Dr. Stead's PA to MD Bridging proposal.

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Happy613

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After reading through many posts in this forum I find myself fascinated by the notion of a PA to MD bridging program. My interest stems primarily from what I see as a severe need for an increase in primary care providers to meet the needs of society. A society that is already hurting from a lack of physicians. A situation that will only be exacerbated as the “baby-boomers” get older. I don't feel very comfortable with doctorates in nursing or the sometimes relentless push to "expand scope of practice," but a truly legitimate and accepted bridging program would be of great value to society.

I came upon the website of Dr. Stead the founder of the PA profession, he details a very insightful plan that would allow midlevels to take a sort of correspondence based course over the internet, while being mentored by a physician. You can check out the details here

http://easteadjr.org/guest.html.

In essence it would allow midlevels to attain an MD degree without having to begin as an MS1. He sets forth various criteria, such as a minimum age of 27, a masters degree, --and perhaps most interestingly-- a required commitment to practice primary care in their home community.

I would be interested to hear peoples reactions to his position paper, since there have been some really interesting discussions on this topic previously. :)

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emedpa said:
I'm all for it...bet you couldn't have guessed that.....

and you would make an excellent MD EMEDPA, plus you can still precept me!!!

im sure this will become a reality in the future, hopefully not to distant, as more and more MD's are heading towards other specialties b/c FP probably deal with the most and get paid the least, not fair at all! i think most PA's who would likely follow this route would be older and know that they want more from their profession. and there should be some kind of commitment towards a FP/IM/PEDI/OBGYN specialty. i heard alot of OB's are scared of lawsuits these days!!!! :eek:
 
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Oh yeah, I'm in for it too . But first I got to get into PA school. :)

Nev
 
I'm not sure if they are offering an MD with a specialization...if they dont, then whats the use of doing 5 years as a PA to MD bridging program. In that case one can got to med school and get their MD there itelf.
 
nev said:
I'm not sure if they are offering an MD with a specialization...if they dont, then whats the use of doing 5 years as a PA to MD bridging program. In that case one can got to med school and get their MD there itelf.


If someone can show me one PA who is in a US residency after completing such a program, or any similar program, please point them out. There are only a handful of Carib programs that will land you a US residency, and that is tenuous at best. Even the big 3 schools have trouble getting people in residencies and ultimately licensed, and this is after 4 years of FULL TIME school. State boards are not stupid. They see that someone completed basic sciences from a distant learning curriculum and that just won't pass the scrutiny of the licensure requirement. If you want to become a physician, you are going to have to go to medical school. Currently there are no known shortcuts that are legitimate. Trust me, I would probably be the person who would know.
 
PACtoDOC said:
If someone can show me one PA who is in a US residency after completing such a program, or any similar program, please point them out. There are only a handful of Carib programs that will land you a US residency, and that is tenuous at best. Even the big 3 schools have trouble getting people in residencies and ultimately licensed, and this is after 4 years of FULL TIME school. State boards are not stupid. They see that someone completed basic sciences from a distant learning curriculum and that just won't pass the scrutiny of the licensure requirement. If you want to become a physician, you are going to have to go to medical school. Currently there are no known shortcuts that are legitimate. Trust me, I would probably be the person who would know.

These threads always end this way..as I thought!
 
Threads don't always end by you having the last word! SDN has been having issues, so people haven't been around to contest you.

I am wondering why you claim that carribean med schools have problems getting graduates into US residency, I looked at a few of the programs, and the big ones declare they have 100% success of placing students into US residency, of those that attempt to gain such. I would find it hard to believe if these statements are blatant lies. I do understand the residencies might be far from desirable locations and hospitals, but they are US residencies leading to US B.E., and thats all that really matters.

Matt, I would love to see substantiated evidence of United states citizen carribean medical graduates being "**** out of luck" when it comes to finding a residency.

This is no way meant to be an attack, just want to get the lowdown.
 
adamdowannabe said:
Threads don't always end by you having the last word! SDN has been having issues, so people haven't been around to contest you.

I am wondering why you claim that carribean med schools have problems getting graduates into US residency, I looked at a few of the programs, and the big ones declare they have 100% success of placing students into US residency, of those that attempt to gain such. I would find it hard to believe if these statements are blatant lies. I do understand the residencies might be far from desirable locations and hospitals, but they are US residencies leading to US B.E., and thats all that really matters.

Matt, I would love to see substantiated evidence of United states citizen carribean medical graduates being "**** out of luck" when it comes to finding a residency.

This is no way meant to be an attack, just want to get the lowdown.

