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Inside the PA Profession

Bridge to Nowhere

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.

Inside the Profession Archives

I get so tired of the ego-abundant medical environment especially in urban areas. While working in a rural facility, I was treated as an equal partner and colleague, able to use the title "Doctor" (because I have a bonified doctorate)-although I ALWAYS clarified during my introduction that I am a Physician assistant, and I was a voting member of the medical staff. In a rural setting, the physicians have realized that it is to their benefit to allow PA's/NP's to be treated as a colleague and share some of the duties rather than treat them as second class scut monkeys. Rural health MD/DO's realize that it gives their clinic more prestige to be able to claim that their mid-level providers all have doctorates and that their staff has better buy-in and satisfaction when it comes to financial production and decision-making. By the way...I'm still waiting for that article from the AMA that says using the terminology "doctor" while being a lowly PA is confusing to patients. It doesn't exist. They have monopoly over the title "physician" but not "doctor." Someday it will be challenged in the supreme court system and will be exposed for what it is- unconstitutional- to limit the usage of one word for a particular subset of practitioners simply because of ego. If you're going to limit the word "doctor" limit it also for chiropractors, psychologists, etc.

My point here, is that PA's have finally found an avenue to be recognized for the knowledge they posess and will be able to share in responsibility (call time, paperwork that can only be signed by an MD or DO, situations that indicate physician-only care)that is required to run a hospital or clinic. It's not a competition...we just want to be part of the team and do our share of the work without having to burden others with co-signatures and frivilous garbage without being broke and tired for 10 more years for yet more schooling and residency when we've already done 15-20+ years of medical care. Most of what is required by an MD/DO by CMS standards is NOT because the PA or NP isn't capable, but is just a responsibility or mandate issue.

LECOM took a step forward as a pioneer in healthcare to assist with this bridge, much like UND did with bridging RN's to be physician assistants (which by the way has been a successful program with high pass rates since the 1960's). The UND program was also considered "going nowhere" and controversial, but has proven to be oober-successful and produces amazing practitioners. I think calling the LECOM program a "Bridge to knowhere" is insulting, elitist, egotistical, and obviously out of touch with healthcare needs, especially in rural areas.

Congratulations LECOM, and thank you. I hope others follow your lead.

Ashley ,  PhD, PA-CJuly 11, 2014
Undisclosed, IA

I completed PA school 13 years ago and I must one gets cured. Ask yourself honestly, how many people have come off their medications? That attitude among many physicians, and even PA's is that the patient won't do what we say so why bother educating them. Educate them on what? Nutrition? Exactly here was nutrition taught? It isn't. Allopathic medicine has no idea of how to counsel people on health. They can't because the model studies disease.

Allopathic medicine prescribes poisonous drugs for the management of chronic disease. Has anyone ever given the thought to risk to benefit ratio? There is one benefit which is the suppression of a symptom and countless side effects. How does suppression restore physiology? That's all there is - physiology. And when that physiology is aberrant, homeostasis is out of tune and disease sets in. What is disease but a perpetual state of imbalance of the physiology. Therefore, the only curative measures comes by restoring physiology. But they don't teach MD's, PA, NP's, and DO's any of this. Instead, it's carry around a prescription pad and write toxic chemicals to suppress symptoms. Is this really what you paid all that money for? Anyone can do that, but not anyone can understand the patient who has the disease and figure out the root cause. That is the purpose of a physician, along with the ability to motivate and inspire the patient to take accountability. An astute clinician can do these things and they bring about the restoration of health. Drugs will never do that. That said, does it really matter that there is a bridge program to go from PA to MD? The philosophy of medicine is entirely retroactive and about suppression. Who cares about the bridge. The end result is suppression and further deterioration. The allopathic model in the treatment of all non-emergent problems does harm by it's very nature.

Chris Fucci,  PAMay 06, 2014

I find Mr. Cawley'somment interesting! It sounds like he is advocating that we need to be good little PA's and support/ protect the reputation of over inflated egos of certain medical schools as if they are the final word in producing excellent providers! I personnaly would be interested in a bridge program, not that I am dissatisfied with being a PA, but just that maybe my knowledge, skills, and abilities would be recognized and respected for just that. As a PA I don't posture myself as a final solution to any shortage, and certainly not as competition to MD/DOs. As long as PAs are relegated to being required to having a "supervising" physician, (in contrast to a truly "collaborating" physician), we are going to be second class citizens and our contribution to health care minimized to even less. I have no illusions about my abilities or need to pursue continuing education. But keep in mind, medical schools contribute more to the health care shortage than any other factor,(generalization I know), by continuing to make it difficult for those that demonstrate solid potentional to enter their "holy of holies". If only 4% of PAs want to go on to medical school why stop them? If 4% is too large a problem for Medical Schools to handle....?

Carl L. Brown Jr.,PA-C

Carl Brown,  PA-C,  Dimond Medical ClinicNovember 11, 2010
Anchorage, AK

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