Dr. Stead's PA to MD Bridging proposal.

corpsmanUP said:

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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I spoke recently with a 3 year medical student at IU. I think for the midwest , this is probably one of the best medical schools around. It was good enough for Lance Armstrong to choose for his cancer treatment. I spoke to him about the difficulty of medical school. He himself was a masters degree chemist working at a large company and found himself training people to become his boss as PhD chemist. He applied to med school at the urging of a friend. He took the Mcat twice and got in. He is smoked the biochem, which he said was the same as undergrad biochem only they go through the book in a quarter rather than a year. He also felt anatomy was the most difficult class and if you could pass that , you could do anything there. He also informed me that attendence to class was about 35%. He said it was less productive than being at class when you needed to read. He also stated that notes were taken for the students so you had access to the material as well. He did fine in school. I had some rotationsl with 3rd and 4th year med students, as well as first year residents. They were always shagging out of the rotation for some lecture or something. I would put a good PA above any 3rd or 4th year med student anyday. The ones on my rotations were always asking me questions. I am planning on going either to medical or dental school and I am 40 years old. I think where PA's go above the medstudents is in experience . I would welcome a program that took me through the first two years and then gave me some credit for having done twice as much as the medstudents in the 3rd and 4th years.

ccqb3189 said:

I spoke recently with a 3 year medical student at IU. I think for the midwest , this is probably one of the best medical schools around. It was good enough for Lance Armstrong to choose for his cancer treatment. I spoke to him about the difficulty of medical school. He himself was a masters degree chemist working at a large company and found himself training people to become his boss as PhD chemist. He applied to med school at the urging of a friend. He took the Mcat twice and got in. He is smoked the biochem, which he said was the same as undergrad biochem only they go through the book in a quarter rather than a year. He also felt anatomy was the most difficult class and if you could pass that , you could do anything there. He also informed me that attendence to class was about 35%. He said it was less productive than being at class when you needed to read. He also stated that notes were taken for the students so you had access to the material as well. He did fine in school. I had some rotationsl with 3rd and 4th year med students, as well as first year residents. They were always shagging out of the rotation for some lecture or something. I would put a good PA above any 3rd or 4th year med student anyday. The ones on my rotations were always asking me questions. I am planning on going either to medical or dental school and I am 40 years old. I think where PA's go above the medstudents is in experience . I would welcome a program that took me through the first two years and then gave me some credit for having done twice as much as the medstudents in the 3rd and 4th years.

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???????

I see several forseeable problems:

1) There is little in an allied or nursing cirriculum that corresponds with the level of basic science required in medical school. You can argue that you don't need to know things like the ryanodine receptor or pterygopalatine fossa, but, at least right now, that is what scientists and physicians think is required.

2) In the 3rd and 4th years you are taught how to take responsibility for a patient, not how to assist a physician. A PA may be able to pass the NBME for Family Medicine, but could they pass the "six pack" of surgery, IM, psych, OB, Peds?

3) The admissions requirements to medical school are so high to ensure that highly intelligent people who can remember massive amounts of information are the only ones given the opportunity to take final responsibility for someone's life. Perhaps someone should study IQ's/memory retention et cetera among PA/Nurses/Physicians and see if this would pose a problem.

Thankfully for everyone, there is no shortcut to becoming a qualified physician.

I think there is little overlap in the education, and PA's would still end up in a 3 or 4 year program. It may not take a PA 4 years to be able to do the job of their physician they are assisting, but it would take them 4 years plus residency to be educated to do the job of their physician.

I sympathize with everyone that who is non-traditional and who came to the realization that medicine is their calling late ... but it is not a reason to change the expectations or admission requirements for medical school education.

ccqb3189 said:

I would welcome a program that took me through the first two years and then gave me some credit for having done twice as much as the medstudents in the 3rd and 4th years.

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You are truly delirious.

There are many NBME board review books available, I'd suggest you go and take a couple of practice step 2/3 exams. If you intend to go to medical school, I would suggest leaving this attitude at home on interview day.

viostorm said:

3) The admissions requirements to medical school are so high to ensure that highly intelligent people who can remember massive amounts of information are the only ones given the opportunity to take final responsibility for someone's life. Perhaps someone should study IQ's/memory retention et cetera among PA/Nurses/Physicians and see if this would pose a problem.

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You pretty much hit the nail on the head of contradiction with your statement........ Intelligence and memory are not the same thing.

Medicine is a memory game, you have to remember and recall a enormous amount of information, it's all figured out for you. The intelligence factor exists based on the nature of the material, but is not paramount in the application of the memory recall.

People with truly exceptional IQ's and of extreme intellect and intelligence, DO NOT become doctors, they become scientists. The percentage of physicians who are actively progressing medicine through pure brilliance of thought, is a minimum at best.

It's the chemists and physicists and computer engineer PhD's who would blow the IQ comparison game, these are the folk that create the meds, the cyber-knife, the MRI equipment, the innovations that have advanced medicine.

As a medical student you suck information like a sponge, but when was the last time you created something new??

Those who practice medicine know the ins and outs of human physiology and pathophysiology, because somebody else figured it out already!!!!

Physicians are trained for YEARS, because it takes that long to absorb all the information and have it correctly catalogued to be properly utilized. It's has everything to do with VOLUME, not with DIFFICULTY.

So, seriously?? Do you think people in medical school are superior to others in IQ??? What people in medical school ARE superior in to most others, is diligence. The diligence to put in the time to get where they want to be.

People with extrememly high IQ's are thinkers, problem solvers, creators...........

Medicine (for the most part) has already been solved.... you are tought WHAT to do, and HOW to do it..........you just need to figure out/remember WHEN is the right time to do it.

So, get off your throne.


BTW, not to downplay medicine, because I am studying medicine and love this stuff..... but, (resources aside) people HAVE done comparisons between computer algorithm and human physician ability to make Dx, and the computer always wins, becuase it goes on just the facts..no human inference to get in the way.

adamdowannabe said:

So, seriously?? Do you think people in medical school are superior to others in IQ??? What people in medical school ARE superior in to most others, is diligence. The diligence to put in the time to get where they want to be.

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Of course I do not think that.

I agree with your post, and perhaps *highly intelligent* is an overstatement. Minimally, I think physicians need to be *reasonably intelligent* but memory capacity is certainly a requirement.

