FNPinKS

It's not impossible to develop a training program that is specific for primary care that reduces the content for people who have been trained and experienced enough to already be practicing the same thing, and not "water it down". I think making something less redundant is possible, but it's also possible to water it down so it must be developed carefully by a panel of members of each profession (NP, PA, and MD).

That's tough to say, because you could either just force everyone through the same program based on a review of the similarities and differences, or you could have a testing program that evaluates strengths and weaknesses. I really would need a panel of PAs and NPs as well as MDs to come together and figure this out collectively. I really don't trust any one of us to do something that big without input from several of each profession.

It does deliver an outstanding product. But regardless whether or not a town in rural America doesn't have a physician because they are somewhere else or they don't exist means the same thing to that rural place. What I am proposing will be a program that will produce MDs with licenses that are restricted to only practice primary care in Health Professional Shortage Areas. Basically instead of these towns being left with NPs and PAs only in the near future (which I don't think would be the end of the world), they have an option to still be cared for by physicians who are trained to be physicians in a different way than what we all know at this point. You are right, an easier fix would be just to push more money into primary care, but I never count on the government or insurance companies to do something like that.

I realize this will require a lot of change. Just because I'm not willing to go to traditional medical school doesn't mean I'm not willing to do the work. I guarantee I can get through a medical class in one location just as I can at another. We're talking about two different spots of dirt for God's sake. And, I must admit, I've never, ever, in any literature, in any discussion, in any dream, heard someone say there "isn't a physician shortage". Even the AAFP has countless articles on that very topic. You can turn it into distribution issues, but it really doesn't change anything. To be honest, I like your answer better for me personally. Removing barriers for PAs and NPs to just take it all over would be super easy for me. Then, I wouldn't have to learn anything additional at all. I think the real problem is unless you go through pledge week, you'll never be a member of the sacred fraternity.

I sure do. The federal funding is exactly what I am aiming for in the long run; and I think it is readily available for this kind of program. There are about 250,000 NPs/PAs, and the predicted primary care MD/DOs in 2020 is 40,000. I think we could completely fill this gap with such a program, and Kathleen Sebelius will eventually read this idea, even if I have to sit on her porch until she gets home from work.

I have recently been presented with a series of events that got me thinking about an evolutionary educational process that I believe will help this country tremendously. I have emailed the Dean of the University of Kansas School of Medicine; a place where I believe will be a perfect launch pad for such a program. I am a practicing NP in rural Kansas, where I do clinic, hospitalist function, ED, long term care, and just about anything that comes through the door. The hospital I work at is very rural, and the two docs are nearing the end of their career. Needless to say, there aren't a lot of physicians beating down the door, which threatens the very existence of the whole institution. We all are aware of the ever-worsening shortage of primary care docs, especially since many of us PA/NPs are filling that role. In comes my idea... We all have been reading about and some of us participating in doctorate programs, which I believe is an effort, at least in part, to become completely autonomous providers. However, I don't think we'll ever be on a level playing field with physicians, whether we think we should or not (I personally don't think our education is anywhere near where it needs to be if we were to even consider competing with allopathic or osteopathic physicians). So, instead of fighting all the time, I propose a solution: a new educational pathway for NPs and PAs can become physicians using the most advanced telecommunications and internet technology available so we can continue to provide care but we can earn a MD or DO. Now I've heard the cynics who will say "no shortcuts to medicine, blah blah blah" but I urge you to find anyone that has been through the minimal 6-7 years of education, and then the probable 3-4 years of additional training it would take to complete a new program such as this, to consider this a "shortcut". At this point in time, there is only one program I am aware of that one can do something like this. It is in American Samoa, and although I'm certain there are students and graduates doing just fine, I know several states will not license graduates of this program. The only other way to earn a MD or DO is to start as if you are a 22 year old college graduate - something that is just not practicle or feasible in the vast majority of our situations. When I enrolled in a DNP program at Saint Louis University, I was encouraged to finally hear about these new "clinical-based doctorate programs" for nurse practitioners. However, after sitting through the first two days on the campus and hearing what it was really all about (really no different than a PhD in my opinion), I was very disappointed but not terribly surprised and dropped out immediately. I did hear a common statement from many NPs in the program - the hunger for more education and the desire to earn a MD/DO. Several of us spoke about the reason why none of us are able to do it (families, income, etc etc). So, the people and their desire is there (probably on a much larger scale than I can imagine). The need for primary care doctors is there. Now we need to find some open-minded schools to create a program to make it happen. The program would have to allow for a great deal of self study. It would have to have practicing physicians who could mentor NP/PA students in the program, which wouldn't be a stretch in many cases as many of us are already working side-by-side. It should fill the gaps in our education which needs to be determined by a team of both NP/PAs and MD/DOs. It should not include rotations in specialty fields; only primary care. And, we should only be able to practice primary care medicine so graduates don't go into specialties thus defeating the purpose of the program. It should have an abbreviated residency training program since many of us have already been practicing every day for many years (ie every 3 years of practice equals 1 year of residency, etc). If graduates do poorly on the USMLE and board certification exams, it will be clear where the weaknesses are and adjustments could be made accordingly. The institution providing such a program could charge just about anything they wanted, as there are many programs that will pay back student loans for practicing in rural areas. It would also command attention from federal funding, especially in light of all the Obamacare changes. I believe there would be literally thousands of us jumping all over a program such as this. I certainly would be first in line....