PA to Physician bridge: Why not?

[Gatewayhoward]

I agreed with the school of thought for a time that a PA is far more below a physician than most people realize and bridge programs would probably never happen.
But why can't a PA with a M.S. someday chose to become a physician without having to go to med school from scratch (a PA told me she could begin med school as a 2nd year)?
It's like saying you have to take your master's all over again to get a doctorate in medicine.
the credentials required to become a physician and their role is constantly changing. Why is this change not possible?

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[deleted6669]

I agreed with the school of thought for a time that a PA is far more below a physician than most people realize and bridge programs would probably never happen.
But why can't a PA with a M.S. someday chose to become a physician without having to go to med school from scratch (a PA told me she could begin med school as a 2nd year)?
It's like saying you have to take your master's all over again to get a doctorate in medicine.
the credentials required to become a physician and their role is constantly changing. Why is this change not possible?

a bridge would require a pa to complete several 1st yr and several 2nd yr classes and probably 1 year of rotations if credit were given for all classes and rotations that are the same. if it was done within a traditional medschool framework it could be done in 3 years working part time year 1 and 2 and then full time rotations for a year. if done as a stand alone program it could probably be done in 2-2.5 years full time. there are not presently any schools that want to train someone to be an md/do for 75% of what they are currently getting paid for this training so what is the incentive for the medschool? they can already fill all the seats with folks willing to pay 4 years of tuition......there are a few carib schools that give pa's advanced standing but no u.s. programs.

 

[sistermike]

Very simple -- if you want to become an MD/DO, go to medical school. If you want to become a PA, go to PA school. Simple as that. There should be no allowance for advanced standings if one has already completed PA school. If that were allowed, you would open an entire new door. Why shouldn't NP's whom have been practicing for 15 years (and probably is just as knowledgeable as many MD/DO's) be given advanced standing. I think everything works well the way it is.

 

[anon-y-mouse]

Also, the better medical schools have already moved to a systems-based approach, where the traditional disciplines are learned organ-to-organ... this has resulted in a substantial increase in USMLE scores at schools who've switched over. Check out the Baylor College of Medicine curriculum just as an example. One of my med school classmates, a PhD in Cell + Immunology, was NOT given credit for those classes, although he's doing quite well in them now (but still is learning a lot more due to the integratedness of the curriculum). Systems-based approaches and the sheer integratedness of the curriculum make it very hard to give credit based on previous work. It's not about "taking the full 4 years of tuition" as emedpa opined... med schools are not vocational career colleges. In fact, it costs a LOT more to educate a med student than schools charge for.

 

[deleted6669]

I agree that a pa to md bridge would require a pa to retake a lot of the ms 1 and ms 2 courses as they are more in depth but courses like ethics, care of the dying pt, physical dx, H+P, and all rotations are taught to the same standard as the medschool courses and could translate straight across. none of the "hard science" courses could translate 100% so a complete retake would be needed but most of the clinical coursework could.

 

[jwk]

I agree that a pa to md bridge would require a pa to retake a lot of the ms 1 and ms 2 courses as they are more in depth but courses like ethics, care of the dying pt, physical dx, H+P, and all rotations are taught to the same standard as the medschool courses and could translate straight across. none of the "hard science" courses could translate 100% so a complete retake would be needed but most of the clinical coursework could.

For those that have taken med school classes, they might be able to be exempted. I think some PA programs take a few classes with the med students (anatomy, physiology).

 

[DNP student]

The problem that I see is that not all PA schools are equal. One school may have PA students in classes with med students, but not all PA schools are associated with med schools. The microbiology class at one PA school may not be as difficult as the micro class at another PA school which includes PA students with med students.

 

[anon-y-mouse]

I agree that a pa to md bridge would require a pa to retake a lot of the ms 1 and ms 2 courses as they are more in depth but courses like ethics, care of the dying pt, physical dx, H+P, and all rotations are taught to the same standard as the medschool courses and could translate straight across. none of the "hard science" courses could translate 100% so a complete retake would be needed but most of the clinical coursework could.

Ok, NO. Rotations are NOT all taught to the same standard as the med school courses. Just because the students are ON the same rotation does not mean they are taught to the same standards. Did PA's have to take the official NBME shelf examination after every rotation? NO. Hence, not the same standard, for starters. I won't go into the other differences.

Ethics, care of dying pt, physical diagnosis, h+p => did NOT take that much time in med school for me... besides, the tune changes (slightly or drastically depending on who you ask) with respect to ethics, since in some situations, people are held at higher standards medicolegally as physicians.

 

[Bandit]

i did take shelf exams after every rotation in PA school.

I am of the same mindset as E--repeat all the science/med classes--aloow to skip (or even precept) H&P, PE, ethics, "coda" in DO school, and all the first and second year "exposure" stuff.

I also agree with DNP that not all PAs or PA programs are created equally. One of the big reasons I left the profession.