Adam,
You need to read before you start typing. This thread is about a BRIDGE program that several non reputable Carib schools are offering PA's in order to get their MD degree in an online format and with minimal education. This thread is NOT about the big three Carib programs that are 4 years in nature and where 2 years are spent on campus. These reputable schools are AUC, SGU, and Ross. But if you really want to start an irrational argument, here in Texas, even these big 3 schools are having trouble getting their grads licensed. Our state medical board is so careful of who they allow to have a Texas license that they have been turning down a lot of these grads even after they have COMLETED a residency in our state.

But this thread is about having someone corroborate the fact that a PA has made it through one of these shortened bridge programs with no basic science time spent on an island (hence done on the internet as these programs allow). I beg someone to find me someone who made it past a state licensing board with such a transcript. I will even admit that there are probably people from these programs who are non-PA's who completed the 4 year version of the school's degree and may have been given a residency.

I think you just got the wrong idea about this thread Adam...no hard feelings. And about threads ending this way, I am simply saying that every thread ever started on SDN about some "pie in the sky" way for PA's to become physicians easily has never amounted to anything other than speculation and rumor.
 
adamdowannabe said:
Threads don't always end by you having the last word! SDN has been having issues, so people haven't been around to contest you.

I am wondering why you claim that carribean med schools have problems getting graduates into US residency, I looked at a few of the programs, and the big ones declare they have 100% success of placing students into US residency, of those that attempt to gain such. I would find it hard to believe if these statements are blatant lies. I do understand the residencies might be far from desirable locations and hospitals, but they are US residencies leading to US B.E., and thats all that really matters.

Matt, I would love to see substantiated evidence of United states citizen carribean medical graduates being "**** out of luck" when it comes to finding a residency.

This is no way meant to be an attack, just want to get the lowdown.


The program that this school is offering is very diffrent from most traditional Caribean medical schools curriculums. I know that schools like SGU and Ross have almost 100% placement in residencies in the US.

I posted the link initially b/c I thought it was a dynamic way to allow PA's to transition to an MD degree. In fact the format of the program is very similar to what Dr. Stead the founder of the PA proffession has written about.

However I just saw a webpage, that calls into question the notion of "internet medical schools." The catch is that this program is not just for PA's who have been practicing in the US successfully....its for anyone!!!

http://www.internetmedicalschool.homestead.com/

Now back to q-bank :(
 
PACtoDOC said:
If someone can show me one PA who is in a US residency after completing such a program, or any similar program, please point them out. There are only a handful of Carib programs that will land you a US residency, and that is tenuous at best. Even the big 3 schools have trouble getting people in residencies and ultimately licensed, and this is after 4 years of FULL TIME school. State boards are not stupid. They see that someone completed basic sciences from a distant learning curriculum and that just won't pass the scrutiny of the licensure requirement. If you want to become a physician, you are going to have to go to medical school. Currently there are no known shortcuts that are legitimate. Trust me, I would probably be the person who would know.


There are only a handful of Carib programs that will land you a US residency, and that is tenuous at best. Even the big 3 schools have trouble getting people in residencies and ultimately licensed, and this is after 4 years of FULL TIME school.


This was what I was refering to, obvioulsy the random PA-MD bridges from far off nations are a risky educaitonal endevor at best, but when you added the idea that the big 3 can't get you anywhere, THAT is what I was contesting.

I do read the threads, I just reply to specific comments without clarifying, my bad..... I will try harder next time!
 
But does that give NPs also an equal chance of turning into MDs?
 
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Obviously not...then it wouldn't be a PA to MD bridge, it would be an NP to MD bridge, one thing that can't be overlooked, an NP will always have their foundations in nursing, and typically only become an NP in a specific area,

the PA has their foundation in medicine, and the basic specialties too, so it would be a different bridge to cross for each.

I have this cool idea though, someone should create a BA/BS to MD educational model, I'm thinking something around 4 years or so, then a few years working under close supervision, that should work right?

*Please accept my humor as best as you can, thanks**
 
adamdowannabe said:
Obviously not...then it wouldn't be a PA to MD bridge, it would be an NP to MD bridge, one thing that can't be overlooked, an NP will always have their foundations in nursing, and typically only become an NP in a specific area,
the PA has their foundation in medicine, and the basic specialties too, so it would be a different bridge to cross for each.
Adam,
Although I agree with your explanation, Dr Stead's proposal DID include all midlevels (yes, PAs and NPs). As a matter of fact, this is what he wrote:

"Throughout the country, colleges and universities are expanding their traditional programs to meet the needs of "non-traditional" students. It is time for accredited medical schools to do the same. They should establish distance learning curricula that would allow experienced community-bound health professionals, such as physician assistants (PAs) and nurse practitioners (NPs), to take medical school courses from home or at work. By doing so, they could build upon the talents of these "non-traditional" but seasoned clinical veterans to increase the number of practicing doctors in rural and medically underserved areas as rapidly and cheaply as possible. .......
What should be the admission requirements for these community-bound, non*traditional students? I would suggest that the first pool of applicants be drawn from the ranks of physician assistants and nurse practitioners who are already working in collaboration with physicians in certain targeted communities of great medical need. These individuals should be at least 27 years old, have master degrees and have graduated from accredited educational programs that included one year of the sciences necessary for medical practice and one year of rotating clinical clerkships necessary to work in primary care specialties and settings. Most PA and NP schools meet these requirements. Finally, the candidates should have completed at least three years of practice under the supervision or in collaboration with a MD or group of MDs who are willing to write support letters and to serve as mentors for them once they are accepted into the distance learning program. "---Dr Stead


