Combined PA/MD Programs- Why do these not exist?

[kittykatmd]

I was wondering if I am the first person to throw this idea out. Creating a single track seems like a no-brainer in terms of providing flexibility to the student. Medical students who want to take a break from academics wouldn't be forced to enter a residency to practice with supervision, and PA's who want to advance their career and gain additional specialist training could enter the match.

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[primadonna22274]

I'm a DO who was a physician first (11 years in practice when I went back to med school, now a FM resident halfway through intern year). I did the first (only) "bridge" program which shaved off one year (M4). It was very intense with no vacation and not much time for electives or audition rotations, but I saved a year of tuition and it was a good fit for me.
What you are proposing is already being tossed around as a "stem cell" model of medical education. I think it would be a GREAT idea and makes a lot of sense but would take some serious overhauling of the entire medical education system.
Still I have hope that we may see some restructuring in the next decade or so as we try to streamline and cut waste in medical education. Stay tuned.

 

[kittykatmd]

I truly hope that overhauling comes to pass, but in the meantime, I'm glad to hear people in higher places are tossing it around. Thanks for weighing in Dr. Primadonna. Enjoy PGY1!

 

[deleted6669]

bridge programs from pa to md/do and continuity program concepts have been toyed with since the founding of the pa profession in the 60s. The founder of the profession (Dr. Stead) felt pas should be able to return to school and attend a shortened program to become physicians. A realistic program would be 2 years long. The current 3 yr bridge program is a good start, but with the advent of 3 yr med programs it becomes obvious that PAs should be able to do considerably less than 3 years. As little as 18 months would probably be viable, most of ms1, part of ms2, and 6 months of clinicals would do it if streamlined directly into a residency. MS4 is largely vacation blocks, interviewing, and electives at many medical schools today. If a residency were assured in primary care upon completion, months of "the interview trail" could be done away with....and paying for vacation blocks just seems silly....

 

[kittykatmd]

I'm familiar with the bridge programs, but I'm afraid that they're never going to be a viable idea because of the way post-graduate education works. There are only a limited number of residencies funded by Medicare, and that's really not going to change, especially with healthcare reform on the horizon. The medical board will never allow PA's into the match algorithm because it will take a seat from a medical student. What I'm suggesting is reciprocal training from the start- a program that awards both degrees simultaneously and allows the graduate to sit for the PANCE, but also awards an MD, thus making one eligible to enter a traditional residency. The students who stop their training to work as PA's solve the bottleneck problem, and there are plenty of people in MD programs who wish they had chosen PA (at least from personal experience and what I've read on these forums). The residency seats go to people who really want them, instead of people who simply are forced to keep going because they have massive debt and no practice rights otherwise.

 

[deleted6669]

I'm familiar with the bridge programs, but I'm afraid that they're never going to be a viable idea because of the way post-graduate education works. There are only a limited number of residencies funded by Medicare, and that's really not going to change, especially with healthcare reform on the horizon. The medical board will never allow PA's into the match algorithm because it will take a seat from a medical student. What I'm suggesting is reciprocal training from the start- a program that awards both degrees simultaneously and allows the graduate to sit for the PANCE, but also awards an MD, thus making one eligible to enter a traditional residency. The students who stop their training to work as PA's solve the bottleneck problem, and there are plenty of people in MD programs who wish they had chosen PA (at least from personal experience and what I've read on these forums). The residency seats go to people who really want them, instead of people who simply are forced to keep going because they have massive debt and no practice rights otherwise.

I would be ok with this if they allowed PAs to "get back on the bus" to finish the md and enter the match.

 

[joeDO2]

MS4 is largely vacation blocks, interviewing, and electives

where was this school when I was applying! for my school: 1/13 blocks is vacation. we get 10 days maximum during the year for interviews, 3/13 blocks are electives (but even the easier choices here like rads and derm I think there is still a good amount of learning)

I do agree however there should be an expedited route from PA to DO/MD. Just not sure what the best way to do it would be.

 

[deleted6669]

where was this school when I was applying! for my school: 1/13 blocks is vacation. we get 10 days maximum during the year for interviews, 3/13 blocks are electives (but even the easier choices here like rads and derm I think there is still a good amount of learning)

I do agree however there should be an expedited route from PA to DO/MD. Just not sure what the best way to do it would be.