Rotations ARE ther same--especially in the third year.

 

[jwk]

The problem that I see is that not all PA schools are equal. One school may have PA students in classes with med students, but not all PA schools are associated with med schools. The microbiology class at one PA school may not be as difficult as the micro class at another PA school which includes PA students with med students.

That's true of any class in any program at any school. Surely you're not suggesting that nursing programs, particularly graduate ones, are uniform, and especially not NP programs.

 

[jwk]

Also, the better medical schools have already moved to a systems-based approach, where the traditional disciplines are learned organ-to-organ... this has resulted in a substantial increase in USMLE scores at schools who've switched over. Check out the Baylor College of Medicine curriculum just as an example. One of my med school classmates, a PhD in Cell + Immunology, was NOT given credit for those classes, although he's doing quite well in them now (but still is learning a lot more due to the integratedness of the curriculum). Systems-based approaches and the sheer integratedness of the curriculum make it very hard to give credit based on previous work. It's not about "taking the full 4 years of tuition" as emedpa opined... med schools are not vocational career colleges. In fact, it costs a LOT more to educate a med student than schools charge for.

There are still plenty of med schools with a more traditional track.

 

[Jengirl18]

Although not all PA schools have classes along with med students, the classes are still taught by MDs. We have an accrediting body called ARC-PA which keeps each PA school in check. When they come, they get down to all the nitty-gritty details.... interviewing professors, preceptors, students, and look through academic files...making sure everything is up to par. By the way, do NP programs have a comittee like this?

 

[Bandit]

lets no turn this into another thread like that guys.

 

[hospitalistpac]

Very simple -- if you want to become an MD/DO, go to medical school. If you want to become a PA, go to PA school. Simple as that. There should be no allowance for advanced standings if one has already completed PA school. If that were allowed, you would open an entire new door. Why shouldn't NP's whom have been practicing for 15 years (and probably is just as knowledgeable as many MD/DO's) be given advanced standing. I think everything works well the way it is.

Since when is opeing up an "entire new door" a bad thing. I am sick of hearing about the dwindling family practice mathc and the lack of doctors here and their. We are talking about PAs going to med school here, not just being handed an MD.

On alighter note, when ever I think about the idea of mad school, I shriek at the idea of rounding on ob patients at 4:30 am. Notes that no one will ever read or care about except maybe that day.
And yes we all take shelf exams
And yes some Pa schools are not as good as other
But I am still interested in discussion about prepraring more PCPs and giving the ambitious PA an "entire new door"

 

[core0]

Since when is opeing up an "entire new door" a bad thing. I am sick of hearing about the dwindling family practice mathc and the lack of doctors here and their. We are talking about PAs going to med school here, not just being handed an MD.

On alighter note, when ever I think about the idea of mad school, I shriek at the idea of rounding on ob patients at 4:30 am. Notes that no one will ever read or care about except maybe that day.
And yes we all take shelf exams
And yes some Pa schools are not as good as other
But I am still interested in discussion about prepraring more PCPs and giving the ambitious PA an "entire new door"

Why do we need more PCP's? Maybe the model is changing to using more midlevel providers? There is already a door if you want to become an MD. It's go to medical school. No one else gets a pass there, why should PA's. The big problem with going to medical school is that you have to leave your job, take on another 100k of debt. Work at 30k for another three years. Then end up making a little more than you are making now. It isn't supposed to be easy. That's the point.

David Carpenter, PA-C

 

[anon-y-mouse]

i did take shelf exams after every rotation in PA school.

I am of the same mindset as E--repeat all the science/med classes--aloow to skip (or even precept) H&P, PE, ethics, "coda" in DO school, and all the first and second year "exposure" stuff.

I also agree with DNP that not all PAs or PA programs are created equally. One of the big reasons I left the profession.

Rotations ARE ther same--especially in the third year.

What shelf exams did you take? Were they published by the NBME?

 

[deleted6669]

bandit is an ms 3 and former em pa . I am guessing he knows what he is talking about.....

 

[Jengirl18]

They are the same kinds of questions-no matter who the exams are published by. I'm using a USMLE 2 book right now to study for end-of-rotation PA exams...

 

[anon-y-mouse]

They are the same kinds of questions-no matter who the exams are published by. I'm using a USMLE 2 book right now to study for end-of-rotation PA exams...

So? I used the BRS anatomy (for step 1) to study for my undergrad anatomy class.

The NBME = national board of medical examiners... the people who actually write the USMLE. It matters if you're not taking the same exams and expect to get credit for the rotations.

 

[MacGyver]

I'm so damn sick and tired of all the disingenuous midlevels who claim that bridge programs would help primary care.

Thats an absolute joke. No midlevel goes to med school because they want to be a PCP. They go to med school because they want the specialty ticket to surgery or some other lucrative specialty that pays much more than what they can get as a primary care PA/NP/whatever.

