The Doctorate Debate
Last month, after spending 12 hours in a compact car driving north to Toronto, Ontario, I attended the AAPA annual conference with 11 of my classmates. (I hope you enjoy the photos depicting this experience!) The conference was filled with highlights such as meeting the delightful editors of
ADVANCE for NPs & PAs, Michelle and Jennifer, and trying out their amazing new iPad app (I want it to go to Android!).
(Note from Michelle: It will!) Toronto was a great city for walking, coffee and shopping. It was an exciting week.
Conferences can be a whirlwind of information and experiences dumped into your brain, and it takes me a couple of weeks to mentally digest what I want to take away - what "clinical pearls" I want to stay aware of. Besides all the free bling I picked up at the expo and the great connections I made with other PA students and practicing PAs, I found some pearls of wisdom.
Perhaps the most interesting session I attended was a discussion about the PA profession and a doctorate degree, led by my Clin Med professor. The blogosphere has exploded with discussions about this topic but it was my introduction to the discussion. The gist being: Should PAs get a doctorate degree and if so why and when? It was enlightening because it was an open microphone session and I heard a half dozen perspectives from PAs, some with doctorates and some without. I entered this discussion thinking, "I'm never gonna go back to school after I finish PA school. That's why I became a PA; I do not want to be a doctor." I came away from this dialogue with a fresh perspective. I am not even close to being sold on ever going back to school for science, but I am more aware of important developments in the PA profession.
The facts first:
- In 2010, U.S. academic institutions awarded 48,069 doctorates.
- Audiology, physical therapy, nursing and occupational therapy all have doctorate options.
- In 2004, the American Association of Colleges of Nursing recommended that by 2015, the requirement for nurse practitioner practice would change from master's to doctorate-level.
- Postgraduate education for PAs has been around since the 1970s.
- In 2008, there were 43 residencies or fellowships for PAs.
- The U.S. Army started a Clinical Doctorate in Emergency Medicine program in 1991.
- Average cumulative debt for a doctoral degree is $57,860.
- Bonus fact: Googling is an effective way to learn about doctoral degrees.
The first perspective came from a faculty who trains military PAs, one of the only "PA doctorate" programs in the country. This is for highly specialized PAs practicing in emergency medicine. I wasn't aware that there was such a thing in my profession; this doctorate most closely mirrors the idea the nurse practitioner field has adopted with their DNP requirement. He presented this degree in a favorable light, emphasizing that its purpose was for better clinical practice, and that it fit into the military model of healthcare.
The second perspective came from a PA faculty member. She insinuated that excellent and experienced practitioners enter academia and often feel slightly inferior with a mere "M.S." after their name. They realize that with no doctorate there's no tenure; most of your peers have more research experience because of the PhD or DHSc (doctorate of health sciences) after their name. Some get their doctorate, which is hopefully paid for by their school of employment. For those in academia, it's a different ball game and it would seem to be almost essential to stay competitive and have a level of knowledge above your students.
Thirdly, the point about PhD versus doctorate in science came up. Both a PhD and doctorates in science are offered, for instance, in the health science field, but PhDs can involve more intensive research and can be longer program of study.
So, what's in a name? Does this title truly change your ability to perform clinically, academically or administratively? Is it just a title? (COMMENTS WELCOMED!) Is the PA profession merely trying to keep up with their nursing counterparts and emulating DPTs? One passionate faculty voiced her opinion that PAs were merely trying to keep up with DNPs and that if we don't evolve and encourage the option of doctorate, we will be left out of leadership in healthcare.
Obviously, it is too early to see the impact that the nursing field will have with their new requirement. However, more education never hurt anyone's knowledge or practice in their field. I believe the more exposure clinicians have to research methods, advances in clinical structure, and management theories, the more advanced our healthcare system will become.
The bottom line, take-home point is that school is never free. You'll sacrifice not only huge chunks of your paycheck but also time with those you love. And counting the cost becomes even more important the older we get. You can never completely predict the impact your degree could have on your job prospects, so knowing exactly why you want that further degree is essential. Plenty of people have great reasons to get a doctorate and plenty of people have great reasons to not get a doctorate. Respecting yourself and others for their reasons cannot be overstated.
I'm still not sure most PAs would ever need a doctorate to function as midlevel providers - I hope we never do - but I believe the free market should remain free, and if there is a market for programs that enhance the PA role in the healthcare field, then let it grow as large as the demand allows.
For me personally when I enter the exam room that I am content hearing, "Nice to meet you, Caroline" instead of, "Nice to meet you Doctor-of-health-sciences Pilgrim."*
My hope is patients will get the best treatment possible and I know for a fact it's an exciting time to be a nurse practitioner or a physician assistant!
*I do realize in clinical practice the title will not be used but I can't help but assume that in my mind I would be thinking, "I am a doctor..."