Fast Tracking PAs and NPs Into Medical School

I have received many positive responses to my comments regarding a pathway for PAs and NPs to become physicians in our March cover article, “Degrees of Latitude: Real Issues Behind Clinical Doctorates.” In essence, I advocated for medical schools to recognize the training and clinical experience of NPs and PAs and provide an advanced and accelerated pathway for these clinicians. As we all know, the need for affordable and accessible health care is growing rapidly in tandem with our increasing population and the aging of America. To meet this challenge, more health care practitioners are needed, especially in the primary care setting.

One solution is to increase the number of PAs and NPs, particularly since we already know that their education is less costly and time-consuming than traditional physician education. Unfortunately, this alone will no longer meet the demand for primary care providers. 

Then there is the proposal I brought up in March—to allow NPs and PAs to become physicians through the process called “fast tracking.” Is this an idea whose time has come? Although further studies are needed, it is my opinion that there is definitely interest in the opportunities that could be offered by such a program.

A big difference between the education of NPs and PAs and that of physicians is not so much the curricula’s core content but the amount of time spent in school. While curricula vary somewhat between educational institutions, PA and NP programs run between 80 and 110 weeks, compared to the typical 155 weeks of a medical school program. At the end of the didactic component, most NP and PA programs will have covered 70% of what a medical school program would have covered.

NPs and PAs, of course, complement their didactic education with clinical rotations in various medical specialties. Although they do not have to serve an internship or residency, the clinical education for PAs and NPs amounts to 1,500 to 2,000 hours of direct patient contact. In addition, many NPs and PAs have up to several years of clinical experience before they even begin their educational programs.

Thus, in designing a fast-track program, perhaps some portion of the didactic and/or clinical years of medical school could be shaved off for PAs and NPs, since they have already invested so many hours in both of those areas. Such an approach would leverage the education and skills NPs and PAs currently have and allow them to build on that foundation to complete the education and training necessary to become a physician. It may also have the advantage of maintaining the current workforce of PAs and NPs while those who are interested in becoming physicians attain additional education in a time-efficient and cost-effective manner.

Another difference in training between PAs and NPs and physicians is the autonomy they have as providers. Although NPs and PAs are trained to give optimal health care, they are taught to do so within either a dependent framework (PAs) or an advanced practice paradigm (NPs), while physicians enjoy more autonomy. However, experienced NPs and PAs do function at various levels of autonomy, depending on their practice setting. Such autonomy, coupled with appropriate clinical training, may minimize the disconnect and facilitate the retraining of PAs and NPs in the role of physicians.

Fast tracking, it should be noted, is not a new idea. In a 2001 article in Clinician News, George Lundberg, MD, former editor of JAMA and Editor-in-Chief Emeritus of Medscape, explained that fast tracking NPs and PAs into medical school could be evaluated case by case, according to their education level and assuming there was a standardized way to measure knowledge and competence.

And Eugene A. Stead Jr, MD, considered the father of the PA profession, in a 2001 article in the North Carolina Medical Journal, outlined a program in which PAs and NPs could progress to the level of physician through an accelerated academic program. His proposal prescribed distance-learning curricula for community-bound PAs and NPs, thereby building on the talents of these nontraditional but seasoned clinical veterans.

Dr. Stead reminded us that 35 years ago, a medical school in Florida observed the market for PhD science graduates plummeting while the market for MDs remained strong. The school jumped at the opportunity to accept these PhD students into their medical program and accepted them as third-year medical students, deciding that the first two years of their PhD program fulfilled the scientific requirements for medical practice. As physician-in-chief, Dr. Stead appointed a few of these fast-tracked medical residents at Duke Hospital and found they performed as well as, and in some instances better than, the students who had spent four full years in medical school.

He also advocated an online program that would consist of 20 health care professionals–turned–medical students. The students would be required to spend one to two weeks on the medical school campus before starting their online coursework. During that time, they would undergo a series of written and oral tests, clinical trials, and other evaluation methods to determine the additional courses they would need to pass the qualifying examinations for medical practice. Each student would then begin an individualized online course of study. At the end of the program, the students would take both the basic sciences and qualifying examinations in the same week, and their scores would be compared with those of traditional four-year medical students. If the nontraditional students performed at the same or higher levels as the traditional students, the program would have been deemed a success and primed for implementation.

