Once upon a time, LECOM’s PA to DO bridge was novel and exciting. I’ve considered it many times. Their Accelerated Physician Assistant Pathway (APAP) was designed to bridge the gap between PA and physician. But it’s far from the perfect PA bridge program and doesn’t do much to incentive experienced PAs to matriculate.
Lake Erie College of Osteopathic Medicine (LECOM) in Pennsylvania is arguably one of the largest medical schools in the country with an enrollment of over 2,000 students. They also claim to receive the most applications of any medical school in the country.
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The First Physician Assistant to DO Bridge
In 2011, LECOM announced the world’s first physician assistant to DO (Doctor of Osteopathy) bridge program. It would be a 3-year vs 4-year curriculum and was intended to commit more graduates to primary care residencies (DO/AOA residencies at the time).
In the last 10 years, the LECOM APAP program has evolved slightly, now allowing half of the 12 matriculants to choose their fate as the rest are still required to commit to training in family practice and to stay there for five years after completing residency. The APAP program originally required the MCAT but now accepts what they call they Academic Index Score (AIS) in place of the MCAT.
The AIS is actually a great idea–at least in the sense that it opens the field to candidates that have had their mettle tested in other ways. It uses undergraduate and graduate GPA together with ACT and/or SAT Critical Reading and Math scores. GPA makes sense, and though I’m not thrilled with the inclusion of the ACT/SAT, it’s a step in the right direction as the MCAT just doesn’t predict medical school success as it claims to do.
Where the LECOM APAP Program Fails
The fatal flaw of LECOM’s PA to DO bridge, however, is that it is still a 3-year program! So the 10 years I’ve been practicing medicine as a PA would largely be ignored and deemed no more valuable than 1 year of med school clinicals? I’ve seen 20,000 patients over that time and diagnosed everything from cancer to rare neurological and autoimmune conditions. There’s no way taking a single year off medical school is a fair trade.
The most insulting aspect however of a 3-year physician assistant to DO bridge is that it’s not even exclusive to PAs. Early Acceptance Programs, or EAPs, knock a year off of the time it takes to become an MD or DO by accepting undergraduate students before they complete their Bachelor’s degree. LECOM offers this 7-year program (compared to the traditional 8 years) to colleges and universities around the country as do many other medical schools.
LECOM has also engineered another 3-year medical school program they call the Primary Care Scholars Pathway that offers the abbreviated med school experience for anyone that commits to a primary care residency and practices in those areas for at least 5 years. Sound familiar? Not a real game-changer, in my opinion.
APAP Students Setting Up Their Own Rotations
A cursory review of several online message boards reveals numerous problems with LECOM as a medical school and their APAP pathway is no exception. Some students found that they had to set up their own clinical rotations and one felt like they were purposefully placed after all other LECOM students. Normally, paying hundreds of thousands of dollars in tuition would preclude a student from needing to scout potential rotation sites, call office managers, and fill out paperwork only to be asked, “Normally, the school does this. Why are you calling us?“
Private School Tuition
And it’s not cheap, either! 3 years in LECOM’s PA to DO bridge will set you back upwards of $200,000 while the average cost of traditional medical school education is around $250,000. Hopefully, these DO-hopefuls would already have made some progress on their PA school loans (which average $100,00-$120,000). But that’s not the only expense of attending a program like this. Working PAs would also need to calculate opportunity costs.
Attending a full-time program as a degreed professional means lost income, which for the average PA is somewhere in the neighborhood of $110,000 a year. So while you’re borrowing $200,000, you simultaneously lose $330,000 in income (plus servicing the remaining PA school debt). Resident physicians completing their training are paid approximately $60,000, so you’d lose another net $50,000 a year completing a traditional 3-year residency. Here’s the math so far:
The above calculation doesn’t account for hidden costs such as rent, insurance, vehicle expenses, food, clothing, prior student loans, etc. My family of 4 spends about $35,000-$40,000 a year in essential expenses which would add another $200,000 onto this 6-year path to becoming a DO. This brings the real opportunity cost for the LECOM program to around $1 million dollars.
And then there’s the issue of matching into a residency. Truthfully, this was more of an issue before 2020 when DO and MD residency accrediting bodies decided to merge. Traditionally, DO residencies were exclusive to DOs but were the minority. MD residencies, considered to be more respected and robust, dominated and accepted both MDs and DOs (if they took the MD licensing exams). This year, all residencies in the US should technically be open to all MD and DO graduates. That’s great for some MDs that wouldn’t have matched, but the only real advantage to DOs, like those graduating from LECOM, is that they’ll eventually be able to drop the USMLE and apply to positions with the COMLEX alone.
LECOM on Probation
In April 2019, the Accreditation Council for Graduate Medical Education (ACGME) placed LECOM on probation for its involvement with Millcreek Community Hospital. One wonders if it has anything to do with the press release a few months later reporting that Millcreek agreed to pay $2.4 million to resolve claims that the hospital was billing Medicare and Medicaid for medically unnecessary services.
Or it could be because LECOM supposedly lost its internal medicine residency at Millcreek due to inadequate training. There are also older reports of Millcreek having to close its general surgery residency for producing poorly trained surgeons.
MD vs DO
What makes a DO different than an MD anyway? Most proponents claim that DOs “look at the whole person” as if MDs, PAs, and NPs did not. The biggest difference is that osteopathic medicine was founded on pseudoscience. Its originator, A.T. Still was a 19th-century physician who believed he could “shake a child and stop scarlet fever” and “cure whooping cough in three days by a wring of its neck”.
Today, DOs like to refer to baby shaking and neck wringing as OMT (osteopathic manipulative treatment) or OMM (osteopathic manipulative medicine)–a skill that most DOs quickly abandon once in real practice as it has no scientific underpinnings.
There Has to be a Better Way
So given the meager acceptance of PA training and experience, the high cost, questionable post-graduate training opportunities, and sub-optimal acceptance of DOs in general, LECOM’s APAP program is kind of a bust. Shouldn’t there be another way to train doctors? You could always go to medical school online or maybe just become a nurse practitioner!
Physician Assistant to Doctor of Medical Science Bridge
Or you could evolve–not into another unknown Master’s level practitioner, perpetually explaining your professional title and fighting for a seat at the table, but into a Doctor, a Doctor of Medical Science. DOs are living proof that those who pursue an unconventional path can ultimately win widespread acceptance. DOs have spent a hundred years fighting the AMA advocating for themselves. They have also undergone a name adjustment. Today most people don’t know the difference between an MD and a DO… a doctor is a doctor. DMS doctors can do the same.