"APP-MD Bridge" Program?

[kenbotelho]

It would be considered an Apprenticeship program and therefore you would be compensated, at least part time for your work with your PA license and seeing patients (see apprenticeship portion of the proposal).  Any further details would need to be ironed out regarding specifics.  

Yes it would include a didactic component in order to sit for the appropriate examination(s).  Do not forget this is a new designation.  We are already practicing medicine actively, writing prescriptions, ordering lab/diagnostic testing.  Residency is designed to learn how to "practice medicine."  This concept has yet to have been explored in a setting where we are "building" on our current skills/experience etc.  Would need to, again, iron this out further with accepting schools. However I do not see Residency as a requirement to practice-especially if this remains a generalist/primary care program and the "apprentice" is actively working as a PCP.

MCAT- would be a deal breaker for our program as well.  It is completely irrelevant to our ability to practice.

[newton9686]

I guess I am trying to understand what would be the benefit? Because for me going to medical school is all about getting the “Golden Ticket” to apply for residency. So if there is no residency are we just talking about independent practice? I mean seems like a lot of work when NPs already have independent practice in the outpatient setting in 50% of the states. 

I did read through much of your proposal Kenbotelho. I like where you head is at, but I think at the end of the day the goal has to be a program that is equivocal to MD, and if not equivocal we need to have an ability to apply for residency. That is the difference. That has to be the goal. 

You are right, Med Schools aren’t going to just give the title of MDs to PAs without the traditional path. And if they aren’t willing to admit the benefit PAs add to medical training (which we do), my thought would be money talks. What if we approached it this way. Every year hundreds of med students drop, sometimes before 2nd semester. That’s millions of dollars these medical programs lose out on and hundreds of physicians that are lost because some 22 year old decided med school was too hard. 

My solution would be to take advantage of these lost spots which are basically wasted right now. Why not offer PAs clinical PHD that basically covers the first 2 years of medical school in an asynchronous fashion (could easily be done). Then when a student drops out the PAs who are currently in or graduated this program can apply for a spot in the class to start 3rd year with everyone else, after a couple month ramp up period. 3rd and 4th year really are only 18 months (you are done basically after you match in March). As long as you made it relatively affordable and gave a clinical PHD, I think a lot of PAs would choose this over the current DSMC even if a clinical spot was not guaranteed. Because worst case scenarios these PAs could start teaching the first 2 years of medical school or at PA programs (would honestly be a step up from a lot of the PHD lectures from not clinicians that we recieve) and Med schools would make more money both by offering another degree with their current material and more importantly take advantage of these wasted spots every time someone drops out. 

Bonus, I feel like a lot of programs are scared to take kids from disadvantaged backgrounds with lower stats and MCAT scores which is why we have such a lack of diversity because they are afraid of them dropping out and losing out on 3.5 years of tuition and a future doctor. However if you had a pool of PAs ready to fill in behind them, you could enroll more students from disadvantaged backgrounds and you are either 1) graduating more diversity or 2) graduating more clinical experience. 

Anyways I am really passionate about making a way for PAs to become MDs. I’m sure there some flaws in my plan but if you ever need some help from someone currently in medical school let me know. 

 

[kenbotelho]

Benefit:  Reduction of physician shortage providing patients with the highest level of care by further educating/training PA/NPs, reducing their barriers to independent practice and would be vying for full insurance reimbursement.  This would also improve our leadership in the field. 

 

Your plan was similar to that of our original plan which was  unfortunately rejected by many medical schools.  This would jeopardize their accreditation and they discontinued the conversation regarding the topic.  There was some room for an advanced standing consideration, similar to that of LECOM.  This was however not my vision for building on our skills/experience. 

[ventana]

no way do I want to give 2-3 years of my life to have some other degree which still is never going to equal MD or NP

[Hope2PA]

It will be a near impossible task to work around requirements of time. If anyone could manage it would be NP to MD because they have power in numbers, however they don't need medical school.  They will be fully independent in all states within 10 years, will have begun getting pay parity, or near that in initial states within few years for DNP, all Without the time and effort of med school. PAs don't have number/power,  and anything less than med school will still likely leave you with limited practice. 
Medical programs could do the following to get great physicians:

1. Eliminate MCAT for PAs, around 50 programs do not require MCAT for students who sign up for BS-MD or DO straight from high school and maintain 3.5 undergrad. Exceptions are made.

2. Based on AAMA total of 156 weeks. Those weeks are broken into blocks. Allow PAs to take online self paced courses, with occasional in resident check ins., students do online now anyway. It May take someone working 8 weeks to complete 4 week block, still counted as 4 of the 156. Clinical rotations harder to figure, AAMA "average" weeks, when totaled equal 74. That's about 17 months, you'd think some limited rotations could be worked out, ie. A family med PA get credit by just working in family med, even take electives  in family med. leaving maybe 12 months of no income, doable.