Regardless of the flaming aspect of your reply, I do however think it important to assess whether as a whole, PA's/NP's would have sufficient mental capactity to bypass the normal medical school admission process which the application/admissions process is designed to ensure. If this isn't an issue, why would a PA be opposed to going through with MCAT/pre-reqs and applying against other applicants.

There are certainly PA/NP's out there because they could not meet the admissions criteria to medical school due to insufficent mental capacity. There are also PA/NP because of life events and they couldn't meet the admissions criteria, (children, age, other family events, et cetera).

I am suggesting as a whole there needs to be a convincing argument why PA/NP should not have to undergo the normal admissions process. Experience in my opinion is certainly not a sufficient one in my opinion.

I think the big point here is .... if someone wants to be a physician, they need to go to medical school. There is absolutely no substitute for a medical school education. PA school is certainly not a substitute.

viostorm said:

Of course I do not think that.

I agree with your post, and perhaps *highly intelligent* is an overstatement. Minimally, I think physicians need to be *reasonably intelligent* but memory capacity is certainly a requirement.

Regardless of the flaming aspect of your reply, I do however think it important to assess whether as a whole, PA's/NP's would have sufficient mental capactity to bypass the normal medical school admission process which the application/admissions process is designed to ensure. If this isn't an issue, why would a PA be opposed to going through with MCAT/pre-reqs and applying against other applicants.

There are certainly PA/NP's out there because they could not meet the admissions criteria to medical school due to insufficent mental capacity. There are also PA/NP because of life events and they couldn't meet the admissions criteria, (children, age, other family events, et cetera).

I am suggesting as a whole there needs to be a convincing argument why PA/NP should not have to undergo the normal admissions process. Experience in my opinion is certainly not a sufficient one in my opinion.

I think the big point here is .... if someone wants to be a physician, they need to go to medical school. There is absolutely no substitute for a medical school education. PA school is certainly not a substitute.

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Tell me exactly why you have an opinion about this? It it because of your elaborate experience, training and teaching of both PA and MD/DO students or because you were a PA before going to medical school? Is it possible that your OPINION could be absolutely baseless like so many are? Just wondering why you have such a strong and "informed" position!

lawguil said:

Tell me exactly why you have an opinion about this? It it because of your elaborate experience, training and teaching of both PA and MD/DO students or because you were a PA before going to medical school? Is it possible that your OPINION could be absolutely baseless like so many are? Just wondering why you have such a strong and "informed" position!

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Allied health professional for 10 years (paramedic/EMT), current med student.

All my opinion is based on anectodal evidence and my own experience. Worked with 100's of PA's during my career. Had friends who tried to get into med school, couldn't and went to PA school. Had friends who changed to PA because of long training process.

The burden of proof is not on me. It is on PA's who want to be physicians without going through the physician training process.

viostorm said:

Allied health professional for 10 years (paramedic/EMT), current med student.

All my opinion is based on anectodal evidence and my own experience. Worked with 100's of PA's during my career. Had friends who tried to get into med school, couldn't and went to PA school. Had friends who changed to PA because of long training process.

The burden of proof is not on me. It is on PA's who want to be physicians without going through the physician training process.

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WOW! You're hired!

How well do you think a physician 5-10-15 years out of UNDERGAD would perform on the MCAT? Heck, how well would I do on the MCAT today, when I took it less then 2 years ago. I am willing to put money on my not scoring well.

The Bridge idea, is about giving existing healthcare providers (PA's) some credit for the medical coursework and experience they have, based on their PA education, and their practicing of medicine. "credit for time served"

Not about sneaking sub-par applicants into medical school.

The only way it would REALLY make sense to me, might be if there was a special medical program, for PA's only.... taking their PA education and filling in all the educational gaps, in a streamlined path towards taking the USMLE steps and getting a residency. If that can be accomplished in 2.5 years, instead or 4...then that would be the 1.5 years of "credit for time served....."

adamdowannabe said:

The only way it would REALLY make sense to me, might be if there was a special medical program, for PA's only.... taking their PA education and filling in all the educational gaps, in a streamlined path towards taking the USMLE steps and getting a residency. If that can be accomplished in 2.5 years, instead or 4...then that would be the 1.5 years of "credit for time served....."

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Perhaps you would agree medical school is already *really* only 3 years. I think most med students would agree 4th year is really about finding your residency. There were 3 year US programs but at least at my school it was discontinued because of high suicide rate.

I also wanted to clarify, I certainly am not implying "If you are not a physician, you are not smart". There are certainly people who are very smart, but not physicians.

What exactly would PA's get credit for and how much time would that save given medical school is really 3 years?

I think it may be more appropriate to give PA's credit for part of "internship year" in residency if they chose to do a medicine or family internship. I can certainly see how some of that training would be redundant.

Ahhh, I never said which "years" would be bypassed. If say Year 4 remained intact (of course it would have to, in order to interview for residencies) and you say it doesn't really count as "a year of medical school", then the bridge system (in your breakdown) might be 1.5 years instead of 3!!

As for the classes that would cross, that would be up to the powers that be. PA school isn't just fluff. Here, peak at this, and you choose which classes might "hold water" in comparison to the classes taken in 2 years of didactic.



This is the didacitc program from a reputable PA program: Any of these classes sound familiar??


Anatomy
The course in anatomy is a central focus of basic science education in the Physician Assistant Program. During this course the student is introduced to gross anatomy presented by the regional approach. The student becomes familiar with the chest, upper extremity, abdomen, pelvis, lower extremity, neck, head, and the central nervous system. Whenever appropriate, clinical and especially surgical correlation's are made both from a diagnostic as well as operative point of view. Instruction is primarily in lecture and lab format, however, atlases and other visual aides are available.

Physiology
The principal objective of the physiology course is to provide physician assistant students with a basic understanding of both cellular physiology and integrative physiology. The course introduces students to the normal vital processes of the human body. Students will be taught the characteristics of cellular structure and the cellular mechanisms, which promote the maintenance of homeostasis. In addition, the specific characteristics of the nervous system, the respiratory system, the endocrine system, the cardiovascular system, gastrointestinal system and the kidney will be discussed in detail to provide a basis with which to compare and characterize clinical disorders.

