"APP-MD Bridge" Program?

[Joelseff]

https://www.linkedin.com/posts/paving-practices_physician-equivalency-program-activity-6978658104305405952-eoAa?utm_source=share&utm_medium=member_android

 

We ALMOST made it a decade without another bridge program proposal popping up... LMU was the closest if I remember...and we know how that ended.

I am not holding my breath BUT this is aimed at both PA and NP maybe it will work 

I'm definitely skeptical.  but wish them success! 

Edited September 22, 2022 by Joelseff

[Reality Check 2]

I logged into LinkedIn and looked at it.

Is this just a poll to see if this group has enough interested parties to pursue accredidation?

Curious who is behind this.

hmmmmmm

[Joelseff]

39 minutes ago, Reality Check 2 said:

I logged into LinkedIn and looked at it.

Is this just a poll to see if this group has enough interested parties to pursue accredidation?

Curious who is behind this.

hmmmmmm

Looks like a PA named Kenneth Botelho. I doubt he's made any headway and the more I look into it, it seems like it's in the spit balling phase... He says he has an 84 page plan but couldn't post it. 

Edited September 22, 2022 by Joelseff

[sas5814]

7 minutes ago, Joelseff said:

He says he has an 84 page plan but couldn't post it.

That is a big spitball...

[Joelseff]

29 minutes ago, sas5814 said:

That is a big spitball...

True. But I hope it's not a whole lotta nuthin... 

[Hope2PA]

Why haven't DMS, LMU and Butler tried to gain legislation? LMU appeared to have really good program backed by physicians, at least they didn't completely nix the idea. There are now as many DMS  and DMSc grads (DO had low number when they started years ago) that could push for their own legislation and independence, licensing board.  Absolutely no reason, other than lack of trying, LMU gave up quickly. If at first you don't succeed, try try again. 

[Joelseff]

13 minutes ago, Hope2PA said:

Why haven't DMS, LMU and Butler tried to gain legislation? LMU appeared to have really good program backed by physicians, at least they didn't completely nix the idea. There are now as many DMS  and DMSc grads (DO had low number when they started years ago) that could push for their own legislation and independence, licensing board.  Absolutely no reason, other than lack of trying, LMU gave up quickly. If at first you don't succeed, try try again. 

LMU tried and they started the "DMS" Degree with the purpose of starting a third doctorate trained medical provider called a Doctor of Medical Science which showed promise but once the Tennessee BOM, AMA etc chimed in/challenged it, they couldn't win. They made compromises and ultimately got rid of the plan and decided to just have the DMS degree for PAs. It would've been a huge win in my opinion. 

Edited September 22, 2022 by Joelseff

[ventana]

this proposal completely ignores the fact that WHO has minimal requirements.

Maybe this can be avoided by the APP-MD nomenclature but then you have create an entire new category of provider through Medicare - also a long tough road.

I, for one, do not want to be lumped in with NP in my professional degree APP-MD - if it were PA-MD maybe but not APP.

[rev ronin]

The easiest way to manage the WHO thing is retroactively classify PA education as counting as up to two years of med school, and then you just have to have a minimum one year bridge program.  Again, with 3 year MD programs out there, anything longer simply doesn't make sense.

[ventana]

Give me one year classroom 

let me take usmle3

 

make me independent.  

[Joelseff]

3 hours ago, ventana said:

Give me one year classroom 

let me take usmle3

 

make me independent.  

I like this idea! (Couldn't "like" any more posts today ) 

[newton9686]

As someone in the process right now I do think it would need to be 30-36 months. There is just too much red tape and opinions to make it work otherwise.

However there is A TON that we could do to make this more doable for PAs

1)  Remove the MCAT. PAs are too far removed form basic sciences and they are at an obvious disadvantage from a 20 something year old living with their parents with no other responsibilities who can study for 3 months for a test that has nothing to do with becoming a physician. If you want to see how well someone is at taking test use their PANCE score and this would provide more than enough info.

2) Make the majority of the basic science courses online with non synchronous learning. I can process a full day of lectures (4 classes)  in less than 2 hours. From there more clinical lectures I need an additional 30 minutes to 1 hour to study before testing. More PhD courses require more studying but again its doable while still picking up enough shifts to pay the bills and put a little towards tuition too.

