PA to Physician bridge: Why not?

[deleted6669]

Since this thread first started several years ago an accredited 3 yr PA to physician bridge program opened at LECOM in pennsylvania.
there are members of this forum who are in the first class. other programs are in the works.

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[Narnian]

Since this thread first started several years ago an accredited 3 yr PA to physician bridge program opened at LECOM in pennsylvania.
there are members of this forum who are in the first class. other programs are in the works.

Do you know specifically what programs are in the works? I guess I mean what schools are in the process of sponsoring a bridge program?

 

[ARAI]

Addressing the issue of why someone would say "no" to a PA-to-Physician Bridge, I'd say it has to do more-or-less with insecurity on part of the naysayers. I strongly believe that an experienced PA's clinical judgement is on par with that of an experienced Physician. For a PA, a licensed medical practitioner, to have to go back to school with a bunch of newbie future docs who don't yet know the difference between spondylosis and spondylolysis, is a waste of time. In short, the PA-to-Physician bridge program would need to be a brand new program that would focus on teaching PAs everything they don't know that medical students learned (and subsequently forgot by the time they graduated). All-in-all, the whole bridge curriculum could be put into a 24-month or less curriculum consisting of 1 year of classes and 1 year of rotations.

 

[Instatewaiter]

Addressing the issue of why someone would say "no" to a PA-to-Physician Bridge, I'd say it has to do more-or-less with insecurity on part of the naysayers. I strongly believe that an experienced PA's clinical judgement is on par with that of an experienced Physician. For a PA, a licensed medical practitioner, to have to go back to school with a bunch of newbie future docs who don't yet know the difference between spondylosis and spondylolysis, is a waste of time. In short, the PA-to-Physician bridge program would need to be a brand new program that would focus on teaching PAs everything they don't know that medical students learned (and subsequently forgot by the time they graduated). All-in-all, the whole bridge curriculum could be put into a 24-month or less curriculum consisting of 1 year of classes and 1 year of rotations.

I would disagree based on my own personal experience with our ED PAs that an experienced PA has similar clinical judgement as an attending- perhaps with a second year resident, but definitely not an attending, especially an experienced one.

Since there are varying degrees of PA training, there would be no way to make sure that the PA would be adequately trained without essentially starting from scratch. So that is why it is 3 years.

 

[Jakester]

While I wholeheartedly agree that PA's are unevenly trained (and unevenly talented) I don't agree that should equal starting at ground zero. There are a number of ways to test knowledge and skills that would ensure that those accepted into such a program bring the requisite skills, etc with them. Of course that presupposes that someone has the skills and interest to create such an assessment process. At this point with only one program in existence, it isn't worth it.

 

[ARAI]

While I wholeheartedly agree that PA's are unevenly trained (and unevenly talented) I don't agree that should equal starting at ground zero. There are a number of ways to test knowledge and skills that would ensure that those accepted into such a program bring the requisite skills, etc with them. Of course that presupposes that someone has the skills and interest to create such an assessment process. At this point with only one program in existence, it isn't worth it.

Assessment tools are already in existence. The PANCE/PANRE (Physician Assistant Certification/Re-certification Exam) would be a potential assessment tool. Practitioners with high scores on these exams have demonstrated a solid understanding and knowledge of medicine. With that in mind, those developing a bridge program can subtract the knowledge required to pass the PANCE from the knowledge required to pass USMLE step 1 & 2 (or COMLEX) and focus on filling in those gaps. There you have it: A standardized bridge program.

 

[sanityonleave]

I'm not usually big on these threads because they tend to be inflammatory, but this thread was somewhat interesting and spurred me to post.

First off, I'm very much against any sort of bridge program, but I'll say that's mostly a knee jerk reaction to any seeming "backdoor" into medical education. I've posted similar comments against Carribean med schools, as well. That said, I think the three year program is fine. Certainly no one can argue that it is a shortcut, and I think giving some credit to PAs for "time served" (especially if, as I think is true, the bridge programs require experience as a PA for several years) seems reasonable. I would lobby very, very strongly against shortening the program to less than three years.

