bill for  100% and not 85% which is a major reason why most hospitals make Docs sign the PA charts from what I’ve been told. I also believe in bridge programs that waive the MCAT for PAs who want to become a doctor, because right now it is very difficult when you have to score the same MCAT score as a 21 year old who is being taught the material on the MCAT and has all the time in the world to study. 

First bolded statement: if thats not the truest statement about first year of medical school, I dont know what is.

 

Second bolded: On top of the MCAT score, the ECs and research opportunities that you can't get because you're working a full time job. 

 

To add: a thought i have about more PA-MD/DO bridges won't happen. There isn't a shortage of applicants to medical school. Not many schools would want to forego an extra year of tuition. 

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PA to MD, I agree, its 99% all about the Benjamins. Until their are external changes you typically do not see internal changes. COVID has proved that. I think there needs to be more studies on PAs and drop out rates. If you could prove your average PA had a lower drop out rate than a standard student, you could make a financial argument for taking more PAs, for example we havent lost any of our 3 PAs, but lost 5-7 typical students after 8 weeks of school. At 30K a semester the school is losing nearly 500K in tuition, which would far exceed the 180K they would loss if us 3 PAs were on a 3 year tract.

 

I also dont neccessary think you have to make the programs 3 years initially. I know a lot of PAs that would go if they would just make medical school more flexible (more online classes, get rid of MCAT requirements, etc.)

I also wondered if there was a world where you could do a program where you allowed PAs to get a "masters" that equivalent to the first year of medical school (online), then programs could require them with the spots they lost to traditional applicants. Then they apply to programs in December/January to start as year 2s. Programs make more money and PAs get to do first year online. 

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23 minutes ago, newton9686 said:

PA to MD, I agree, its 99% all about the Benjamins. Until their are external changes you typically do not see internal changes. COVID has proved that. I think there needs to be more studies on PAs and drop out rates. If you could prove your average PA had a lower drop out rate than a standard student, you could make a financial argument for taking more PAs, for example we havent lost any of our 3 PAs, but lost 5-7 typical students after 8 weeks of school. At 30K a semester the school is losing nearly 500K in tuition, which would far exceed the 180K they would loss if us 3 PAs were on a 3 year tract.

 

I also dont neccessary think you have to make the programs 3 years initially. I know a lot of PAs that would go if they would just make medical school more flexible (more online classes, get rid of MCAT requirements, etc.)

I also wondered if there was a world where you could do a program where you allowed PAs to get a "masters" that equivalent to the first year of medical school (online), then programs could require them with the spots they lost to traditional applicants. Then they apply to programs in December/January to start as year 2s. Programs make more money and PAs get to do first year online. 

Multiple PAs in one class? That would be nice. 

 

That would be an interesting study. There seems to be an increase in PAs applying from what I have seen on here and on reddit. Do it and see if you can get published lol. 

 

Your dream world scenario isn't too far off. I don't see medical school having the same length for much longer. Most classes are recorded and students are learning through outside resources anyway. My program recently completed a renovation of our entire building for most classes to have 1/6 of the student body attend. I don't see why a majority of medical school can't be hybrid with on campus relating to physical exam things. 

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This is exactly what I mean. We are trying to force ourselves into becoming MD / DO and of course not getting anywhere because of the above reasons. 
 

Why don’t we take the DO approach and forge our own way forward into a doctorate equivalent through our own bridge program and then fight to be recognized as Md and Do are. We can create our own residency programs etc. 

 

so you can be a PA, and then if you want the independence/higher skill set, complete the doctorate (with whatever is missing from medical school) and our own PA residency that mirrors MD/DO and have equivalence. 

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12 minutes ago, DelusionalEnthusiasm said:

 

so you can be a PA, and then if you want the independence/higher skill set, complete the doctorate (with whatever is missing from medical school) and our own PA residency that mirrors MD/DO and have equivalence. 

There is a whole school of thought that the MD/DO divide is useless and DOs should convert to MDs. They already merged residencies. A big reason why it hasn't happened is because some DO schools won't meet the LCME criteria their MD counterparts have to. This would likely fall under the same umbrella.

A bridge from PA--medical school is more a better idea than adding an "equivalent". 

 

Fun thought exercise however. 

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14 hours ago, newton9686 said:

 I also believe in bridge programs that waive the MCAT for PAs who want to become a doctor, because right now it is very difficult when you have to score the same MCAT score as a 21 year old who is being taught the material on the MCAT and has all the time in the world to study. 

Lecom APAP already does this: 

https://lecom.edu/college-of-osteopathic-medicine/com-pathways/apap/

I am in my 50s and if I didn't have family responsibilities, mortgage, kids in college, etc I would still do this. I was very close to applying for the first class in 2002 when my family life got complicated. 

