Is Now the Time to Discuss a PA-to-Physician Bridge Program?

I think this is a terrific idea.

My idea would be for a accelerated medical school program that basically fills in the gaps from the standard PA masters program.  Didactically this would primarily be one year of science while also updating clinical knowledge.  This would be followed by a year of clinicals thus equalling the two years of clinicals a traditional medical student receives.

I believe there should be some minimum requirements if this were to happen.

1.  The PA should have passed at least one resertification exam (this also ensures that he/she has been practicing for a minimum of six years).  I also think if the PA has had all six years in one primary care field (ie. family practice, internal med., ER), and they plan on continuing in that field as a physician, they should have an accelerated residency as well.  (Ideally, they should also be paid a PA salary while doing so.  I may be getting too "pie in the sky" here.)

2.  This type of program should be reserved for the brightest, most caring, and most motivated PA's.  Those finishing such a program have to be extremely compitent, well respected physicians.

We are trained to look at risk v. benefit.  I think the benefits of such a program far outweights the risks.

Here is the truth. if you go to carebians medical schools for 3 years, you will get MD. if you have a foriegen MD, you can trade with US MD. Here the truth is both they got an opportunitis at least to show their capacities through different phases of exams.%0d%0athere is no book written for PA for clinical practices. we practice the same model. Practicing from PA- MD strength the clinical quality. It does not diminish the clinical practice.

I think it is a wonderful option for PA'S that have extensive experience and want to take their career to a higher level. What do we need to do to make this happen. I am interested and would like to know who we need to talk to to get this started.

I have noticed NP's tend to get things done quicker than us .This is the time for us!!!

We PAs are tired of being treated as scut monkeys with no respect. A PA-MD bridge program is long overdue!!!

I've read all of the posts, and I have a few questions. I have been a practicing PA with two Bachelor's degrees for 7 years. I have worked in two teaching hospitals, and I am still in love with medicine. I understand the arguments brought up about us reaching a ceiling of clinical practice. I respect the limitations (for lack of a better word), as we are not doctors. I think the DNP is a very slippery slope with a lot of potential dangers for people to practice autonomously without the proper training. I do not think our current training (or that of NPs)  provides us with the experience and knowledge to take on the responsibility of 100% autonomy in practice. Whether additional training will be added onto a Clinical Doctorate to foster that knowledge remains to be seen. So, as someone that wants to continue to grow in medicine, the best solution for me at this point in my life to guarantee the proper training, is to pursue an MD. However, that little things called the MCAT has basic sciences on it that I haven't seen in 10+ years. I would be interested in discussion about an alternative entrance in regards to bypassing the MCAT. I am ok with starting at day one of medical school. I just do not want to have to audit three years of basic sciences to prepare for a standardized test that says nothing about what type of provider I have already proven to be. Any thoughts on this aspect?

WHY NOT? If there's a track made available for a vetted PA, already at a Masters or Bachelors level, to matriculate into an MD track and pass the required boards, then why not. Choice is a beautiful thing. The PA field has many attractive characteristics that will keep the profession alive for a long time. Not every PA will want to drop their career and go through more hoops through the MD track.  

One problem a PA might face is passing the Step 1 for this is essentially your basic sciences. I for one did not take Histology, Embryology, or Neuroanatomy and it's been several years since my last basic science course. I remember many of my M1/M2 friends complaining how worthless some of the classes they had to take, but the information is on their Step 1. Maybe only Step II & III and board examinations will be required for the PA-MD track. As PA students, we go through the same Flexnarian medical model as the medical students. We are exposed to the main components as in medical school, often taught by the same basic scientists and MDs that are leaders in their respective fields. Our clinical year is almost identical to the M3 year. Another side note, my friends also thought their M4 year was a bit of a waste. Most agreed they appreciated the decompression time and had better interviews for their residencies. It’s not an accident that PA school almost mirrors medical school for this allows for a better complement in the PA-MD partnership.  

If someone wants to put forth the effort and expand his or her career track then I'm all for it. I'm not for an easy way out. I believe the same standards should apply in terms of passing the appropriate boards to attain the title of MD. Certainly a minimum level of competency must be adhered to.  Also, a residency should not be required for those PAs that have practiced a while, especially those practicing in General Medicine.

The concept of a bridge program (BP) is, in my opinion, frought with successive consequences which would only serve to undermine our profession.  

First of all, BPs only serve the PA who wishes to become a physician.  It does nothing to better the PA profession or the patients we serve.  Second, BPs have the very real potential to become the alternative means with which people pursue becoming a physician.  The sub-set of applicants who may pursue this option are those with good GPAs but who do not perform well on the MCAT and are thus denied admission to medical school.  Surprisingly enough, this represents a significant amount of denied medical school applicants.  We do not want such people to use our profession as the proverbial stepping stone to eventually get into medical school.

Finally, we need to examine and deal with why people are choosing to leave the profession and become physicians.  Is it primarily because of the individual's personality and their inability to deal with being the "assistant" or is it because of larger reasons which we as a profession should identify and address?   Either way, BPs do not serve our profession nor our patients and as such, should not consume our efforts.  We have bigger fish to fry......

