why am I reading your board? I'm nosey.

[jumpin bean]

After reading your PA vs MD threads, I couldn't resist the temptation to post.

I believe a part of the reason why becoming a doctor takes so long is to allow for the students to mature during their 20's and come out the end of residency in their 30's!

Seriously though, I have worked with many NP's and PA's as a medical student and resident. There isn't much difference between the on-the-job training they receive in their first job and what I do in my residency. You can teach most any person anything. You can teach surgical procedures. Many first assistants can do the operation just the same as their boss. Surgeons don't have an exclusive skill that only they hold. You can also teach the knowledge base and physical exam. You can gain experience in primary and specialty care. There isn't anything magical about medical school.

In my experience, mid-level providers become pretty darn good providers with less education. Why don't we take away the burden of medical school? The loans, the decade of my life that passed, the 100 hr/week in the hospital in 3rd year of medical school. (Some smarter folks had the luxury to goof off in medical school, but I assure you that I spent days and nights in the classroom, lab, and library.) Maybe we should just shorten the undergrad component. The p-chem I took isn't exactly coming in handy in my job. However, I do use basic chemistry, calculus, physics, and of course the life sciences. It was really the 2nd half of college that was superfluous. We should be able to streamline this process.

We could either get rid of the US Medical Licensing exams, or we could just have everyone take it whether they came from an allopathic, osteopathic, NP, or PA background. I do think everyone should do a residency though.

What if no matter what school you went to (allopathic, osteopathic, NP, PA), you could take the USMLE and apply and complete a residency of your choice. Maybe, we could just standardize all the undergrad and grad curriculums across the country. We could make 4 years in the classroom (2 in basic science 2 in clinical science), and 2 years in the hospital. After those 6 years you could be granted your graduate degree. Then you do a residency in your chosen field. After one or two years of residency you could do a research project/dissertation and be granted your doctorate. This way the burden is decreased, everyone who is delivering the same care is getting paid the same, and with the increased numbers of providers we might actually meet the healthcare needs of the community.

I think it could work, and the standardization of the curriculum and titles would lead to less confusion for the public.

I hate it when the gray hairs think I need to suffer because they did, so I don't think medical education should continue to be a burdern just because I suffered through it. Just because I took the long hard road (13 of my best years) doesn't mean that's the way it should be forever.

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[zenman]

Ah, the voice of reason

 

[JudoKing01]

What if no matter what school you went to (allopathic, osteopathic, NP, PA), you could take the USMLE and apply and complete a residency of your choice. Maybe, we could just standardize all the undergrad and grad curriculums across the country. We could make 4 years in the classroom (2 in basic science 2 in clinical science), and 2 years in the hospital. After those 6 years you could be granted your graduate degree. Then you do a residency in your chosen field.

Not quite what you had in mind, but there are some 48 or something programs in the US that are 6 year BS/MD programs for students graduating from high school. 2 years of pre-med, 2 years of basic science (MD) and 2 years clinical rotations (MD). No MCAT required, etc. I imagine they are hard as hell to get into though.

 

[jumpin bean]

Not quite what you had in mind, but there are some 48 or something programs in the US that are 6 year BS/MD programs for students graduating from high school. 2 years of pre-med, 2 years of basic science (MD) and 2 years clinical rotations (MD). No MCAT required, etc. I imagine they are hard as hell to get into though.

If we study that cohort and determined that these MD's that did the 6 year program don't have a major deficit, we could shorten all the curriculums. We could take the best aspects of MD, DO, PA, NP training and philosophy and merge them into a common 6 year medical training. Some people say that increasing the total number of spots would let unqualified people become providers. They are already becoming competent providers, but through several diverse routes. The stardardization of curriculum and USMLE would ensure high quality. People considering becoming providers shouldn't be discouraged by residency because it can be as short as 3 years and you do get paid a salary. I'll make almost $45,000 pre-moonlighting next year. Also, I was a resident before and after the 80 work week rule, and I think it has made life much more bearable. After 6 years of school and 2 years of residency and research, everyone would receive a doctorate. One profession with one title will be less confusing for the public.

 

[dhageremtp]

But as long as there are paramedics, nurses, rad techs, phlebotomists, etc. there will always be confusion in health care.

