Vol. 17 • Issue 5 • Page 16
Inside the Profession
A lot of discussion has taken place lately regarding so-called bridge programs for PAs. Advocates of the idea believe such educational programs would provide a PA with, let's say, five to 10 years of clinical practice experience, some amount of advanced standing (i.e., a shorter period of training) toward the MD or DO degree.
Supporters note that bridge programs would provide a pathway for PAs who wish to become physicians. They contend that medical school content is similar to that of PA programs in that they are medical-model in structure and overlap in many areas. Proponents also note that such programs could help address health workforce issues in that they could be structured to require service in primary care and offer a shorter training period for the fully qualified physician.
The idea of bridge programs gained additional traction in March at the PA Clinical Doctoral Summit, which was devised and sponsored by the AAPA and the PAEA. Among the summit's recommendations was that "The PA profession should explore with physician education groups the development of a model for advanced standing for PAs who desire to become physicians (sometimes called a 'bridge program')."
What's in It for Physicians?
It seems reasonable for PAs to further study bridge programs, but we should fully think through the ramifications.
An initial key question: What would be the motivation for a U.S. medical school to offer such a program? In my view, very little. As one who has spent the last 35 years working in medical schools, such institutions have a well-deserved reputation as being elitist, traditional organizations that are not known for innovative medical education programs. Further, most medical schools do not grant advanced standing to anyone, whether a PhD, dentist, veterinarian or other doctorate-prepared health professional. What makes people think these institutions would change their policies for PAs?
There are other reasons why bridge programs are unlikely to come about. The notion of PAs becoming physicians does not benefit the health workforce. It simply takes a proportion of practicing PAs out of workforce for five to seven years and generates another physician, who likely would enter specialty practice. Unless one could impose a stipulation that bridge program graduates enter primary care practice-an unlikely proposition in a society that thus far has refused to place specialty impositions on new medical school graduates-the public stands to benefit little from the prospect of another specialist physician.
Yet another issue: Presumably, the advanced-standing part of a bridge program would exempt PAs from year 1 and/or year 2 of medical school. That clearly would put such students at a disadvantage in their attempt to pass Step 1 of the United States Medical Licensing Examination, which is basic science in content. How would a PA who has been out of study of the basic sciences since his or her PA education fare in this examination? Ostensibly, it is the practical clinical experience, not knowledge of basic medical sciences, that PAs would bring to a bridge program. It would be difficult to translate that element into advanced standing in an MD or DO curriculum.
We Need More PAs, Not Fewer
The final factor is that bridge programs essentially are a plan for PAs to leave the profession. This would make it difficult for the AAPA or the PAEA to have an official position on or endorse the notion. How can those whose role is to promote the profession support programs wherein PAs would exit it?
Estimates of the number of PAs who successfully go on to medical school are about 4%, suggesting that a large majority of PAs are quite satisfied with their career choice.
It seems to me that the discussion of bridge programs falls somewhere between professional delusion and wishful thinking on the part of a minority of PAs. We have more important things to worry about.
Instead of spending time and resources on the unrealistic prospect of bridge programs, the PA profession, from the workforce policy point of view, is better advised to invest in strategies designed to attract more PAs to primary care. Physicians continue to avoid primary care, and PAs are increasingly emulating that unfortunate pattern. A consequence of this trend is the loss of faith among the medical community and policymakers in the promise that PAs would help meet the needs of the health system and population.
Our health system needs more primary care providers, including PAs. Figuring how we can provide incentives for more PA graduates to enter primary care, not the pursuit of improbable bridge to physician programs, should be of prime focus in PA workforce policy discussions.
James F. Cawley is professor and director of the PA/MPH program at the School of Medicine and Health Sciences at The George Washington University in Washington.