First, to Lucas A.   Yes, we physician assistants ARE practicing medicine !  I've practiced medicine for the past 24 years. I graduated PA school when the profession was only 10 years old. Some PA's then had only associates, and I ran into one who was OJT and grandfathered.

I think the bridge is a great idea. Give credit where credit is due. I took classes right along with med students and was held to the same standard during classes and rotations.  I think that within 25 years, maybe sooner; the Doctorate in Clinical Science will be a third pathway to independent practice. First there were just MD's; then the DO's had to fight to get established. So I think (and hope) that the DSC's will get there also.

Primary care!  It took a change to surgical intensive care to change my views the acute care facility where I worked for four years hadn't the autonomy.  I left the acute care facility and took up primary care.  Let's mobilize PA practice!  

Ed is on track, let's advocate PA practice!  Let's advocate primary care!

I agree with Ed mobilizing PA practice.  Let's advocate PA practice.  Prior I did cardiothoracic surgery for 3 years in rural practice Eastern Missouri where there was not a primary care PA, all that was offered at the time was surgery so I've changed to neurosurgery, and since, moved to Boston.  I'm considering a move to Eastern Missouri, to practice primary care.  They opened a rural primary care clinic.

I oppose the bridge.  I've moved my practices to otolaryngology.

Alas I oppose this bridge.

as more and more practitioners sued for medical malpractice, I resign my opinions and oppose this bridge.

Respectfully,

Ivan

I TAKE BACK MY STATEMENT.

I accidently came across this blog and have to say it's a bit shocking, but not surprising. I know alot of docs who would find it interesting.

Why don't we help lessen the doctor shortage by encouraging  the sciences early on, giving more med school scholarships, and incentives for certain areas of practice. In other words, let's have more people go into medicine. That means the full medical school curriculum and training.

I totally disagree that we should come up with a phoney MD degree shortcut under the pretense that medical care will collapse if we don't.  If you chose to be an NP or PA, why can't you be happy with who you are and who you aren't? Who is going to decide that your education to date is exactly the same as a subset of medical school? Whoever wrote "I want to finish my medical school" is confused....he didn't go to medical school in the first place.

Yes, I know plenty of smart PA's, NP's (and other health care professionals) but they also have gaps in their knowledge. At the risk of sounding "old school", medical school and residency is needed for the depth and breadth of knowledge needed to practice medicine. PA's and NP's can do alot, but they aren't practicing medicine. To believe so requires you to think that 15 months of school and a year of clinical rotations is equivalent to  11-13+ years in school/training.  That seems to be the reason alot of people pursue the PA route. They don't want to spend that much time in school.

It seems that your real aim is ego (the Dr. title) and money and you don't even pretend otherwise. You want the glory without the effort. If you only cared about patients, this topic wouldn't even come up.

I'm sorry you're middle aged and made what you believe to be a wrong career choice. If you really want to be an MD, you should go to med school and start on square 1. You might just find that you haven't covered square 1 before.

Just Say "No" to shortcuts and phoney degrees. Everyone on the health care team has a role. Someone has to lead and that someone is a qualified, competent doctor who completed the full medical school curriculum and post-MD internship/residency/fellowship.

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I have thoroughly enjoyed the discussion and comments of this blog.  Thank you, Mr. Cornel for this post and others for their commentary.  With the emergence of the Doctorate of Clinical Science in other professions, it has emerged into our profession.  Good, bad or indifferent—it is here.  As with other professions, it has not granted or given more autonomy or money.  Nor do I predict it to give any more to our profession except initials at the end of the signature block.  The end result is that the autonomy, public prestige and money that comes with being a physician can and will only come through a medical school.  Hence, why the “bridge” program is so appealing and is having such a lively discussion on this forum.  

Here are some more things to discuss or think about.  The PANCE in lieu of the MCAT?—only if admission committees were not taking score; there should probably be a Professional MCAT that mimic more of the clinical vignettes of the USMLE.  

It may be flawed to think new schools are only receptive of a “Bridge Program”.  Lake Erie College of Medicine has a 3 year medical school curriculum for primary care.  With a 3 year FP residency, it takes 6 years to become a physician. Shortening medical school is not a novel idea.  Also, the military could be an avenue.  The military is having such a hard time getting physicians that now their scholarships come with a 20 thousand dollar signing bonus.  The PA DcS was construed mainly for a recruitment/retaining tool for PAs in the military.  

Limiting “bridge” physicians to primary care will only close doors to our bright wonderful colleagues.  Maybe I err in understanding a broader scope of the definition of “primary care”, but to limit anyone from a fair Match would only make a 2nd class physician in the eyes of peers and ultimately job opportunities.  I do believe, honestly, that residency programs would prefer or want “bridge” students.

I look forward to seeing more comments on the subject.

I have been covering the PA profession for more than 11 years. When I first started, people talked a

Dr Ross,

I completed the last certificate program at Western Michigan University Class of 1998. Completion of my BS requires liberal arts classes that I just haven't taken the time to complete. my lack of degree has not hindered me I work along side those "Highly educated" NPs and make more salary due to my experience and talent, Their advanced degrees do not make them better providers. Yet I would like to enter a PA-MD program because I now am limited to care as my physician practices, not always the best medical care.

So under your bridge plan with my certificate and 10 years experience do I fit in? or would you require more book learning?  