3) Make clinical skills more check off or perhaps a 1 week boot camp to prepare you for any practical examination requirements with again a lot of online learning. I think anatomy lab could be done online as well. Likely synchronous, but the online lab we did during the Delta surge was actually more informative and efficient than the traditional cadaver lab because there is no questioning what you are looking at and how it relates to everything else. Plus, you are not spending hours “cleaning things up”. Not to say I recommend  online lab for those who have never done a cadaver dissection, but for most PAs who have already done the full dissection in PA school I think there’s an argument that online anatomy labs would be more beneficial

4) All testing could be done remotely with new monitoring programs.

5) Obviously would need to be done MD, possible DO if they turned OMM into 1 week boot camps focusing on the minimium requirements to pass boards, but honestly the best bet would be MD because it is just an unnecessary burden for the vast majority of DO students that MDs and PAs have shown is not necessary or realistic  for clinical practice and most DOs do nothing with once they start clinicals other than try to remember enough to pass boards. 

I believe by doing these 4 or 5 things PAs could still do the full first 2 years more in a way that is way more conducive to peoples lives, meets all requirements for the first 2 years of medical school  and attainable with a significantly lower the barrier to entry by removing the MCAT since it does not accurately predict PA’s ability to succeed in medical school. If there was one good thing about COVID is it has shown that all of these things can already be done. There is just needs to be a program that puts it all together.

Then it just comes down to clinicals which we have already seen can be done in an accelerated fashion in just 1 year. Thus the result is PAs would only have to really give up 1 year of salary to complete all clinical requirements (and perhaps even here something could be worked out where PAs could earn a stipend because of the value they would bring to the team).  

The key to making this pipe dream a reality is you are still have PAs fully jumped through all the hoops to become a physician. But you doing it in the most efficient way possible and in a way that gives credit to those who completed PA school and already sacrificed so much to get to where they are. 

[Hope2PA]

I know, close family friends who went to MD program pre covid, 2 different schools, 2 different students. Both said they seldom went to class, only the occasional required labs. All lectures were provided and they watched at 1.5 speed on their own time. Then yet another student started MD program fall of 2018, ended up completing most of spring 2019, fall 2109 and spring 2020 all remote from another state. Current student, not as close family friend, more acquaintance,  at another program said they will only had about 18 months of clinical from  s and part of them are remote, graduating 2023, but already has schedule.  You are right, medical schools have designated, required 151-152 weeks, those weeks, based on student reports, are sometimes (I've heard more often than not, but not all programs operate the same) scheduled as 4 days a week because they need time to study on day 5.  It can be done, if programs could admit that they are already functioning in such a way and just do little tweaking. It is my understanding medical school requires specific weeks, also positive med students don't always spend full days or even 5 days a week in clinic to count as a week. 100% sure because it happened in a clinic where I worked. Physician said they'd learn what they need in residency, this is just to give them a taste of various fields. 

[newton9686]

I mean several of my clinicals as a PA were only 36 hours (3 12s a week). So I don’t think that’s innately wrong. I also know during many of our internal medicine and surgical rotations they are doing 70-80 hour weeks with the residents as 3rd and 4th year med students, so its not always that easy. But I see your point, even though its 4 years its not like you are sprinting the whole time. If you remove breaks and basically everything after match day its probably only 38-39 months to begin with. I think the bigger issues are the MCAT, cost, and making the labs more conducive to working professionals. While it might not be realistic to work in med school for undergrads seeing everything for the first time, both myself and the other PA in our class still work fairly regularly (me more than him) But I guess my point is we have shown and many medical students have being doing medical school largely 70-80% remote for a long time. It would just take a program being open and advertising this as an option for PAs and especially removing barriers to entry like to MCAT. 

 

[Joelseff]

PA Botelho posted this on APPA Huddle about his proposal. 

https://huddle.aapa.org/discussion/new-program-for-advanced-practice-providers-to-further-career-to-a-physician-title?ReturnUrl=%2fbrowse%2fallrecentposts

Looks like he's done quite a bit of legwork. He states he spoke with several University Med School Programs and was even told by the AMA head of medical education "If the UK program is successful, this concept would be hard to argue against."

 

Edited September 27, 2022 by Joelseff

[kenbotelho]

Hi everyone,

I have posted the proposal to the AAPA huddle site.  The concept is based on a "competency based" education and therefore would include experienced PA/NPs.  Our idea is directly based on the work of Dr. Eugene Stead and the formation of the PA profession; taking a highly trained/skilled workforce and using a program to advance their ability to care for their patients.   This would allow us to be independent and without oversight.  Based on the conversations I have had with multiple Universities up to this point the designation likely will be unable to include "MD" and therefore would likely need to change.  However, the concept itself is strong.  It will likely require a considerable amount of support.   However when you look at it rationally, in an Internal Medicine/Primary Care setting (and multiple others) our day to day is very similar/at times identical to that of our attending physicians.  Therefore the competency based structure makes the most sense.  

