Boston University Chobanian & Avedisian School of Medicine is one of just two medical schools nationally where physician assistant (PA) students and medical (MD) students attend classes together for an extended period. In the past, BU PAs would take foundational science courses like biochemistry, physiology, and gross anatomy separately from medical students, while joining them for the pathophysiology course.

This year, PA and MD entering classes started simultaneously in August, with 18 months of combined classes taught under a new curriculum launched last year for medical students, a team-based learning technique that integrates foundational sciences and pathology and closely mirrors the cooperative approach they will encounter in their careers.

“Teamwork is foundational to the curriculum, and our physician assistants have a lot of work experience, many of them in healthcare. Some, but not all, of our medical students have that,” says Priya Garg, MD, associate dean for medical education. Garg notes that as more doctors gravitate to specialties, PAs and nurse practitioners are helping to fill the ever-widening shortage of primary care physicians.

Created in the 1960s in response to a physician shortage that continues today, the PA position was initially filled by many post– Vietnam War medical corpsmen. There are now 304 PA education programs in the United States; curriculums also include over 2,000 hours of clinical rotations. There is no residency requirement.

BU’s PA program began in 2013 in part due to the need for more PAs at Boston Medical Center, says Susan White, MD, assistant professor of obstetrics & gynecology and PA program director.

“There’s more need for the PA profession because it’s a cost-effective way of providing care. Physicians alone can’t keep up with the demand for medical care,” says Aliza Stern, MMS/MMSc, director of didactic education for the PA program.

A 2020 Association of American Medical Colleges report predicted a shortage of between 54,100 and 139,000 primary care physicians by 2033. The Affordable Care Act enacted in 2010 created greater access to health insurance and healthcare, helping to spur demand for the position. There has been a 34% growth in licensed PAs since 2006, and according to the United States Department of Labor, a 38% increase in PA jobs is predicted as necessary over the next decade to meet the need.

The prerequisites for medical school and admission into a PA program are very similar, says White. Initially, there was some concern that PA students would not keep up academically, but their track record on other combined courses has demonstrated their competency. “We’ve had the PAs in the second-year DRX (Disease and Therapy) course for a long time, and their performance has been pretty equivalent to the MD students,” says Garg.

PAs fall under the supervision and direction of licensed physicians, which has helped create a team philosophy and approach at the clinical level. Medical and PA school administrators hope the new team-based learning approach will further remove barriers and encourage familiarity for PAs and MDs alike.

“Most MDs have very little understanding of what other people in healthcare do until they’re pretty far along in their residency, which is a detriment to being successful in treating patients,” says Garg. “The fact that they’re sitting next to someone who is training in the PA program will help them to understand what a PA is and hopefully undo some of the bias that exists. In clinical practice, it’s much more about teamwork and everyone contributes their expertise.”

PA students go directly from graduation into clinical settings. BU’s program has a lot of appeal to prospective students, says Stern, because of the challenge and academic rigor associated with being taught at a university medical school.

While other PA programs may have instructors teaching classes outside their specialties, BU can call upon specialists in all fields, including a robust research community, medical school faculty, and physicians at Boston Medical Center.

“It is important for PA students to have a really good foundation of medical knowledge,” says White, adding that instead of having two separate programs teaching the same courses, “the right thing to do was to join them.”