I would like to begin by stating that this is solely my opinion and should not be recognized as the opinion of those I am employed by or teach.

I would like to congratulate you all of you in discussing a topic that has been considered "taboo" for many years. It takes courage to openly discuss a topic that I am sure has been on many minds of individuals like ourselves. Our profession is in a whirlwind of change. It is "evolving". Our practice has changed and so has our attitude. It is given that all of us have the aptitude to practice medicine. We prove that everyday. Many of us have been in practice for 20 or more years, with enough knowledge equal to that of a physician. But that reality does not replace the credential necessary for peer and public recognition.

The argument I have heard is that if you wanted to be an MD than you should have gone to medical school. A second reality is that many of us became PA's later in life as adult learners. And unknown to us at the time, after several years of practice, may have a renewed interest in pursuing the higher degree credential in other words the "MD" degree.

But as we all know there are rituals and rites of passage that have to be performed in order to do so, which may work for the younger immature student.  As an adult learner and seasoned PA this method may not necessarily be efficient or desirable.

The topic of a bridge program is a wonderful idea.  But do we really want to become what we have consistently tried not to be? The philosophy of the PA is to spend time with their patients, educate them, be their advocates, be good listeners and full fill every aspect of their physical and emotional health. Now does this sound like an MD to you (forgive my generalization)? How many patients prefer to see the PA when given a choice?

I believe our topic is autonomy. My hope is that those of us (PA’s) who have made the journey to "MD"- hood will maintain that core philosophy  of PA and begin to convert other non-PA  MD's and possibly bring back the humanity to medicine.

So how do PA's maintain their philosophy and their identity and become autonomous without becoming an MD/DO?

We create an “evolved” PA, a new professional independent health care provider.  The title should be “D.M.P” or Doctor of Medical Practice. It would be recognized the same as MD/DO, and would be the highest level of academic credential a PA can achieve. It can be a step progression. It should not be considered a starter degree but and advanced degree for those who wish to pursue it. A “D.P.A” can be reserved for those who dedicate themselves to administration or education and the “D.M.P” for those who dedicate themselves to clinical practice.  

This is a thought I share with you all, I am proud of being a PA and I believe that if we don’t take the evolution of our profession seriously and into our own hands others will do it for us- and it may not produce favorable results.

I agree with the idea of a PA-MD bridge program. I welcome the challenge and the undertaking of a rigorus curriculum. I do not believe PA's should start from square one.  Dr. Eugene Stead also believed in the idea of a PA-MD bridge. Matter of fact he proposed critera for such a program prior to his death. It read as follows; Physician Assistants who had a masters degree with at least 3 years of clinical experience would attend medical school with the promise of working in primary care. It's time to expand our opportunities as clinicians. I would love to work with Dr. Ross on putting a pilot program together with a medical school.  Sign me up!

Why should anybody waste time reading about some "fictional" fairy tale called  Dr. Seuss' "The Sneeches" to make decisions about real life issues? I hope this isn't the mentality of my fellow professional colleagues? If you look at other public educational campaigns and their results in regards to educating the public to get respect they simply don't work. The public at the end of the day will make decisions based upon titiles. I don't know too many people who care if their Doctor is board certified, fellowed, diplomate, associate or even AOA. At the end of the day people hear the doctor title wether it is Optometrist, Opthomologist, psychologist, psychiatrist, DO, MD, DNP etc....All that follows after that is BUNK basically. I think the further point to note is that if you look at other professions where a provider class chose to stay in the ASSISTANT model they were either phased out or have a tough time finding a job. Ask the OTA's, RA's and the PTA's if public campaigns would have saved their jobs or bought them respect. It disturbs me as a previous PA with a lot of friends in the PA profession the lack of depth, foresight and sometimes mere intelligence with some of the comments made on this website. I mean that everyone can have their opinions and comfort levels but reality must dictate the extent to which one forms or holds on to beliefs that result in policy. I would advise all to not quote Dr. Seuss as a point of refrence, that is just simply embarrasing, hence only the initials for the name in the comment I guess. "MOVE FORWARD" to doctoral distinction one way or another or be "MOVED ASIDE" by the DPT's, DNP's, DOT's, DPM's or some other Doctor.

Colin Ross MD PhD MPH PA-C

To those of you who think attending a PA-MD program will grant you the respect you feel we deserve, please read Dr. Seuss' "The Sneeches". We will always be 2nd class providers. We need to educate the medical profession and the public about how great PAs are. We don't need to change our degree. If you want to be a doctor- go to medical school.

The older I get, I am becoming more and more dissatisfied with the lack of respect and the treatment that I often see (me included) PA's receive from Physicians who often times are even much younger in age and with minimal experience.

When I decided to become a PA, I did so with the understanding that there will always be someone to whom I could turn to in times of need. Less and less, physicians want to assume responsibilities, and only do so, when is beneficial to them.

Do not get wrong idea; I am not including all physicians in this statement. I have worked with so many great physicians whose work ethics were second to none.  Perhaps, I have made my opinion based on my recent 10 years of practice, which have caused me to accept this as a fact.  It can perhaps be particularly associated with the field which I have been working during this time.

