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Perceptions About Bridge Programs for PAs

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With millions of newly insured Americans expected to enter the healthcare system by 2019, and with the growing shortage of primary care physicians, the United States faces a medical crisis. One potential solution is the development of bridge programs enabling PAs to become family physicians. Such programs would create physicians more rapidly than traditional medical programs.

If a PA wants to become a physician today, none of his or her education or experience transfers. In 2009, the Physician Assistant Education Association decided against supporting the exploration of advanced standing in medical schools for PAs, citing concerns about PAs leaving the profession, its desire to focus on PAs and their patients, and concerns about whether medical schools would look favorably on bridge programs.

To address the latter concern, we surveyed a sample of PAs and physicians to determine the perceptions of PA-physician bridge programs and the ideal length of such programs.

Study Methods

Study participants were a random sample of 100 practicing certified PAs in varying specialties and 100 practicing family physicians, all in North Carolina. A total of 39 PAs and 22 physicians responded.

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The PA survey comprised 12 closed-ended questions and one open-ended question for written comments, while the similar physician survey comprised 10 closed-ended questions and one open-ended question. Closed-ended questions on both surveys had five possible answers - strongly disagree, disagree, neutral, agree and strongly agree. (To see the surveys and survey data, view this article at www.advanceweb.com/NPPA.)

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We compared and analyzed PAs' and physicians' responses to two survey questions, one asking whether it is time for a PA-physician bridge program, and another asking about the appropriate length of such a program. Our study hinged on these two questions; we used the other questions to identify themes, perceptions and misperceptions.

Results of the Survey

PAs' overall view of bridge programs was positive, with the median of PAs agreeing that it is time to develop them. PAs said the ideal length is 3 years, including didactic work and residency. Physicians generally were neutral about the idea; their ideal program length is 5 years.

All PA respondents were happy being PAs, with a majority reporting being very happy, and most felt respected by physician colleagues. In PAs' open-ended responses, bridge supporters cited career advancement and more professional autonomy. Reasons for lack of interest included older age (55 and above) and an aversion to more student loan debt.

In their open-ended responses, some physicians suggested that a PA's ability to attend a bridge program would depend on that PA's skills and experience. Some physicians said a bridge program was an interesting idea; others were against it.

"It is my understanding that PAs have a 2-year degree after college to fulfill PA requirements," one physician wrote. "I think they need to go back for a full 4-year medical degree. There are too many basic sciences that need to be covered to build a good foundation." Another wrote, "Training in basic sciences in allied health programs is not as rigorous as with medical school, and clinical rotations are also very different. I would not support credit for PA training but would encourage PAs to go to medical school."

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An Opportunity to Educate

Our study was limited in that only 22% of physicians in an already small sample responded, and they left more questions unanswered than did PAs. Still, we can surmise that the physician responses stem from their belief that PA education lacks rigor and depth compared with physician education, and from their generally poor understanding of PA education.

Our study reveals that physicians' lack of knowledge about PA education influenced a lack of support for PA-physician bridge programs. It shows the need for PAs to educate physicians about the rigorous curriculum of PA education.

Steven R. Saldutti is a PA at Brevard Family Practice in Brevard, N.C. Jeff Alexander is an associate professor at the A.T. Still University Doctor of Health Science Program in Mesa, Ariz. Guy Nehrenz is executive associate dean and professor at the Nova Southeastern University College of Allied Health and Nursing in Fort Lauderdale, Fla. Carmelo Hernandez is a physician at Sylvan Valley OB/GYN in Brevard, N.C.

New Medical School Models

At least three programs have been developed that truncate medical school to 3 years, excluding residency. Texas Tech University's Family Medicine Accelerated Track condenses the standard 4-year curriculum to 3 and culminates in an MD degree. Lake Erie College of Osteopathic Medicine in Erie, Pa., offers two programs: the Primary Care Scholars Pathway, in which participants graduate in 3 years with a DO degree equivalent to that of a 4-year academic program, and the Accelerated Physician Assistant Pathway, a fast-track 3-year medical school curriculum enabling certified PAs to obtain a DO degree.


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