However, there's one theme in the 2006 section of this thread that strikes me as so incredibly hollow -- and it's a common one among midlevels speaking about a bridge program: the fact is, you guys are not going into a bridge program to work 70 hours/week as a FP doc in Pine Apple, AL (real place). Midlevels who go into medicine are likely to be attracted to the same thing as regular MD grads -- areas of medicine that have a combination of salary, lifestyle, interesting practice, and location. I'm not saying that as a shot at PAs going into the bridge program, but as a fact of life -- it's the same reason we have trouble getting traditional med school grads to practice in rural FP settings. While I'm sure a lot of people smarter than me will make pro vs con arguments for these three year bridge programs, I think that to claim creating such a bridge program is going to funnel PAs into FP residencies and ultimately into rural practice as a family doc is disingenuous.

 

[sanityonleave]

Addressing the issue of why someone would say "no" to a PA-to-Physician Bridge, I'd say it has to do more-or-less with insecurity on part of the naysayers. I strongly believe that an experienced PA's clinical judgement is on par with that of an experienced Physician. For a PA, a licensed medical practitioner, to have to go back to school with a bunch of newbie future docs who don't yet know the difference between spondylosis and spondylolysis, is a waste of time. In short, the PA-to-Physician bridge program would need to be a brand new program that would focus on teaching PAs everything they don't know that medical students learned (and subsequently forgot by the time they graduated). All-in-all, the whole bridge curriculum could be put into a 24-month or less curriculum consisting of 1 year of classes and 1 year of rotations.

Wow -- you outed us. We didn't learn anything in medical school that's important that you don't know as a PA. You're so much smarter than those silly docs and silly medical students.

My mom is a NP x 15 years (started practice in 1996). She has a lot of negative things to say about NP programs, but that's neither here nor there. That said, she had someone approach her who was lobbying for expanded practice rights for NPs and PAs in Alabama who wanted her to sign a petition as a long-standing provider to give "virtually independent" practice rights to midlevel providers -- and she told them to go to hell.

As she said: "I love my job, but I recognize my limitations. I did not go to medical school, and even having been in IM practice for 15 years, I still regularly consult with the physicians in my practice on difficult cases. The scariest thing to me about new grad NPs and PAs is that they don't know what they don't know -- and often times don't know when to ask for help."

Good physicians will tell you how daunting it can be at times trying to maintain a mastery of the breadth of knowledge required to practice good medicine, especially in primary care. For you to be so flippant about the idea that there might be knowledge that you don't have just indicates that you're a classic example of "you don't know what you don't know."

 

[deleted6669]

the fact is, you guys are not going into a bridge program to work 70 hours/week as a FP doc in Pine Apple, AL (real place). Midlevels who go into medicine are likely to be attracted to the same thing as regular MD grads -- areas of medicine that have a combination of salary, lifestyle, interesting practice, and location. I'm not saying that as a shot at PAs going into the bridge program, but as a fact of life -- it's the same reason we have trouble getting traditional med school grads to practice in rural FP settings. While I'm sure a lot of people smarter than me will make pro vs con arguments for these three year bridge programs, I think that to claim creating such a bridge program is going to funnel PAs into FP residencies and ultimately into rural practice as a family doc is disingenuous.

as with docs it really depends on the person. If I were to ever go back I would want to be a small town fp doc. my current work is inner city/rural/disaster med/developing nations relief work and I can think of no better use for a medical degree than to be a rural fp doc in a small town doing a bit of everything; covering the er, admitting my own pts and following them through their hospital course, delivering babies, etc. chances are if I did this I wouldn't make much more than I make now.
there are 2 kinds of folks who will enter these bridge programs. folks who want to know more and do more and folks who want to make more. the current bridge program requires 50% of each class to pre-select a primary care specialty.

 

[ARAI]

My mom is a NP x 15 years (started practice in 1996). She has a lot of negative things to say about NP programs, but that's neither here nor there.

While I don't mean to disrespect you Mom's poor opinion of her own training and abilities, I'll restate that this conversation is about PAs, not NPs. Hence, the comment is irrelevant. While PAs and NPs share similar responsibilities, the training programs are nothing alike. If I wanted to make an argument about how Doctors of Medicine are trained, I wouldn't bring up the opinion of, say, a Chiropractor. That's likened to what you just did.

"The scariest thing to me about new grad NPs and PAs is that they don't know what they don't know -- and often times don't know when to ask for help."

You'll hear this same comment about recently graduated medical students too. I think you're simply making arguments for the sake of arguing.

Good physicians will tell you how daunting it can be at times trying to maintain a mastery of the breadth of knowledge required to practice good medicine, especially in primary care.