Regardless, of which type of degree / PA-MD bridge /gap, etc., which ever new concept, we will always be seen as a second class provider / citizen, for lack of better term.  As a friend of mine who is a physician putted it: "A permanent Intern."

Nowadays, when I am interviewing any new PA prospect, I emphasize this point to them.  I stress to them that if they want to become physicians, they should do so and choose that path instead, and not to become PA’s. However, I always make time to counsel them on the many great things PA’s can do that physicians will not do or can not do, etc.

I believe that the PA profession is a noble one, and that the role of the Physician-PA needs to be clearly re-looked and redefined.

Physicians need to understand who we are, our capabilities and they need to stop seeing us as cheap labor and / or money maker machines. They must start embracing and respecting us as proven professionals, backed by our over 30+ years of a positive contributing profession.

For those PA's who are still young and would like to complete their physician training, they should do so. For rest of us, middle age practitioners, we should continue to strive to provide the best quality medical care which has been entrusted to us to deliver. Furthermore, we must make all efforts to remain very watchful and cognizant of any pattern of wrong doing on behalf of our supervising physicians.  We should never become part of anything that could tarnish our PA Profession.

Finally, I am a pro-physician-PA  harmonious and cooperative working relationship, one who will benefit all involved parties, but one that will always put patient care first and that will never compromise the integrity of the PA profession.

This is a great nation. One nation onto God filled with many opportunities and also complicated by a very complex health care system that tends to use and miss-use all parties involved.

We must not become a victim!

Respectfully,

Ivan

This is in answer to RN-PA Ackerman. First of all I didn't know that the certificate programs still existed for PA's. Since I am a factual type person please tell me what school you graduated from so that I can verify that there are still PA certificate programs for people with an AS degree? That is news to me. Second of all research has shown based upon the malpractice statistics that doing well or passing a standardized exam just predicts how well one would do on a standardized exam and not in the profession.   See "Internal Bleeding, Our epidemic of medical mistakes" Audio digest volume 53, issue 36, 9/25/05 I mean I think there is a reason other than patient safety why review courses for these standardized exams cost so much, $2,500 average and then the test are also very expensive, CSA $1,200. I proposed a scheme for independant PA practice based upon knowing the career history of DO's, DPT's and now DNP's. I like to think ahead. I like to be proactive instead of reactive. I like to play offense and not defense. A lot of community medical clinics and rural medical settings are held "hostage" by some MD's because they can't have the wonderful PA work in the clinic without them.  The bottom line is I think it is great that you made a mid-career change but don't short change yourself by being stagnant in the PA profession. DNP's want and will take your job eventually as the independantly practicing Primary care practitoners for the coming primary care crises in America. I wouldn't want your mid-career change to be a trip to the unemployment line in the right now future. Take it from someone who knows history and has been in this game for a long time on the MD and PA side. My MD colleagues are all for DNP's because in private conversations they know that their lack of training under the an Allopathic hospital based program will eventually cause the DNP idea to fail and MD's will come to the rescue. As long as PA's are dependant practitoners providing passive income to an MD at a 4 to 1 rate of return now,  MD's are all for you as a PA to have all the education in the world, recertify, do postgraduate training and be a higly trained asistant.  Think on these things.

Dr. Ross, In your PA-MD Bridge program idea at what base educational level do you see this "outpatient specialist" requiring?

I have a certificate with my AAS.  I've passed the PANCE and PANRE (with ease). Do I qualify? or would I need a BPAS? MPAS? DPAS?  I am the type of PA  that PA was meant to be this was a midlife career change.

Jesse Edwards.  My comment got distorted and cut short.  I do not know why those symbols/letters came up after your name.

Harold Mauer's response back to me was; "There are no short-cuts"  Although, as you know, he does not have any respect either for the UNMC PA program or PA's in general, and his  statement further clarifies that.  I wanted to also thank you for all you have done for the PA profession in the state of Nebraska and the rest of the U.S. you have been a tremendous asset to PA's everywhere.

Jesse Edwards,%0d%0a   The formation of a bridge program from PA to MD would indeed answer many if not all of the problems in regards to the primary care physician shortage.  I presented this same question/statement to UNMC's Harold Maurer, and the only thing he could come up with is

Certainly the idea of a PA to Physician "Bridge" would be a good way to address some of the physician shortage issues.  There can be little debate that such a program would be successful.  PAs are trained in the physician model of education and have an equivalent skill set and provide and equivalent level of care. Given the the knowledge base and skill set of a PA far surpasses that of an average medical student, the concept of starting as a freshman medical student would seem ridiculous.  Many of our PA program professional phases already run 27 months, while the required program length for MD programs is just 32 months.

I do not subscribe to the idea that PAs are "ready for residency". New medical graduates function under the auspices of an RTL (resident training license) and work under a senior attending phycian faculty member much in the same manner as a PA functions in a supervised capacity.   I believe that a PA with any significant level of experience already possesses a knowledge and skill set that surpasses that of all but the most talented senior residents in most non-surgical settings.

The similarities being what they are, a reasonable "bridge curriculum" could still take 32 months to meet the requirements of MD programs, but could encompass the perceived "gaps" between PAs and MDs education and internship. Thus, a PA completing such a progarm would be prepared to enter practice as a generalist physician (GP), or elect to enter a typical physician residency program.

