Considering the Physician Assistant Entry-Level Doctorate

I am all for doctorate programs for our profession. I am not for making it an entery level requirement. The PA Profession will always have critics questioning our competency. Even with a doctorate degree, the requirements and limitations will be the same.

The debate will be lost.  PAs were created to be a low cost , highly skilled supervised medical care giver. Yes  our occupation has been changing first mandatory BS, now MS, and future demands for entery level doctorates. I am glad after 30 + years I am near retirement, and  woun't be in the active argument. If as  the above discussions sugest, PAs are  at a disadvantage for lack of a competitive degree, there is some validity is its prusute.The two year pa  is dead, long live the doc PA, and the associated costs an indebtedness.  

I do think that "physician assistant" is misleading to what we do. I have thought that even reversing it to be "assistant physician" would be better and that the public would be able to tell that we are fully capable of diagnosing and treating. I too work in a facility where NPs are half the midlevel staff and they do have more autonomy, but not by much, although they think that since they worked as nurses before that this makes them better. I have to remind myself that PA school is based under the medical model and not the nursing model, of the two midlevel positions the PA reflects the training of the physician the most. This is why my supervising physician hires only PAs he is sick of nurses trying to be doctors and wants a person on his team that has similar training. I have spoken with him on the topic of a doctorate PA and he thinks there should be a fast track to become a MD or DO due to the similarities in training and undergraduate work that PAs do before the Masters programs. I personally agree if that is what a person wants to do.

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Competencybased education, and lifelong aren't mutually exclusive.  We have a minimum of 100 CME hours every two years to maintain certification and must recertify/retake our boards every 6 years.  Our education as PAs is comprised of, on average, 100 semester credits and 2000+ clinical hours.  

    I concur with Kim, PA-C comments and statements of Feb20th, 2009. And I urge my entire fellow PAs to read her comments before making any statement.

   In my opinion, since the name of our profession (Physician Assistant) itself is by far too confusing to the public let alone most of my patients, before adding Doctorate to it; to further complicate our role in the health profession, we need to re-evaluate the name PA itself and assign a clear and precise name that reflects our role and responsibility in the health care community. (ie. Health officer, or some name that does not mislead our role and cause confusion to the public as a result patient luck of confidence towards the quality of health care we provide.)

I said Health Officer, because where I came from my patients and the public in general were very well informed about what Certified Health Officers’ (CHO) role and responsibilities were in the Allied health community. CHOs have BS or MS in Health Officer from Medical School or Health officers department in universities with teaching hospitals, and did exactly what we as a PA doing here but with autonomy more like a NP. CHOs were trained in the medical setting and did clinical rotation with 3rd&4th year medical students and residents in various specialties as all Physician Assistants here. The only difference between the PA that I am today and the Health Officer I was 19 years ago is, that I went through the same exact training all over again as a PA here but have no autonomy to practice medicine the way NPs do with less medical exposure and with the back ground of totally different set of training. Not to mention the amount of time that I am spending with patients explaining the difference between PAs and Medical Assistants and assuring them that I am not a medical assistant who is there to only take their vital signs and write their c/c for the doctor, but that I am a certified PA who is there to diagnose their problem and provide them with the proper treatment.

Therefore,  while I am 100% for the doctorate level degree for our ____?proffesion, the Doctor in Physician Assistant is even more confusing for me as a PA

I disagree with the comment above.  The public is confused enough without further mudding the waters. The doctoral programs I have reviewed carry little impacted over my practice.  I fail to see how this further alphabet soup of titles will change my practice.  We as NPs continue to struggle to educate the public, government, and insurance companies on the vast individual and global health benefits NPs offer. It will not serve us well to confuse the public, government, and insurance companies. I ask for restraint to not run full speed ahead and blindly follow academia.%0d%0a%0d%0a

Bring the on the Doctorate -

Had the eye opening experience of working with a less then stellar NP who identified herself as Doctor because she has a Phd in EDUCATION - how crazy is that?  

We already call non MD's Doctor - ie eye doc's, counselors, NP's - heck we do enough and know enough we should be able to earn a clinical doctorate.  BUT - I will always call myself PA as I think in the USA if you walk into an exam room in a white coat and introduce yourself as Doctor the patient reasonably expects that you went to MEDICAL COLLEGE no PA or NP school.....

Sign me up for a Doctorate level bridge program.....

I have read all the articles posted on the PAEA Clinical Doctoral Degrees – Bibliography website, as well as the comments posted thus far. What I find so ironic is how old this debate surrounding the appropriate degree for the Physician Assistant truly is. 10 years ago, the debate was whether or not to standardize the degree at the graduate level for our profession, but then the degree being debated was a master’s.  The arguments and justifications for this move have not changed, only the level of degree has. In 2000, The PAEA (then known as APAP) recognized “that PA education in accredited programs is conducted at the graduate level and recommend[ed] that PA programs grant students a credential reflective of this level of curriculum.” (APAP Degree Task Force, 2000)

So why are so many in our profession so afraid of a graduate degree? Competency-based education, life-long learning, and a practice doctorate are NOT mutually exclusive.  Our education as PAs is comprised of, on average, 100 semester credits and 2000+ clinical hours.  We have a minimum of 100 CME hours every two years to maintain certification and must recertify/retake our boards every 6 years. The RN (BSN) who seeks to become an NP (DNP) averages 80 semester credits and 500 - 800 clinical hours. He/she has a minimum of 25 CME hours every two years, depending on specialty certification, and there are no recertification requirements.

