Since there is already a PA to DO bridge program, I believe that FMGs who are ECFMG certified and who passed the Step 3 should be able to challenge the PANCE. I know that this was done before (FMGs challenging the PANCE) and majority of these FMGs who passed the PANCE didn't do well as PAs. But I don't think these FMGs who didn't do well were ECFMG (or whatever they called it back then) certified and passed another test like Step 3.
FMGs who are ECFMG certified who passed Step 3 should be able to challenge PANCE
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Actually no FMG has ever taken the PANCE without going to PA school. A number of states have licensed FMGs as PAs and Florida developed their own PA license test (which no FMGs were able to pass).
Since the PA - DO bridge involves - shock - going to medical school. It seems appropriate that a FMG - PA bridge would involve - shock - going to PA school. FMGs make up a substantial portion of PA classes and pass (or fail) the PANCE at a rate comparable to non-FMGs.
History teaches us that taking shortcuts generally works out poorly for the patients. Our experience with FMGs as PAs in California, Florida, Oklahoma and Washington bears this out. If you want an easy button to practice medicine in the US try somewhere else.
David Carpenter, PA-C
With all due respect, having a bachelor's degree and going to a medical school for 4 yrs. plus another yr of internship, not to mention passing the local board exam and working as a GP for a number of years and
passing the USMLE Steps 1, 2 CS and CK and the USMLE Step 3 is not taking a shortcut. IMHO, these FMGs should be allowed to challenge the PANCE or NCLEX and work as NPs or PAs. US med school graduates who do not want to do or finish residency should also be allowed to do this.
passing the USMLE Steps 1, 2 CS and CK and the USMLE Step 3 is not taking a shortcut. IMHO, these FMGs should be allowed to challenge the PANCE or NCLEX and work as NPs or PAs. US med school graduates who do not want to do or finish residency should also be allowed to do this.
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You're original statement was that FMGs with step 3 should be allowed to take the PANCE. Your new statement is that physicians with an internship who are eligible for licensure in many states should be allowed to take the PANCE? Those people are called Physicians. US BOMs issue unrestricted medical licenses. They would never let someone who is eligible for a medical license get a different medical license to work in a supervised environment. The US graduate question is a different still.
Bottom line your original statement was that a foreign trained physician who is unable to get a residency and who has never trained in the US medical environment should be allowed to take a test and practice medicine in the US even under supervision. Hopefully this rephrasing your statement helps you understand why the State BOMs are against this.
David Carpenter, PA-C
Kindly read my original statement. I said, "I believe FMGs who are ECFMG certified and who passed Step 3 should be able to challenge the PANCE." In order for a FMG to be ECFMG certified, he/she should have passed Steps 1 and 2 CK and CS (Step 3 is needed inorder for a resident to get a license to practice).
With the shortage of primary health care providers here in the US (esp. in rural areas) and the looming addition of 32 million more Americans to the system, why not tap these FMGs who are ECFMG certified, who already passed the Step 3 and who are here legally, to help in addressing this problem. FMGs who could not get into residency for various reasons (number of years from graduation and lower than average Step 1 score) will have a chance to practice their profession under the direct supervision of a MD and earn a decent living, instead of doing odd jobs that are not related to their profession.
I believe that this is a win-win situation for the FMGs and the American public.
With the shortage of primary health care providers here in the US (esp. in rural areas) and the looming addition of 32 million more Americans to the system, why not tap these FMGs who are ECFMG certified, who already passed the Step 3 and who are here legally, to help in addressing this problem. FMGs who could not get into residency for various reasons (number of years from graduation and lower than average Step 1 score) will have a chance to practice their profession under the direct supervision of a MD and earn a decent living, instead of doing odd jobs that are not related to their profession.
I believe that this is a win-win situation for the FMGs and the American public.
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Considering this was tried in both California and Florida, and was a miserable failure in both places, IMHO it would only end up a lose lose situation.
Just as there is no CLEP exam for med school, there should be no CLEP exam for PA school. It is just asking to let substandard performers practice medicine and putting the public at risk.
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To everyone who gave their 2 cents, thank you. I would love to hear what the attendings, residents and medical students have to say about this. I put this idea out just for every SDN members to debate upon. To bradt, obviously you are misinformed and please stop the name calling. Peace
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You posted it in the clinicians forum that few physicians read. You are badly misinformed about how medicine is practiced in the US.To everyone who gave their 2 cents, thank you. I would love to hear what the attendings, residents and medical students have to say about this. I put this idea out just for every SDN members to debate upon. To bradt, obviously you are misinformed and please stop the name calling. Peace
I read your initial statement and replied to it. You then threw out this stalking horse:
A licensed intern is a completely different thing from an FMG who is not able to secure a residency.
Putting untrained FMGs into the American health care system is hardly a win-win situation for the American public.
American medical training is designed to protect the public by removing practitioners who are not able to practice at the standard of care for their profession. In the Allopathic and Osteopathic systems this can happen during medical school, during residency or during the step process. This results in approximately 7% of those who are accepted to medical school not becoming physicians.
PA school has two points to remove students. During PA school and the PANCE test. Approximately 5% fail during PA school a very small percent eventually fail the PANCE. Removing PA school as a requirement removes an opportunity to remove potentially dangerous providers. Proof of this concept has been shown in both attempts to use FMGs as PAs. In Florida FMG "PAs" have a disciplinary rate more than 7x that of the PA population in general. This despite having one of the most restrictive practice environments in the country.