(not to pick on those professions, I mean as long as there are many different specialized jobs in the health care industry, the general public will be confused. It woudl eliminate confusion on the PA, NP, DO, MD parts.)

 

[Ryan]

He he, they already do this in Europe and in essence all you are doing is creating a whole bunch of Docs. Unfortunately there would be much lobbying against this among insurance providers b/c then they would have to pay a bunch of licensed physicians (that could get expensive in our society). Realize that you would only be cutting down the traditional path by 2 years and you would also sacrifice the educational diversity among Docs.

I like having colleagues with History, Philosophy, Education and Theology degrees in the mix. I believe that this is one of the things that keeps our medical society flexible and over time this will increase our openness to new avenues of health care which is very important for increasing the health of the population. It would be a great disservice if we all had the same streamlined education and this streamlined approach is available to those who seek it (6yr or 7yr BS/MD or BS/DO programs). I'm not saying that the streamlined approach is inherently bad; it should just be one of many options to being a doc.

If you’re worried about the confusion issue, just call people who are clinicians without a medical degree Mr. or Ms. in stead of Dr. and realize that taking care of a patient is a TEAM approach now-a-days. The days of the “Almighty Doctor” are gone. The physician NEEDS everyone from the receptionist to the specialist to care for their patients. Is the doc the "team captain"? Yes, most of the responsibility lay squarely on their shoulders. However, if I'm a FP doc working in a clinic and I see a rash that I'm not sure of, and I know that the PA in the next room down has done a derm subspecialty, you bet I'm going to call them in and get their professional opinion before I treat.

It's all about a team approach in my opinion, what position do you what to play, what are your talents? Do you enjoy making the call on the play, kicking for a field goal or crushing the quarterback on a blitz? All are viable and necessary for a football team to function. The options are there for you to choose. Wow, I just wrote more than I intended... I must be bored now that I'm on summer break! Peace out yo!

 

[lawguil]

He he, they already do this in Europe and in essence all you are doing is creating a whole bunch of Docs. Unfortunately there would be much lobbying against this among insurance providers b/c then they would have to pay a bunch of licensed physicians (that could get expensive in our society). Realize that you would only be cutting down the traditional path by 2 years and you would also sacrifice the educational diversity among Docs.

I like having colleagues with History, Philosophy, Education and Theology degrees in the mix. I believe that this is one of the things that keeps our medical society flexible and over time this will increase our openness to new avenues of health care which is very important for increasing the health of the population. It would be a great disservice if we all had the same streamlined education and this streamlined approach is available to those who seek it (6yr or 7yr BS/MD or BS/DO programs). I'm not saying that the streamlined approach is inherently bad; it should just be one of many options to being a doc.

If you’re worried about the confusion issue, just call people who are clinicians without a medical degree Mr. or Ms. in stead of Dr. and realize that taking care of a patient is a TEAM approach now-a-days. The days of the “Almighty Doctor” are gone. The physician NEEDS everyone from the receptionist to the specialist to care for their patients. Is the doc the "team captain"? Yes, most of the responsibility lay squarely on their shoulders. However, if I'm a FP doc working in a clinic and I see a rash that I'm not sure of, and I know that the PA in the next room down has done a derm subspecialty, you bet I'm going to call them in and get their professional opinion before I treat.

It's all about a team approach in my opinion, what position do you what to play, what are your talents? Do you enjoy making the call on the play, kicking for a field goal or crushing the quarterback on a blitz? All are viable and necessary for a football team to function. The options are there for you to choose. Wow, I just wrote more than I intended... I must be bored now that I'm on summer break! Peace out yo!

Great post! From only an educational standpoint, can the MD/DO education (4 years) be shortened while keeping the residency portion the same while still producing the same quality practitioners? Another interesting point of Jumpin Bean - can the pre-reqs. be changed and still have the ability to construct a quality physician. Anybody can predict the resistance of the medical community, financial impact to colleges and universities ect.
I suspect that the pre-reqs and length of medical school serve as a type of filter that allows only the most qualified and a devoted candidate succeed, but is all this baggage necessary? I guess the question is could it be done in three years as opposed to four years? Could we eliminate Org II and Physics II as pre-reqs. Could we add a semester of didactics and allow PA's to apply to Primary care residency training and if they did complete the physician residency, would they be as competent as the MD/DO in primary care.

