The Elusive Physician Assistant to MD Bridge

I’m not ashamed to say that this is a phrase I’ve Googled many times: pa to MD bridge. Or: physician assistant to MD bridge. Why? Because as capable and competent as I’ve become after 8 years of practicing primary care medicine, I want to be able to do more for my patients. 

Do PAs Need a Bridge to MD?

Now, that’s not to say that PAs don’t already do a lot for their patients. PAs are the primary care provider for countless individuals and families across this country and others. Several published studies have found that patient outcomes are no different when treatment is rendered by a PA versus a physician

North Dakota’s HB 1175

Most states in the US have failed to catch up with reality, however. In a long-overdue move, North Dakota recently passed HB 1175 which states that, as of August 1, 2020, PAs will no longer be required to have a supervisory contract with a physician for licensure–a similar recognition was just made within the entire Indian Health Service

The most exciting provision in HB 1175 is the allowance PAs to own their own practice without a collaborating physician as long as they have more than 2 years or 4,000 hours of experience and obtain the approval of the North Dakota Board of Medicine. Those with less experience must still rightfully collaborate with a physician. North Dakota should be a model for the rest of the country. 

Physician Assistant to MD Bridge: PA vs MD

As exciting as this is, however, I don’t think any North Dakota PA would consider themselves a physician. Although interestingly enough, the Oxford definition of physician is “a person qualified to practice medicine” or “a person who cures moral or spiritual ills; a healer”. 

As a PA myself, I am acutely aware of my deficiencies and I’m eternally grateful for seasoned physicians that provide support and guidance when needed. I’m even more grateful when such wise clinicians do so in a spirit of collegiality. 

Without diminishing my PA education or experience, I freely admit that there are gaps between my training and that of an MD. It’s impressive how much can be condensed into a 2-3 year PA program, however, especially given the new trend to reduce medical school to 3 years. The biggest difference in the two educational experiences, in my opinion, is the residency requirement where newly minted docs spend several years in structured, supervised practice. There are significant parallels between the supervised practice of a resident and that of a PA, but they are not the same. 

So, why not accept PAs to physician residency programs? Because they can’t even accept all physicians! As long as the residency experience is funded by Medicare, and under the control of the federal government, it will remain a significant bottleneck. Besides the fact the residency slots are limited, PAs wanting to enter medical school on some sort of advanced level have no options but to start from scratch (LECOM, often considered the first PA to physician bridge, is not a great example as they only knock a year off for PAs or anyone else who wants to do primary care). 

The Doctor of Medical Science

So what option are we left with when the country needs more healthcare providers with the freedom and flexibility to fill the shortages we’ve been experiencing for decades? Without a solid physician assistant to MD bridge program and a path to residency, PAs see 2 options: 1) fight for more legal authority as done in North Dakota or 2) create our own bridge program. Enter the Doctor of Medical Science (DMS). 

The first of it’s kind, the Doctor of Medical Science program at Lincoln Memorial University offers a unique curriculum that was developed in conjunction with DeBusk College of Osteopathic Medicine. According to their website, “the purpose of the program is to provide a comprehensive advanced medical training program to PAs who wish to further their medical education.  It is the mission of the program to have a positive impact on health care in underserved regions by preparing highly qualified PAs with a new set of advanced medical skills and knowledge base.”

Their program consists of a Clinical Medicine path for practicing clinicians or a Medical Education path for PA and health educators. The Clinical Medicine track is further divided into 3 cognates: Primary Care Medicine; Internal Medicine; and Emergency Medicine.

LMU DMS students take 45 credits over 4 semesters progressing through modules dedicated to 9 subspecialties in medicine: neurology; psychiatry; pulmonology; nephrology; cardiology; endocrinology; hematology; gastroenterology; and infectious disease. Added to the 88 credits earned in my Master’s PA program, these 133 credits are more than the 128 credits earned in my 4-year bachelor’s of Health Science. DMS students also spend several weeks on campus in high-yield, face-to-face training such as point of care ultrasound. 

Necessity is the Mother of Invention

My purpose here is not to suggest that a Doctor of Medical Science is necessarily equivalent to the Doctor of Medicine (we compare DMSc vs MD here) but that it fills a necessary role that was already reasonably well handled by the PA. This is a move we should all support and understand for what it is–not a challenge to physicians but innovation born of necessity. 

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