Bottom line the state BOMs and the PA profession determine who gets to be a PA. The route for FMGs to become PAs is already established. Apply for, get accepted and pass PA school. Then take the PANCE.
David Carpenter, PA-C
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The problem here seems to be the fact of poor pay. Fix the pay problem instead of creating one by making a different one by allowing MDs to become PAs automatically.
not sure what you pay moonlighting would be, but in NC forty bucks an hour for urgent care work as a PA is common. If that's not more than you can make moonlighting, I then you should stick to your MD license
.I was not trying to be a stalking horse. I brought out this idea knowing that it will be met with skepticism and derision. But with the current shortage of primary healthcare providers here in the US, this should be an idea worth debating upon. Plus I was also trying to get the consensus of my fellow SDN members regarding this idea.
I agree that a medical intern is different from a FMG who passed USMLE Steps 1 and 2 CK and CS and Step 3. But I think you misconstrued me. I said "US medical school graduates who do not want to do or finish residency should also be able to do this" (this includes those who do not want to apply or finish internship).
I would also like to point out that the purpose of USMLE Step 3 is "to asses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in an ambulatory setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. A principal organizing dimension for Step 3 design is normal conditions and disease categories. Second and third organizing dimensions are the clinical encounter frame and physician tasks. Step 3 content reflects a data-based model of generalist medical practice in the US." (www.usmle.org) So I'm standing by my original statement that FMGs who passed USMLE Steps 1 and 2 CK and CS and who passed Step 3 should be able to challenge the PANCE and after passing it, practice medicine under the direct supervision of a licensed MD/DO.
Regarding the FMGs during the '80s who were accepted as PAs by virtue of being FMGs and who performed below standard as you like to point out (I'm sure not all of them and it is unfair to lump a heterogenous grp of people), these FMGs-PAs did not pass the USMLE Steps 1 and 2 CK and CS and Step 3
I agree that a medical intern is different from a FMG who passed USMLE Steps 1 and 2 CK and CS and Step 3. But I think you misconstrued me. I said "US medical school graduates who do not want to do or finish residency should also be able to do this" (this includes those who do not want to apply or finish internship).
I would also like to point out that the purpose of USMLE Step 3 is "to asses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in an ambulatory setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. A principal organizing dimension for Step 3 design is normal conditions and disease categories. Second and third organizing dimensions are the clinical encounter frame and physician tasks. Step 3 content reflects a data-based model of generalist medical practice in the US." (www.usmle.org) So I'm standing by my original statement that FMGs who passed USMLE Steps 1 and 2 CK and CS and who passed Step 3 should be able to challenge the PANCE and after passing it, practice medicine under the direct supervision of a licensed MD/DO.
Regarding the FMGs during the '80s who were accepted as PAs by virtue of being FMGs and who performed below standard as you like to point out (I'm sure not all of them and it is unfair to lump a heterogenous grp of people), these FMGs-PAs did not pass the USMLE Steps 1 and 2 CK and CS and Step 3
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If "Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care." why don't you just go practice medicine after passing the step 3?
There is a reason that every state requires at least an internship in order to p get an unrestricted license to practice medicine. There is a reason that most insurance companies will not credential you without completing a residency. And there is a reason that states will not license you as a PA without graduation from PA school and passing the PANCE. These reasons are based on the realization that shortcuts toward practicing medicine do not serve the public interest.
In regard to passing the step 3, a number of the FMGs in Florida had applied for and been turned down for residencies indicating that they had at least passed step 2. They are not a homogeneous group, however, they do tend to engage the medical board (complaint wise) in a homogeneous manner. Bottom line there is more to being able to practice medicine than being able to pass a test.
Finally if physicians are not willing to go to rural areas what makes you think that FMGs will go there? And where will you find the physicians to supervise them in these rural areas? The PA profession is a separate and distinct profession for that of a physician. While there is significant overlap, the training for each profession is distinct. Furthermore there is (anecdotally) significant variability in medical school experience which makes it difficult to evaluate in terms of PA experience. Once again if you want to be a PA go to PA school (3% of PA students are FMGs).
David Carpenter, PA-C
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This is just to shoot down the rural argument. I hate this argument. Its the same one always used by people to expand their scope of practice, but you know where most of them practice, the cities and suburbs. If this is allowed, most people will just do want NPs and PAs do now, practice in cities. Also in your scenario as has been pointed out, the person has a license. They dont need to be a PA. Moonlighting typically pays more or the same as a fully licensed PA. I live with 2 residents. I dont moonlight, but both of them do, and they make more than $40/hr. The limiting factor is the hours we put in for residency make it hard to moonlight much. But back to my point. Give people licenses to "bridge the rural gap" or "primary care shortage" and many will take the license and ignore it. Just ask all the "specialist" nps, pas, and primary care np and pas that dont practice in the rural setting.
I don't think it is the medical knowledge one has or the clinical judgment one can render that is the bottom line here. One of the most important lessons taught in the PA curriculum is the students' legal and ethical understanding of dependent practice - something no physician is taught. You cannot moonlight as a PA and retain the independent practice of a physician in that setting. In working with FMG's who have gone through PA training (which more often than one might think, can kick their butt) that is still a difficult adjustment for them.
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