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Yeah they do. But it’s also only one program in a less than ideal location. Additionally what I’ve heard since the PA/DO who started the program has moved on the replacement director doesn’t always come of as PA friendly. Combine that with their curriculum which is a lot of self and book learning and it’s not a great option for everyone. So It is a option, but we need way more options as PAs.

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The MDs are not our customers.

The insurance companies are not our customers.

The right approach is that of the DCs, NDs, and others who have less scientific rigor than us: Customer demand.

Patient demand.

How many times have you heard "I'd rather see a PA because doctors never listen to me."

The world doesn't need more doctors. The world doesn't need as many doctors as it has, and the ones it does have, at least in the North American model, should often be removed from patient care because they are, in many cases, dangerously ineffective at it.

Doctors suck at empathy.  Suck at communication. Suck at humanity.  That's why "quacktitioners" are stealing patients and revenue away: the medical model is broken. It demands they cease being human in the name of some misguided mystique that "doctor" and "god" are pretty much equivalent.

How many doctors do you know who are decent human beings? Hopefully, each of you know a few, but for the most part, they're not.

When MDs and DOs start hearing "Go away and send me a PA" then we will be on the right track.

We are not half-assed MDs.

We are medical professionals who did this with a lot of work, but without an entrenched set of lying, hazing, and sleep deprivation known as residency.

We are better than doctors--not at diagnosing undifferentiated illnesses (and let's be honest: how often is that really needed?), but at being patient healers. House, MD plays well because House is just the average misanthropic doctor drawn bigger and more cartoonish.

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Nah, House plays well because like his progenitor and essential blueprint Sherlock Holmes, he offers the reassurance that no matter how weird or frightening things get, there is always an explanation that can eventually be found. 

I think it’s a little simplistic to say PAs are better at empathy, or healing, or listening. I do agree that there are hidebound and quite toxic elements of modern North American medical education, and many of them serve ends and use means that make for lousy caregivers at the end of the process.

That was why I, at age 32 or so, took a good hard look at what my resident friends and co-workers were going through, and tried to figure out how the pros and cons would break down for me. I decided I wanted the luxury of not being locked into one specialty the rest of my life, and as a secondary concern I worried a little bit that I might get kicked out for punching some deserving face at 3am on a particularly bad day.

We might say that we benefit from going through a less-abusive educational experience, or that we have less of a total dose over time of the unhelpful, dehumanizing stuff.

And yes, leaning in to those times when patients lead the chorus would be great, but I don’t think that really happens at the scale we would need to leverage it into serious change. Half the people who say things like that to me think they’re paying me a huge compliment to say they “don’t mind not seeing the doctor.” The other half include a small proportion who think they can get me to prescribe or approve something because I’m so caring and patient and nice. 

Part of the issue is, there are way more PAs who started out on a track other than biology major/ pre-med and then came to medicine out of choice. Or at least, following a career track that comes from an academic track you started when you were 19 has pitfalls that get a little better when you start even a few years later, I think. 

Personally, I think we just need more MDs and PAs who started as humanities and liberal arts majors. That’s the scholarship I would fund, if I had Bezos money. 

 

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@rev ronin ooof...you had a rough day man? While I share some of your sentiments I really hesitate to generalize an entire body of individuals as "dangerously ineffective" indecent human beings.

I'm going to assume your comments relate to your lived experience as an outpatient provider, an experience that I haven't had. Maybe that undifferentiated patient doesn't present to you all that often but on the inpatient side of things I am incredibly happy to work as part of a team to manage all the way the body can go sideways.

Hope you're staying healthy.

 

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1 hour ago, MediMike said:

@rev ronin ooof...you had a rough day man? While I share some of your sentiments I really hesitate to generalize an entire body of individuals as "dangerously ineffective" indecent human beings.

I'm going to assume your comments relate to your lived experience as an outpatient provider, an experience that I haven't had. Maybe that undifferentiated patient doesn't present to you all that often but on the inpatient side of things I am incredibly happy to work as part of a team to manage all the way the body can go sideways.

Hope you're staying healthy.

Ok, in rereading that, it seemed a little more vitriolic and less hyperbolic than I intended.  For context, I had just gotten back from a chaplain call to help an EMT who had a status epilepticus <2 yo kid turf'ed to her BLS rig by a medic as "a febrile seizure". December is always the worst month for first responders, and I've been one long enough that I definitely have a shorter fuse than most.  I am, on the whole, happiest I have ever been professionally as a PA with the mix of my own clinic and 1099 work.

But no, the essence of what I said stands: while we don't necessarily train PAs to be healers, we definitely train Docs to be non-healers. Thankfully, many of them overcome that.

And yes, I do believe MDs belong in high-risk, high-stakes specialties rather than in outpatient primary care settings.

What I don't see fixing things for PAs is picking a different name, or a different fight with a different competing professional organization.  We win by doing patient care--and care in every sense of the word--better than everyone else.