I would speculate that such a program would require that PA applicants have a given length of experience (six years or so)following graduation.  I would also think that  recent PANRE scores could be used in lieu of an MCAT (which measures knowledge in preclinical science knowledge for med school applicants, while the PANCE/PANRE are more akin to the Step 2 and Step 3 medical licensing examinations for medical graduates).  Proceeding to physician licensure after completion of a "bridge program" could be accomplished via an exam such as that administered to international medical graduates.

As practical and simplistic as such a program would be to implement, there is little doubt that there would be many in the traditional medical education community that would stand ready to oppose it.  Medical education tends to be dogmatic and resistant to change in spite of undeniable benefits to society.  A real concern in this situation would be that "bridge program" graduates would not be accepted into residency programs, denied the ability to practice in some locales, and denied participation in physician associations, insurance plans, etc.

This would essentially result in some of our finest PA graduates becoming what some would term "second class doctors" despite their achievement.

The idea is sound, practical and achieveable.  Whether or not the medical community at large still possess the foresight of Dr. Eugene Stead is in doubt.

IMHO

Dr. Stead, yes, the same physician to whom we owe our existance seemed to think so! He wrote an article on this about six years ago and perhaps one of you still has it. I will search my computer and look for it. I would also suggest contacting Doug Condit at Montifiore, who happens to save all of this valuable information.

We can't kick against the idea if Dr. Stead says that it is perfectly appropriate.

Bob

I think the PA-MD program is a fantastic idea.  With a few years of clinical experience...most PA's are absolutely ready to attend residency. Regarding the foreign medical graduates....there is a huge difference between FMG and PA's.  PA's are trained in the medical model which is approved by the US system of medicine.  PA's have the same standard of care as MD's with less years of formal training.  Many FMG come from parts of the world where medical care is at a much lower standard from our own.  Getting into medical school in some foreign countries is often easier then getting into a community college in the USA.  Many of those programs are shorter then PA programs and begin as early as 16 years of age with little or no criteria to start "training". Do you want someone who comes from a country where medical care is centuries behind our own calling themself an MD or a PA?!  The first step the PA profession needs to take is to change the name!!!  Physician ASSISTANT is the most confusing part of the profession...you are your own worst marketing campaign! Call yourself Physician Associate or something else and fire anyone at the AAPA who is holding you back.  

I've been waiting and watching for a bridging program to happen.  I, like many others, have been asked multiple times..."Do you have your own office?"  The thought of starting over from scratch is unrealistic for many.  I BELIEVE in patient care with all my heart...but to do the job of an md and make a pa's salary is unfair.  There are multiple bridging programs throughout the nursing field.  Even nurse to nurseanethesist...with what qualifications???  And I mean nothing personal to ANY nurse...I believe the time is NOW for the PA to MD bridge.  BUT, there would certainly have to be some sort of qualification.  Because lets be honest...we've all seen it...there are both good and bad doctors as well as both good and bad PA's.

We should join together to advance patient care!

Sign me up!!

"TO BE LIKE MIKE"

Larry I am flattered and Michael thanks for your comments. Unfortunately level headed people that are waying in on this subject are not the ones that make policy. For IMG's/FMG's/PA's what is really most important is the opportunity to get clinical training. If our primary goal in Medicine is to produce quality health care practitioners with patient friendly personalities then the objective should be to work and fine tune all bridge programs, PA to MD, IMG/FMG to PA or MD, to achieving that goal. Years ago the medical community learned that 4.0 students with perfect MCAT scores did not make good doctors. We have also learned that grueling residencies do not produce good doctors hence the 80 hour resident work week etc....I had a professor who was a 96 year old pathologist that told me when he started practicing as a doctor, penicillin was the talk of the town as some new antibiotic in the fight against pnuemonia. Too much lobbying and politicking goes on in this countries medical care system and that is why patients and practitoners alike are not terribly happy with the state of medicine. The formula in medicine for success and happiness is simply, work from a standpoint of patient satisfaction first and secondly work as a team and not individual demagods. Instead of creating more hoops for people to jump to become ??????? The focus should be on creating pathways to provide more efficient and a more personally satisfying healthcare system. Go foward with your bridge programs because I personally need more "Teamates".

Colin Ross MD PhD MPH PA-C

Hello,

I completely agree with the ideas and sentiments set forth in this forum.  As a medical student, I did a lot of my 4th year clinical rotations with PA students.  I agree that some of them are as bright or brighter than some medical students.  They would make great doctors.  But, I find the whole topic a little bit hypocritical by the PA profession.  I have a lot of friends that are IMG/FMGs that, for one reason or another, cannot get into U.S. residency even after passing the USMLE Steps.  When they try to use their skills as a PA, they cannot without going to a PA program for an additional number of years.  Yet, I believe most on this forum believe that PAs should be able to become MDs using their versions of the USMLE Steps or by just taking them without going back to school.  What about IMG/FMGs becoming PAs?  Why was there such a backlash when IMG/FMGs were allowed to take just the exam without going back to school?  The fact that they are IMG/FMGs already acknowledges that they went to comparable training to PAs.  Would you expect MDs to go back to school if they wanted to become PAs when you believe you shouldn't to become MDs?  Why would they have to go back anyway?  Unless they haven't been practicing for more than five years, I would agree.  Otherwise, I don't.  As for bridging programs, I think Dr. Colin Ross' post was exceptional.  What I'm getting at is, for the sake of fairness to everyone (PAs and IMG/FMGs alike), there should be a bridging program for both PA-MD and IMG/FMG-PA.  If any MD, PA, or IMG/FMG wants to transition to the other, it should be fairly attainable while keeping our professions's high standards.  But, it shouldn't be so opposed as not to be worthwhile.  As healthcare professionals (MDs, PAs, or IMG/FMGs), I believe we are basically the same and we shouldn't be restricting each other but helping each other focus on our main objective:  delivering a high standard of clinical care in a timely manner to those in need.