YOu dont need med school to be a primary care doc. Med school is for specialists, and the only a foolish midlevel would choose to go 100k in debt so they could be a primary care MD instead of a primary care PA because there is essentially no difference in those career paths.

 

[core0]

I'm so damn sick and tired of all the disingenuous midlevels who claim that bridge programs would help primary care.

Thats an absolute joke. No midlevel goes to med school because they want to be a PCP. They go to med school because they want the specialty ticket to surgery or some other lucrative specialty that pays much more than what they can get as a primary care PA/NP/whatever.

YOu dont need med school to be a primary care doc. Med school is for specialists, and the only a foolish midlevel would choose to go 100k in debt so they could be a primary care MD instead of a primary care PA because there is essentially no difference in those career paths.

Thats not completely true. Locally there is a Pediatrician that started out as one of the CHA/PA grads (Child health associate - PA specializing in pediatrics). It does happen, just not often. I would in general have to agree with you on the cost. You also have to look at the opportunity cost. $100k in debt plus loss of 80k income x 7 years ($560k) - $30k per year for residency = cost for medical school and residency around $570k pretty expensive (note these number are representational only).

David Carpenter, PA-C

 

[deleted6669]

Thats not completely true. Locally there is a Pediatrician that started out as one of the CHA/PA grads (Child health associate - PA specializing in pediatrics). It does happen, just not often. I would in general have to agree with you on the cost. You also have to look at the opportunity cost. $100k in debt plus loss of 80k income x 7 years ($560k) - $30k per year for residency = cost for medical school and residency around $570k pretty expensive (note these number are representational only).

David Carpenter, PA-C

DAVID- my actual cost of medschool is around 1 million dollars if you consider 7 yrs of lost income, the price of medschool and loans to live on and subtract 120k for residency pay(40k/yr x 3 years).
really doesn't make sense for me financially unless I get a full scholarship and work through school and moonlight extensively........and then I break even around the time most docs retire....

 

[jwk]

So? I used the BRS anatomy (for step 1) to study for my undergrad anatomy class.

The NBME = national board of medical examiners... the people who actually write the USMLE. It matters if you're not taking the same exams and expect to get credit for the rotations.

Favorite lines from Stripes

Psycho - Anybody calls me Francis - I'll kill you.

Sgt Hulka - Lighten up Francis

 

[DNP student]

That's true of any class in any program at any school. Surely you're not suggesting that nursing programs, particularly graduate ones, are uniform, and especially not NP programs.

No, I'm not saying nursing programs are uniform; which is why a nursing student cannot transfer in the middle of any nursing program. I'm just stating that the differences in PA programs would make a bridge for med school difficult at best.

 

[core0]

No, I'm not saying nursing programs are uniform; which is why a nursing student cannot transfer in the middle of any nursing program. I'm just stating that the differences in PA programs would make a bridge for med school difficult at best.

For PA schools there is a minimum didactic material that must be covered. There is also a minimum clinical component that is easily evaluated. This would be easy to evaluate. Some programs put additional emphasis on top of this, but everyone adheres to the minimum.

David Carpenter, PA-C

 

[core0]

DAVID- my actual cost of medschool is around 1 million dollars if you consider 7 yrs of lost income, the price of medschool and loans to live on and subtract 120k for residency pay(40k/yr x 3 years).
really doesn't make sense for me financially unless I get a full scholarship and work through school and moonlight extensively........and then I break even around the time most docs retire....

I used the average salary for PA's and what residents were making in Pennsylvania 5 years ago. Mine would be worse. In GI 4 years of med school, 3 years of IM, 3 years fellowship, 1 year of special procedures for a total of 11 years. 4 yrs med school = 100k 400k lost income, 7 years lost income = 100k-40k = 60x7 or 420k for a total of not quite $1 mil. Pretty hard to imagine. Even if for some odd reason someone could skip med school the 7 years of residency and fellowship would be pretty hard to justify. Not to mention buying in to a practice after that. Good thing I like what I do.

David Carpenter, PA-C

 

[lloydchristmas]

I'm so damn sick and tired of all the disingenuous midlevels who claim that bridge programs would help primary care.

Thats an absolute joke. No midlevel goes to med school because they want to be a PCP. They go to med school because they want the specialty ticket to surgery or some other lucrative specialty that pays much more than what they can get as a primary care PA/NP/whatever.

YOu dont need med school to be a primary care doc. Med school is for specialists, and the only a foolish midlevel would choose to go 100k in debt so they could be a primary care MD instead of a primary care PA because there is essentially no difference in those career paths.

You are basically saying that more doctors in primary care would not help primary care. That's disingenuous.