Given the climate I work in, I understand all too well that Nurse Practitioners are our closest competition in the job market. Nationally, NPs outnumber us 2 to 1; in my work place that number is 3 to 1. They claim they are better educated and more qualified because of their degree, and there is the public and legal perception that they are. In the court case of Beck-Wilson v. Principi (No. 04-4010), the US Court of Appeals recognized NPs as being “higher educated and hav[ing] received more training than PAs” because of their professional degree.  It doesn’t matter that this legal opinion does not accurately reflect our profession’s competencies; it has set legal precedent and is an accurate reflection of degree standing.

To quote the PAEA, “Nurse practitioner programs have already standardized at the graduate level, and although quality of education and competency of graduates is not assured by standardization of the academic credential, the fact remains that NPs are the closest competitors for PA jobs. In a tight job market, when other factors are equal, it is reasonable to conclude that the graduate with an advanced degree will have a competitive edge, and graduates with lesser degrees may be disadvantaged.

While it is not the goal of the PA profession to engage in a degree race with other health care providers for the sake of ‘one-upmanship,’ there is a public perception that the academic credential should be commensurate with the level of responsibility for patient care. This perception can affect decisions by the public seeking medical care and by policy makers who shape the health care system and its associated economics. A single graduate professional degree would add clarity to the definition of the profession and make it easier for non-clinicians to understand the level of PA responsibility. In addition, there remains a longstanding hierarchy related to educational attainment in most professions, especially those involved in health care.” (APAP Degree Task Force, 2000)

As a PA practicing in one of the largest health systems in the country, I experience this perception first hand on a daily basis.  NPs are paid more for doing the same work because of their degree, and as they move toward a DNP, we PAs are feeling the job market squeeze.  If I, and my fellow PAs, are to remain competitive within healthcare, a clinical doctorate must be available to us and to future graduates.  

Healthcare, in all of its modern complexities, is now at the doctorate level for PTs, OTs, Audiologists, social workers, psychologists, pharmacists, NPs, AND PAs.  Those who fear the doctorate degree, need not pursue it, but please allow those of us who desire a degree reflective of our ongoing clinical and academic pursuits to achieve one.  In closing, I concur with the CONCLUSION reached in VALUE ADDED: GRADUATE-LEVEL EDUCATION IN PHYSICIAN ASSISTANT PROGRAMS, with this one caveat:  the PA “master’s degree movement” is now a “doctoral degree movement.” Thank you.

I disagree with the comment above.  The public is confused enough without further mudding the waters. The doctoral programs I have reviewed carry little impacted over my practice.  I fail to see how this further alphabet soup of titles will change my practice.  We as NPs continue to struggle to educate the public, government, and insurance companies on the vast individual and global health benefits NPs offer. It will not serve us well to confuse the public, government, and insurance companies. I ask for restraint to not run full speed ahead and blindly follow academia.%0d%0a%0d%0a

I feel that we need to move quickly toward getting the doctorate degree programs in place. These doctorate degrees should be optional for experienced PA's that have the will to pursue them. We have fallen behind the times with our old fashioned methods of thinking. All other mid level providers have moved on, so why have'nt we??? If we continue with this way of thinking I foresee us changing our names to DNP Assistants (Doctorate of Nurse Practitioner Assistants). That sounds like a well respected profession to me.

"We leave ourselves looking less skilled when people can say that 2 years and no degree can give you a PA. This is rarely the case, but it is exactly the scenario that critics of our profession use against us."

"We leave ourselves looking less skilled?"  Your critic's a bunch of false assumptions.  Who says we are less skilled and are they informed about the PA profession?  Are you a practicing PA or a layperson putting the profession on a proverbial pedestral?  

"Times are different now, and expectations are different as well."

Budget cuts are affecting medical institutions.  And expectations haven't changed, patients continue to expect quality care.  

How is this cost-effective??!

It is not a very strong argument to say that if we wanted to be a doctor, we would have gone to med-school. The many of us that are interested in a doctorate in PA would like to do so under the PA profession, not MD/DO. We leave ourselves looking less skilled when people can say that 2 years and no degree can give you a PA. This is rarely the case, but it is exactly the scenario that critics of our profession use against us. I do not think the doctorate should be the entry-level, but I believe it should be a way to further our education without starting back at square one, along with those that have not yet learned medicine.

Yes we should consider the fact that we are in a new century & class of Physician Assistants. However, if we as physician assistant wanted to enroll in a doctoral program, I believe we would have gone straight to med school from the very beginning... How about we just improve on the PA field and make what we have more stronger....

PA's are and always will be competency-based trained practitioners. I do not agree with the move toward doctoral degree. Many think this will equate to more respect and responsibility, which it probably will not and will not improve pay. Think people...we are acting like the current geriatric population, which could care less about the PA's that follow...the cost of doctoral training will definitiely break the bank. For the good of the profession, please reconsider this...

As many have said before, we cannot be set in "old fashioned" ways of thinking that will cause our profession to fall behind. Times are different now, and expectations are different as well. To move ahead toward the doctorate, whether entry-level or as an option, is absolutely necessary. It is absurb that we cannot further our education to doctorate-level, considering our actual responsibilities and the nature of our career.