PAs have to maintain certification at more frequent intervals than NPs & Physicians. If not by interest, then through pure necessity PAs are striving to maintain mastery and breath of knowledge required to practice good medicine.

I would lobby very, very strongly against shortening the program to less than three years.

A 3-year program is far too redundant.

When you subtract what a PA student learns in 2.5 years of PA school from what a medical student learns in 4 years of medical school, the remainder is not 3 years of missed information. Nor is it 2 years. It's not even a full 1 year. That's why a 3 year program is too long.

Let me ask you this: Between a 2-year bridge program or PAs getting independent practitioner rights, which would you rather have? Personally, I'd rather see the shorter bridge program. I think you would too.

Now the next question: Should a PA be given the option of skipping the 1st year of residency if they are already experienced in the area in which they are doing their residency? I say "YES." If I PA has 3 years experience working in Internal Medicine, I think their residency should be shortened by 1 year if they decide to stay in Internal Medicine.

 

[dilated]

Let me ask you this: Between a 2-year bridge program or PAs getting independent practitioner rights, which would you rather have? Personally, I'd rather see the shorter bridge program. I think you would too.

No, I think most of us would prefer they get independent practitioner rights (given that NPs have it anyway, who cares). The primary value of a US allo MD is how standardized it is. Backdoor methods of getting one would cheapen our degree.

And the idea that any specialty would shorten their residency to give credit for "work experience" is laughable. What's in it for them to devalue their training and say that a formalized educational experience is unnecessary, you just need to learn on the job? Nothing and it would make their field look bad compared to others (you'd sure never see neurosurg giving credit for being a neurosurg PA). It will never happen.

 

[sanityonleave]

I'll just let the NP thing rest. I was making a point, but clearly it wasn't appreciated. I recognize the training programs are not equivalent, but similarly, your training program is not equivalent to the MD degree.

You'll hear this same comment about recently graduated medical students too. I think you're simply making arguments for the sake of arguing.

Yea, but the difference is that medical students go on to do 3-7 years of residency where they continue to be humbled by the knowledge of their superiors. They don't just waltz out into the world of practice and assume that anything that don't know yet isn't important, as you seem to have done.

PAs have to maintain certification at more frequent intervals than NPs & Physicians. If not by interest, then through pure necessity PAs are striving to maintain mastery and breath of knowledge required to practice good medicine.

Yea -- board recert classes every few years really force you to keep your clinical skills sharp. Unless the PA boards are significantly more demanding than the IM boards (a fact which I highly doubt), that's a non-starter.

A 3-year program is far too redundant.

When you subtract what a PA student learns in 2.5 years of PA school from what a medical student learns in 4 years of medical school, the remainder is not 3 years of missed information. Nor is it 2 years. It's not even a full 1 year. That's why a 3 year program is too long.

Wow. Your arrogance is mind-boggling. Did you even read the posts in this thread made by PAs who later went to med school talking about the volume of material they felt like they hadn't covered? You don't even listen to people who used to be in your field, so I don't know why I think I'm going to be able to get through to you. However, neither of us have nearly the credibility of someone who has attended both PA and med school, as several posters in this thread have, and they have ALL said that medical school was significantly more difficult.

Let me ask you this: Between a 2-year bridge program or PAs getting independent practitioner rights, which would you rather have? Personally, I'd rather see the shorter bridge program. I think you would too.

Now the next question: Should a PA be given the option of skipping the 1st year of residency if they are already experienced in the area in which they are doing their residency? I say "YES." If I PA has 3 years experience working in Internal Medicine, I think their residency should be shortened by 1 year if they decide to stay in Internal Medicine.

You know what, you're right. Actually, why should you have to do any additional schooling or training at all? You guys clearly did all of the material of medical school and residency in a much shorter time period because you're a lot smarter than us stupid medical students. I think we should retrospectively award everyone with a PA degree an MD/PhD, and maybe one other honorary degree, depending on what coursework they feel like they've covered. Took an epidemiology class in college? We'll tack on an MPH. How about a "Business for Dummies" class? Here's an MBA! Hell, keep adding letters after your name until you run out of space on your white coat.

You know, in one way, your posts have been valuable, ARAI. They tell me that despite all of the great, reasonable PAs I've met, I have to make sure to closely supervise any PAs that I work with until I get to know them, because I never know which one has a giant chip on their shoulder and has decided that their training is "just as good as mine." And that person is going to kill someone, and then it's my fault. I'm just glad that all PAs aren't as bitter and angry about their chosen course of training as you. You didn't go to medical school. Get over it. If it means that much to you to be called "doctor" and have the MD on your coat, apply to the three year bridge program. That said, it begs the question: why the hell did you apply to PA school to begin with? ... I wouldn't even venture a guess.