    Also, to reiterate what Dr. Ross said, an invitation to the PA's to attend medical school would be with recognition of the PANCE exam in place of the MCAT.  

    Dr. Ross makes great points and has some solid ideas.  I agree that it would be very difficult for a PA who has been out of college for years to go back and successfully pass the STEP1/2 exams.  I think it would be a good first step then, to allow a PA with years of experience into medical school without having to take the MCAT.  I know for myself, it has been 8 years since taking Organic I & II and Biochem I & II, I would have to go back and repeat those courses to refresh myself enough to pass the MCAT.  So then I take the MCAT, an exam that is supposed to help predict my ability to become an MD??  I think my years of actual patient care experience should be ample evidence of that!  

    If medical schools across the nation are needing to increase their enrollments, then the first place they should start is by sending a letter of invitation to the PA's!!!

Being a PA in Missouri it is nice to hear this kinda of talk.  Somtimes I think the PA is the most hated and bashed medical profession in the state.  We have the nuses, DO's trying to get rid of us it seems. We have began to make some progress we decreased or supervision from 100% to 66% yeah. This bridge progam idea would be great, it would suck for me since I started out in Critical care and Surgery that is the only job in the area I could get at the time there was not much call for Primary care. please if a bridge opens or if there a place I need to go to support the idea sign me up.

On a side note I understand that the Duke MD program is very similar to the PA program 0ne year books, then they start clinical for two years then graduation

I also didn't know that this is the difference between the DNP,(Doctorate of Nursing Practice degree) and the PA Educational model. Thanks once again my dear ex-classmate.

PA Education                                               NP Education

4 years BS degree                              2 or 4 Years RN degree

4 Years MPS degree                               2 Years NP degree

------------------                                          -----------------------

Total 8 Years                                                Total 6 Years

PA Education                                                 NP Education

MEDICAL MODEL                                          NURSING MODEL

--------------------------                                      ----------------

Allopathic Training                                        Nursing Training

PA Residencies                                 (DNP) Doctorate Of Nursing

and Years                                                Practice curriculum

of Hospital based

training

-----------------------                                     ---------------------------

Hospitalist 1-2 years                                          YEAR ONE

Geriatrics 2 years                            Advanced Science, Economics

Surgery 1-2 years                             Biostatistics, Health

ER Medicine 1 year                            outcomes, Methods for

Internal Med 1 year                          evidence, Clinical Practice

Bioethics

                                                                         YEAR TWO

                                                      Resource Management, Exam

                                                      of Practice, Clinical

                                                      Project, DNP Project,

                                                          Clinical Practice

---------------------                               ---------------------------

1 to 2 Years Hospital                            Hospital training ???????

training

FINAL TALLY

------------------------------------------------------

DNP = Clinical Doctorate, "Doctor" title, Billing

directly for DNP services without an MD's name,

Independant practice, Respect and patient trust.

---------PHYSICIAN ASSISTANT UMBRELLA-----------------

Certificate, Bachelors degree, Masters degree, PHD

degree, MD degree.

Hospital training or no hospital training.

1 year in practice or 30 years in practice.

Misdemeanor if MD is figure head and PA runs/owns the

clinic.

Lab results arrive with MD's name, calling PA the

assistant, no name mentioned, just "the PA".

MD makes a mistake=Oversight, PA mistake=Incompetence

At the end of the day grand total-------------------

ASSISTANT.

I went to school with Dr. Ross. This guy is fearless and makes a lot of sense. He should lead our political organization. I was so moved by this comment and have pondered about it for sometime. I actually think his licensing scheme makes a whole lot of sense. It allows us as PA's to get the educational level that we want and the level of autonomy that goes along with the education. I found this very sensible commentary by my ex-classmate on one of these blogs. I wish I would have dreamed this up. Colin, you should have stayed a PA.

I thank all of my "colleagues" PA,MD,DO etc....for your kind comments on this web-site. I encourage the percentage of the 68,000 PA's that subscribe to this great magazine to elect representatives who are progressive and have you in mind. STOP electing scared and out of touch administartors who advance legislature to move you 3 steps backwards for ever 2 steps taken fowards. Big deal if your administrators have lobbied for the right for a Physician to supervise 4 PA's versus 2. Why is this rediculous? This is called franchising. The same thing that Mcdonalds and any other business does to make money. You now have 4 assistants that can bill under your name as an MD instead of 2 . How in the world is that a benefit to you as a PA or your patients who prefer your expertise and style than your supervisors? . For those who don't get what I am saying look at it this way, $4 of passive income is better than $2 of passive income for any franchise or "PC" John Doe MD PC ever see this distinction? Well now you know why. This is just an example of how your PA administrators are short changing you and that has to stop. In light of the new Doctoral PA degree this is my progressive and contemporary reccommendation to a licensing scheme which looks out for PA's, Clinicians and patients. It doesn't matter what title you use in this scheme the "SUBSTANCE" of what I reccommend is what I hope drives home.