3 Then allow to match for residency. I bet a surgical PA would be an amazing surgical resident, and very valuable to the program. 
 

[EMEDPA]

I would hope any potential bridge would not be limited to primary care. The LECOM bridge allows 1/2 the class to commit to primary care and half to apply to any specialty. Their match list is pretty good for EM, ortho, Anes, etc.

[Reality Check 2]

Alas, I am too old for this now….

[Joelseff]

25 minutes ago, Reality Check 2 said:

Alas, I am too old for this now….

I am too and with my physical limitations I can't do it. Besides, I finally reached a point in my career where I do good Medicine, get pretty good respect from colleagues and pay is enough to support my family on one income plus some luxuries and I don't see myself going back to school now... Maybe 5-8 years ago... I think this is more for the next generation or at the very least, start the conversation of gaining independence for our profession OTHER THAN OTP (which let's face it is not exactly independence and not really winning hearts and minds). 

Edited September 29, 2022 by Joelseff

[deltawave]

How long did it take DOs to achieve parity? 
 

See you guys in 20 years. 
 

Best bet is to just continue the path. Get the “Doctor of…” titles out there so legislators who only see “assistant” or “associate” will allow legal parity. Too many roadblocks and detours trying to satisfy AMA, ACEP, WHO, etc. Go ‘round and get the law makers on board and we can achieve what the NPs have done without doing a “residency,” going back to school as an apprentice, or taking time to do what we already do unpaid. 
 

Lobby federal and state legislatures with money and voters. This is how business works these days. 

[kenbotelho]

This is unquestionably difficult.  The Apprenticeship portion of the program would allow for PAs to continue to practice, albeit part time, while working towards this new designation which would not have restrictions and would ultimately be seen as a "Physician."  In regards to the focus being generalized practice (Emergency, Internal, Family etc) this is simply to appeal to a broad audience, filling a considerable need.  My hope that this would be successful and allow for additional specialties in the future.  However further negotiations and input from the accepting institution would help make this clearer.

[EMEDPA]

14 hours ago, Reality Check 2 said:

Alas, I am too old for this now….

You and me both...just got my exit strategy job, granted I will probably be there for 15+ years. 

[Reality Check 2]

At least 10 more years for me at govt job - vested pension and hopefully lifetime insurance.

Can't see school now for much more than a Masters in Health Administration - cue the Dark Side and Darth Vader voice.....

Try to retire at top grade and pension payments.

Now, back to my regularly scheduled mayhem.

 

[ventana]

no way do I want to give 2-3 years of my life to have some other degree which still is never going to equal MD or NP

 

 

yup NP is already autonomous.... why do we need to spend 10's of thousands and ongoing education and stress when NP already have it??

[EMEDPA]

1 hour ago, ventana said:

yup NP is already autonomous.... why do we need to spend 10's of thousands and ongoing education and stress when NP already have it??

 

[kenbotelho]

Thanks for the feedback everyone.  Criticism is essential for growth.  I appreciate your input.

[PAMalignantHeme]

Here is the PA Malignant Heme reality check ...... 

 

1. The clinician / physician shortage is in very specific specialties and regions of the country. It i s unlikely to benefit much by increasing the number of private PA MD NP programs. Largely speaking there is no clinician shortage in the US. And we are producing a number of NP/ PA that NO workforce model accounts for. Even some health workforce expert studies which comment on shortage do not include NP/ PA contributions. I met with a health workforce expert once on a panel at a policy conference that didnt even realize the role of PA in primary care. He did not realize PA could independently see patients in primary care setting. Also the explanation for this shortage is intentionally vague so politicians have talking points and universities looking to create cash cow PA/ NP programs can appear altruistic. At a cost of 150k for PA school not many people 200k in student debt are looking to move into a rural or urban underserved area and work primary care for 100k a year. 

 

2. Medical Schools / Medical Intuition has little to no incentive to create shortened programs that will require significant cost to construct. Why not have the customer (thats what students are to universities, sadly)  just come in for the full 4 years like they are doing now. They have no shortage of applicants for that. Why create a different model?  

 

3. The solution is improving PA practice laws and making NP education more robust to meet their desired job descriptions. Also we need funding to support some programs that allow for shorter medical school / training for MD who only want to work in primary care. Maybe some tax and other incentives for people who want to work in underserved primary care settings? This is already being done in some areas. 