 

[sanityonleave]

No, I think most of us would prefer they get independent practitioner rights (given that NPs have it anyway, who cares). The primary value of a US allo MD is how standardized it is. Backdoor methods of getting one would cheapen our degree.

And the idea that any specialty would shorten their residency to give credit for "work experience" is laughable. What's in it for them to devalue their training and say that a formalized educational experience is unnecessary, you just need to learn on the job? Nothing and it would make their field look bad compared to others (you'd sure never see neurosurg giving credit for being a neurosurg PA). It will never happen.

Also, one hundred times this. I'd much rather PAs lobby and get some farcical "independent practice rights" than deal with ARAI's ridiculous idea of 1 year of med school + 1 year of residency or whatever he feels is appropriate to "prove" that he already has more knowledge than those silly doctors.

Give PAs independent practice rights = the PAs can argue with the malpractice insurance companies about exactly how "independent" they should be. And it'll give the ambulance chasers someone else to follow around for a while. Might harm a few patients, but that's caveat emptor, right? The patients need to learn to navigate the alphabet soup on their own to figure out which of the 9 people in white coat asking to be called "doctor" went to medical school. (HINT: It's the guy in scrubs asking to be called "Jim").

 

[ARAI]

I'll just let the NP thing rest. I was making a point, but clearly it wasn't appreciated. I recognize the training programs are not equivalent, but similarly, your training program is not equivalent to the MD degree.

I never said PA training was equivalent to MD/DO training. You are using childish argumentative tactics to try an win at a discussion in which there's no clear-cut right answer.

As for PAs who go back to medical school and tell you the material is so much more vast than what they learned in PA school, either they a) went to PA school many years ago before the accreditation standards were changed to what they are today, or b) now that they're going to be MDs, they really want people to think it's so much more intense and difficult when it's actually 70%-80% redundant course work.

Unfortunately, your last response was full of sarcasm and ill-will. I could sit here and lecture you about how bad that reflects on you, but I won't waste your time. Instead I'll say this: that disrespect and attitude you are showing for another medical professional really isn't going to cut-it in the real world. I and every Physician/PA/NP/RN/Hospital Administrator in the room would have turned our backs on you in a real-time conversation. Oh, and you would have also just lost a massive referral base.

 

[sanityonleave]

I never said PA training was equivalent to MD/DO training. You are using childish argumentative tactics to try an win at a discussion in which there's no clear-cut right answer.

As for PAs who go back to medical school and tell you the material is so much more vast than what they learned in PA school, either they a) went to PA school many years ago before the accreditation standards were changed to what they are today, or b) now that they're going to be MDs, they really want people to think it's so much more intense and difficult when it's actually 70%-80% redundant course work.

Unfortunately, your last response was full of sarcasm and ill-will. I could sit here and lecture you about how bad that reflects on you, but I won't waste your time. Instead I'll say this: that disrespect and attitude you are showing for another medical professional really isn't going to cut-it in the real world. I and every Physician/PA/NP/RN/Hospital Administrator in the room would have turned our backs on you in a real-time conversation. Oh, and you would have also just lost a massive referral base.

You're right. My sarcasm didn't help the conversation, and you've kept your responses relatively level-headed (with the exception of the ad hom in the last post, but it was probably deserved). I lost my temper because I find your opinion infuriating and condescending, but there was no cause for that. I apologize for my childish remarks.

That said, I find the idea that all of the PAs who have since gone to medical school simply went to sub-par PA schools or have suddenly "turned their backs" on the PA profession to be a bit of a hollow argument. I can't offer any evidence to the contrary, however. Perhaps one of those illustrious folks would enlighten us on this one?

My final question to you still stands, though: why do you now want to become a physician? There are a lot of PAs and PA students who lecture people who want to become a physician but don't get in to med school that PA school is not "an alternative" to medical school but an entirely different path. That's supported by the argument among many on this board that folks who complete med school should not be allowed to practice as PAs once the graduate without doing a residency (don't get me wrong, I agree with the sentiment). We've acknowledged that they're fundamentally different fields, so why all of a sudden should there be a two or three year "jump" from PA to MD, since we've already acknowledged that they're different? Do you really think that having people who couldn't get into med school flock to PA school with the hopes of "backdooring" their way into medicine would be good for your field? I find it interesting that we have some of the very same people on this board who so vehemently support the above arguments separating PAs from MDs now are arguing for equivalency.