Maybe the best way to construct a physician is to make everyone become a physician assistant first. after X number of years of practice as a PA, they could apply to further their training with endorsement from a physician. I have no idea, but surely there are alternative ways to become an MD/DO and there might even be ways to better the training of a physician!? Who knows?

 

[JudoKing01]

He he, they already do this in Europe and in essence all you are doing is creating a whole bunch of Docs. Unfortunately there would be much lobbying against this among insurance providers b/c then they would have to pay a bunch of licensed physicians (that could get expensive in our society). Realize that you would only be cutting down the traditional path by 2 years and you would also sacrifice the educational diversity among Docs.

I like having colleagues with History, Philosophy, Education and Theology degrees in the mix. I believe that this is one of the things that keeps our medical society flexible and over time this will increase our openness to new avenues of health care which is very important for increasing the health of the population. It would be a great disservice if we all had the same streamlined education and this streamlined approach is available to those who seek it (6yr or 7yr BS/MD or BS/DO programs). I'm not saying that the streamlined approach is inherently bad; it should just be one of many options to being a doc.

If you’re worried about the confusion issue, just call people who are clinicians without a medical degree Mr. or Ms. in stead of Dr. and realize that taking care of a patient is a TEAM approach now-a-days. The days of the “Almighty Doctor” are gone. The physician NEEDS everyone from the receptionist to the specialist to care for their patients. Is the doc the "team captain"? Yes, most of the responsibility lay squarely on their shoulders. However, if I'm a FP doc working in a clinic and I see a rash that I'm not sure of, and I know that the PA in the next room down has done a derm subspecialty, you bet I'm going to call them in and get their professional opinion before I treat.

It's all about a team approach in my opinion, what position do you what to play, what are your talents? Do you enjoy making the call on the play, kicking for a field goal or crushing the quarterback on a blitz? All are viable and necessary for a football team to function. The options are there for you to choose. Wow, I just wrote more than I intended... I must be bored now that I'm on summer break! Peace out yo!

Good post, and good points. I think that having those 6 year BS/MD programs available for high school students that want to apply is a good idea, but having the majority of schools require a bachelor's is great, since it promotes educational diversity, like you said.

And I don't think we could shorten the actual 4-year medical school length. There's so much information (from what I gather) that you have to learn, and from what I'm told, even those 4 years are too short.

 

[jumpin bean]

The PA, NP, and CRNA are already providing care and will in the future be awarded a doctorate, so there is going to be a whole bunch of docs anyway. Also, the positions that people are playing (MD vs. PA vs. NP) are becoming more and more alike and the roles are blurring especially as the years on-the-job rack up. In the future if several disciplines are awarding doctorates and each of their professional organizations have successfully lobbied for independence, I think that standardizing health education and licensing exams will be crucial.

In private practice, these professionals are already providing care autonomously for all practical purposes. I think that shows that the education can be streamlined and still produce a quality physician. As far as the filter theory goes, there are plenty of people who have good enough grades to get into med school who might be willing to apply to medical school if it is a shorter time/money investment. We can already see their devotion in their work as mid-level providers, so I don't think we need to worry about a devotion filter. Only a 2 year decrease in the length of training shouldn't discourage applicants. They should only think of it as 6 years which isn't different than what the PAs do currently. Residency is more like a first job.

The pre-med pre-reqs seem reasonable and applicable in my job. It was other course work that I don't use very much. I agree that a liberal arts education brings a positive contribution to the table, but with a shortage of docs to see all the patients (hence the physician extenders) maybe that is a luxury we can't afford. It's true the yearly income for a physician would go down because there would be more docs, but you would also decrease the debt (less tuition, sooner entrance to workforce). Also, you would decrease the prolonged period of delayed gratification. This will help mellow out the sense of entitlement that grows inside of us as we drive our beat-up car from college for a decade. These two things would soften the blow of a lower income.