As a father and husband and disingenuous midlevel, the only way I would go to med school to be a PCP is if there was a shortened bridge because going the traditional 4 yr with 3 yr res doesn't make it worth the extra income. If it were shortened to 3-4 yrs total, it may be worth it. I don't think there should be a shortened bridge for anything other than primary care. The only reason I'd do it is because it's hard to find administration that will listen to reason when you talk business. You can lay it out as simple as it is and they'll still say, "yeah, that makes sense, but here's $60K take it or leave it". And the doc in the same position doing the same thing billing the same amount will get more than twice that. That's why I'd go to a bridge med school.

It's worth a try, and I think the majority would agree that if it worked it would provide more primary care docs to this country. If it doesn't work, then all the disingenuous midlevels will fail the USMLE and will remain midlevels anyway.

 

[anon-y-mouse]

You are basically saying that more doctors in primary care would not help primary care. That's disingenuous.

As a father and husband and disingenuous midlevel, the only way I would go to med school to be a PCP is if there was a shortened bridge because going the traditional 4 yr with 3 yr res doesn't make it worth the extra income. If it were shortened to 3-4 yrs total, it may be worth it. I don't think there should be a shortened bridge for anything other than primary care. The only reason I'd do it is because it's hard to find administration that will listen to reason when you talk business. You can lay it out as simple as it is and they'll still say, "yeah, that makes sense, but here's $60K take it or leave it". And the doc in the same position doing the same thing billing the same amount will get more than twice that. That's why I'd go to a bridge med school.

It's worth a try, and I think the majority would agree that if it worked it would provide more primary care docs to this country. If it doesn't work, then all the disingenuous midlevels will fail the USMLE and will remain midlevels anyway.

The reason they're paid more than double what you get for the same thing is that they're trained to see and manage the zebras, when they arise.

 

[lloydchristmas]

The reason they're paid more than double what you get for the same thing is that they're trained to see and manage the zebras, when they arise.

I understand this. But from a strictly financial standpoint, what is this worth in a PCP setting? Nothing. If I see someone with a problem that I can't figure out with a great deal of confidence, I'll refer them in a heartbeat. Since Zebras are 1 in a million by definition, I don't see the financial advantage to managing them vs referring out.

 

[deleted6669]

I understand this. But from a strictly financial standpoint, what is this worth in a PCP setting? Nothing. If I see someone with a problem that I can't figure out with a great deal of confidence, I'll refer them in a heartbeat. Since Zebras are 1 in a million by definition, I don't see the financial advantage to managing them vs referring out.

I think his point is missing them and not refering when it needs to happen. this happens to docs too.....

 

[anon-y-mouse]

I think his point is missing them and not refering when it needs to happen. this happens to docs too.....

obviously at a much lower rate, a physician's training is more comprehensive.

 

[deleted6669]

obviously at a much lower rate, a physician's training is more comprehensive.

agreed. the rate is lower for md's. I would not say much lower though.....

 

[anon-y-mouse]

agreed. the rate is lower for md's. I would not say much lower though.....

data? anecdotally, the PA's and NP's at my undergrad student health center were notorious for missing diagnoses- acute tenosynovitis for me, pyelonephritis for my roommate... one PA even told a friend of mine to "work out more" when it was later found that he had minimal change disease. another friend was prescribed bactrim for something innocuous, but then started showing signs of HTN... his concerns were dismissed when he went into the clinic and saw the PA, who said it was probably caused by impending exams and stress. well, i insisted he go back and see the MD, who strongly suspected interstitial nephritis, and he was hospitalized and treated for it. there's really a difference in the most acute cases. of course, i don't think most physicians really care about mundane (yet common) issues like otitis media, for which any monkey can be trained to identify and give amoxicillin.

I will never entrust my own health or my family's care to a midlevel practitioner, since no one can predict when early accurate diagnosis can save a life- that is, unless the midlevel is part of a well-controlled team (such as NP taking vitals or ordering labs before someone's surgery, etc.) of course americans are too cheap to realize that there is a potential tradeoff involved when lesser qualified individuals are allowed to practice medicine.

 

[deleted6669]

So everone needs to be seen by a triple boarded internist/surgeon/em doc....they would probably miss less than a single boarded md.....

 

[Jengirl18]

How about the doc who missed SIADH, and I picked up the dx? We are now working her up for it, and exlporing the possibility of a paraneoplastic syndrome. Shame on that doc Doesn't matter if they are a doc or PA... there are dummies in every field.

 

[Faebinder]

Seriously.... no seriously....

You want to become an MD/DO after being a PA for 10 years? Fine go to med school... heck with your experience you will be the killer ACE of the class and end up picking whatever specialty you want. (YES there are PAs/NPs who went to become MDs and DOs.. these people do exist and they are the kick assers in the medical class).

We all took financial and risks and TIME FROM OUR LIVES risk....

There are 40 year old medical students out there. You too can do it...

The argument to make a bridge..... well whose gonna make it? The government pay for it? If they can pay for it then why arent they paying for more medical students to be accepted and for more residency positions to be opened? PA/NP are mid levels made so that they supplement the MD/DO shortage..why would the government have interest in reducing the mid levels when it needs them?