4 year degree= Bachelors of Physician Assistant Sciences (BPAS)

7-8 Year degree=(bachelors and 2-3 years of additional

training) Masters of Physician Sciences (MPAS)

7-8 Year degree previously mentioned+Post-Graduate training=

Doctorate of Physician Assistant sciences (DPAS)

Distinction/educational level is clear in this scheme.

BPAS, MPAS and DPAS. In my proposed licensing scheme the

bachelors trained professionals are the only ones that

need to follow the current PA-Physician supervisory

model. MPAS and DPAS Should be "INDEPENDANT" practitioners. This scheme allows the

employer, hospital or physician to decide if they

would like to hire a clinician who needs supervision

or hire an independent clinician. This licensing

scheme leaves choice on the table. Here are the

advantages for each scenario;

1) For the individual who doesn't want to invest a lot

of time in the educational process and would feel more

adept practicing Medicine under a supervised

Physician/Mid-level model then the BPAS training model works

out quite well.

2) A Physician in Solo practice or a medical group

would probably prefer a clinician under the BPAS model.

A hospital, community/rural clinic I am almost certain

would prefer a DPAS trained individual who is "INDEPENDANT" under my

proposed licensing scheme. These are the medical facilities that need committed providers who will work and become part of the community.

Note to Jesse Edwards,

Karen Bass is a California State Assembly Majority Leader who is also a PA.   She has been fighting (and winning) for PA issues since she took office.   I believe she would be willing to take up your idea.

After 20 yeas as a PA, I am seriously contemplating attending Medical School. In some of the Magazines we receive there is info from PA to MD. All of those programs are overseas.

It would be great to have some in the U.S. I do agree that you should have a few years of experience before entering.  In addition, it should be in the same motto as those overseas so those of us who need to work can do so.The time for this is NOW. SIGN ME UP.

After becomming a PA, I did go to Med School.  Unfortunately, I did not pass the USMLE, which I agree is a PAIN.  I ended up after a few close tries going back to the PA profession.  

The flaw of beginning at an advanced standing in Med School, is that the basic sciences of Med School requires very detailed knowledge of medicine that are then tesed while in the 3rd&4th years, as well as on the USMLE.  Therefore, the fail rate would be high.  

However, the thought of using the PANCE to enter the limited MD roll, then moving on from there as previously mentioned would be the most productive for those who want to take that step.  I do feel that one should have some years of clinical practice before being allowed to do this though.

SIGN ME UP!!!!!!!!

I have been looking for a program like this for years.  I chose the PA profession because I wanted to practice medicine and it was already my second career choice.  I did not choose the PA profession because I thought I had less skills or knowledge than someone who went to medical school.  I know we as PA's are as knowledgable, but many of us do not have the time to go back and start all over.  

I think this is a great idea.  I can't say how many times I've had patients say "you give great care, why don't you just become a doctor?".  They can't seem to see past initials.  It highlights my thinking that when it comes to patient care, PA's are on par with doctors.  I realize that MD's and DO's get more background knowledge in the first 2 years of med school, like embryology and biochem.   I also know that, at the program I went through, the PA's get much more indepth knowledge in EKG interpretation, radiology, and especially physical exams than the med students.  So for me, it all comes down to the residency training.  I think that if a PA can pass the USMLE steps 2 and 3, complete a master's degree level PA program and complete a residency program, they should be granted an MD license.  I think there should be stringent qualifications set for anyone looking to make the PA-MD bridge, but there are many PA's who would be well qualified.  This should certainly be offered only to physician assistants, and not other providers who are not trained in the medical model.

I agree with the PA-MD bridging prgoram, especially in the underserved areas.  I have worked 3 years at a tribal clinic in Wisconsin and LOVE my job.  The UW-Madison WI School of Medicine has  developed a Rural MD training program. I naively called and asked if I could join it at the residency level, or at least the 3rd year med school level, so I could upgrade PA-MD and then continue to provide care in this underserved area.  That went over like a lead balloon.  Colin's idea was what I had in mind as I am committed to rural/underserved.  Let's start working towards this!!!    Paula

I have been a practicing PA in primary care for  more than 28 years. I have often thought about  medical school . My blessings to those Pa's who want to  become MD's . But I strongly support my title and profession , an MD degree does not make you a better health care provider or patient advocate. I now smile when patients tell me they would rather see the PA than the doctor.

As a PA who unfortunately had to go through the hoops of getting an MD degree I would love to weigh in on this subject. First of all I applaud this idea. To me this is the first truely progressive "IDEA" that I have seen talked about by the great PA profession. The PA profession needs to stop being pushed around by NP's and taking up the rear for every other doctoral profession. First of all looking at the didactic and clinical training years of the current PA programs, these programs are really geared towards producing a first year Primary care resident. Secondly there is already a national standardized exam for PA's to go from PA-S to PA-C. Thirdly there is already a 6 year re-certification exam. Finally there are already hospital based post-graduate training programs for PA's. In my opinion the following PA to MD bridge program is how I would do it. Remember a lot of what I propose exposes some inside information that you and the public may not know about your all knowing and powerful MD.

