Perceptions of PA Doctorate Degrees

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Well I’ve read the opinions of quite a few of our peer’s and colleagues. In fact, I personally know and have great respect and admiration for many of the posters on this topic. But I’ve always have had strong views on the academic side of this topic. I started addressing this quite a few years ago and was considered a heretic. I advocated for the Bachelor’s to be the entry level degree. Then residencies would provide the basis for a credible Master’s. I’ve always felt that residencies should be mandatory, not optional. It is an old school concept of an apprenticeship. And I know from personal experience that it prepares you for the real world.

At that time, folks were looking for a piece of rope and a tall tree, for my view was in the minority. The vision was that the NCCPA credential was all. Instead of all that fancy non-functional theory, applied knowledge and proficiency were the only aspect worthy of consideration. The belief was that increasing academic levels would force out the under- funded and disenfranchised minorities. I am afraid that I have found his to be true (This statement is made from antidotal observation, not hard objective data).

But cultural, social, and legal circumstances over time have appeared to make these points moot. In truth, the rigor and depth of entry level primary training does appear to be worthy of a graduate level degree. Due to the degree creep; shortly anyone without a doctorate will be at a competitive disadvantage. It seems like even housekeeping now has to have an associate’s in environmental science.

I am retired military, and have watched the evolution of the US Army’s clinical doctorate debate with great interest. The clinical side appears to be in line with the emergency residency that I completed in the early 1990’s at Los Angeles County General Hospital. The remainder of the curriculum seems to be research oriented. And after serious introspection on the topic, I find that I really can’t find an adequate rationale to speak against this concept and program. Perhaps if we could provide other tracks, I would argue for the program in a much more aggressive manor. Instead of a research focus perhaps tracks in administration, management, policy, finance, etc.

So I guess I’ll finish this part with two thoughts. A doctorial in clinical studies for Physician Assistants is finally reaching the point where it is a viable reality. Academia should make the program available if desired-but under no circumstances be mandatory. And I am without doubt completely opposed to an entry level program. Go and learn your art. I know that I’ll be beaten severely for this remark-but pay your dues. Learn to be efficient and proficient; learn to understand the people (patients) prior to advancing to what must be considered a leadership level.

I truly believe there two issues much more important to address at this time before this becomes the focus for our profession. That is our professional title and the concept of “dependent practitioner”.

At the inception of our profession, the term “Physician’s Assistant” was probably appropriate. Not much in the way of a threat to the medical establishment with this wording. But again over the years things change. As we’re all aware, it is frustrating to recurrently explain we’re actual practitioners and not medical assistants. But the title does leave people with the perception that we are their equivalents. Perception becomes reality in most people’s minds.

We need to decide as a group what new title we wish to use. It could be Medial Practitioner, Clinical Practitioner, etc. Use whatever accurately describes our function and position within the health care arena. Some worry that it will alter our enabling legislation in states. Others feel concern that it will alter our relationship with organized medicine. This in truth is a bogus assumption. Any legislator can easily change this with a single line amendment. Sorry, but this argument is utilized by individuals that are running scared. They are concerned about resistance from the medical establishment to block it. It just isn’t going to happen. Now that the Federal government is going to force the increased utilization of all alternative providers, organized medicine has no hope of stopping something as simplistic as this. After all, I’m not arguing for the right to perform open heart surgery without supervision. The profession is no longer a new kid on the block that need’s to be a supplicant to others. Sometimes you have to be willing to defend yourself over what’s right.  

Please recognize this simple fact. The completion of a doctorate will bring us within the realm of the training programs (content and time wise) utilized in Western Europe to train physicians. I am in no way arguing for, nor desire parity with American/Canadian trained physicians. I am a strong proponent of oversight and review by the seniors from the appropriate house. But we do assess, diagnose and manage/treat. Society owes us the respect that accompanies our level of education, training, experience and responsibility.  We have earned this by demonstrating our abilities and competence over the last several decades.

The other topic of great concern is the label “dependent provider”. This was (and still is) appropriate when speaking of other’s functioning in technical roles, such as paramedics. Nor do I advocate independent practice. I do argue for, and support the concept of PA’s performing in the setting of an “autonomous practice”. And in truth, isn’t this how a majority of our profession practices today? With the exception of New York, we can not acquire a license without another provider’s (i.e. Physician, Dentist, Podiatrist) permission/signature. Even Chiropractors are classified by the government as “independent providers” after the completion of a three year professional program.

Haven’t we proven that we’ve “outgrown” that particular restrictive requirement? Society, please recognize the very simple fact that the profession has grown up. We would all appreciate it if we were treated as such.