One of my em attendings spent 6 months of his ms4 yr hiking in the himalayas from clinic to clinic as an" international rural medicine elective".... during which he summited multiple 7000 M peaks, got married, had his honeymoon, etc.

 

[deleted6669]

This is actually a very, very intriguing idea. If I understand you correctly, the first two years of school would basically be PA school. At that point students could either decide they're done, get their PA degree and go out into the world - OR - they could then go on to another two years of school which would be the additional basic sciences and rotations necessary to get an MD. It really would be win-win. Plenty of med students regret their decision one or two years in, but are too in debt to do anything about it. Problem solved. Plenty of PA's end up regretting not going to med school but would have to go back for all 4 years which is just too much. Problem solved. Since both train under the medical model, it seems like a very potentially doable proposition.

Would it work? I have no idea, but it is quite an interesting thought.

The issue is it would have to be done at the same program. PA school is very little of ms1, much of ms2, and all of ms3. The current bridge is all of ms1 and ms2 and a combined hybrid of ms3/ms4 for the final year.
the continuity program would probably need 12-16 mo of didactic and 6-12 months of clinicals, depending on the student.

 

[kittykatmd]

Thank you! I think actually the ideal would be the first 3 years- MS1, MS2, and the first year of clinicals, with those deciding to pursue residency continuing onto M4. A bit extra time for those on the PA route, but considering that 3 year PA programs are already in existence, I think enough people would be willing to throw in their hats for the opportunity to stop/continue as they please.

 

[kittykatmd]

I would be ok with this if they allowed PAs to "get back on the bus" to finish the md and enter the match.

It's trickier with the PA's already practicing. My thinking was more for students who are just entering education. I think that true bridge programs for the seasoned PA's will become more viable with this type of system in practice, however, as residency slots open up. They could be built on as a separate program with schools offering this training, perhaps, with the two programs sharing the same faculty.

 

[Mad Jack]

bridge programs from pa to md/do and continuity program concepts have been toyed with since the founding of the pa profession in the 60s. The founder of the profession (Dr. Stead) felt pas should be able to return to school and attend a shortened program to become physicians. A realistic program would be 2 years long. The current 3 yr bridge program is a good start, but with the advent of 3 yr med programs it becomes obvious that PAs should be able to do considerably less than 3 years. As little as 18 months would probably be viable, most of ms1, part of ms2, and 6 months of clinicals would do it if streamlined directly into a residency. MS4 is largely vacation blocks, interviewing, and electives at many medical schools today. If a residency were assured in primary care upon completion, months of "the interview trail" could be done away with....and paying for vacation blocks just seems silly....

The trouble is that there is a lot that is missed in the basic sciences for PAs. Basic sciences alone require around 19 months to complete, and then you have to do at least a year of rotations at the physician level (since PA rotations aren't equivalent to medical student rotations, hence the requirement of 12 months of rotations at the 3 year bridge program), so that's 12 months, giving you a minimum of about 31 months total if you ran it straight through.

 

[Mad Jack]

The issue is it would have to be done at the same program. PA school is very little of ms1, much of ms2, and all of ms3. The current bridge is all of ms1 and ms2 and a combined hybrid of ms3/ms4 for the final year.
the continuity program would probably need 12-16 mo of didactic and 6-12 months of clinicals, depending on the student.

If there were a school that had a PA program in which the PA students functioned in the same clinical capacity as the med students, and in which as many of the required courses as possible were taken with the medical students, a faster bridge would certainly be more feasible.

 

[deleted6669]

If there were a school that had a PA program in which the PA students functioned in the same clinical capacity as the med students, and in which as many of the required courses as possible were taken with the medical students, a faster bridge would certainly be more feasible.

places with both pa and md students typically schedule ms3 and pa2 interchangeably. my pa2 was equivalent in every way to the ms3 students on rotation with me. we did exactly the same things with the same responsibilities. I did 100 hr weeks on surgery, took ob call, delivered babies, etc.

 

[deleted6669]

The trouble is that there is a lot that is missed in the basic sciences for PAs. Basic sciences alone require around 19 months to complete, and then you have to do at least a year of rotations at the physician level (since PA rotations aren't equivalent to medical student rotations, hence the requirement of 12 months of rotations at the 3 year bridge program), so that's 12 months, giving you a minimum of about 31 months total if you ran it straight through.