Dr. Stead listed some requirements for those entering the program. Applicants would need to be NPs or PAs with a master’s degree from an accredited educational program, already working in areas of medical need. They should have completed at least three years of practice, and they must have a physician mentor once they are accepted into the distance-learning program.

To sum up, there can be no doubt that the need exists for fast-track programs. And we have various models to draw on to fine-tune these programs.

A key question remains, however: Is there enough interest among PAs and NPs to pursue further education to become physicians? Would they consider leaving their profession for medical school, especially when recent job satisfaction surveys show PAs, at least, are very happy with their positions? (Only 65% of NPs, on the other hand, actually stay in practice as NPs.) In their textbook Physician Assistants in American Medicine, Hooker and Cawley suggest that only 4% of PAs move on to medical school, although others believe that number could be as high as 8%. It is not known what percentage of NPs make this move.

Equally important, is there enough interest among medical school administrators in offering fast-track programs? While opinions may vary as to the efficacy of an accelerated medical school program, it seems the only way to really know for certain is through a pilot program. Would medical schools be interested in conducting such studies?

Other unanswered questions relate to public policy. Would society ultimately benefit from these programs? Would they indeed improve primary care delivery? Or would PAs- and NPs-turned-physicians follow the same maldistribution patterns currently seen among traditional physicians today, toward specialization and urban practices and away from primary care in rural settings? Could NPs and PAs who enter fast-track programs be compelled to practice in rural and/or primary care settings?

Obviously, there is much to discuss here. And to further the dialogue and the debate, I would love to hear from you on this intriguing issue. Send your comments to [email protected].

I have received many positive responses to my comments regarding a pathway for PAs and NPs to become physicians in our March cover article, “Degrees of Latitude: Real Issues Behind Clinical Doctorates.” In essence, I advocated for medical schools to recognize the training and clinical experience of NPs and PAs and provide an advanced and accelerated pathway for these clinicians. As we all know, the need for affordable and accessible health care is growing rapidly in tandem with our increasing population and the aging of America. To meet this challenge, more health care practitioners are needed, especially in the primary care setting.

One solution is to increase the number of PAs and NPs, particularly since we already know that their education is less costly and time-consuming than traditional physician education. Unfortunately, this alone will no longer meet the demand for primary care providers. 

Then there is the proposal I brought up in March—to allow NPs and PAs to become physicians through the process called “fast tracking.” Is this an idea whose time has come? Although further studies are needed, it is my opinion that there is definitely interest in the opportunities that could be offered by such a program.

A big difference between the education of NPs and PAs and that of physicians is not so much the curricula’s core content but the amount of time spent in school. While curricula vary somewhat between educational institutions, PA and NP programs run between 80 and 110 weeks, compared to the typical 155 weeks of a medical school program. At the end of the didactic component, most NP and PA programs will have covered 70% of what a medical school program would have covered.

NPs and PAs, of course, complement their didactic education with clinical rotations in various medical specialties. Although they do not have to serve an internship or residency, the clinical education for PAs and NPs amounts to 1,500 to 2,000 hours of direct patient contact. In addition, many NPs and PAs have up to several years of clinical experience before they even begin their educational programs.

Thus, in designing a fast-track program, perhaps some portion of the didactic and/or clinical years of medical school could be shaved off for PAs and NPs, since they have already invested so many hours in both of those areas. Such an approach would leverage the education and skills NPs and PAs currently have and allow them to build on that foundation to complete the education and training necessary to become a physician. It may also have the advantage of maintaining the current workforce of PAs and NPs while those who are interested in becoming physicians attain additional education in a time-efficient and cost-effective manner.

Another difference in training between PAs and NPs and physicians is the autonomy they have as providers. Although NPs and PAs are trained to give optimal health care, they are taught to do so within either a dependent framework (PAs) or an advanced practice paradigm (NPs), while physicians enjoy more autonomy. However, experienced NPs and PAs do function at various levels of autonomy, depending on their practice setting. Such autonomy, coupled with appropriate clinical training, may minimize the disconnect and facilitate the retraining of PAs and NPs in the role of physicians.

Fast tracking, it should be noted, is not a new idea. In a 2001 article in Clinician News, George Lundberg, MD, former editor of JAMA and Editor-in-Chief Emeritus of Medscape, explained that fast tracking NPs and PAs into medical school could be evaluated case by case, according to their education level and assuming there was a standardized way to measure knowledge and competence.