If you want the independance then you need to take the risk just like everyone else.

 

[MyChoice]

It seems that many of you have very strong opinions, almost to the point of resentment. I am fairly new here, and don't know the history behind this, but I am not sure why this is so.

So who exactly is this jerk? And why do we care about his thoughts? Well, I am the 40 year old PA, who is looking at going to medical school... the traditional way. Not because I feel that this is the best format, but because this is currently the only one.

PA schools are not all equal, much the same way that not all MD schools are. One way that MD programs make sure that all graduates are capable is by having all students take USMLE Step 1&2. If those who are worried feel that a knowledge deficit is the main hurdle, then have all applicants inteested in advanced standing take the Step 1. But since it is only available to current medical students, make the admission contigent on a passing Step 1 score. This will weed out the unwelcome undereducated, and put some money into the system.

I know that there is a tremendous amount of knowledge that I could absolutely benefit from by starting from the beginning, but is it really necessary? I have taken practice Step 1&2 exams with the MD & DO students that I trained with during my clinical rotations. I scored above the median routinely. My clinical assessments and decision making skills were top notch, so sayeth the Chief Residents of ALL services I rotated on - this is why I am now looking to go back for more. So should every PA interested in advanced standing be accepted with open arms? NO!!! Just as all pre-meds are not accepted. But provide the opportunity to show ability, then decide on a case by case basis.

As for paying for the programs. The NHSC has more openings than it knows what to do with. It costs them when slots are not filled by providers, because it means that the population of the given areas must seek health care needs outside the system. THIS IS MORE EXPENSIVE! By creating more physicians, and placing them within the NHSC, the costs are covered more than adequately. And so are many of the student loans.

By the by, I am not just a PA with a one-sided perspective. I am a paramedic and an RN as well, and I have devoted over 15 years of service to my medical training and experience.

OK. That's all from me. Go ahead...let me have it.

 

[deleted6669]

MyChoice - You offer forward thinking in your opinion on Step 1 testing. Maybe there should be some kind of "credit" per se for PA/NP programs if one wishes to go to med school, but the problem is exactly what you present: how do you make an equivalent transfer credit? One way to level the field is the step 1. I'm curious to see what others have to say about this.

Good post.

I would be ok with that. if you want to give me a yr off for passing step 1 I'm there! how about 2 yrs off for passing step 1 and step 2.....1 yr of didactic then 1 yr of clinical then residency.....

 

[anon-y-mouse]

How about the doc who missed SIADH, and I picked up the dx? We are now working her up for it, and exlporing the possibility of a paraneoplastic syndrome. Shame on that doc Doesn't matter if they are a doc or PA... there are dummies in every field.

Yeah it does. The overwhelmingly vast majority of physicians are superior to non-physicians at the practice of medicine. If you want to feel legitimate in considering yourself equal to a physician, go to med school- until then, you're still an assistant no matter what our screwed up HMO-driven health care market thinks. I'm sure there is a place for midlevel providers, but it is not in a position where doctors can most probably do a better job. As I have said previously, the former midlevel in my class has remarked on how much more comprehensive and thorough (and overwhelming) her training has been so far compared to her PA courses, and just reiterated this to me recently during the neoplasia block. Since the LCME *strictly* sets curriculum standards, this would be no different at any US med school really.

Mychoice: how would you know whether you scored better than the "median" on these "practice exams"? If you knew anything about the USMLE, you'd know such objective data is not released. In fact, no one knows what the USMLE is scored "out of"... and how that results in the 3 and 2 digit scores out of 99 (which are neither percentages nor percentiles). Who wrote the "practice exams" you took? I'm calling BS on this one. Also, you must clearly be pulling something out of somewhere if you have had the knowledge to answer the biochemistry and histology questions from your curriculum, not to mention neuroanatomy/neuroscience, immunology, epidemiology, genetics classes that we had in full... I'm sorry, I don't think there was time for "clinical lab interpretation" and "medical vocabulary" as separate courses in med school.

While you mentioned steps 1 and 2, you neglected to mention Step 3, which is a 2 day examination, and the multi-day specialty board exams usually with both oral and written components.

 

[anon-y-mouse]

MyChoice - You offer forward thinking in your opinion on Step 1 testing. Maybe there should be some kind of "credit" per se for PA/NP programs if one wishes to go to med school, but the problem is exactly what you present: how do you make an equivalent transfer credit? One way to level the field is the step 1. I'm curious to see what others have to say about this.

Good post.

I disagree with the idea of credit based on passing the USMLE. 1) med schools are frowned upon for "teaching to the boards", so they rarely do. and 2) if you found me before I started med school, gave me 3 months, some Goljan review, tons of qbank and qbook questions, I strongly feel I would pass since I'm a really good test taker. Obviously I wouldn't have really learnt the material properly, and so this isn't quite diagnostic.