I don't know how we could make everyone (universities, insurance companies, current physicians) go along with this plan. All of the above would have to make monetary sacrifices. However, we would have a standardized education and testing for health care providers (increase patient safety), decrease the burden of training (good for students), increase the numbers of providers (good for the community), and even out the reimbursement (more fair for the mid-levels that are seeing patients unsupervised 90% of the time anyway). It seems like the right thing to do in my humble opinion.

I appreciate everyone's participation in this conversation. It's important that we, as the future of health care, have these discussions.

 

[Freeeedom!]

Let me tell you from a 33 year old residency graduate that used to practice as a PT (me).

Medical school NEEDS to be 4 years, it could be longer. When i was a PT I thought I was pretty damned smart, then medical school kicked me in the ass. Every aspect of medical school built on the next. In fact each created a hurdle to jump over. Not everyone who enters...will leave. This is good, I like the idea of the possibility of failure. It NEEDS to be there.

Residency is an absolute must...no less than 3 years, there is no debating this. I sometimes shudder at the NP's that have no clue that they have no clue. Have no idea of the pathology, have no idea of how to interpret tests. The PAs have done quite a nice job of using an abreviated medical model...that is what they do, they are Physician Assistants...they need to know similar knowledge as myself. They do VERY similar rotations and shadow doctors when they are students. While this could go on and on...I am whole heartedly in favor of LONG AND RIGOROUS training. It is not supposed to be easy, it is not supposed to be a fast track to residency. It is the marine corps for the brain. Hell, if I could go BACK to pathology I would, because I have forgotten so much.

Asking a medical student if they think their training is too long is like asking an athlete if they like training camp...hell no, they want to play in the game. But ya know, some of us NEED TRAINING CAMP.

While "jumping bean" believes what he/she says, thus speaks the voice of inexperience. The world now revolves around liability...medico legal liability. It is perception. It is training. It is about risk.
You could give a RT a doctorate...but as soon as the **** hits the fan, they will hand the litigation ET tube to the physician. Medicine is guided by liability and risk.

 

[jumpin bean]

Let me tell you from a 33 year old residency graduate that used to practice as a PT (me).

Medical school NEEDS to be 4 years, it could be longer. When i was a PT I thought I was pretty damned smart, then medical school kicked me in the ass. Every aspect of medical school built on the next. In fact each created a hurdle to jump over. Not everyone who enters...will leave. This is good, I like the idea of the possibility of failure. It NEEDS to be there.

Residency is an absolute must...no less than 3 years, there is no debating this. I sometimes shudder at the NP's that have no clue that they have no clue. Have no idea of the pathology, have no idea of how to interpret tests. The PAs have done quite a nice job of using an abreviated medical model...that is what they do, they are Physician Assistants...they need to know similar knowledge as myself. They do VERY similar rotations and shadow doctors when they are students. While this could go on and on...I am whole heartedly in favor of LONG AND RIGOROUS training. It is not supposed to be easy, it is not supposed to be a fast track to residency. It is the marine corps for the brain. Hell, if I could go BACK to pathology I would, because I have forgotten so much.

Asking a medical student if they think their training is too long is like asking an athlete if they like training camp...hell no, they want to play in the game. But ya know, some of us NEED TRAINING CAMP.

While "jumping bean" believes what he/she says, thus speaks the voice of inexperience. The world now revolves around liability...medico legal liability. It is perception. It is training. It is about risk.
You could give a RT a doctorate...but as soon as the **** hits the fan, they will hand the litigation ET tube to the physician. Medicine is guided by liability and risk.

Inherent in taking on the doctorate level of training would entail assuming the liability risk. The mid-level providers are already assuming this expanded and mostly unsupervised scope of practice. They are lobbying for more and more. They see patients on their own. They only discuss a minority of cases with a supervising physician. They have a pretty good case to make for independent practice because of the independence we have already given them. If we don't embrace, standardize, and test (licensing exams) these expanding professions, chaos will come.

I spend 20hrs/week studying in addition to my clinical duties as a resident. I do this not for fear of being pimped, but because of the gravity of the awesome responsibility given to me when I care for a patient. Learning never ends. I'm all for long and rigorous training, but the reality is mid-levels are asking for and being given more autonomy.

I've always hoped that my long and rigorous training gave me some extra deeper or broader understanding (even if it was subtle) since I've already gone through the trouble of jumping through these flaming hoops! I'm glad to hear that someone who had one level of training and went on to the next can see a difference.