I agree that we would have to do all of ms1. we probably only need around 1/2 of ms2, having already taken the rest. 18 months would definitely cover all the didactic component. add one more year(or even 6 months without interview time/vacation blocks, etc) and you could have an equivalent education.
If you were to compare pa school to one of the new direct entry 3 yr md primary care programs you would see that we have already done more than 1/2 of their curriculum.

 

[pamac]

I don't see bridge programs taking hold in an extended fashion. It's actually reduces the number of providers by taking one provider with prescribing privileges and making them into another provider with prescribing privileges. You don't increase the number of providers in the field, you simply enhance the training of another and take a seat that could be filled. Certainly in state funded schools, you'd have legislators asking themselves what benefit this has for the state when provider shortages are on the horizon. Private programs might continue to offer this, but you run into the issue of limited residency spots. I imagine PA trained med school grads are good picks for residencies, but if this goes broad, policy makers will start to ask questions. I don't see med school changing itself around to accommodate a potential influx of PAs. There's nothing really remarkable about an abbreviated program for PA's other than it only recruits PAs and gets them through cheaper and in 3 years. NYU offers a 3 year program as well... For anyone that wants to apply.

If bridge programs took off in the way suggested, where you make the PA profession a waypoint on the way to medicine, you'll basically destroy the PA profession by implying it's a career that students settle on because they can't move on to be a physician. Who is going to stop at PA unless they have to? Imagine how patients will treat you as a PA and what kinds of questions they will ask when you walk in the room? "Why didn't you keep going to be a physician?". Be careful what you wish for.

 

[deleted6669]

Imagine how patients will treat you as a PA and what kinds of questions they will ask when you walk in the room? "Why didn't you keep going to be a physician?". Be careful what you wish for.

And that would be different than right now how? we already get that question all the time...
I think the advantage of pa to md/do grads is that those folks would be more likely to work in underserved areas than folks who were not previously pas. the pa profession already selects for the types of folks who prefer rural/underserved practice (there is a greater % of pas in these areas than either nps or physicians) , so those same folks would be more likely to practice in those types of areas as physicians...and more physicians in those areas means you can bring in more pas who previously could not have gone to certain areas due to a lack of collaborating physicians for them to work with...

 

[pamac]

I can see 3 year programs becoming more widespread across the board for all applicants, and with that possibly a handful of PA bridge programs. What I don't see is any kind of pathway integration on par with what's been suggested, where there is seamless transition through through both professions. I don't see physicians wanting to push it (or wishing they had trod that path themselves), and I don't think you'd see PAs wanting it if they really did want to stick with the profession. Imagine how long it would take to have your wages as a PA hit the floor. A few of those who are PAs and unsatisfied and want to move on to MD or DO would be interested in this kind of approach, but the vast majority of the rest would see the potential harm in that.

 

[deleted6669]

Imagine how long it would take to have your wages as a PA hit the floor. A few of those who are PAs and unsatisfied and want to move on to MD or DO would be interested in this kind of approach, but the vast majority of the rest would see the potential harm in that.

Actually most of the pa to doc folks I know (n=probably 10) worked as pas while in medschool and made decent $$.

 

[pamac]

Sure, they do that now under the current system. If PA was a waypoint towards MD, they would be considered little more than residents, and would be compensated as such. That's where the danger comes in. By being a distinct entity, PA value is greater than if they are a box to check on the way to being a physician. You don't want to open that door, because healthcare would eat that up.

 

[Placidius]

I'm a DO who was a physician first (11 years in practice when I went back to med school, now a FM resident halfway through intern year). I did the first (only) "bridge" program which shaved off one year (M4). It was very intense with no vacation and not much time for electives or audition rotations, but I saved a year of tuition and it was a good fit for me.
What you are proposing is already being tossed around as a "stem cell" model of medical education. I think it would be a GREAT idea and makes a lot of sense but would take some serious overhauling of the entire medical education system.
Still I have hope that we may see some restructuring in the next decade or so as we try to streamline and cut waste in medical education. Stay tuned.

I've never heard the stem cell analogy. That is a perfect analogy for what I could see as a great way for us to do education for doctors and nurses.