One Program for all clinicians?

[NewtonsApple]

I had a nice talk with my program director after class recently and he filled me in on a lot of things he has seen and been apart for his what I believe is 30+ years of being a PA. At one point he served on the AAPA board and along with others they voiced and idea for a system that would incorporate all of clinical training. There would be one program model for MDs, PAs, Paramedics, nursing (although adding nursing was futile on its own).

 

Proposed was that all students attend the same program for all levels of medicine. You would be excepted to the first level and your performance on exams along with desire would dictate your advancement to go to the next level. Each level would be a position in medicine and correspond to a certain amount of classes. Level one would be nurses and medics, two would be the mid-level provider, and three would be the Doc. Once you left school with a particular license you would always have the opportunity to reapply to the program and continue your education to advance. I believe there was an idea to have some apply and be accepted to a particular level or license and they could advance in the program with performance.

 

Of course this went about as far as a meeting and it was shot down. However, I think there are some great ideas in this model of education. I am curious as to what others think?

[EMEDPA]

Makes sense so it won't ever happen.

at least there is a bridge program now for pa's that gives us a yr of credit toward becoming a physician....now if they would just get rid of the mcat requirement....

[MCHAD]

I think it would be damaging to the PA profession...hear me out:

People already assume that because I didn't go to medical school I must have "Settled" for PA school because I am to dumb to get into a Medical School. With the system that you described, the people that really couldn't get into medical school would be forced to "Settle" at being a PA or RN if I understand what you are describing...

[marilynpac]

I have to agree with Chad, the people that keep advancing would certainly have a superiority complex and the ones who didn't would have an inferiority complex.

[popopo]

I concur with chad also

[COTA for now]

It seems to me that SOME PAs are very staunchly "I never wanted to be a doctor" and there is alot of tension around the subject of transitioning. I know in the therapy world, there are bridge programs for COTAs to become OTRs, PTAs to become PTs, in nursing there are LPN-RN programs, in respiratory there are CRT to RRT bridges. There are even programs bridging EMT-P or RRT to RN. The more I think about it, the more I wonder why PA to MD/DO is so much more controversial. Whenever I see comments citing the "we practice medicine, trained in the medical model of a physician" line of thinking it seems that in certain contexts, PAs very much choose to identify with medicine, which makes it seem a bit less like a wholly separate occupation. I mean, isn't the spirit/root of PAdom all about bridging from one spot in healthcare(Corps, RN, RT, EMT, etc) into something else?

[coloradopa]

It seems to me that SOME PAs are very staunchly "I never wanted to be a doctor" and there is alot of tension around the subject of transitioning. I know in the therapy world, there are bridge programs for COTAs to become OTRs, PTAs to become PTs, in nursing there are LPN-RN programs, in respiratory there are CRT to RRT bridges. There are even programs bridging EMT-P or RRT to RN. The more I think about it, the more I wonder why PA to MD/DO is so much more controversial. Whenever I see comments citing the "we practice medicine, trained in the medical model of a physician" line of thinking it seems that in certain contexts, PAs very much choose to identify with medicine, which makes it seem a bit less like a wholly separate occupation. I mean, isn't the spirit/root of PAdom all about bridging from one spot in healthcare(Corps, RN, RT, EMT, etc) into something else?

The thing about the other programs you mentioned (with the exception of the LPN-RN) is that there is no bridge program per se. You don't get advanced standing for OTA for OT etc (unless things have changed a lot in the last few years). In the case of LPN-RN both are licensed professions where there is common classwork.

 

In the case of PA to MD bridge its impossible to evaluate the academic and clinical experience of PA students. The PA profession does not have the same standardization that allopathic or osteopathic programs have. In one way its the strength of the profession. Programs can be tailored to meet the needs of the students and the communities within the ARC-PA standards. On the other hand it makes it difficult if not impossible to translate for another profession.

 

In my mind thats how it should be. The PA profession is a separate and distinct medical profession from physicians. We have our own standards of practice as well as clinical and didactic training standards. The other reason to discourage this is the upcoming situation with the residency system. There are already tens of thousands FMGs that are unable to get residency spots. As the number of US grads increase, the ability of FMGs, IMGs and osteopaths is going to shrink. At some point a finite number of allopathic grads will not be able to get residencies. If there is a path one way that gives medical school graduates a reason to demand a path the other - to be licensed as PAs. Historically we know how that works (poorly). By keeping the professions separate we keep that pathway closed.

 

David Carpenter, PA-C

[chatcat]

 

Proposed was that all students attend the same program for all levels of medicine. You would be excepted to the first level and your performance on exams along with desire would dictate your advancement to go to the next level. Each level would be a position in medicine and correspond to a certain amount of classes. Level one would be nurses and medics, two would be the mid-level provider, and three would be the Doc. Once you left school with a particular license you would always have the opportunity to reapply to the program and continue your education to advance. I believe there was an idea to have some apply and be accepted to a particular level or license and they could advance in the program with performance.

 

 

The problem with this is that all people who would enter this model don't have nor do they need the same level of pre_ requisite work to accomplish their level of care within medicine. Also, the specific programs of the various career paths in medicine have very different objectives for their level of care in the medicine team. I don't think a "one program fits all" approach is really feasible given the diverse roles in healthcare.