Microbiology
The course in microbiology and immunology familiarizes the student with the basic information needed to understand the role of these disciplines in clinical medicine. Lectures are supplemented with demonstration materials from the Laboratory of Microbiology whenever feasible. The core course includes Bacteriology, Mycology, Virology, Parasitology, and Immunology. Emphasis is placed on the presentation of practical and useful infectious disease topics relevant to clinical practice.

Biochemistry
Medical biochemistry emphasizes the biomedical principles of carbohydrate, protein, and lipid chemistry fundamental to clinical medicine. Basic biochemical information is presented and integrated with selected nutritional and health problems by means of lectures and clinical discussions. Specific topics include vitamins, minerals, the chemistry of respiration, pH balance, blood coagulation, and hormonal effects on the metabolism of proteins, carbohydrates and lipids. Clinical biochemistry correlates concepts of medical biochemistry with clinical problems such as maintenance of good health, aging, wound healing and growth. Specific topics include hormonal dysfunction, pancreatic/ gastric function, iron/heme metabolism, and mineral/water balance.

Pharmacology
The course in pharmacology introduces the student to therapeutic drugs, their chemistries, actions and uses. Instruction is presented in lecture format. Emphasis is placed on the practical application and evaluation of drug actions on the functions of various organ systems of the human body including but not limited to the autonomic nervous system and cardiovascular system. Studies of antibiotics as well as other important topics are also covered.

Pathology
This course in pathology introduces the student to the natural history, etiology, pathogenesis (gross and microscopic) and clinical findings associated with disease states. Instruction is presented mainly in lecture format with the use of visual aids. Emphasis is placed on disorders commonly encountered in surgical patients.

The Medical Interview
This course will introduce the student to the skills necessary for successful medical interviewing. Course materials and readings will explore the relationship between normal conversation and medical interviewing. The student will learn and practice various techniques for eliciting an accurate medical history from a variety of patient types. Each section of the medical interview will be studied and practiced in detail in preparation for the patient encounters scheduled for the subsequent semester.

Physical Diagnosis I & II
This course, offered in a two-semester sequence, introduces the student to the fundamental techniques of interview and examination. The student will use this basic knowledge throughout his or her career in medicine. Emphasis is on performance of mastered techniques, medical chart recording and oral presentation format in preparation for the clinical phase of education.

Surgical Aspects of Primary Care/General Surgery/Surgical Specialties
The surgery courses are divided into three semesters. The student is introduced to clinical problems common to the discipline of surgical practice including clinical presentation and the correlation between anatomy, pathology, and stage of disease and treatment. Indications and contraindication for surgery are presented along with a pertinent discussion of surgical techniques. The student is introduced to operating room protocol, asepsis and scrubbing, gowning and gloving, instrumentation, suturing and knot tying. The disciplines of orthopedics, radiology, and anesthesiology are also introduced.

The entire Surgery curriculum includes laboratory sessions which are designed to introduce the student to the practical care of patients including bedside procedures such as intravenous catheterization, blood drawing, techniques of hemostasis, suturing methods, use of drains, catheterization techniques, nasogastric intubations, wound care management, and preoperative, postoperative and daily note writing. At this time the student is introduced to the hospital setting and is assigned to attend morning rounds on various clinical rotations in preparation for clinical rotation.

Fundamentals of Primary Care and Clinical Medicine I & II
The medicine course is divided into two semesters. Each semester's course is divided into smaller modules, which introduce the student to the various medical sub-specialties. The student is introduced to recognition and management of common medical problems encountered inpatients and outpatient medical facilities. These include topics such as hypertension, cardiovascular and pulmonary diseases, diabetes, hematologic disorders, hematology, oncology, endocrinology, and otolaryngology and multiple system abnormalities of the elderly.

Obstetrics and Gynecology
This course introduces the student to the fundamentals of prenatal care and childbirth as well as common obstetrical and gynecologic problems and other issues related to women's health that are encountered in clinical practice.

Pediatrics
This course introduces the student to the fundamentals of growth and development, well-baby care, principles of immunization, commonly encountered childhood diseases and their treatments as seen in clinical practice.

Psychiatry
This course introduces the student to the fundamentals of common behavioral abnormalities and their treatment as encountered in clinical practice. Topics include the professional-patient relationship, reactions to history taking and physical examination, stress and coping mechanisms, detection and treatment of psychiatric complications, and management of death and dying.

Physician Assistant Seminar
This course prepares the student to understand the role of the physician assistant in the 21st century healthcare in the United States. Topics are addressed such as professionalism, legal aspects of health care, use of medical literature, familial and cultural components of health care, medical ethics, health promotion/disease prevention, and patient education.

Emergency Medicine
This course further explores concepts introduced in Fundamentals and in Surgery lectures, with an emphasis on emergent care and life-threatening illness and injury. Common presenting complaints seen in emergency medicine settings, their diagnosis and treatment are addressed. Explores emergency medicine both as a field of study and as a medical specialty.

Research I
This course explores the basic concepts of research in the health sciences and the communication of new information to peers. Standard style and content for research proposals, publications and presentations are utilized. Topics such as problem finding, formulation of a research questions, methodology, design, instrumentation, literature review, ethics and funding are explored. Published research articles will be critically analyzed.

Research II
This course applies the theoretical foundation of Research I in the formulation and satisfactory completion of a written final project, working individually with a project advisor. The research process will conclude in an oral presentation to peers and submission of a clinical review article suitable for publication in a peer-reviewed journal.

Epidemiology
This course applies the scientific method to the study of disease in populations. The epidemiological method for studying a problem involves description of the frequency and determinants of a disease in a defined population , evaluation of factors that may cause a disease, and experimental studies of the effects of modifying risk factors on the subsequent frequency of a disease.

Biostatistics
This course provides an introduction to statistical methods as applied to health care research. Topics include population sampling, hypotheses testing, probability, and chi-square, linear regression and correlation, analysis of variance and non-parametric statistics.

I agree that there is overlap, but I think there is just too much that is different

My impression is if med school is like plowing a field at 6 inches deep, PA school would be plowing the same field at 3 inches.

But then again ...