BAM
 
This might make me sound ignorant, but I feel it just shows my lack of knowledge:

I wasn't aware that NP's did an entire year of rotating clerkships of the medical specialties, but more specifically spent 500-900 hours in clerkship in their only area of study (family med, pediatrics, women's health, etc) which would by nature of stead's requirements put NP's out of the runng.

And, then again, I question if NP's do an entire year of medical sciences as opposed to some medical diagnosis and treatments class along with all the advanced nursing courses they take.

This is in no way picking a fight, again, it might be my ignorance, this is just what I have come to understand from reading certain posts and certain NP program websites. Please correct me (albeit nicely) if I am wrong.
 
I've been biting my tongue (fingers?) on this one but have to chime in.
Adam, did you read Dr Stead's proposal? I did. Interesting, but I don't think it will fly. What I think this would create is a two-tier system of physicians in the US where "traditional" MDs are looked at differently (preferentially?) than "bridged" MDs. When it came time to do credentialing for third-party payors (insurance, etc.) and hospitals, not to mention malpractice, I can't imagine these "bridged" MDs would be treated equally.
We probably do go over the top when it comes to educating physicians in this country, but the system, however imperfect, is firmly in place and very slow to change. 35 years ago when Dr Stead proposed PAs, the medical community met the idea with skepticism at best and outrage at worst. PAs have proved their worth in the US and definitely fill a need; I am convinced there will always be PAs as long as our medical educational system remains "traditional".
On a personal note, I've been a PA for five years now, working in the trenches of primary care. I was well prepared to practice medicine WITH SUPERVISION (far less supervision now than when I first graduated--now I very rarely need to consult) as a PA, but I am continually reminded of what I don't know. I wouldn't feel comfortable as a "bridged" MD, which is why I've rejected the Caribbean extension programs. I think the biggest thing about becoming a physician is not medical school, though, but residency: this is where MD/DOs really LEARN how to practice medicine. Sure, I could do a PA residency in some particular discipline, but then I would still be a PA.
You could also argue that my first 3 years out of school were my "residency", and in a sense they were. From that perspective, medical school might be a breeze for me now, but I have other reasons for wanting to go back (personal ones mostly).
Thoughts?
Lisa PA-C
applying for MD 2006

adamdowannabe said:
This might make me sound ignorant, but I feel it just shows my lack of knowledge:

I wasn't aware that NP's did an entire year of rotating clerkships of the medical specialties, but more specifically spent 500-900 hours in clerkship in their only area of study (family med, pediatrics, women's health, etc) which would by nature of stead's requirements put NP's out of the runng.

And, then again, I question if NP's do an entire year of medical sciences as opposed to some medical diagnosis and treatments class along with all the advanced nursing courses they take.

This is in no way picking a fight, again, it might be my ignorance, this is just what I have come to understand from reading certain posts and certain NP program websites. Please correct me (albeit nicely) if I am wrong.
 
Ok..I'm sorry if my question sounds wierd. But what is I become a PA and specialize in internal medicine and work in that same field for 5 years. Then I decide to go to med school and get an MD. Does that give me any advanced placement to becoming an Internal medicine MD?
Thanks
Nev
 
nev said:
Ok..I'm sorry if my question sounds wierd. But what is I become a PA and specialize in internal medicine and work in that same field for 5 years. Then I decide to go to med school and get an MD. Does that give me any advanced placement to becoming an Internal medicine MD?
Thanks
Nev

Nope. There is currently no U.S. allopathic or osteopathic program that grants advanced standing based on prior education or experience (other than for classes at another medical or dental school). Several do allow incoming students the chance to "test out" of some basic science courses - but these tests are extremely difficult. Some of the "practical" coursework in medical school will be "easier" for you, but you will still have to take them...

As for an IM residency, I doubt highly that any of them would give you credit for "time served". Not out of disrespect for PAs, but rather because of the financial and production benefits to the institutions hosting the residency.

- H

Sorry.
 
Ditto. If there were a shorter path to MD that still resulted in me obtaining a desirable US residency, I would've found it. I've looked!
Lisa

FoughtFyr said:
Nope. There is currently no U.S. allopathic or osteopathic program that grants advanced standing based on prior education or experience (other than for classes at another medical or dental school). Several do allow incoming students the chance to "test out" of some basic science courses - but these tests are extremely difficult. some of the "practical" coursework in medical school will be "easier" for you, but you will still have to take them...