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2 hours ago, rev ronin said:

Ok, in rereading that, it seemed a little more vitriolic and less hyperbolic than I intended.  For context, I had just gotten back from a chaplain call to help an EMT who had a status epilepticus <2 yo kid turf'ed to her BLS rig by a medic as "a febrile seizure". December is always the worst month for first responders, and I've been one long enough that I definitely have a shorter fuse than most.  I am, on the whole, happiest I have ever been professionally as a PA with the mix of my own clinic and 1099 work.

But no, the essence of what I said stands: while we don't necessarily train PAs to be healers, we definitely train Docs to be non-healers. Thankfully, many of them overcome that.

And yes, I do believe MDs belong in high-risk, high-stakes specialties rather than in outpatient primary care settings.

What I don't see fixing things for PAs is picking a different name, or a different fight with a different competing professional organization.  We win by doing patient care--and care in every sense of the word--better than everyone else.

What specifically makes you feel changing name/titleis not important? I have talked to legislator who CANNOT get past assistant, helper, not practitioner or provider. I’ve been in meetings with pretty ignorant CEOs who listen to CNO say they need to focus on NP rather than PA APP because PAs are only assistant and NPs function as practitioner. What do you say to people who deal with that issue? It is real, and a growing problem.  But you are fine, you have done well for yourself so why not keep things as they are. 
Also, could you further explain what you mean by not fighting or competing with another profession?  Lastly, it’s hard win or prove your abilities when hospital has decided they want the independent practitioner. This is happening. But again, no need to change title and no need to compete, you are doing fine.

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4 minutes ago, Hope2PA said:

What specifically makes you feel changing name/title is not important? [...]
Also, could you further explain what you mean by not fighting or competing with another profession?

First, I'm referring to the number of posters here who keep bringing up that MCP polled better than Physician Associate. My message to them is: don't let the perfect be the enemy of the good. Maybe MCP would have been better overall, fine, but the internal inertia guaranteed that it wasn't going to happen. We're not changing names again, so there are basically two camps: Those moving forward with Physician Associate, and those not.  Those not include those who want to stay assistants and those who want to be MCPs. While the two groups might be quite opposed in philosophy, they're effectively aligned in practical terms.

Second, yes, do not focus on NPs. Right now, in my personally owned occupational medicine business, I have to deal with the fact that an NP gets 100% of the physician reimbursement rate, while I get 90%.  That's going to cost me thousands of dollars per year, and each of those dollars comes more or less directly out of my profit. So yes, I have skin in the PA vs. NP game, and more than most.

Having said all that, the politics of envy and competition irrevocably change us. If we see the NPs as our enemies, or the physician lobby as our false and fair-weather friends, we cannot see the patients as our customers. The main thing is to keep the main thing the main thing.  I love having to deal with all the petty nonsense involved in running my own business, because I get to decide how to do the best thing for my patients--not some bean counter I'll never meet, not some disinterested physician overseer, but me, the one who sits down with each of them every visit.  I could care less about what economy of scale from which I'm not benefitting, the joy in my day to day world is that I own my relationship with each of my patients.

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Rev- I like all of this except referring to patients as customers....yes, they are in one sense, but that is what leads to crap like press-ganey, etc. We need to treat patients as patients, not as customers. That is one nice thing about working in the ER. I don't have to care about repeat business. I do what is right for the patient, not what google or their chiropractor neighbor says they need....

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20 minutes ago, EMEDPA said:

Rev- I like all of this except referring to patients as customers....yes, they are in one sense, but that is what leads to crap like press-ganey, etc. We need to treat patients as patients, not as customers. That is one nice thing about working in the ER. I don't have to care about repeat business. I do what is right for the patient, not what google or their chiropractor neighbor says they need....

Point well taken.  I haven't once cared for the Press-Ganey system for ANYONE, and I think it distorts medicine. That's not the sort of customer care I'm talking about.

In primary care, eating disorders, and occupational medicine, I see patients again and again. I actually get to develop relationships with them. They bring their spouses or partners in to meet me, tell me about their children. I called one up this morning to see how he was doing postoperatively.  That patient-practitioner relationship is only ever badly approximated by the term 'customer,' but 'patient' doesn't seem to have the right semantic range for this sort of relationship either.

I am not neutral when it comes to my patients. I consider it my duty to do my best for them, and advocate for their best outcome. They are 'mine' not in any sense that I own them, but rather that we have an agreed relationship that I will look out for their best interests, responsible for their well-being, primarily within the medical sphere. That involves me doing my best, but also referring them to the best specialists and helping them to understand what each specialist has in turn said about their case.  It involves me saying 'no' when a request isn't the best thing to do for the patient. I tell people 'no' all the time, but I do it while explaining why what they've asked for isn't the best thing at this time.  About 20% of my patient panel are people whom I've declined to prescribe narcotics for, or tapered them to some extent. Why do they stick around if I'm not the candyman?  Because I really and sincerely care for them. They're my responsibility, voluntarily assumed, to get them to heal and prosper.

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