I was actually offered a job teaching anatomy to the PA students. The guy told me "be careful of freaking out the PA students, what is important to them is not important to med students, med school goes into much more depth in head/neck/pelvis/perinium then PA. PA goes more into depth in some cases in musculoskeletal"

Many of the PA's that would be applying would have been working at least 3 years according to Stead. So here is the problem, they have lost much of the science background. Do they still remember what muscle is innervated by what? Probably not, so actually, they would have more catching up to do because a lot is forgotten.

I'm not arguing that it would not be possible to turn a PA into a MD/DO, but I disagree that it is the right thing to do nor that it would save them any time to make them equally competent.

I think the most important thing to be careful about is working for a doctor in their office does not make a person a doctor, nor eligible to become a doctor.

Oh, and by the way, in gross anatomy, our PA class learned so much about the pterygopalatine fossa and we had a running joke about it. You can't compare PA anatomy to allied health/nursing anatomy. Often, PA and med students take gross anatomy together.

Hahaha...that brings back memories of last semester EMED

group_theory said:

I think where the short-cut will be most useful is at least the first 6 months of internship (unless of course you're in a new field -- EM PA becoming a psych intern). I can see cutting out some time in residency for PAs who are in the same field.

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This will NEVER work. They don't even give board certified physicians much if any credit when changing residencies. In my emergency medicine program there are 4 FP's who EACH had to repeat their intern year. I'm sorrty to tell you, but if there was one thing you could not eliminate it would be the internship requirements. A PA has never TRULY or OFFICIALLY served as a house officer where they are the final authority on what happens to a patient between 5PM and 7AM....routinely. The step from medical school to intern is monstrous! You go from half listening as a 4th year who was thinking about your residency application to being obsessive compulsive about every detail of a patient's care because you know you are going to get crushed in the AM by your attendings and upper levels. There is no PA experience that would eliminate the need for an intern year. If a PA has specialty training, that is of no comparable assistance in internship. A CV PA might be able to skip 3 months of a CV fellowship, assuming they made it 5 years past general surgery, med school, etc...

Everyone just needs to realize that there is no good way to make a physician out of a PA. The best thing about a PA going to medical school is that it gives them a tremendous leg up in the admission's process (assuming they can at least score reasonably on the MCAT), the med school process, the residency application process, and you will reap the rewards of having almost twice the education. Your fellow med students will be extremely jealous around you on test day because they know you are going to destroy the curve. Like I said, it allowed me the luxury of being able to work, make great money, essentially be debt free, and get into a very competitive residency.

You have to ask yourself why you would be desiring to become a physician after being a PA. If it is because you want to take your knowledge with you to the next level and benefit from it astronomically, then 4 years is the only route. If you want a shortcut, you will end up getting shortchanged, because there is NO possible way to do a short version of medical school as a PA and still benefit on the boards from your previous knowledge. To endure medical school at a more rapid fire pace would never allow you to work, never allow you to do well, and never allow you to blow away the boards. All of things are likely and possible the 4 year route. How many premeds would DIE for the chance to bring that kind of assurance to their med school process? I think many. Plus, its always true that the higher scores bring higher paying specialty jobs down the road....otherwise people with 205 USMLE's would be plastic surgeons routinely.

Stop arguing over 1 year here, another half year there. To save 18 months of your life you are trying to sell away your future. Look at the 4 years as a way to keep your sanity and bide your time as a PA still making good money.

The bottom line though is that there is a significant difference between a PA curriculum and a physician curriculum. You can upload every PA curriculum syllabi on here and it will still not speak what I know to be the truth. There is a SIGNIFICANT difference. They are very similar nonetheless, but they are not meant to serve the same end.

If you were to have a theoretical bridge program you would have to first convince the legislators who fund med students. Tuition pays for about 1/4 of the medical school cost. The taxpayers pay the rest, at least at state schools. The benefit to the state would be worthwhile.

The real difference between PA school and medical school for me was this:

Histology..PA schools do NOT provide this
Anatomy- 40% more at the med school level
Physio- 65% more at the med school level
Pathophys- 80% more at the med school level
Clin Med- Equivilant
OMT- completely new to me, but only if you go to a DO school
Pharmacology- virtually the same

3rd year clerkships- only real difference is the unconscious view the attendings and residents take toward PA students as a whole. Having seen it from both sides, I can definitely say that it is commonplace for PA students to be pimped as hard as the med students. They just don't know what PA's are supposed to know. Of couse someone will dispute this and say they were hammered as PA students on clinicals, but I stick by my position.

Next, each 3rd year clerkship is longer, and at the end of it you have a major board exam. Each one of these board exams is harder than the single solitary board exam it takes to become a PA...the PANCE.

Throw in 2 USMLE or COMLEX exams and you have over 9 major board exams to ruin your weekends. The medical school curriculum FORCES you to study whether you like it or not. PA students often have no hurdle between first year and practice except the measely PANCE. That difference alone is monumental. If you cumulatively add the possibility of being given easier assignments on rotations, less complex patients at times, being less challenged and allowed to just "show up" for rotations, along with no serious study hurdle between rotation and practice and you get a bunch of dumb a$$es graduating from PA school who "ought not" give a dog aspirin.

It's sad but true. I had a buddy in PA school fail PANCE twice before passing it. He works in ortho thank God!! There is the occasional idiot that makes it through all these med school barriers but there is at least a better system of checks and balances.

Overall I would cautiously assume that PA school is roughly half of the first 3 years of medical school. This means you could in theory shave 1.5 years off the curriculum somewhere.

Saying this though is like saying that you could save 50% on your annual haircut bill if you could ask the barber not to cut each hair, but only the visible hairs each visit. You could probably tuck under some of the deeper hairs and spray them down with hairspray. But the bottom line is that it costs a lot more time for the barber and you to take this route. Just cut them all and I guarantee you will come out looking better!!

This discussion is as old as SDN. I remember being on the defensive side of this argument back in 2000 with our esteemed Freeedom from SDN. He was a 4th year med student and I was a practicing PA who thought I deserved more credit for my education coming into med school. He told me I would be humbled and that he doubted my PA education would help much. He was right about being humbled, but was wrong about how much my training would help.

But, the truth is, I was also a strong student as a PA, and thus I think that is why also did well as a med student. I have seen 5 other PA students in med school here with me and I don't think any of them have done better than average in med school.