 

[sanityonleave]

I never said PA training was equivalent to MD/DO training.

Not directly, no. But you argued that PAs with 2.5 years of training (one of classroom instruction) could "catch up" to med students and finish medical school in less than a year. Actually, by that statement, you're making the argument that PA school is more rigorous than medical school, since you could actually finish med school in less total time by doing PA + med than regular med school.

 

[sanityonleave]

As for PAs who go back to medical school and tell you the material is so much more vast than what they learned in PA school, either they a) went to PA school many years ago before the accreditation standards were changed to what they are today, or b) now that they're going to be MDs, they really want people to think it's so much more intense and difficult when it's actually 70%-80% redundant course work.

Unfortunately, your last response was full of sarcasm and ill-will. I could sit here and lecture you about how bad that reflects on you, but I won't waste your time. Instead I'll say this: that disrespect and attitude you are showing for another medical professional really isn't going to cut-it in the real world. I and every Physician/PA/NP/RN/Hospital Administrator in the room would have turned our backs on you in a real-time conversation. Oh, and you would have also just lost a massive referral base.

Do you believe that one year of PA school covers 80% of the material covered in two years of medical school? Just speaking about classroom time, not even talking about the roughly 1.5x clinical time.

If you do, we're at an impasse, because I don't believe that and there's no real way to prove one way or the other. The implication there is that PA students are learning the material at about 150% the rate of medical students in med school. If that's true, I'm impressed -- I (and most of my classmates, as far as I can tell) could never keep up with that.

 

[deleted6669]

Do you believe that one year of PA school covers 80% of the material covered in two years of medical school? Just speaking about classroom time, not even talking about the roughly 1.5x clinical time.

nope.
ms1 is much more in depth than pa school. pa's who go back to medschool should complete the entire ms 1 year so they have a standardized knowledge foundation. I teach current pa and md students and know this to be true.
ms2 overlaps a lot with pa school.
ms 3 and pa 2 are the same at many places. this is why the current( and future) bridge programs grant(will grant) 1 yr of credit.
ms4 is really what the student makes of it. you can be a flake or do lots of hard core sub-I's.
having spoken with the guy who started the lecom bridge it is set at 3 yrs for a reason. that is the min amt. of time to have an accredited medschool program in the u.s. at the current time. it won't go shorter than this.
I don't think pa's should get time off in any residency. credit in medschool for the pa clinical yr is all the credit we should get. the first yr of any residency is the most intense and to suggest we should skip it is frankly ridiculous. not that I am in favor of skipping any time but if we did it should be stuff from the later yrs, not foundational material from internship.
ARAI- you are coming off a bit highbrow here. really. might want to cool it a bit.
yes, pa's learn a lot. a good argument can be made that a pa can do 80% of what a primary care doc can do in outpt practice right out of school. that doesn't mean we learned 80% of the material, it means that you need 60% of the material to do 80% of the work.
I used to feel like you do. some of my early posts here are rants. over time I've become comfortable with the stuff I know really well, tried to learn stuff that I don't know, and accepted that there is a reason for consults from specialists; you can't know everything. even great docs ask for help. I get asked for help by docs all the time about stuff I do more than they do and I ask them about stuff from their areas of expertise.

 

[ARAI]

My final question to you still stands, though: why do you now want to become a physician?

I have neither the desire nor intention to ever go back and become a physician. I am very happy as a PA. What I don't like is the idea of creating a PhD program for PAs. PAs study medicine under the same model as MDs. Hence, the doctorate form of a PA degree is a MD, not a PhD. I'm happy that there is a 3 year bridge-program for PAs now, but it's not really a "bridge" program. As emedpa said, the criteria for medical school accreditation in the US is a 3-year program. The 4th year of medical school is actually unnecessary for medical school accreditation in the United States. In my opinion, a true bridge program would give PA students credit for M2 and M3. Thus, leaving only M1 & M4 to be completed. The PANCE or USMLE step 2 could serve as as a standardized exam prior to entering such a bridge program.

I don't think pa's should get time off in any residency.

And what if the PA has done a PA residency, which is the 1st year of a MD residency? Or what if a PA has worked in Surgery for 5 years--you don't think that's worth a 1-year reduction in a surgical residency? I do.