And Eugene A. Stead Jr, MD, considered the father of the PA profession, in a 2001 article in the North Carolina Medical Journal, outlined a program in which PAs and NPs could progress to the level of physician through an accelerated academic program. His proposal prescribed distance-learning curricula for community-bound PAs and NPs, thereby building on the talents of these nontraditional but seasoned clinical veterans.

Dr. Stead reminded us that 35 years ago, a medical school in Florida observed the market for PhD science graduates plummeting while the market for MDs remained strong. The school jumped at the opportunity to accept these PhD students into their medical program and accepted them as third-year medical students, deciding that the first two years of their PhD program fulfilled the scientific requirements for medical practice. As physician-in-chief, Dr. Stead appointed a few of these fast-tracked medical residents at Duke Hospital and found they performed as well as, and in some instances better than, the students who had spent four full years in medical school.

He also advocated an online program that would consist of 20 health care professionals–turned–medical students. The students would be required to spend one to two weeks on the medical school campus before starting their online coursework. During that time, they would undergo a series of written and oral tests, clinical trials, and other evaluation methods to determine the additional courses they would need to pass the qualifying examinations for medical practice. Each student would then begin an individualized online course of study. At the end of the program, the students would take both the basic sciences and qualifying examinations in the same week, and their scores would be compared with those of traditional four-year medical students. If the nontraditional students performed at the same or higher levels as the traditional students, the program would have been deemed a success and primed for implementation.

Dr. Stead listed some requirements for those entering the program. Applicants would need to be NPs or PAs with a master’s degree from an accredited educational program, already working in areas of medical need. They should have completed at least three years of practice, and they must have a physician mentor once they are accepted into the distance-learning program.

To sum up, there can be no doubt that the need exists for fast-track programs. And we have various models to draw on to fine-tune these programs.

A key question remains, however: Is there enough interest among PAs and NPs to pursue further education to become physicians? Would they consider leaving their profession for medical school, especially when recent job satisfaction surveys show PAs, at least, are very happy with their positions? (Only 65% of NPs, on the other hand, actually stay in practice as NPs.) In their textbook Physician Assistants in American Medicine, Hooker and Cawley suggest that only 4% of PAs move on to medical school, although others believe that number could be as high as 8%. It is not known what percentage of NPs make this move.

Equally important, is there enough interest among medical school administrators in offering fast-track programs? While opinions may vary as to the efficacy of an accelerated medical school program, it seems the only way to really know for certain is through a pilot program. Would medical schools be interested in conducting such studies?

Other unanswered questions relate to public policy. Would society ultimately benefit from these programs? Would they indeed improve primary care delivery? Or would PAs- and NPs-turned-physicians follow the same maldistribution patterns currently seen among traditional physicians today, toward specialization and urban practices and away from primary care in rural settings? Could NPs and PAs who enter fast-track programs be compelled to practice in rural and/or primary care settings?

Obviously, there is much to discuss here. And to further the dialogue and the debate, I would love to hear from you on this intriguing issue. Send your comments to [email protected].

I have received many positive responses to my comments regarding a pathway for PAs and NPs to become physicians in our March cover article, “Degrees of Latitude: Real Issues Behind Clinical Doctorates.” In essence, I advocated for medical schools to recognize the training and clinical experience of NPs and PAs and provide an advanced and accelerated pathway for these clinicians. As we all know, the need for affordable and accessible health care is growing rapidly in tandem with our increasing population and the aging of America. To meet this challenge, more health care practitioners are needed, especially in the primary care setting.

One solution is to increase the number of PAs and NPs, particularly since we already know that their education is less costly and time-consuming than traditional physician education. Unfortunately, this alone will no longer meet the demand for primary care providers. 

Then there is the proposal I brought up in March—to allow NPs and PAs to become physicians through the process called “fast tracking.” Is this an idea whose time has come? Although further studies are needed, it is my opinion that there is definitely interest in the opportunities that could be offered by such a program.

A big difference between the education of NPs and PAs and that of physicians is not so much the curricula’s core content but the amount of time spent in school. While curricula vary somewhat between educational institutions, PA and NP programs run between 80 and 110 weeks, compared to the typical 155 weeks of a medical school program. At the end of the didactic component, most NP and PA programs will have covered 70% of what a medical school program would have covered.

NPs and PAs, of course, complement their didactic education with clinical rotations in various medical specialties. Although they do not have to serve an internship or residency, the clinical education for PAs and NPs amounts to 1,500 to 2,000 hours of direct patient contact. In addition, many NPs and PAs have up to several years of clinical experience before they even begin their educational programs.