Like I said, the bottom line is there is a significant difference.

viostorm said:

Perhaps you would agree medical school is already *really* only 3 years. I think most med students would agree 4th year is really about finding your residency. There were 3 year US programs but at least at my school it was discontinued because of high suicide rate.

I also wanted to clarify, I certainly am not implying "If you are not a physician, you are not smart". There are certainly people who are very smart, but not physicians.

What exactly would PA's get credit for and how much time would that save given medical school is really 3 years?

I think it may be more appropriate to give PA's credit for part of "internship year" in residency if they chose to do a medicine or family internship. I can certainly see how some of that training would be redundant.

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Are you serious? Do you even really know anything about PA programs or what they do afterwards? PAs don't just practice in Family Medicine, they work in any specialized area from cardiothoracic surgery to sports medicine. And not only are they gaining highly valuable experience, their formal education has to be ongoing. PAs must log 100 hours of continuing medical education every two years. I'm pretty sure that any PA that has spent a few years practicing is going to have more knowldge than any Pre-Med student let alone a med student freshly entering their residency.
Now, I'm not saying PAs should get free rides as far as going through the med school hoops. Perhaps there should be special testing though, similiar to a placement exam. Why should they be forced to take classes that aren't neccessarily needed? Just sayin'.

Just Sayin'?

Ha. Sometimes I really make myself laugh. I haven't even gone through the PA program yet. It just seems to me that the knowledge gained should help a PA when it comes to Med school, and having a, yes I'm going to say it, specialized program with exams equivalent to say an M-CAT or any other entrance exam is reasonable. For a PA it's not just "4 years of med school", it's the 2 years before that they had to go through to become a PA as well. Not every PA is going to want to become a doctor, but the ones that do should get the chance to do so without having to start from the beginning again. I don't think it's worth it, just so you can possibly be the best in your class. Wouldn't you want to be the best in a class full of students that have a similar education and set of experiences? I know I would. In fact that's what I plan on doing...but you know plans, so we'll see.

13deadflies said:

Not every PA is going to want to become a doctor, but the ones that do should get the chance to do so without having to start from the beginning again.

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No.

No, no, no. No, you can't have any alternate routes that avoid in any way any admission criterion. And in the event that you are granted admission on the level playing field of standardized criteria, no, you can't have "advanced standing". No, you can't consider yourself "basically a doctor", and medical school is NOT your option nor your entitlement unless you complete every step everyone else has. There's a reason why every medical school program is accredited based on standardized criteria, there's a reason why every medical student has to fulfill every requirement, including licensing exams and coursework. There's a reason why there are no shortcuts and there are no concessions.

Consider the position of the NBME in the case of the dumb girl who sued the NBME (after having failed the USMLE Step II the first time), asking for truly excessive accommodations for Step II in order to nurse her baby. They held their ground, on the grounds that it's unfair to everyone else taking the exam and unfair to patients to give such unreasonable concessions on such an important licensing exam. It's all important.

And just FYI - just about every non-MD healthcare provider forum here on SDN is talking about some sort of "MD bridge" program. Go over to the podiatry forum, check it out. Go over to the DO forum. It'll never happen - should never happen, to maintain the integrity of the degree. Part of me worries 45% of this push is for people who have insecurity about their degree to get the MD degree to shut people up who question them, 45% for people with insecurity about their degree to be able to say, "yeah, I had the option to get the MD, but (blah blah blah some BS excuse)...and I decided I didn't want to", and 10% for legitimately competent and equally capable professionals to make a natural and seamless career transition. I would be behind it if I thought that 10% were bigger, but based on some of the petty replies on here bashing each other, I'm not at all convinced.

I heard some carribbean PA to MD programs exist

Northerner said:

And just FYI - just about every non-MD healthcare provider forum here on SDN is talking about some sort of "MD bridge" program. Go over to the podiatry forum, check it out. Go over to the DO forum. It'll never happen - should never happen, to maintain the integrity of the degree.

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This is key. If you start to have bridging programs and online MD programs, it dilutes the value of the degree. If we followed that path, then the medical profession will end up looking like the nursing profession with its alphabet soup of degrees and certifcations that only another nurse would understand.

Taurus- Could you explain this to me:
Medicine in the future: NP requests ultrasound from ultrasound practitioner, then refers patient to surgical nurse practitioner for biopsy. Biospsy performed under anesthesia by CRNA. Cytolology tech practioner reviews the slides and gives results. Treatment is provided by oncology nurse practitioner who requests a CT from CT tech practitioner to assess results of treatment. Eventually autopsy is performed by pathology tech practitioner.

Don't want that future? Then support PA's & AA's.

Wouldn't you just replace 'NP' with PA and 'CRNA' with AA? What would be the difference, except that their not nurses? I'm not trying to be snarky, I just don't understand.

brightness said:

Taurus- Could you explain this to me:
Medicine in the future: NP requests ultrasound from ultrasound practitioner, then refers patient to surgical nurse practitioner for biopsy. Biospsy performed under anesthesia by CRNA. Cytolology tech practioner reviews the slides and gives results. Treatment is provided by oncology nurse practitioner who requests a CT from CT tech practitioner to assess results of treatment. Eventually autopsy is performed by pathology tech practitioner.

Don't want that future? Then support PA's & AA's.

Wouldn't you just replace 'NP' with PA and 'CRNA' with AA? What would be the difference, except that their not nurses? I'm not trying to be snarky, I just don't understand.

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Because both PAs and AAs are dependent practitioners. Their scope of practice is dictated by the supervising physician. Their is no desire for "independence". Both groups are committed to working in partnership with physicians.

David Carpenter, PA-C

My take is that if you're going to practice medicine then be forthright about it and say you're practicing medicine. Doesn't it then follow that the group to provide oversight for you is the state Boards of Medicine? The issue is that many groups are attempting to try to expand their scopes of practice not by meaningful education but other means such as political contributions and questionable "doctorates". The response I advocate is through the free market by correcting supply and demand. For every group that is pushing for expanded scope, then we need to support groups that will act as effective counterweights. This will keep things in balance.