 

[adamdowannabe]

I agree Cpt.Frdm

In a perfect world, we could genetically identify people who will eventually try for medical school, and start them into their medical training post highschool. 8 years of medical education, medical school is an attempt (in 2 years) to teach someone every aspect of how the human body should work, and then everything we know about how it goes wrong. Ideally every doctor would have such a perfect knowledge of the human body, that no matter what goes wrong, a physician should be able to figure out why, and fix it! But, doctors are only tought everything to watch for as a disease state, everything we have already seen...as new things pop up, people medical doctors just don't know what to do yet! (try new treatments until something takes, or the patient dies whichever happens first!)

If it takes every Phd 8+ years of specialty trianing in their subjects (2 years of specifics in undergad, 2 year MS and 4 for the PhD) how does a physcian master the human body and medicine in so little time? We all know, the undergrad classes of the premed don't have much to do with anything, except some really basic principles as applied to the body. Medical school should just be a decade, w/o residency, that out to be enough mastery!

This 2 years of didacto learning isn't really as extensive as it could be (too much to ever learn maybe?)

Or how about streamlining the perfect medical team... train physicians to do be part of a threesome, someone spends their whole education learning just to take a history, and find the rout of the issue. Then *tag-team* another physician trains entirely to break the problem down and create a plan of attack, and *tag-team* a 3rd physician hasn't a clue how to get through the history of the plan, but they can administer treatment and follow results like no ones business!!!

Having one person do all of these things, means no one will ever have the understanding of medicine that needs to be had in order to truely be AWESOME!

*** This is mostly satirical, but seriously though, if it wasn't so damm expensive to go to medical school, maybe some people who really want to master this thing called medicine, will spend 4-5 years in classrooms learning it!***

 

[toughlife]

Let me tell you from a 33 year old residency graduate that used to practice as a PT (me).

Medical school NEEDS to be 4 years, it could be longer. When i was a PT I thought I was pretty damned smart, then medical school kicked me in the ass. Every aspect of medical school built on the next. In fact each created a hurdle to jump over. Not everyone who enters...will leave. This is good, I like the idea of the possibility of failure. It NEEDS to be there.

Residency is an absolute must...no less than 3 years, there is no debating this. I sometimes shudder at the NP's that have no clue that they have no clue. Have no idea of the pathology, have no idea of how to interpret tests. The PAs have done quite a nice job of using an abreviated medical model...that is what they do, they are Physician Assistants...they need to know similar knowledge as myself. They do VERY similar rotations and shadow doctors when they are students. While this could go on and on...I am whole heartedly in favor of LONG AND RIGOROUS training. It is not supposed to be easy, it is not supposed to be a fast track to residency. It is the marine corps for the brain. Hell, if I could go BACK to pathology I would, because I have forgotten so much.

Asking a medical student if they think their training is too long is like asking an athlete if they like training camp...hell no, they want to play in the game. But ya know, some of us NEED TRAINING CAMP.

While "jumping bean" believes what he/she says, thus speaks the voice of inexperience. The world now revolves around liability...medico legal liability. It is perception. It is training. It is about risk.
You could give a RT a doctorate...but as soon as the **** hits the fan, they will hand the litigation ET tube to the physician. Medicine is guided by liability and risk.

So when the midlevels are awarded doctorates, will they no longer require physician supervision and be 100% liable? I would not like to see them expect higher paychecks and demand more autonomy if they are not going to be 100 responsible for their work. Even now,I feel that they play docs by having one assume the liability for them via chart reviewing.

Also, wait until the lawyers learn about this midlevels and they will likely ramp up their lawsuits since the midlevels may be an easier prey for them.

 

[JudoKing01]

I would not like to see them have full autonomy more so than higher paychecks. Just because you have a doctoral in nursing doesn't mean you are a physician. Nurses go to nursing school, doctors go to medical school. You learn different things, and fact is, no matter how much you learn at NP school or how long you've been doing it, when **** hits the fan, you need a doctor to really know all the ins and outs of what's going on and what to do. I know that's going to piss off a bunch of people here, but it's the truth. I know a lot of nurses who know what they're doing, but that's when it comes to nursing. As far as I'm concerned, a nurse shouldn't be going to nursing school because it'll let them get a doctorate in nursing and be called doctor, they should go to nursing school to be a great nurse. If you want to be Dr. So-and-So with the responsibilities of an MD, go to med school.