 

[anon-y-mouse]

So everone needs to be seen by a triple boarded internist/surgeon/em doc....they would probably miss less than a single boarded md.....

Haven't you head of the law of diminishing returns? That "triple boarded" physician has still been held to the same high rigorous state licensing standards that all other physicians have, and legally, a physician has always been able to practice any type of medicine once clearing the certification hurdles. The jump from the less comprehensive degree to the more comprehensive one is huge, but the jump from one MD to another is necessarily much less so because they were held to the same standards in the first place. The slippery slope argument won't work here.

 

[anon-y-mouse]

I'd like to hear more about what you all think for PAs/NPs who want to apply to med school.

We're not on the issue of SHOULD they go to med school, but HOW and should they start from scratch or be able to get AP credit somehow.

Discuss !

Scratch, it is the only way to ensure consistency. My classmate with the PhD in biology was not exempted from any of our courses, since his undergrad and grad school classes did not deal specifically with the clinical correlates involved in biochemistry. Isn't it important to explain to a patient why the atkins diet is bad, for example? or map out the consequences of a newborn's metabolic disease?

 

[Noeljan]

I have an undergrad degree in nursing, and finishing up my graduate degree in Biochem right now. I am applying for fall 07 (medical school). I think it is ridiculous for anyone to become a physician without the traditional medical school route, internship, residency, etc. Who is to say who deserves credit for this or that. The bottom line is, I want to be the best physician possible for my patients and myself, and would be short changing everyone IMO if I do not go through the full medical education.
And why are people stressing so bad for this bridge stuff? You want to be a doctor that bad? Go to medical school then. I think it would also be bad for the PA/NP profession. They are separate programs and should stay that way.

 

[deleted6669]

"While you mentioned steps 1 and 2, you neglected to mention Step 3, which is a 2 day examination, and the multi-day specialty board exams usually with both oral and written components."

when I took the pa boards it was a week long exam with required components(separate exams) in primary care, surgery, core medical knowledge, and physical examination. since then the format has changed somewhat but the same concepts are covered.
a good pa could pass steps 2 and 3 right now and would only have to study for step 1. the main difference between medschool and pa school isn't clinical proficiency, it's basic medical sciences.many pa's use step 2/3 study guides as well as fp board prep guides to study for our national board exams,which by the way we have to retake every 6 yrs to maintain certification in addition to 100 hrs of cme every 2 yrs.all pa's have to take the same primary care based recert board exam every 6 yrs, regardless of what specialty they work in so continued proficiency in primary care is required.

 

[anon-y-mouse]

"While you mentioned steps 1 and 2, you neglected to mention Step 3, which is a 2 day examination, and the multi-day specialty board exams usually with both oral and written components."

when I took the pa boards it was a week long exam with required components(separate exams) in primary care, surgery, core medical knowledge, and physical examination. since then the format has changed somewhat but the same concepts are covered.
a good pa could pass steps 2 and 3 right now and would only have to study for step 1. the main difference between medschool and pa school isn't clinical proficiency, it's basic medical sciences.many pa's use step 2/3 study guides as well as fp board prep guides to study for our national board exams,which by the way we have to retake every 6 yrs to maintain certification in addition to 100 hrs of cme every 2 yrs.all pa's have to take the same primary care based recert board exam every 6 yrs, regardless of what specialty they work in so continued proficiency in primary care is required.

other than that step 2 requires knowledge of ALL main subspecialties in some rigor, not just primary care. also, the use of the same study guides does NOT say anything about the rigor of the test. i used my brother's MCAT prep books when i was in high school, and found them quite relevant and useful. maybe i should have taken the MCAT then; i'm sure i would have "passed" since i was a "good student".

which brings me to another point... you are being *highly* presumptuous when you say a "good" PA could pass steps 2 and 3 "without studying". these exams are not at ALL trivial and every year physicians and med students study countless hours for them in order to be able to pass, including experienced foreign medical graduates from english speaking countries. my cousin, an attending physician in the NHS in britain, top of her class, etc. studied months to take her USMLE steps 2 and 3 despite her vast experience. there is just a tremendous breadth and volume of knowledge one's expected to know cold.

as for step 1 content: it is ALL 100% clinically oriented, though it is "basic" medical sciences. every question can shape someone's treatment, no matter how esoteric or rare the relevant case is. there's nothing really "basic" about it unless by basic you mean "fundamental". without understanding the fundamentals to the fullest extent, one is a poorer clinician who simply gains experience mindlessly following a set algorithm without knowing what's fully going on. of course, this is what medical school is for; on the other hand, trade school (and expanded "independent authority") is for those who seek the prestige but are unwilling to put in the effort.