Taurus said:

My take is that if you're going to practice medicine then be forthright about it and say you're practicing medicine. Doesn't it then follow that the group to provide oversight for you is the state Boards of Medicine? The issue is that many groups are attempting to try to expand their scopes of practice not by meaningful education but other means such as political contributions and questionable "doctorates". The response I advocate is through the free market by correcting supply and demand. For every group that is pushing for expanded scope, then we need to support groups that will act as effective counterweights. This will keep things in balance.

Click to expand...

Not to mention - if it is our firm belief that we are the best people to be providing care to patients, we are morally obligated to stand up for that and actively oppose those who are pushing to replace us.

The reason PAs shouldnt be given advanced standing is that even though they learn the same things as doctors, med school goes more in depth. Furthremore, a scientist who has gotten a nobel prize for his work in biochemistry would still have to take biochem if he decided he wanted to become a doctor. Its not just knowledge, its also standardization.

Northerner said:

Not to mention - if it is our firm belief that we are the best people to be providing care to patients, we are morally obligated to stand up for that and actively oppose those who are pushing to replace us.

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Wrong.

NURSES provide the best care.

Physicians (Specialists to be precise) are best at diagnosing.

horsenurse25 said:

Wrong.

NURSES provide the best care.

Physicians (Specialists to be precise) are best at diagnosing.

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Fair enough. Then we agree that diagnosis and treatment plans should be done by physicians.

Northerner said:

Fair enough. Then we agree that diagnosis and treatment plans should be done by physicians.

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Yes.... and no.

Like so many areas of medicine, that is a gray area.

Midlevels through experience and training can equal or exceed many a family doctor. In my area of expertise - geriatrics, I have found that NPs are much the preferred practitioner of choice for most.



Flindophile....excellent post.

horsenurse25 said:

Yes.... and no.

Like so many areas of medicine, that is a gray area.

Midlevels through experience and training can equal or exceed many a family doctor. In my area of expertise - geriatrics, I have found that NPs are much the preferred practitioner of choice for most.



Flindophile....excellent post.

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Give me a break-- I know that must be a nice person, and a wonderful nurse that cares very much for your patients, but are you honestly telling me that you think a nurse who has less education and less training is going to outperform a doctor?

fluffy2b said:

Give me a break-- I know that must be a nice person, and a wonderful nurse that cares very much for your patients, but are you honestly telling me that you think a nurse who has less education and less training is going to outperform a doctor?

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Don't bother arguing with her. She's an idiot. She thinks that an NP getting a PhD in neuroscience is equivalent to a neurologist and likes to introduce them as "Dr. so and so".

Taurus said:

Don't bother arguing with her. She's an idiot. She thinks that an NP getting a PhD in neuroscience is equivalent to a neurologist and likes to introduce them as "Dr. so and so".

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Ahh Taurus. Now, now...no name calling or I might have to tattle on you to the moderators... What would I do without you to misquote me and make derisive fun??? I think your paranoia is running away with you...


A qualified, experienced nurse practitioner (not RN, but NP) is an excellent mid-level provider and in many cases provides excellent care similar to a family doctor. They can exceed in care and holistic treatment plans, especially in geriatrics where there is a serious lack of interest from the physicians at large. They can certainly refer cases that are over their head to specialists... just as family doctors do.

If you had ever worked in a long term care facilitiy you might know what I am talking about...

NPs and PAs are the future.

In the real world, not on this narcissistic fishbowl of a forum board, NPs and PAs are welcome, appreciated, and acknowledged members of the health care team.

Taurus... you are the past. Thank God.

By the way, weren't you going to tell me exactly how nurses do not practice medicine??? I am waiting...

horsenurse25 said:

whole lot of stuff snip

By the way, weren't you going to tell me exactly how nurses do not practice medicine??? I am waiting...

Click to expand...

This is one place that I will agree with Taurus. Almost every state nurse practice act has a section that say something along the lines of "nothing in this section shall constitute the practice of medicine". This is because if they admitted that NPs practice medicine then by all rights they should be under the direction of the BOM. Instead they are under the BON which does not have the background or the expertise to evaluate medical acts.

This leads to a huge disconnect between between the BON and the BOM on what they discipline people on. There is very strong concordance between state BOM discipline and the national practitioner data bank. On the other hand hand there is significant discordance between BON discipline and the national practitioner data bank. In my opinion anyone that practices medicine - diagnosis and prescribes - should be under the BOM. That includes NP, CNS (in states where they diagnose and prescribe), CRNA and CNM. If they want to be under BON also for their RN license then fine.

David Carpenter, PA-C

horsenurse25 said:

Ahh Taurus. Now, now...no name calling or I might have to tattle on you to the moderators... What would I do without you to misquote me and make derisive fun??? I think your paranoia is running away with you...


A qualified, experienced nurse practitioner (not RN, but NP) is an excellent mid-level provider and in many cases provides excellent care similar to a family doctor. They can exceed in care and holistic treatment plans, especially in geriatrics where there is a serious lack of interest from the physicians at large. They can certainly refer cases that are over their head to specialists... just as family doctors do.

If you had ever worked in a long term care facilitiy you might know what I am talking about...

NPs and PAs are the future.

In the real world, not on this narcissistic fishbowl of a forum board, NPs and PAs are welcome, appreciated, and acknowledged members of the health care team.

Taurus... you are the past. Thank God.

By the way, weren't you going to tell me exactly how nurses do not practice medicine??? I am waiting...

Click to expand...

Either report his post or don't, no one cares about your ridiculous "threats", nor the PM Taurus would receive if you did.

You are missing the point, however. Though I agree with you that NP's may be competent within their training (and perhaps sufficient to handle many if not most PC cases), we believe that: (1) a physician is the better provider, (2) the vast majority of patients, all things equal, would prefer a physician, and (3) the movement away from physicians filling the primary care role and towards peripheral care providers providing this role instead is largely a financial one, which may compromise the treatment patients receive. That's why you should expect resistance from physicians, because we feel this is happening for the wrong reasons, and certainly don't want it to expand.

Good post, by the way, core.

Northerner said:

Either report his post or don't, no one cares about your ridiculous "threats", nor the PM Taurus would receive if you did.

You are missing the point, however. Though I agree with you that NP's may be competent within their training (and perhaps sufficient to handle many if not most PC cases), we believe that: (1) a physician is the better provider, (2) the vast majority of patients, all things equal, would prefer a physician, and (3) the movement away from physicians filling the primary care role and towards peripheral care providers providing this role instead is largely a financial one, which may compromise the treatment patients receive. That's why you should expect resistance from physicians, because we feel this is happening for the wrong reasons, and certainly don't want it to expand.
.