 

[lawguil]

Just curious! Does anybody like the idea of having anybody that wants to become a physician go through what we call PA school now thus eliminating the four year medical school model. Make them work for a couple of years assisting physicians (working as a PA). If they would like to further their training to the physician level, they could complete a bridge program for the additional training to become a physician and complete a residency in whatever they were accepted in. Might this produce a more competent physician? Licensing exams would be the same, but might lesson the financial burden of the student and give people looking for the autonomy of the MD/DO exceptional experience.

Just a side note. I recently participated in some educational research (that hasn't been published yet) that questioned how much material a student can absorb over x amount of time. We basically took the chemistry curriculum that covers all the material of 12 chapters (which is typical in most college/university) and taught it to a random sampling of students. Then taught 8 chapters of the same text to another random sampling of students, but over the same period of time. We then used standardized tests from the textbook company to test the students. There were three tests that were randomly given to the students of each class. The interesting result was that the students that only covered 8 chapters from the text tested significantly higher! I mean it wasn't even close! The research has its problems, but overall was fairly solid data. My point is that if it is true that x person can only absorb Xy amount of material over Xyz amount of time, is the intensity of medical school advantageous or should we extend training with breaks and in my example, a break that includes valuable experience and financial reward before tackling additional education. Who knows, but it is an interesting scenario - at least to me! L.

 

[adamdowannabe]

Lawguil, there is one majoy issue with what you offer, 90% of med students couldn't get into PA school! Not based on the competitive nature of PA school (lower admissions rates then med school based on only ~3,500 PA grads a year) but, PA admissions requirements are more indepth then most medical programs. On top of all the premed course work (chem,bio,ochem, sometimes physics) most all PA programs require a year of A&P....(then PA students retake a Gross anatomy class and a Phys class in PA school) But, the main difference in EXPERIENCE.

The reason PA school can even begin to put out competetant providers in two years, is the huge amount of experience most PA students have prior to school. Although some programs are becoming 5 year bs/ms programs and have almost zero required previous experience....... that is not typical. Years and years of being around medicine (in some aspect or another) holds two purposes, it shows the applicant knows what they are committing too in terms of a career (all the issues associated with medicine) something most medstudents usually only make assumptions about (because they they often lack hands on experience of medicine in the real world). Secondly, I think the experience allows PA students to assimilate into the role of decision making health care provider pretty well, or at least a whole bunch more effortlessly then someone stepping into medicine for the very first time. Hopefully making rotations a more efficient learning experience. (rapid learning curve). I have read some posts on SDN in which rotating med students bitch about how PA students on the same rotation are always doing everything, and basically being a gunner......... both PA and med students are on the rotations to do and learn the exact same things, so gunner or not, med or PA, everyone is pretty much equal to get as much exerience on a rotation, it's just the PA student might have much more previous experience and be more willing to jump in and be the gunner! Plus newbie doctors get an internship year of having your hand held and being tought stuff all over again for another ~4,000 hours....... PA students typically don't have that liberty, so rotations really have to count. A PA student with no hands on previous experience might flounder in rotations (fear, shy,uncomfortable all play a part) and when they spend 4-8 weeks without doing much, thats a sad thing.

So, I see your point, as to suggest that medical students might become better doctors if they had to do something medical to confirm their desires to become a physician. It is true that if you have good grades, and a decent MCAT score, you can get into medical school without every having seen a sick person (and many people do) and then not for another two years (after it's too late) do you actually get to see how you fit with being in a hospital in the power role. It's sad to know students can dedicate their lives to a career based on a hunch of what it will be like, especially in the era of Medical dramas on TV,

*on a side note, I read somewhere, that based on the popular TV shows of the seasons, rates of college majors and career goals change. ER had an increase of students wanting to go into medicine, Law&Order had people wanting to be detectives, and now CSI has everyone wanting to be a criminalist; people take these shows as "real life" and think they will be doing those things. If only all these kids that want to be CSI realize it's sitting in a lab all day running tests on things you don't know about...they take a crime and then take 3 months worth of lab work and condense it into 1 night's worth of work. HA!*

 

[PharmDr.]

soo true. Thats why im going for dentistry.