Thus, in designing a fast-track program, perhaps some portion of the didactic and/or clinical years of medical school could be shaved off for PAs and NPs, since they have already invested so many hours in both of those areas. Such an approach would leverage the education and skills NPs and PAs currently have and allow them to build on that foundation to complete the education and training necessary to become a physician. It may also have the advantage of maintaining the current workforce of PAs and NPs while those who are interested in becoming physicians attain additional education in a time-efficient and cost-effective manner.

Another difference in training between PAs and NPs and physicians is the autonomy they have as providers. Although NPs and PAs are trained to give optimal health care, they are taught to do so within either a dependent framework (PAs) or an advanced practice paradigm (NPs), while physicians enjoy more autonomy. However, experienced NPs and PAs do function at various levels of autonomy, depending on their practice setting. Such autonomy, coupled with appropriate clinical training, may minimize the disconnect and facilitate the retraining of PAs and NPs in the role of physicians.

Fast tracking, it should be noted, is not a new idea. In a 2001 article in Clinician News, George Lundberg, MD, former editor of JAMA and Editor-in-Chief Emeritus of Medscape, explained that fast tracking NPs and PAs into medical school could be evaluated case by case, according to their education level and assuming there was a standardized way to measure knowledge and competence.

And Eugene A. Stead Jr, MD, considered the father of the PA profession, in a 2001 article in the North Carolina Medical Journal, outlined a program in which PAs and NPs could progress to the level of physician through an accelerated academic program. His proposal prescribed distance-learning curricula for community-bound PAs and NPs, thereby building on the talents of these nontraditional but seasoned clinical veterans.

Dr. Stead reminded us that 35 years ago, a medical school in Florida observed the market for PhD science graduates plummeting while the market for MDs remained strong. The school jumped at the opportunity to accept these PhD students into their medical program and accepted them as third-year medical students, deciding that the first two years of their PhD program fulfilled the scientific requirements for medical practice. As physician-in-chief, Dr. Stead appointed a few of these fast-tracked medical residents at Duke Hospital and found they performed as well as, and in some instances better than, the students who had spent four full years in medical school.

He also advocated an online program that would consist of 20 health care professionals–turned–medical students. The students would be required to spend one to two weeks on the medical school campus before starting their online coursework. During that time, they would undergo a series of written and oral tests, clinical trials, and other evaluation methods to determine the additional courses they would need to pass the qualifying examinations for medical practice. Each student would then begin an individualized online course of study. At the end of the program, the students would take both the basic sciences and qualifying examinations in the same week, and their scores would be compared with those of traditional four-year medical students. If the nontraditional students performed at the same or higher levels as the traditional students, the program would have been deemed a success and primed for implementation.

Dr. Stead listed some requirements for those entering the program. Applicants would need to be NPs or PAs with a master’s degree from an accredited educational program, already working in areas of medical need. They should have completed at least three years of practice, and they must have a physician mentor once they are accepted into the distance-learning program.

To sum up, there can be no doubt that the need exists for fast-track programs. And we have various models to draw on to fine-tune these programs.

A key question remains, however: Is there enough interest among PAs and NPs to pursue further education to become physicians? Would they consider leaving their profession for medical school, especially when recent job satisfaction surveys show PAs, at least, are very happy with their positions? (Only 65% of NPs, on the other hand, actually stay in practice as NPs.) In their textbook Physician Assistants in American Medicine, Hooker and Cawley suggest that only 4% of PAs move on to medical school, although others believe that number could be as high as 8%. It is not known what percentage of NPs make this move.

Equally important, is there enough interest among medical school administrators in offering fast-track programs? While opinions may vary as to the efficacy of an accelerated medical school program, it seems the only way to really know for certain is through a pilot program. Would medical schools be interested in conducting such studies?

Other unanswered questions relate to public policy. Would society ultimately benefit from these programs? Would they indeed improve primary care delivery? Or would PAs- and NPs-turned-physicians follow the same maldistribution patterns currently seen among traditional physicians today, toward specialization and urban practices and away from primary care in rural settings? Could NPs and PAs who enter fast-track programs be compelled to practice in rural and/or primary care settings?

Obviously, there is much to discuss here. And to further the dialogue and the debate, I would love to hear from you on this intriguing issue. Send your comments to [email protected].