Click to expand...

Other than your beliefs... show me the literature to prove them.

As far as I have found, the literature and studies have proven exactly opposite to what you believe.

(I can only speak for NPs since that is my area. I am certain PAs have similar results)

Namely: acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows did not have any different results for patient outcome, and in fact, often the outcomes WERE SIGNIFICANTLY BETTER when NPs were involved.

Just some quick articles:
1) Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit
2) Utilization of Nurse Practitioners in Long-term Care: Findings and Implications of a National Survey
3) Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians in Training
4) Some Patients Have Comparable Short-Term Health Outcomes When Treated By Physician or Nurse Practitioner
5) Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.

To your argument of preference:

The problem is that many people are still not entirely certain what a NP is, and simply cling to the traditional 'doctor' status.
1) Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration

However,
Studies have shown that once a patient has had NP involvement they report enhanced patient outcomes and higher levels of satisfaction
1) Development and Effectiveness of Nurse-Led Arthritis Clinics

To your belief that mid-levels becoming primary care providers will result in a decrease of quality of care, well, the studies have proven just the opposite, as I have shown...

And finally, in a study to determine what real physicians in the setting thought about NPs, the response is exactly opposite to what you believe:
Perceptions of Physicians, Nurses, and Respiratory Therapists About the Role of Acute Care Nurse Practitioners

You can probably google all these articles.
But if you cannot find them, I can provide links.

And Taurus and I have a history it is very fun to rattle his cage... poor endangered species that he is...


Final Note: As for my beliefs... I KNOW that everyone benefits when mid-levels and physicians all work together to ultimately provide the best patient-centered care possible. The BEST physician is the one who realizes he does not sit in an Ivory Tower dispensing Magical Medical Healing Magic and that there is something to be learned and gained by working with all the members of the team.

Everyone wins in that situation.

We all want the same thing, so let's just get on with it.

horsenurse25 said:

Other than your beliefs... show me the literature to prove them.

As far as I have found, the literature and studies have proven exactly opposite to what you believe.

(I can only speak for NPs since that is my area. I am certain PAs have similar results)

Namely: acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows did not have any different results for patient outcome, and in fact, often the outcomes WERE SIGNIFICANTLY BETTER when NPs were involved.

Just some quick articles:
1) Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit
Despite the title compares ACNP/Physician teams to Fellow/Resident Physician Teams.
2) Utilization of Nurse Practitioners in Long-term Care: Findings and Implications of a National Survey
Dealt with "satisfaction" not outcomes.
3) Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians in Training
Compared residents to ACNPs
4) Some Patients Have Comparable Short-Term Health Outcomes When Treated By Physician or Nurse Practitioner
Interesting study - see below
5) Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up.
Poor follow up. The initial study showed no difference in health care measures between patients randomly assigned to physicians or NPs. The follow up lost so many patients that it was not statistically valid. Given the measures of healthcare that were used, they would need more than 5 years following 500 patients in each arm to show a difference. Also the physicians in this study had more visits implying that either they spent more time with the patients (another myth goes crashing down) or they had more complex patients. This was not well stratified but remains the best comparison of NP and physician practice. The original deserved publication in JAMA. The follow up deserved publication in whatever obscure journal it was published in.

To your argument of preference:

The problem is that many people are still not entirely certain what a NP is, and simply cling to the traditional 'doctor' status.
1) Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration
Umm Yeah has nothing to do with comparing physician practice and NP practice.

However,
Studies have shown that once a patient has had NP involvement they report enhanced patient outcomes and higher levels of satisfaction
1) Development and Effectiveness of Nurse-Led Arthritis Clinics
This has nothing to do with NPs. It is about nurse led clinics in rheumatology. Despite the similar title, the term nurse practitioner is used very differently in the UK. These are nurses that are given additional training and use a protocol driven formula to address the disease states. This is similar to US coumadin clinics. This is a result of a severe lack of rheumatologists in the UK and the fact that most GPs in the UK refer almost everything out (based on my discussion with PAs working there). A lot of the conditions that are dealt with in these clinics like OA are routinely dealt with in the US by primary care.

Lots of stuff deleted

Click to expand...

So despite your claims there has not been a study that shows equivalent or better outcomes by NPs when compared to practicing physicians. You are simply parroting the NP line which is simply not true. The Columbia study is the closest thing and it foundered over power and lack of follow up. When compared to supervised physicians (fellows and residents) NPs show equivalence. Given that 98% of NPs work in a supervised environment it will probably be impossible to separate out the physician component from the NP component. The same problem exists in the study of PA practice. Studies show that a practice with PAs is more efficent, has shorter wait times and is more profitable. However, I sincerely doubt that you will ever be able to show a study where outcomes are better and attributable solely to the PA component.

Interestingly when the NHS in the UK approached the nursing council about expanding NP practice in a manner similar to US NPs they (according to the NHS representative) wanted nothing to do with it since it constituted the practice of medicine. So was born the NHS PA pilot program (in a manner eerily similar to Dr. Steads program).

Simply put to claim that NPs provide equivalent or better care than practicing physicians is not supported in any meaningful scientific way.

David Carpenter, PA-C

I don't need to say anything. horsenut is her own worse enemy.

horsenurse25 said:

Ahh Taurus. Now, now...no name calling or I might have to tattle on you to the moderators... What would I do without you to misquote me and make derisive fun??? I think your paranoia is running away with you...


A qualified, experienced nurse practitioner (not RN, but NP) is an excellent mid-level provider and in many cases provides excellent care similar to a family doctor. They can exceed in care and holistic treatment plans, especially in geriatrics where there is a serious lack of interest from the physicians at large. They can certainly refer cases that are over their head to specialists... just as family doctors do.

If you had ever worked in a long term care facilitiy you might know what I am talking about...

NPs and PAs are the future.

In the real world, not on this narcissistic fishbowl of a forum board, NPs and PAs are welcome, appreciated, and acknowledged members of the health care team.

Taurus... you are the past. Thank God.

By the way, weren't you going to tell me exactly how nurses do not practice medicine??? I am waiting...