 

[Bandit]

I hate to say this, but freedom is exactly right. Without exception. I have been an ER PA for many years. I worked independantly in rural ERs with MD back up by phone only (a very common situation by the way)--thought I was pretty good.

Now--yep you guessed it--med school. The depth of the info is tremendous. PAs (some) are unbelievable and run circle around many residents--but they are not the same. Dont get me started on the NP thing.

Med school has to be four years. Folks, look how fast your lives go by. 4 years is NOTHING.

 

[lawguil]

Lawguil, there is one majoy issue with what you offer, 90% of med students couldn't get into PA school! Not based on the competitive nature of PA school (lower admissions rates then med school based on only ~3,500 PA grads a year) but, PA admissions requirements are more indepth then most medical programs. On top of all the premed course work (chem,bio,ochem, sometimes physics) most all PA programs require a year of A&P....(then PA students retake a Gross anatomy class and a Phys class in PA school) But, the main difference in EXPERIENCE.

The reason PA school can even begin to put out competetant providers in two years, is the huge amount of experience most PA students have prior to school. Although some programs are becoming 5 year bs/ms programs and have almost zero required previous experience....... that is not typical. Years and years of being around medicine (in some aspect or another) holds two purposes, it shows the applicant knows what they are committing too in terms of a career (all the issues associated with medicine) something most medstudents usually only make assumptions about (because they they often lack hands on experience of medicine in the real world). Secondly, I think the experience allows PA students to assimilate into the role of decision making health care provider pretty well, or at least a whole bunch more effortlessly then someone stepping into medicine for the very first time. Hopefully making rotations a more efficient learning experience. (rapid learning curve). I have read some posts on SDN in which rotating med students bitch about how PA students on the same rotation are always doing everything, and basically being a gunner......... both PA and med students are on the rotations to do and learn the exact same things, so gunner or not, med or PA, everyone is pretty much equal to get as much exerience on a rotation, it's just the PA student might have much more previous experience and be more willing to jump in and be the gunner! Plus newbie doctors get an internship year of having your hand held and being tought stuff all over again for another ~4,000 hours....... PA students typically don't have that liberty, so rotations really have to count. A PA student with no hands on previous experience might flounder in rotations (fear, shy,uncomfortable all play a part) and when they spend 4-8 weeks without doing much, thats a sad thing.

So, I see your point, as to suggest that medical students might become better doctors if they had to do something medical to confirm their desires to become a physician. It is true that if you have good grades, and a decent MCAT score, you can get into medical school without every having seen a sick person (and many people do) and then not for another two years (after it's too late) do you actually get to see how you fit with being in a hospital in the power role. It's sad to know students can dedicate their lives to a career based on a hunch of what it will be like, especially in the era of Medical dramas on TV,

*on a side note, I read somewhere, that based on the popular TV shows of the seasons, rates of college majors and career goals change. ER had an increase of students wanting to go into medicine, Law&Order had people wanting to be detectives, and now CSI has everyone wanting to be a criminalist; people take these shows as "real life" and think they will be doing those things. If only all these kids that want to be CSI realize it's sitting in a lab all day running tests on things you don't know about...they take a crime and then take 3 months worth of lab work and condense it into 1 night's worth of work. HA!*

Sure. I agree with what you're saying. What I'm wondering is should the way in which we train physicians change - which would obviously change the way PA programs work. Basically, should physicians be trained in such a way that they are capable of passing an entry level exam so that they could begin practice after two years in a role equal or the same as a PA, but giving this person an opportunity to advance their training later in their career to become a physician? Basically what I'm suggesting is that we EXSPECT more from physicians in a practical sense. However it also has advantages for the student financially as well.

Also consider the experience to become a PA can be as simple as working as an EMT for 1500-2000 hours. Honestly, it isn't that demanding and the experience is invaluable.

I'm not advocating this in anyway (not that my advocating it would carry any weight anyway), but just wondering from an education standpoint, what is the best way to train a physician so that they are "better" educated and training to be a provider.