As for an IM residency, I doubt highly that any of them would give you credit for "time served". Not out of disrespect for PAs, but rather because of the financial and production benefits to the institions hosting the residency.

- H

Sorry.
 
Another thing: it's not that I want "shorter" because of skipping steps but because of the amount of money it's going to cost me to go back to med school, not just in terms of tuition but in lost earned income while I'm in med school!
Lisa

primadonna22274 said:
Ditto. If there were a shorter path to MD that still resulted in me obtaining a desirable US residency, I would've found it. I've looked!
Lisa
 
I really think that the brdging program is a great idea and I do feel that there is nothing wrong in becoming a doctor through certain strict shortcuts. No offesne, but I have encountered doctors who go to medical scool, complete fellowships and are USELESS! On the other hand, I have seen PAs in that same field practicing 10x better than the physicians.
 
Personally, I believe that a bridge program would produce physicians that are better trained and prepared for entry-level healthcare (at least with a PA to MD/DO bridge program). I would put physicians who went through the "bridge" as the first class physicians and the typical medical school model second. If you have the all the didactics along with a residency, why would you be less of a physician, especially considering a PA's previous experience and knowledge. I think it's reasonable to believe that 1. A PA could consume more material more quickly because they are already conversant with medicine and can already extrapolate complex medical cases. You could throw more advanced material at them over x amount of time. (especially using PBL) 2. If a PA has 3 years experience coupled with more classroom time and a residency, you have a physician who in theory should be better prepared than four years of medical school and a residency. Perhaps the argument is that PA schooling covers less detail so they are not interchangeable credits.
My argument is that it may be true, but probably carries little to no weight educationally. If you provide PA's with one year of didactics in a bridge program, you could cover material that a second year medical student couldn't touch. Follow it up with one year of rotations followed by a residency. There is a reason why medical schools are starting to give students clinical exposure earlier in the medical training - because it has value and engages the student.

Our educational system is not ideal. Meaning there are better ways to create a learning environment than we currently use in the US. Part of why undergrad is four years has to do with efficiency, tradition and money. It's reasonable to say that not all four year degrees are equal. Basically what happens is an educational institution tailors a program to meet the four year deadline, even if that means stretching out X amount of material over four years to give somebody a hotel resort management degree or cramming in a crapload of information and work over four years to give somebody a mathematics degree. My point is that there are better ways to train a physician, but we would have to extend the length of medical school/training. In fact it would probably look like something along the lines of a PA program followed by xy years of practice with supervision (similar to a PA role) in three different settings like EM, IM, FP (or whatever - in fact you could make it so the student could do this for 2 years or ten - whatever they needed or wanted financially.), followed by 10-12 months of classroom, followed by a year of practical rotations and then a residency. Certainly, residency would be slightly different, but would prepare residents for board certification. There seems to be a great deal of value to a student when they receive classroom instruction followed by practical experience, followed by another classroom experience. The initial classroom experience is needed to give students a base for the practical experience. When the students return to the classroom after their practical experience, the students are so much more engaged to the material and can really begin to understand it functionally. I think the medical school model that we use now works, but isn't necessarily the best for the student either educationally or financially. Medical schools have basically tailored the program to fit neatly within a four year block of time. Why four years, who knows - It works, but it works best for the academic institutions, not the learner.



I think the whole PA to MD/DO bridge thing is interesting because it is happening in other high profile vocations as well. In the state that I live, we have just changed the way that our police officers are trained. It used to be that if you wanted to become a police person such as a sheriff or a town cop, you went to the police academy, but if you wanted to be a STATE TROOPER, you went to the state police academy that was tougher, meaner, longer and more demanding in the classroom. If you were a sheriff or a town police officer and wanted to become a state police officer, you had to go to the SP academy just like everybody else. The state reevaluated this practice because of two reasons, 1. It’s expensive to run two academies 2. The SP academy only occurred when there was a need for new state troopers so they only took applications every two-five years when they could take on a full class. The problem was this always created a shortage in various parts of the state. The state police commissioner resisted the desegregation of the academies simply because of what the academy represents, but the state decided to streamline the training. Now all cops go to the same academy for twelve weeks, but the state cops go for an additional 6 weeks of training to learn the state police way of doing things. Now if a town cop wants to become a state cop, they simply apply and if they are accepted, they only have to complete the six weeks of training essentially creating a bridge program. It makes sense because you can build from the skill and experience of seasoned police officer and end up making a better state cop. Ironically, it’s very similar to what we’re talking about here.