ARAI- you are coming off a bit highbrow here. really. might want to cool it a bit.

You might be confusing my frankness with arrogance. I'm not being arrogant as to say PAs can do everything doctors can do, because we can't. However, there's no way a 3-year bridge program isn't going to be completely full of redundancies. For example, when an RN goes onward become an ARNP, they don't make the RN go back and re-do the entire RN degree before taking ARNP courses. Instead, the ARNP program builds on top of the knowledge already attained from the RN program. Likewise, a proper PA-to-MD/DO should build-on what a PA already knows as opposed to making the student retake a large number of classes.

 

[deleted6669]

A few thoughts:
as I mentioned above, 3 yrs is the shortest possible time in which to train someone to be an md/do and have it be accredited. any discussion of a shorter program is pointless. could some pa's do it in 2.5 yrs? sure, but it wouldn't be accredited so why discuss it?
re: residency: a surgical pa residency teaches someone to be an excellent surgical pa, not a surgeon. their training in the o.r. focuses on being a great 1st assist, not doing the surgery independently. md residencies follow a structured format so surgeon A from program 1 learns what surgeon B from program 2 learns. the same can not be said of pa residencies.
in em for example some residencies for pa's focus on care of patients with mild to moderate acuity with very little time spent in the icu and no anesthesia rotation. these pa's are taught to work with close physician supervision and do not get training in things like ultrasound line placement while other programs train pa's in all standard procedures and levels of acuity and have as a stated goal that the pa be able to practice solo in rural depts without on site supervision. A PA from the first program I described is ready to work in most em settings with supervision but not solo like a PA from the more aggressive program. because programs are not standardized the entire md residency program would need to be completed. the reason we get a yr of credit for pa2 in the current bridge program is that it(pa2) is structured in such a way that all pa's have access to the same required rotations.all students who have completed pa school should have a min level of clinical competency.

 

[atcpt1]

A few thoughts:
as I mentioned above, 3 yrs is the shortest possible time in which to train someone to be an md/do and have it be accredited. any discussion of a shorter program is pointless. could some pa's do it in 2.5 yrs? sure, but it wouldn't be accredited so why discuss it?
re: residency: a surgical pa residency teaches someone to be an excellent surgical pa, not a surgeon. their training in the o.r. focuses on being a great 1st assist, not doing the surgery independently. md residencies follow a structured format so surgeon A from program 1 learns what surgeon B from program 2 learns. the same can not be said of pa residencies.
in em for example some residencies for pa's focus on care of patients with mild to moderate acuity with very little time spent in the icu and no anesthesia rotation. these pa's are taught to work with close physician supervision and do not get training in things like ultrasound line placement while other programs train pa's in all standard procedures and levels of acuity and have as a stated goal that the pa be able to practice solo in rural depts without on site supervision. A PA from the first program I described is ready to work in most em settings with supervision but not solo like a PA from the more aggressive program. because programs are not standardized the entire md residency program would need to be completed. the reason we get a yr of credit for pa2 in the current bridge program is that it(pa2) is structured in such a way that all pa's have access to the same required rotations.all students who have completed pa school should have a min level of clinical competency.

I wouldn't be surprised that this is an oversimplification. I've heard this several times....any references (not saying the standard doesn't exist, but would love to read the actual language)? I can't seem to find anything online.

It seems sad that as much as we know about education, they are regulating time spend in school rather than a curriculum you must complete. (Note: I have found information on curriculum standards for med schools online)

I suspect that most folks would be fine with completing "3 years" of med school while they work full-time as PA's and complete specific educational modules to "bridge" the gap in educational content.

However, going to med school full-time alongside folks (recent undergraduates) who know nothing about medicine makes no sense to me.

I would take advantage of the education, skills, and preexisting knowledge of PA's and immediately begin teaching more advanced skills and science to create the more ideal physician/researcher combo. If a PA has to spend 3 years in college to become a mediocre entry level physician, which makes little sense. PA's need something that couldn't be designed into the grand scheme of traditional medical education! Teaching traditional medical students and PA's to be physicians shouldn't be the SAME - training PA's should have a different curriculum with an end result that would be superior! You have to make it worth a PA's time.

That is how a real 15+ year educator with a PhD would think, anyway!
Basic andragogy! It makes no sense to start a PA and a 1st year med student in the same place.