Movement on Physician Assistant Doctorate Issue

Despite what you all have offered-make no mistake NP's are looking to replace PA's and put them(us) out of buisness.  Powerful lobbies and large union numbers are working everyday to protect nursing practice and diminsh PA reimbursement, therefore our ability to practice.  Now I don't know if PhD is the way to go, I do know that regardless what happens we need to start addressing these issues legislatively (the NP/PA debate) and make sure we are not inaccurately portrayed amoungst the lawmakers.  It is my firm belief that PA's ar better trained, on average, have a better understanding of medicine than NP's do.  Not to say there are not excellent NP's out there, because there are.  However, legislatively they are our rivals and have more money and numbers to bury us if we are not careful.  They are attempting to do so everyday(and this is not a joke).  Become active and pave the way to securing the PA profession and advancing it.  PhD or not, tell your PA colleagues that they must become active in their state association and AAPA.  If we don't speak for ourselves, a NP will be happy to speak for us.    

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 accidently came across this blog, and have to say it is shocking, but not surprising. I know PAs who would find it amusing.

We chose the PA profession, who says our level of training to date isn't the same as medical school?  The commentary "I want to finish my medical school," "excellent rigorous, doctoral training," "PA profession still has room to grow and improve" is confused.  he/she didn't go to medical school in the first place.

"B A " You are barking up the wrong tree.  We went to medical school.  

Your reports are unoriginal, and not aligned with the wishes of Dr. Stead.  

PAs are here to step in the primary care workforce.  

Getting a doctoral degree would not improve my practice as a PA.

Apologies for offending you Carla. Not at all my intention. I have practiced 10+ years as a PA, love medicine, and believe the PA profession still has room to grow and improve. I only report what I've learned and observed over time, comments from PA and MD colleagues, and what seems in step with the evolution of the US medical system. I'm glad you're satisfied with your  position, which is why offering a doctoral option - for those who desire this level of training, may be the best direction for the profession to go.

"B A" our nation does not revolve around you in spite of where you "perceive" the PA profession "needs" to "evolve."  I doubt your-Royal-Highness has ever worked with PAs, and would accept this "excellent rigorous, doctoral training" on par with whatever training you've had in spite of your advocating "excellent rigorous, doctoral training."  

Before you roll out your "outside looking in argument", and try to slam down PA education only to complain about PA education subsequently, subsequent to all the "doctoral distinction" in the world isn't on par with MD training, or "less of a liability you are," these are fleeting, fleeting perceptions.

PAs are gradually gaining acceptance.  Our founding fathers didn't create our great nation rapidly.  None of the our nation's presidents were ever impulsive, and made ill-planned decisions.. hmmm.  But word of wisdom --  All which is done rapidly, and affects the lives of many people needs to be preexamined, and questioned.

"B A" do you know WHY a number of PA schools are receiving federal grants to educate competent, cost-effective providers?  

Do you "perceive" PAs everywhere should perceive ourselves a "less accepted" minority population?  You come on here to bully.  Respect all human beings, not only providers advocating "low stress, boutique medicine" pointing a finger at our "primary care shortage" where there shouldn't be.  We need less Your-Royal-Highness adolescents looking down upon those unlike-your-Royal-Highness, and work towards improving patient outcomes.  

PAs are a minority; but I neither think we have "absolutely no voice or presence in health care delivery or planning processes" nor are we a "liability."  We see our own patients, carry our own malpractice insurance, and our PA population providing care to underserved regions are Medicare providers, not of that is professionally obscured.  You need not be so "fed up" on temporary perceptions.

We need not put up with Your-Royal-Highness who cannot see the light, but is merely consumed with degradation-should our AAPA advocate an appropriate change, the change should be -- associate.

In my field, I am respected, compensated appropriately and appreciated by my colleagues and patients. I must express my thanks to the PAEA/AAPA/AMA who came before me and paved this road and I am thankful for the PAs and those are still in school to find every opportunity to educate the public on what we do.  How do we do that? Lobbying for Excellence in Clinical Arenas by offering to serve as consultants for the "newbies" who have only begun working in the PA profession.  Helping others in primary care, more representative in the private sector of each state/locale than an extra title after my name.  

Hang those Masters Degrees and National Certifications (I have two certifications in EMT and Medical Technology) on your walls folks!  The public needs to be knowledgable, to differentiate and delineate.  I am frequently asked I received my training.  Back to work... Happy New Year's!  

I commend the AAPA for critically reviewing current PA training and degree options. Based on 10+ years of experience, I strongly support the creation of a doctoral-level option for PA (physician associate) training.

US medicine and health care have changed significantly over the past 20 years. Although initially welcomed as a solution to the shortage of primary care physicians, non-doctorate level clinicians - no matter how skilled or valued by their patients/practice, have not gained acceptance in the US health care system. PAs and NPs, though at times clearly more skilled than some of their MD colleagues, suffer from being categorized and presented to the public as "midlevel providers," paid low salaries for challenging positions MDs wouldn't touch (wisely), and have absolutely no voice or presence in health care delivery or planning processes.