If higher education became a "socialized" government program were college was paid for from taxpayer money, there is a chance that college education could change dramatically. It would probably be more evidence based as compared to today’s capitalist based educational structure where a student is looked at as a source of revenue as opposed to a learner/student. Further, it’s realistic to believe the government would look for ways to reduce the financial burden of college to the tax-payer. Hopefully it would put an end to all the inflated degree programs and allow undergraduate programs the flexibility to train students based on the needs rather than the number of credits the institution is looking to bill for.

Good enough, L.
 
I think new bridging programs, especially offshore are a bad idea more because the graduates would be marginalized than because its not a workable idea.

I think it would be fine for current medical schools to admit PAs into their 3rd year classes if they can score well on the board exams. BUT they should have to complete a full residency just like other MD grads before they can be board certified. There should be no shortcuts for that.
 
Well, that was one of Dr.Stead's thoughts and I dont know if he had actually proposed it to the responsible authorities who would make this bridging program a reality. And sadly, Dr.Stead passed away a few days back.
 
I'm just revisiting this post. I admit that lawguil's arguments are compelling, but I'm still hesitant.
Why? Because I've been a PA in the trenches for five years. I work in family practice--I know a little about a lot--and if there is any microcosm of PAs who would do best on some PA-to-MD bridge program, FP PAs would be it. I'm just coming up on my first NCCPA recert and although I know I'll have to study some, it won't be like my buddies who work in ortho or CT surg and have forgotten a lot of basic medicine.
Even so, I don't think a bridging program will fly. I've wondered about this for a long time. I've looked into the 3-year Caribbean programs where you're only on-campus for a month at a time and do the rest of the courses by extension. I'm self-motivated, I teach PA students, and I know how I learn best. But do I really believe I know everything I need to know without a directed course of study? Not bloody likely.
Now, say I could achieve advanced standing in medical school because of my PA experience, sure, I would take it. It would still be damn hard work! To tell the truth, though, the #1 reason I would choose a shorter course would be to limit the educational expense as much as possible and get back into the working world and make money sooner. That is by far the most scary prospect about going back to school: giving up a very comfortable salary to which I've grown quite accustomed. Am I nuts? Probably.
So, if an accelerated PA-to-MD program turns up in the next two years that is indistinguishable from any other MD educated in the US and ensures high pass rates on the USMLE and secures me a competitive residency, sign me up. Until then, I'm not holding my breath. :rolleyes:
Lisa

nev said:
Well, that was one of Dr.Stead's thoughts and I dont know if he had actually proposed it to the responsible authorities who would make this bridging program a reality. And sadly, Dr.Stead passed away a few days back.
 
I know one who's practice sent him to DO school. Fostering this practice (Training for service, much like hospitals do with RN's) is a great way to promote 'Bridging' of PAs.
 
nev said:
I really think that the brdging program is a great idea and I do feel that there is nothing wrong in becoming a doctor through certain strict shortcuts. No offesne, but I have encountered doctors who go to medical scool, complete fellowships and are USELESS! On the other hand, I have seen PAs in that same field practicing 10x better than the physicians.


If someone wants to become a Medical Doctor, he/she must complete the requirements of medical school to get his/her MD. Then to practice, he/she must sit for the respective board exam and become board certified. I encourage anyone who wants pass this exam without residency/fellowship training, but with correspondence, online certification (are you kidding me?) to attempt such a task, or to let alone accept the responsibility that physicians takes. I respect ancillary health professionals for their duties, but I think it is no comparison to what board certified physicians are expected to know or be responsible for.
 
my ER group is overwhelmingly helping me with med school. Paying for books, allowing a stipen (a rather handsome one as well) guarenteed er residency and moonlighting/ employment after. Waving some of the time one has to put in for partnership. all I have to do is get through it. I know, not the easy part right? Well guess what guys and gals----you would not believe how much easier med school is for a top flight PA.

Imagine going to med school--already have taken gross, patho, biochem, two sems of pharm, three sems of clinical med--many years of clinical experience. There are actually people in med school that never took anatomy.

I ran circles around residents as a PA. I am YEARS ahead of the students in my med school.

My point here is that resonable people can agree that there must be "some" thing that can expidite the medical education for a PA that has met certain criteria. No one has ever asked for a short cut---I am the first to say no short cuts. Just some professional courtesy with respect to "shadowing physicians" and H and P.

As a long time ACLS instructor--I have to retake ACLS? Even with a current cert card? Get off the horse guys/gals.

A smart institution will initiate a three year bridge program (likely DUKE) for experienced PAs. Nlo summers off and no long Christmas break. Get it done and get out.
 
adamdowannabe said:
Obviously not...then it wouldn't be a PA to MD bridge, it would be an NP to MD bridge, one thing that can't be overlooked, an NP will always have their foundations in nursing, and typically only become an NP in a specific area,

the PA has their foundation in medicine, and the basic specialties too, so it would be a different bridge to cross for each.