 

[deleted6669]

the residents at the fp residency I used to work and teach at had this to say about the usmle:
step 1 study for a month
step 2 study for a week
step 3 remember a #2 pencil.....

and yes, by "basic" medical sciences I did not mean easy/etc. this is how most medical schools describe the content of the ms 1 yr.

for a potential bridge I am not asking to be exempted from any basic medical science courses because I know that my pathophys, micro, etc only covered what was absolutely needed to practice and did not cover many of the finer points covered in medschool. however if such a bridge existed pa's should not have to repeat courses that are equivalent to medschool courses. let them sit for the final exams and practicals for history taking and physical diagnosis and exempt them outright from all the fluff courses like ethics, care of the dying pt, etc
for rotations let them test out of most of the ms 3 yr by taking the shelf exams for peds, im, surgery, psych, ob, fp, and em. if they don't pass the shelf they redo the rotation. I can say in all honesty that I was treated exactly like a med student on rotations. this may not be true of all pa students. that's fine. they wouldn't pass the challenge tests and would have to redo the courses and rotations in question.
I have it on good authority that at least 1 medical school is currently investigating the possibility of a 3 yr pa to physician bridge with 18 months of didactics and 18 months of clinicals.it's going to happen. it's just a question of when.

 

[anon-y-mouse]

the residents at the fp residency I used to work and teach at had this to say about the usmle:
step 1 study for a month
step 2 study for a week
step 3 remember a #2 pencil.....

and yes, by "basic" medical sciences I did not mean easy/etc. this is how most medical schools describe the content of the ms 1 yr.

for a potential bridge I am not asking to be exempted from any basic medical science courses because I know that my pathophys, micro, etc only covered what was absolutely needed to practice and did not cover many of the finer points covered in medschool. however if such a bridge existed pa's should not have to repeat courses that are equivalent to medschool courses. let them sit for the final exams and practicals for history taking and physical diagnosis and exempt them outright from all the fluff courses like ethics, care of the dying pt, etc
for rotations let them test out of most of the ms 3 yr by taking the shelf exams for peds, im, surgery, psych, ob, fp, and em. if they don't pass the shelf they redo the rotation. I can say in all honesty that I was treated exactly like a med student on rotations. this may not be true of all pa students. that's fine. they wouldn't pass the challenge tests and would have to redo the courses and rotations in question.
I have it on good authority that at least 1 medical school is currently investigating the possibility of a 3 yr pa to physician bridge with 18 months of didactics and 18 months of clinicals.it's going to happen. it's just a question of when.

Let me discombobulate this for you.

Step 1: 6 weeks has been found to be the optimal time to study because beyond that time, you forget what you reviewed in week 1, etc. However, it is only possible if you've actually *learned* the stuff in the first place. The actual learning itself takes a much longer period of time, i.e. during the classes themselves.

Step 2: 4 weeks or so is optimal, but this is misleading because students study for the NBME shelf exams at the end of every rotation, and those NBME exams are written by the same people who write the USMLE. Hence, the study time is much much greater. Foreign graduates have to study more for it because they hadn't studied for that material for the official / regular NBME shelf exams.

Step 3: No one gives a crap about what score you get on this exam unless it's a pass, since you're already in residency.

I don't have an entire class on history, taking care of the patient, etc. those are not deemed as important, and it's all rolled into one "doctoring" type of class, which includes many issues re: ethics, medical malpractice for physicians, practice management, etc.

Also, keep in mind that you're talking to FP residents, most likely the very bottom of the class (but even the worst student in the class is still called doctor). I'm surprised you are unwilling to accept what you don't actually know. If I were your "supervising physician" (though I would never ever risk my license to give free reign to a midlevel), I don't know how I would feel about the fact that you think you're practically a doctor without having gone to med school.

My Dean is quite heavily involved in the LCME and the accreditation proces and has told me in the past that any efforts to shorten curriculum and provide advanced standing for students is quite verboten and frowned upon... that schools in Florida and South Carolina have proposed measures, but have been rebuked for it. I don't think it's going to happen

 

[MyChoice]

Anon-y-mouse & all other interested parties,

With regard to your response to my last posting: I stated that I took practice exams, & routinely scored above the median. This was out of the students in these programs, not the national exam. These tests were provided to the allopathic & osteopathic medical students by their respective programs, so as to help them prepare for the actual test.

As for the pulling something... comment. Many PA's trained quite vigorously in their respective medical programs. I do not with whom you have intereacted, but it is obvious that the experience was quite disappointing for you. However, maybe you should actually find out what the curriculum of a well developed PA program involves before you challenge the integrity, knowledge, and veracity of an entire profession. As much as you have to say about the thoroughness of physicians in making sure that they have all of the facts prior to making decisions, and the hastiness of others in their lack of due diligence to do the same, your lack of real information and understanding with regard to PA education, really makes you unable to speak to this topic intelligently. (This is not meant to be personal, just factual). If you would like to correct this lack of knowledge, I would suggest talking with the AAPA. Or if you have no regard to speak with those who do not have an MD or DO after their name, I would talk with George Washington University, Yale, Keck School of Medicine, PCOM (if you prefer osteopathy), or any number of other actual medical schools who have PA programs as a part of their institutions.