Click to expand...

You're certainly going out there on a limb to say that PA's and NP's are the future of medicine-- I would certainly agree that there is a place for them in medicine. They can be an invaluable asset to a physician, but that certainly doesn't change the fact that they are there to assist the physician and not replace him/her.

Medicine is changing and evolving so rapidly that it is hard for even the doctors to keep up, so I don't see how nurses with degrees that are based in nursing theory are going to be able to utilize this information in a safe and effective manner in the same way that a physician who was trained in the medical model for 7+ years is-- there is just no way. The science is cutting edge, and spending 30 hours in class learning nursing theory isn't going to help you.

As for the articles, they're bogus. Reading one of them that you or one of your colleagues had posted a while back was interesting-- the data was so pathetic (low power, low CI, etc) that the study shouldn't have been published. But all the other NP's were looking at was "NP's do just as well MD's." You guys really need to learn how to properly read a study.

As for not seeing the "whole patient," believe me we do. Just because we have more training doesn't mean we don't see a patient in front of us who is embarassed, sick, who has a family who loves them and who they love. Believe it or not, we really care a lot about our patients, so stop giving us all this crap about "nurses take care of patients, doctors don't care. We care. That's why we went to medical school. Some of us got a little burnt out along the way, and sometimes we have bad days, but for the most part we care a lot about our patients, and we don't need a bunch of courses not nursing theory to tell us that we should care about our patients and that stress isn't good for them. That's called common sense, and we already have that.

In a few years, we will be overwhelmed by the renewal of FP/GP/Prim Care docs in the workforce. The physician job market is like any other that follows the trend of peaks and valleys. Currently, the valley in the primary care world will be filled leaving another valley elsewhere in medicine.

We have seen it with ALL fields. Some classic examples in the last few years have been: Radiology, Anesthesia & ER. These residencies were a dime a dozen (relative to todays standards) say 7-10 years ago.

The world of the GP/FP/Prim Care is on the rise again. There are PLENTY of FGM, DO & MDs beginning to look at this field again. The ability to obtain certifications and perform various in-office procedures is bringing it back into the limelight. It is just a matter of time until this valley fills and the next forms.

How many people are talking about OG/GYN? This field has WONDERFUL fellowships but the liability and length of programs has become a roadblock to many. I believe PAs have a wonderful spot to fill in medicine, but I don't see a need to transition them to MD or DO in the near future.

Also, there are more medical schools being built and slotted for in the current model. Google to find some, you will see a decent amount planned for the next 5 years.

Finally, as it stands the match is ad competitive as it has been in years. The incentive to return to school with a floundering financial world and being at war is far tooooooooooo high. We have an unsightly amount of graduates and not enough training programs. Yes, I know people will claim that FP/Prim Care doesnt fill every year -- but I think that will be changing here VERY soon.

I wish you all the best.

Osteo

ccqb3189 said:

. I would welcome a program that took me through the first two years and then gave me some credit for having done twice as much as the medstudents in the 3rd and 4th years.

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talk about smoking something good! LOL. wow!!!

mig26x said:

talk about smoking something good! LOL. wow!!!

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PUFF... puff.. PASS...

Osteopathology said:

In a few years, we will be overwhelmed by the renewal of FP/GP/Prim Care docs in the workforce. The physician job market is like any other that follows the trend of peaks and valleys. Currently, the valley in the primary care world will be filled leaving another valley elsewhere in medicine.

We have seen it with ALL fields. Some classic examples in the last few years have been: Radiology, Anesthesia & ER. These residencies were a dime a dozen (relative to todays standards) say 7-10 years ago.

The world of the GP/FP/Prim Care is on the rise again. There are PLENTY of FGM, DO & MDs beginning to look at this field again. The ability to obtain certifications and perform various in-office procedures is bringing it back into the limelight. It is just a matter of time until this valley fills and the next forms.

How many people are talking about OG/GYN? This field has WONDERFUL fellowships but the liability and length of programs has become a roadblock to many. I believe PAs have a wonderful spot to fill in medicine, but I don't see a need to transition them to MD or DO in the near future.

Also, there are more medical schools being built and slotted for in the current model. Google to find some, you will see a decent amount planned for the next 5 years.

Finally, as it stands the match is ad competitive as it has been in years. The incentive to return to school with a floundering financial world and being at war is far tooooooooooo high. We have an unsightly amount of graduates and not enough training programs. Yes, I know people will claim that FP/Prim Care doesnt fill every year -- but I think that will be changing here VERY soon.

I wish you all the best.

Osteo

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I saw that train-a-comin' long ago. Happy in my specialty here

I haven't read all the responses and just skimmed the article but I have thought something like this should exist for a while, so I just thought I'd throw out my dreamy thoughts.

I compared a particular PA program with the same school's MD curriculum. It seemed like the PA program was essentially the 1st and 3rd years of their MD curriculum. It would be ideal for PA-Cs who have worked a certain number of years to be able to go back and complete year 2, take the boards, then do elective rotations for another year, and then graduate with a medical doctorate.

As a nurse and 3rd year medical student - nursing school does not prepare you for the hellish amount of information that must be mastered in medical school. I spent as much time or more than my peers studying because I had to know the why of disease that is not required as a nurse and I found myself having to "relearn" a good deal of what I was taught in the various courses I took as a nurse.

I was more comfortable with patient interaction and this has served my well in my 3rd year. There is no short cut as it stands now but I think PAs could take abbreviated basic science courses since they are trained in the medical model and complete many of the same courses. Their clinical hours may not be the same but are far more structured than FNP online degree programs. So maybe there could be a 3 year bridge program that allowed PA's to test out of some courses they have already completed.

I think the bachelor requirement prior to medical school just adds debt and time to an already arduous process. Medical school could be 6 years plus residency and just skip the whole bachelors requirement all together. My under graduate work (minus pre-reqs) added very little to the whole process other than I manged to finish 4 years of college prior to med school - big deal. But that is another thread....

Well I am all for those BS/MD 6 year programs. The medical school component is 100% identical than those doing the traditional routes. They just cut out most all of the non-science components of an undergraduate degree.

http://www.neoucom.edu/audience/applicants/succeed/admi/AdmiCurr/CurrPhaseI