1) Most PA's would have a difficult time passing USMLE step 1. This is a useless standardized exam, that tests your ability to "recognize" in a multiple choice setting small and obscure non-important basic science facts. This is the first required test for licensure as an MD. The MCAT and USMLE step 1 simply predict your ability to perform on standardized test and nothing more. I would propose that the PANCE be considered a substitute exam for USMLE step one.

2) Upon passing the PANCE, the PA student should be allowed into a Primary care residency called "out-patient specialist", Primary care specialist, or rural medicine practitoner. A one year post-graduate program that emphsizes more out-patient rotations with a determined amount of necessary hospital hours.

3) At the end of this one year very focused post-graduate year the PANRE could be considered a subsitute exam for USMLE step 2.

4) Upon passing the PANRE, the PA, now an MD with a limited license to practice outpatient primary care medicine for 2 years under the direct supervision of a board licensed MD with a contract and delegation of services agreement that parallels the current PA/MD type contracts.

5) At the end of these 2 years, a limited MD license is granted which would limit the individual to practice out-patient primary care medicine at a community or rural medicine clinic as an MD.

6) If the PA wants to do anything other than rural medicine or work in a community medicine clinic then I think letting the PA into medical school with advanced standing at the third year level and letting him/her persue the traditional route, internship/residency/USMLES could be the second option.

First of all there are 11 states that offer MD's a license of eminence. An MD with just one year of internship can practice medicine with a free and unrestricted license without completing residency. The federal government at one time awarded foreign MD's, PA licenses without going through PA school so that IMG's/FMG's could practice medicine at federal facilities. Florida once tried to offer Foreign MD's the ability to take the PA exam for a PA license without any training. Florida even at one time offered a special licensing exam for foreign MD's. There is now a move to open up more medical schools and increase medical school class size to off-set the physician shortage. I hope all PA's will really push to be the primary care force in America with respect, independance and doctoral distinction. I just would hate to see my PA colleagues go through unecessary pain like I did to join the MD club. Tradition is hurting the medical profession and our patients are suffering also.

Colin Ross MD, PhD, MPH, PA-C

    I think this is a fantastic idea, however it seems to be like the elephant in the room that no one wants to talk about.  I believe without hesitation that experienced PA's should be able to matriculate into medical school with advanced standing as either a 3rd year student or even a resident by challenging the STEP 1 and 2 exams.  

    The problem however lies with the physicians.  I have actually discussed this idea with doctors over the years and most (by far) thought it laughable.  The AMA has a very "old school" mentality of "if I went through it, you must go through it".  Hence the decades of resident abuse.  

    I think this country needs such a pathway, this healthcare system needs such a pathway, the underserved areas need such a pathway.  I believe LITERALLY that it would take an act of congress to force the AMA to open it's hallowed hallways to a group they already think of as "those that took a short-cut".

Shortly after helping to start the Nebraska PA Program in the mid 1970s I proposed to the Medical School Administration that experienced rural based PAs in Nebraska be given an opportunity to return to our medical school as third year students provided they were willing to return to the rural areas after completion of med school and residency.   So, obviously I have been in support of this idea for many years.  In the eary 2000s, Dr. Stead called me suggesting the exact same thing.  I had to tell him that my idea had gone nowhere.  An articulation  agreement between a PA Program and a medical school to test this idea would be a great thing.  Perhaps the Feds would help fund such an experiment.  Anyone know a good congressman?

PAs should definitely have a benefit when going to medical school. They are above the game and obviously have the desire and brains. Something must be done!!

Thanks for presenting this thought Steve. I have said on many occasions that the PA profession was born on a field of blood. This is true of opportunities such as a PA to Physician Program. There are many very sharp PA's in our profession who have served in critical roles in their practices or institutions. There are the military PA's who have served and are presently serving in harms way. These PA's have distinguished themselves on the battlefield and have won the respect of their colleagues, their superiors and the men to to they provide medical care. If any group of PA's were to have the opportunity to make this transition I think it should be fostered by the military who has accelerated the training of the PA and has transformed him/her into the professional that I speak about now. This would also increase the number of volunteers to serve in the Armed forces. I say, Look at the Climate, test the winds and let this thought take wings.

Bob Blumm

I would like to study with PA's who are in the process of taking their recertification exam in Northern Virginia, Maryland & Washington, DC area.

I could be reached via my e-mail me directly at “iamselling2007@hotmail.com”.

Thank you,

Lisa

Atta boy, Steve...props to you!!!

You pose some fantastic thought provoking questions--took the precise words from my mouth!

Hahnemann Univ. packed 4 years (9 mos. multiplied by 4) of med school into a jam-packed 24 straight invigorating yet rewarding months.  If I ever enter the political arena, I shall propose if a PA has shown proven and supervised excellence/competency, we may be encouraged to apply to and matriculate at Residency Programs throughout our nation.

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