The foundation of this program is: "Patients over politics, and practicality over prestige."

 

Ken Botelho

[kenbotelho]

I will post our proposal as well.

Physician Equivalency Program 2022.pdf

[kenbotelho]

[rev ronin]

PA Botelho,

Thank you for this. Good, forward-thinking ideas and solutions are even more welcome here than honest gripes are. Because we're a pseudonymous and open site, you may see trolls here you won't see on the Huddle. At the same time, you'll reach a lot of PAs who aren't members of AAPA or who don't participate on Huddle.

[ventana]

Need to sit and read this. 
skimmed it. 
 

seems like a possible idea 

most exciting is that someone is actually thinking outside the box.  We need a visionary leader that can inspire change with in our profession.  How about going after true reform for current PA??

 

[EMEDPA]

My main concern is that APP-MDs would be treated just like PAs. I can hear it already, "well maybe these folks did the classroom portion of med school, but we all know that the residency makes the physician..."

I wouldn't want to see grads of this program lumped in with med school grads who didn't do a residency and forced to work as associate physicians in a handful of southern states , still having their notes signed.

I think we need to go for full parity, just like the LECOM program. You graduate and you are a physician. You then do a residency, or at least an internship. In my mind, anything less and we will not be accepted as equals, and that would just be treading water for a current PA or NP.

[CAAdmission]

41 minutes ago, EMEDPA said:

My main concern is that APP-MDs would be treated just like PAs.

This is one really legitimate concern. We would still be third class citizens under this model, no two ways about it. 

My other major concern is that it should not include nurse practitioners. The PA profession was founded by a physician, modelled after medical school, and designed to follow a medical model. NPs always emphatically tell me they practice nursing and not medicine, they already have a doctorate, and they already have an avenue to independent practice. 

[rev ronin]

4 hours ago, ventana said:

We need a visionary leader that can inspire change with in our profession.  How about going after true reform for current PA??

Sorry, one can't even run for AAPA president unless you've served in the HOD and various checkbox positions for a number of years.

[kenbotelho]

Reform under the PA model/profession would be met with considerable and continued resistance as that is not the original design of the profession.  We would need to "prove" that we can complete the same testing and obtain further education to help advance.  In terms of NPs, some my not like it but we are already looked as equals by the majority of medical professionals.  Under a competency based model they are included.  Dr. Stead's vision included training corpsmen, did not matter which brand of the military they were serving.  Eventually this including training paramedics etc.  

In terms of being 3rd class citizens, we need to be aware that this will likely be the case for years. If anyone thinks that this would be an immediate success that would be equal or greater to a MD/DO is not a student of history.  When the PA profession started we were not well liked, or respected.  This would take time, hard work, advocacy etc. However if we were able to accomplish this we would have successfully created a pathway to a "Physician," would be able to practice independently/no oversight, and also be helping to reduce the "Physician shortage." 

Also we have tried to create a model, and discussed a plan to multiple schools regarding a program taking PA to MD. This would greatly disrupt their medical school credentialing and therefore they needed to discontinue any further discussions.  This would create a new designation and therefore put us at a Physician level/title.  LECOM's model is more of an "advanced placement" than it is a unique pathway that builds on our experience, skill set etc.  

Change takes time.  We need to start somewhere.  Patients over politics, practicality over prestige. 

[EMEDPA]

I like your idea in theory, and while I admit that I have not read the 84 page document I think it must have a few components.

1. ability to complete all didactic requirements on our own time while working at least part time as a PA. Watch recorded lectures, etc with a few on campus days for physical exam stuff, testing, etc

2. No mcat. Any requirement for this is a deal breaker.

3. ability to schedule clinicals in blocks with time off between blocks for life. ( for example 1 month of ICU rotation then back to work as a PA for a month then 1 month of general surgery, etc). It has to be a hybrid part time program or no one will do it. You can't ask people to give up 100k /yr+ to be guinea pigs for a program that may not change their practice.

4. Eligibility for USMLE step 1, step 2, and Step 3

5. A guarantee from the organization that accredits residency programs that grads of this program will be eligible to enter the match if they so desire. Realistically they will have to do at least 1-2 years of residency to be licensed in any state.