I have this cool idea though, someone should create a BA/BS to MD educational model, I'm thinking something around 4 years or so, then a few years working under close supervision, that should work right?

*Please accept my humor as best as you can, thanks**

Hi adamdowannabe,
We have graduate medical degrees in Australia. Basically do a 3yr undergrad degree in any discipline with a decent GPA, sit the GAMSAT (standardised graudate medical school entry test) and if selected, you then do a 4yr medical degree, 1yr internship and hey presto you're a doctor. That's the footnote version anyways. That is all.

David
 
That's what I'm talkin' Bout! :)
 
primadonna22274 said:
I've been biting my tongue (fingers?) on this one but have to chime in.
Adam, did you read Dr Stead's proposal? I did. Interesting, but I don't think it will fly. What I think this would create is a two-tier system of physicians in the US where "traditional" MDs are looked at differently (preferentially?) than "bridged" MDs. When it came time to do credentialing for third-party payors (insurance, etc.) and hospitals, not to mention malpractice, I can't imagine these "bridged" MDs would be treated equally.
We probably do go over the top when it comes to educating physicians in this country, but the system, however imperfect, is firmly in place and very slow to change. 35 years ago when Dr Stead proposed PAs, the medical community met the idea with skepticism at best and outrage at worst. PAs have proved their worth in the US and definitely fill a need; I am convinced there will always be PAs as long as our medical educational system remains "traditional".
On a personal note, I've been a PA for five years now, working in the trenches of primary care. I was well prepared to practice medicine WITH SUPERVISION (far less supervision now than when I first graduated--now I very rarely need to consult) as a PA, but I am continually reminded of what I don't know. I wouldn't feel comfortable as a "bridged" MD, which is why I've rejected the Caribbean extension programs. I think the biggest thing about becoming a physician is not medical school, though, but residency: this is where MD/DOs really LEARN how to practice medicine. Sure, I could do a PA residency in some particular discipline, but then I would still be a PA.
You could also argue that my first 3 years out of school were my "residency", and in a sense they were. From that perspective, medical school might be a breeze for me now, but I have other reasons for wanting to go back (personal ones mostly).
Thoughts?
Lisa PA-C
applying for MD 2006

Well yes and no. You did do 3 years, but I don' t think you can really compare them to MD residency. Their 3 years of training is maybe like 5-6 years of regular (40hr week work). I mean PA's don't put in central lines, plus your workload was probably very defined, and you signed out at the end of the day. All that working 30hr per shift builds you up as a physician and gives you confidence to practice. You also see a lot more cases than a PA, by pretty much living in the hospital. Plus you are constantly on rounds, you have educational requirements and you are constantly reading. So I wouldn't really consider those even close to equal. But I see you are jumping ship to MD. I wonder what your opinion will be once you are doing your residency. Best of luck Lisa.
 
"I mean PA's don't put in central lines"

ah...actually we do. and chest tubes, and intubations, and run codes, etc
I am not trying to say that a yr out of school = 1 yr of residency. it does not. however pa's working in trauma, em, hospitalist pa's, etc have a scope of practice very similar to the docs they work with. many small and/or rural er's are staffed by pa's only so if a trauma pt comes in who needs advanced procedures the pa does them.I work a few shifts a month solo at such a facility and frequently stabilize trauma pts, mi's, etc before shipping them to a facility with a higher level of care.in the last yr have intubated pts, run codes, tx anaphylaxis, done septic workups on babies, etc( we do lp's too....).
my pa partrners there have performed precipitous deliveries in the parking lot, have cardioverted several folks with unstable tachys, placed IO's in septic/dehydrated babies, etc...it's whatever comes in the door
 
emedpa said:
"I mean PA's don't put in central lines"

ah...actually we do. and chest tubes, and intubations, and run codes, etc
I am not trying to say that a yr out of school = 1 yr of residency. it does not. however pa's working in trauma, em, hospitalist pa's, etc have a scope of practice very similar to the docs they work with. many small and/or rural er's are staffed by pa's only so if a trauma pt comes in who needs advanced procedures the pa does them.I work a few shifts a month solo at such a facility and frequently stabilize trauma pts, mi's, etc before shipping them to a facility with a higher level of care.in the last yr have intubated pts, run codes, tx anaphylaxis, done septic workups on babies, etc( we do lp's too....).
my pa partrners there have performed precipitous deliveries in the parking lot, have cardioverted several folks with unstable tachys, placed IO's in septic/dehydrated babies, etc...it's whatever comes in the door


Ditto....the pa's and np's where i work spend rotations in the unit sometimes teaching (yes...teaching) other PA student's or med students. they run every code in hospital and now cover ICU on the nite shift as the 'house officer' (except the ER..but once the patient is admitted the patient no longer is under the jurisdiction of the ER doc so the PA's cover that too). In short...pa's in my hospital are actually more respected for their knowledge and skills than likelyl half of the attendings. they listen, they respond, they think, most have manners and write legibly, and they come back and check on the patient. putting a central line in is the 'everyday' stuff.
 