As I stated previously, I am entering through the traditional pathway, and I am not trying to shortcut my way to a degree. Nor do I wish to not get all of the medical knowledge possible in the process. The only point any of those persons who have made comments to this topic in the affirmative have tried to get across, is that if it is possible to assess knowledge already gained, then could credit be given for that information and that information alone. No one is looking for a free lunch.

 

[deleted6669]

"The only point any of those persons who have made comments to this topic in the affirmative have tried to get across, is that if it is possible to assess knowledge already gained, then could credit be given for that information and that information alone. No one is looking for a free lunch."

they will never get it but thanks for trying.
most of what I think pa's should get credit for in a bridge would be clinical, not didactic. I have never argued that pa school didactics are equivalent to medschool. I will argue that pa's should be able to test out of rotations where they met(and sometimes exceeded) the same standards as medstudents.

 

[anon-y-mouse]

Anon-y-mouse & all other interested parties,

With regard to your response to my last posting: I stated that I took practice exams, & routinely scored above the median. This was out of the students in these programs, not the national exam. These tests were provided to the allopathic & osteopathic medical students by their respective programs, so as to help them prepare for the actual test.

As for the pulling something... comment. Many PA's trained quite vigorously in their respective medical programs. I do not with whom you have intereacted, but it is obvious that the experience was quite disappointing for you. However, maybe you should actually find out what the curriculum of a well developed PA program involves before you challenge the integrity, knowledge, and veracity of an entire profession. As much as you have to say about the thoroughness of physicians in making sure that they have all of the facts prior to making decisions, and the hastiness of others in their lack of due diligence to do the same, your lack of real information and understanding with regard to PA education, really makes you unable to speak to this topic intelligently. (This is not meant to be personal, just factual). If you would like to correct this lack of knowledge, I would suggest talking with the AAPA. Or if you have no regard to speak with those who do not have an MD or DO after their name, I would talk with George Washington University, Yale, Keck School of Medicine, PCOM (if you prefer osteopathy), or any number of other actual medical schools who have PA programs as a part of their institutions.

As I stated previously, I am entering through the traditional pathway, and I am not trying to shortcut my way to a degree. Nor do I wish to not get all of the medical knowledge possible in the process. The only point any of those persons who have made comments to this topic in the affirmative have tried to get across, is that if it is possible to assess knowledge already gained, then could credit be given for that information and that information alone. No one is looking for a free lunch.

Allopathic and Osteopathic students don't take the same test, though Osteopaths can take the USMLE if they wish. I don't know of any school which provides "practice" USMLE tests; at least none of the many schools where I interviewed, and none where my friends go. Part of the reason for this is that step 1 is 8 hours long and has 350 questions; no school makes their students do that. Any redacted test is not indicative or representative of the full thing.

Also, where would you have learnt the in-depth knowledge of subjects like medical biochemistry, histology, immunology, and others that are NOT part of the PA curriculum, in order to "do better than the median" on these exams?

You might have taken some in-house test, but it was certainly not that.

Also, I did not say that there was no place for midlevel providers, but many overstep and overestimate the boundaries of their knowledge base.

I'm glad you're taking a traditional route; perhaps at the end of it, you will realize in retrospect how vast the difference really is.

"Credit for knowledge known" is touchy, especially when it can vary so much on a case-to-case basis, when idiot-savants can memorize Robbins and make a 100%, and when licensing and accreditation issues are involved. It sets up a nasty precedent and slippery slope. Hence, it is in the best interest of the integrity of the MD degree and profession that shortcuts be avoided at all cost.

most of what I think pa's should get credit for in a bridge would be clinical, not didactic. I have never argued that pa school didactics are equivalent to medschool. I will argue that pa's should be able to test out of rotations where they met(and sometimes exceeded) the same standards as medstudents.

The biggest and most faulty assumption here is that the first and last 2 years of med school have nothing to do with each other. One's performance in the wards is partly based on one's knowledge base from the preclinical years; yes, this includes coming up with thorough differential diagnoses that include the biochemistry, histophysiology, immunology, etc. of the condition and being able to integrate that into a concrete explanation. Just last week, an attending asked me about a patient we saw with atypical Down syndrome and I had to recall that it was a Robertsonian 14-21 translocation and actually explain to him what that entailed, how it happened, at what point during embryogenesis it took place, and how I would explain that to the parents. We then saw a patient with xeroderma pigmentosum, and I was pimped on what set it apart from cockayne's syndrome and WHY one results in more cancerous lesions (nucleotide/global excision repair, etc.) and theoretical therapies and potential pharmacological interventions. Just examples, but the clinical years aren't just about being algorithm-driven body mechanics. Sure, there is a lot of learning procedures, patient care, ward management, how to work up a patient, etc. but that is usually the easy part compared to acquiring and integrating all the information in the first place.