 

I had the privilege to meet and discuss the PA profession with Dr. Eugene Stead . This man was one of the most amazing educational innovators . His concept of taking corpsmen with extensive medical training and providing a unique curriculum to allow them to become better skilled in patient care by expanding their education was certainly a unique niche in the healthcare team of the 1960s. The PA profession was never meant to be a "bridge" to becoming a MD,rather it was created to meet the growing health care demands by training non MD professionals competent in clinical decision making.Dr. Stead's core belief was that the best training in medicine (for both MDs and PAs) was provided by direct patient care. He found the direction of Master's degrees in PA education quite interesting. When asked about the advanced academic degrees that has become the trend of PA education he wanted to know how this improved the outcome of patient care? ( Dr, Stead was such a no nonsense type of MD despite the fact that he taught at some very prestigious academic institutions... I got the sense he loved being a rebel in these institutions.)

 

Innovation in education is really needed in our current healthcare system to provide the needed manpower in most healthcare professions. The nursing profession has been quite proactive in innovative programs that take community college trained RNs and team up with 4 year universities to provide "fast tracks" to BSN status. I think it's wonderful that we now have an innovative program that allows PA-Cs to transition to MD with reduced training time. I would hope that the PA profession will explore innovative educational opportunities that would recruit other medical professionals with extensive medical training to becoming PAs.

[LESH]

I would hope that the PA profession will explore innovative educational opportunities that would recruit other medical professionals with extensive medical training to becoming PAs.

 

Well Cat I would say that some of us in the profession are still trying to do that...lol. Till 2020 @ least :)

Lesh

[rev ronin]

In the case of PA to MD bridge its impossible to evaluate the academic and clinical experience of PA students.

 

Sure you can. It's not going to fit into the existing models, but there are plenty of methods--albeit untried, likely time consuming, and difficult to tune--by which to evaluate PAs who want to uplevel.

 

There are already tens of thousands FMGs that are unable to get residency spots. As the number of US grads increase, the ability of FMGs, IMGs and osteopaths is going to shrink. At some point a finite number of allopathic grads will not be able to get residencies.

 

The FMGs who are unable to get any match are either 1) too picky, in that they're just not willing to locate for one of the thousands of family medicine residency spots which go unfilled every year, or 2) not competitive. You're also positing no increase in the number of residency spots, when in fact the federal government has been planning on expanding the funding available for such slots. Rather, the biggest problem with the residency system is that is a de facto indentured servitude with inhumane working conditions that undermine patient safety, which young, unattached MD students with no life experience are willing to tolerate in hopes of a huge payoff once it's over.

[Febrifuge]

My knee-jerk response is that this model would exacerbate the problem we have when people ask us, "so when are you going to complete your training?"

 

The pure fact of it is that I had the opportunity to be an MD, and I didn't want to. I wanted to be a PA. I think it devalues the PA profession a little bit to encourage the misconception that we are somehow "junior doctors" or something. It's a fine line, because in some ways and with the right kind of understanding in place, that's not a horrible description... but in the sense that the public hears the word "Assistant" and assumes we are either unfinished or just plain not qualified... no. Just no. Being a midlevel is a great choice for me, and I love what I do, but every single day I bump up against some form of basic misunderstanding about what I am, and what I do. Anything that makes that worse, I can't support.

[EMEDPA]

Feb...that's why it's so important to support the name change to physician associate.....never say assistant again....

The association of fp pa's just came out in support of this in addition to the >100 "prominent pa's" including former presidents of the aapa, progranm directors, high ranking military officers, and members of the first class at duke who signed off on this campaign earlier this yr.....

SEE THIS EARLY VERSION :

http://www.physicianassistantforum.com/forums/showthread.php?t=25777

[chatcat]

Well Cat I would say that some of us in the profession are still trying to do that...lol. Till 2020 @ least :)

Lesh

 

Lesh:

Keep up the good work!

As you know,our professional has definitely seen a shift in the demographics of our PA applicants. One of the shifts in PA training is a trend of favoring academics over health care experience by some programs. Those of us who have been in the professional for decades know that a Master's degree doesn't equate to better clinical training. I know some outstanding PAs who entered this professional with years of previous health care experience(Medics, EMTs, RT) yet lacked extensive academic background.These non degree applicants received a certificate from a PA program,passed PANCE and now are PA-Cs. We are loosing such capable applicants with the current trend of academic focus over health care experience.

Personally, I think it would be an innovative educational move if we allowed more diversity in training and academic degree options...there really is more than one way to train a PA-C.

[Febrifuge]

Feb...that's why it's so important to support the name change to physician associate.....never say assistant again....

Thanks; I'll check out the URL. And I do introduce myself as a "PA," following up if people ask with "Physician Assistant, otherwise known as Physician Associate." It's also interesting to me that my new name tag (for my new Urgent Care job) reads "Physician Asst. Cert." ... like that's not confusing.

 

And now that the election is over, I'll be asking my state House rep to support adding "Physician Associate" to the list of titles that per state licensure board rules can ONLY be used by licensed PA's. I figure this is a relatively easy introductory step; next comes making 'Physician Associate' an allowed/ preferred term within my employer health system.