it is not uncommon to see a pa teaching residents on a specialty service.with the recent 80 hr cap on residents many places have gone to pa house staff teams in addition to residents. the pa's cover the icu as well as the floors and follow their own pts. at norwalk hosp. in ct. the entire housestaff is pa's with isolated md's serving as chiefs of service taking call from home. I have worked at 2 facilities with fp residents and have precepted many of them on procedures and work ups. the 1st place even had the interns do an er procedures month with the pa's after which we wrote their evals for that block.
a residency trained/boarded doc in any given specialty will 99% of the time know more than a pa in that specialty but the specialty pa likely knows more about the specialty than docs from other specialty fields or primary care.it's all about repetition. I have worked in em for 18 yrs and seen a lot of pts(probably close to 100 thousand pts at this point) with many different presentations so as a consequence I know more em than most fp docs, for example.
 
tupac_don said:
I mean PA's don't put in central lines, plus your workload was probably very defined, and you signed out at the end of the day.

As E- & Lizzie have stated...YES we do. PAs are placing central lines in both the adult and pediatric populations. Docs (and well-trained PAs) are training PAs to perform central lines & other complicated procedures on a daily basis.

Take care. :)
 
emedpa said:
it is not uncommon to see a pa teaching residents on a specialty service.

Any residency program that does this should have their Medicare funding pulled. ONly weak ass programs with FMGs would pull this kinda crap. PAs are best used seeing the patients, not teaching residents.

the 1st place even had the interns do an er procedures month with the pa's after which we wrote their evals for that block.

Again, another weakass program filled with FMGs that no american medical graduate would want to match into


a residency trained/boarded doc in any given specialty will 99% of the time know more than a pa in that specialty but the specialty pa likely knows more about the specialty than docs from other specialty fields or primary care.it's all about repetition. I have worked in em for 18 yrs and seen a lot of pts(probably close to 100 thousand pts at this point) with many different presentations so as a consequence I know more em than most fp docs, for example.

So what? Are you competing with FPs for ER jobs? I doubt it, so whats the purpose of that comparison? Anybody who spends full time working in the ER will know more than somebody who never steps foot into one.
 
Any residency program that does this should have their Medicare funding pulled. ONly weak ass programs with FMGs would pull this kinda crap. PAs are best used seeing the patients, not teaching residents.

weak ass programs like duke, hopkins, yale, etc....


Quote:
a residency trained/boarded doc in any given specialty will 99% of the time know more than a pa in that specialty but the specialty pa likely knows more about the specialty than docs from other specialty fields or primary care.it's all about repetition. I have worked in em for 18 yrs and seen a lot of pts(probably close to 100 thousand pts at this point) with many different presentations so as a consequence I know more em than most fp docs, for example.
So what? Are you competing with FPs for ER jobs? I doubt it, so whats the purpose of that comparison? Anybody who spends full time working in the ER will know more than somebody who never steps foot into one.

yes, as a matter of fact I am competing with fp docs. many small and/or rural facilities are staffed with an fp doc or a solo pa...by being an experienced em pa I can and have taken jobs that otherwise would have gone to an fp doc....
at one facility I currently work at they schedule the pa's and fp md's interchangeably.
 
MacGuyver has been on a real tirade this week. He has been tearing up the forum with his insight on NPs and PAs. He even felt the need to revive this thread which has been dead for nearly six months just to make sure PAs or FMGs for that matter aren't taking themsleves too seriously.
 
...Luckily, some of us heading into the PA profession are in no danger of taking ourselves too seriously.

Ba-dump-bump. :D
 
MacGyver said:
Any residency program that does this should have their Medicare funding pulled. ONly weak ass programs with FMGs would pull this kinda crap. PAs are best used seeing the patients, not teaching residents.



Again, another weakass program filled with FMGs that no american medical graduate would want to match into




So what? Are you competing with FPs for ER jobs? I doubt it, so whats the purpose of that comparison? Anybody who spends full time working in the ER will know more than somebody who never steps foot into one.

MacGyver, so nice to hear from you again...barrrrf.
 
I agree with the idea EXCEPT the requirement to commit to practice primary care. I have zero desire to practice in such a setting, due to the fact that the lack of stimulation would drive me quite mad very quickly.
 
MacGyver said:
Any residency program that does this should have their Medicare funding pulled. ONly weak ass programs with FMGs would pull this kinda crap. PAs are best used seeing the patients, not teaching residents.