 

 

 

[ventana]

Just a thought 

PA with >10 years of supervised practice become fully independent for PCP.  And reimbursed at 100%

[Reality Check 2]

27 minutes ago, ventana said:

Just a thought 

PA with >10 years of supervised practice become fully independent for PCP.  And reimbursed at 100%

Let me take the FP or IM boards to prove it

[deltawave]

18 hours ago, Reality Check 2 said:

Let me take the FP or IM boards to prove it

You shouldn’t have to. 
That’s the point.

Plus, they would never allow it. Big Med isn’t handing over the perceived keys to the kingdom. Again, only the law makers can. 

[Reality Check 2]

I have no problem proving my worth by taking a test that a physician takes.

Something has to give. 

The PA profession is going to die at the hands of NPs and their independent status.

I am too old to go to Medical School and not willing to incur a couple hundred thousand in debt.

Give me a path after 30 years to do more and help with the Primary Care and Physician shortage.

We have to do something.

AAPA sure isn't. 

[rev ronin]

22 minutes ago, Reality Check 2 said:

AAPA sure isn't. 

They've recently published a new logo, a new marketing campaign, and are retooling Huddle so that fewer people feel unsafe when confronted by other opinions.

[Hope2PA]

2 hours ago, rev ronin said:

They've recently published a new logo, a new marketing campaign, and are retooling Huddle so that fewer people feel unsafe when confronted by other opinions.

They, along with narrow minded HOD, ignored the million dollar research on how to best rebrand for future. Are now spending more money on what was determined by experts as not a good name brand. But yes they have done a lot for PAs , however with something so important as marketing, along with still keeping mindset of must be forever tied to physician, they have totally wasted a lot of time and money. Still to narrow minded to see their error. Just like a patient who ignores solid scientific research medical treatment and instead chooses  treatment their psychic healer suggested at the same cost. Very smart. 

[Reality Check 2]

The day AAPA uses the words for LIP or autonomy, independence and actually does something besides an asinine paid study that they will inevitably ignore - that is the day they will see another dime from me. 

When the subject is THIS big and this important and the surge of NP only jobs is THIS big - and AAPA is SILENT…… not addressing the 1000 lb purple elephant in the room - I do not encourage anyone to go the PA route and certainly NOT NP - go to medical school.

[ohiovolffemtp]

ACEP also announced major campaigns against any increased scope of practice or autonomy for PA's or NP's.

[newton9686]

On 10/2/2022 at 2:36 AM, ohiovolffemtp said:

ACEP also announced major campaigns against any increased scope of practice or autonomy for PA's or NP's.

I mean you have to look at the context of this as well. With the recent ER report suggesting there will be an oversupply of ER physicians in large part to the growth PAs and NPs by 2030, this is an expected statement. Literally no one in medical school is going Emergency Medicine right now. The match rate last year was better than Family Medicine I think. Like we have international grads getting into Duke’s ER residency which is pretty unheard of. Sucks for me because I am looking at primarily anesthesia and radiology which has absorbed a lot of the applicants who would of probably applied ER before this report which made them super competitive matches literally overnight. 

The problem with emergency medicine is 80% is relatively routine care that can be managed by your average PA or NP. As most MDs and DOs want to work with PAs and NPs who can help with less acute patients so they can focus on the sicker patients. The challenge comes from being able to manage that last 10-20%. And as a lot of our Solo PAs on this board will tell you, those PAs and NPs are not a dime a dozen. We’re talking bad asses with at least 5 years experience at a minimum, with the majority 10+. Plus most of the time ER trained physicians do not want these jobs and they would otherwise be staffed by family medicine physicians with limited ER experience (who usually rely on well trained ER PAs for all the procedures). So I just have a hard time seeing ER physicians being ran out by PAs and NPs.  Personally, I know I can run a fast track and help manage and stabilize the sick ass medical patients  when we get overrun (which is most days) after working a couple years in urgent care and as a hospitalist. But no way in hell am I signing up to work some small town ER and being the only doc present and being liable for everything that walks through the door with resources that mirror that of an urgent care. And unfortunately unlike CRNAs and surgeons who can decide who to operate on in small town hospitals, you cannot stop someone from walking through the door as a ER patient, even if it is not in the patients best interest because you don’t have the resources to care for them. Trust me I have tried lol. But right now the sky is falling in ER world so ACEP is going to say what is in the best interest of their constituents first before considering anyone else.  

Yeah its unfortunate that the ACEP has this stance. Because I do think PAs and MD/DOs could work together to better staff these small town hospitals without threatening the future of the ER profession. But when you follow the Benjamins, this is an expected statement. ACEP has also always hated PAs and NPs so there’s that….