You must be an idiot! I usually don't resort to name calling, but you take the cake. The program you are referring to is Yale. Is that a "weak ass" program? Where are you in residency, Grenada??? :laugh:

Pat
 
hospPA said:
You must be an idiot! I usually don't resort to name calling, but you take the cake. The program you are referring to is Yale. Is that a "weak ass" program? Where are you in residency, Grenada??? :laugh:

Pat

he's not in residency. he's not even a doc. he is some idiot premed worrying that there will be no job for him when and if he ever gets into medschool.
 
emedpa said:
he's not in residency. he's not even a doc. he is some idiot premed worrying that there will be no job for him when and if he ever gets into medschool.

Figures. Unfortunately, there "will" be a job for him if he gets in and out. Hopefully not anywhere near me :eek:

Pat
 
I have been in health care for about 22 yrs. 15 as a xray tech and 7 as a PA. I have worked in Neuro surgery , orthopedic surgery and currently ER Medicine. I work in a teaching hospital. I cant tell you how many times I have helped residents learning how to treat or read an xray. Experience means more in medicine than anything. I dont think it happens in 3,4,5 or even 8 years of residency. If it did, then you would not see some surgeons who could not operate or get confused and have to have someone come in and help. I have seen it. I remember a quote by a non-college educated engineer who was applying for a job that he had done for 35 years. He was asked, what made him think he was qualified for a supervisor job when he had no college education, he replied, If you were going to send someone to the moon, would you want someone who had been there or someone who read a book about it.
 
emedpa said:
he's not in residency. he's not even a doc. he is some idiot premed worrying that there will be no job for him when and if he ever gets into medschool.
I am curious. Do you know of any bridge programs out there for Masters PA's wanting to become MD's or DO's
 
adamdowannabe said:
Threads don't always end by you having the last word! SDN has been having issues, so people haven't been around to contest you.

I am wondering why you claim that carribean med schools have problems getting graduates into US residency, I looked at a few of the programs, and the big ones declare they have 100% success of placing students into US residency, of those that attempt to gain such. I would find it hard to believe if these statements are blatant lies. I do understand the residencies might be far from desirable locations and hospitals, but they are US residencies leading to US B.E., and thats all that really matters.

Matt, I would love to see substantiated evidence of United states citizen carribean medical graduates being "**** out of luck" when it comes to finding a residency.

This is no way meant to be an attack, just want to get the lowdown.
I happen to work as a PA in a teaching hospital in Indiana. I see new residents every year. It use to be foreign students were still trained in american medical schools. This year all of about 20 or so internal medicine residents are not only foreign ,but graduates of foreign medical schools. Most of these were not american taught as most carribean schools are. This is the first year I have ever seen this in my particular hospital. I think more and more american doctors feel they dont make enough for the hassles and foreign doctors are happy with the income
 
ccqb3189 said:
I am curious. Do you know of any bridge programs out there for Masters PA's wanting to become MD's or DO's
No reputable ones(yet).
a few foreign programs will give pa's a break on requirements( samoa, antigua, etc)
 
I can assure you that if an attending physician is allowing a PA to teach a resident in a particular setting, that attending is convinced that the PA is well above average and capable of doing it. I believe you can take a PA who is exceptional and place them in this kind of role.

I just finished med school and am moving to the University of Iowa next month to start my residency in emergency medicine. This will be the first time in 8 years that my PA title will be behind me. However, I chose this program for many reasons, one being that it utilizes exceptional PA's in the ED and I plan to learn from them. Sure I can probably teach them a thing or two as well about my area of expertise, but that doesn't mean it cannot go both ways.

MacGyver..Don't sweat it, this is not the norm and it is not occuring that PA's are the primary teachers in any residency. You can bet their spectrum of teaching is related to more finite tasks and scope that they are exceptionally good at. Its not like they are leading rounds every day and the attendings have taken a hiatus. That I can assure you would get a residencies' accreditation yanked.

No bridge programs exist still, but I hope that changes in the future. Having done both PA and medical school now, I believe the only time off could be to merge the first 2 years and eliminate the redundant clinical medicine courses. Clinicals will still have to be done, and 4th year is mandatory...trust me!! 4th year is all about applying, interviewing, and spending lots of money on suits and travel. It cannot be omitted because the match process makes exceptions for no one.

3 years is doable, but it would be tough. You could not work as a PA much if any in that time period. I am actually an advocate for promoting PA's to take the 4 year road. Its much slower paced compared to PA school, you learn more as you take more reading time, and you can work a lot. I earned close to 120K over 4 years (I know that sounds small) and was able to keep a house, and incur less debt. Hell I just bought a quarter of a million dollar house in Iowa City off that saved income and low debt, and I was able to do so well at the 4 year pace that I did exceptionally well on the boards. I was number 2 in my class, and trust me when I tell you that its nice to have those kinds of stats going for a competitive residency.

4 years is not that long when you are working on the side. Go for it!
 
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