There are many entrenched practices that effectively cast doubt and create confusion about non-doctoral clinicians. Many hospitals and health care facilities offer "doctor searches" that only list MDs, imposing professional obscurity upon their PA and NP staff, although they may provide identical medical services and work in the same practices as staff MDs.

The concept of the licensed "dependent" clinical provider was fine in the early days, but clearly needs to be eliminated: State licensing and "practice agreement" regulations run the gamut; but typically are viewed by MDs and facility directors as a pain in the neck, deserving of substantial extra pay for the supervising MD, and at the end of the day, who wants to be 100% liable for someone else's practice? All busy clinicians, MDs and PAs alike, dread the laborious, time consuming and antiquated practice of retrospective chart reviews, which many administrators believe to be the cornerstone of "supervisory" mechanisms.

At the present time, the only difference between a master's trained PA or NP, and an MD is the length of formal training, the degree, and licensing regulations. Most of the current problems and obsticals that prevent full use and recognition of PAs and NPs, could be solved by advancing profession training to doctoral level.

PAs and NPs deserve equal access to graduate-level didactic and clinical training resources, including the option to train for and receive a doctoral degree. There isn't any good reason why medical students and residents should have a monopoly on the nation's clinical training resources and sites, when we're confronted with a shortage of primary care providers, and, PAs and NPs represent trained clinicians prepared for doctoral-level medical training. Money is always an issue, but squeaky wheels and well articulated needs typically get oil!!

I also believe offering a doctoral option is the only way to stem the hemorrhage of the PA and NP professions' most ambitious and talented clinicians, who often "see the writing on the wall" and leave clinical practice early or mid-career, because of the lack of professional recognition and limited avenues for professional advancement, in comparison to MD colleagues.

We'll see what the future holds! I encourage all PAs who wish to see the profession evolve in a positive and meaningful manner, to voice support for the development of rigorous, excellent doctoral training options.

Ultimately, who will be responsible for the welfare of the patient? Dr. MD, Dr. PA, or Dr. DNP?  Who will supervise whom? While some PA's and NP's are working on the transition to doctorate, how do they suppose the practice laws will change?

I've been a PA since the early 70's and seen many changes in the profession, most were good, some not so good, but one this is certain, as long as you're a PA, you'll always be, in the eyes of the patients, an "assistant" to the physician, unless you are the physician.

On the contrary, our patients do not see their practitioners on an "elevated plane", or as some seem to equate it with "respect". Our patients want to know we are accessible to their needs, can gather enough patient history to provide quality care, take our time to cure their illness, retain our clinical capacity to provide treatment options, and can provide post-op.  Sitting behind this desk in my white coat, we already place ourselves in a position of "authority" the word is "authority" but means we should always practice cautiously, and not be overconfident of our clinical capacity.  

Please don't do this Physician Assitants. Don't follow some the ridiculous NP's and their glorified masters degree. It looks incredibly foolish and they are creating a lot of physician enemies. PA's should keep the masters degree and show that they are incredibly capable and competent providers without a fluffed up doctorate. For God's sake in the U.K. the doctors have a M.B.B.S. a bachelors degree of medicine. This is nothing but some universities trying to make a quick buck.

Is this just one more line blurring 'doctor'?   Locally, we had someone promoting themselves as 'Doctor Soandso'...he had a PhD and the patients were confused.  We already have to remind our patients that we are PA's, in spite of their protests that they may be receiving better care from their mid-level provider.  I also agree about the cost...where's the practicality in this?  Isn't it ironic that the list of the sponsor group members already seems confused about how to list their credentials?  No one else found that funny?

I work with competent PAs, and think the PA-specific doctorate is not the right course of action.  I'm a specialty physician not currently certified although licensed PA graduate.  I was a second career applicant to PA school among PA school applicants.   Referring to today's densely populated health care provider system, an insured patient deals with endless practitioner options re: who their practitioner is.  Each primary care or specialty, are hundreds, thousands practitioners for every insured.  This densely populated health care provider system would not benefit the nation in the longrun, and with the population of practicing PAs, some practices haven't been recipients of cost-effective PA care.  The PA-specific doctorate is not constructive to overall cost-effectiveness in the medical community, and would not make programs more affordable to second career PA applicants in the underserved urban and rural, further decreasing underserved regions patients' access to care.  PAs are competency based, a number of applicants whom are second career applicants -- former paramedic, Corpsmen, and medical practitioners as well.  What this "new AAPA" administration could constructively advocate is promote cost-effective primary care -- or specialty practice, encourage underserved practitioners to enroll in PA school, federal grants, and might former underserved practitioners benefit the medical community, as well as underserved rural and urban regions.

The PA-specific doctorate issue needs to be addressed, buried, etc.  Anybody who thinks that this alleviates primary care crisis is deceiving themselves. Which PA is going to go thousands of dollars into more debt only to become a primary care practitioner and make less annual salary than they could make as a PA?  

I guestimate that at least 99% of the PAs who advocate this PA-specific doctorate program would go into the specialties. They damn sure wont be going into primary care.  PAs are huge primary care advocates at the current rate.  They advocate primary care at higher percentages than other practitioners, all that and more without a doctorate.

As far as the PA profession PRESSURED into primary care, this shouldn't happen either. Programs can ENCOURAGE students to do so, promoting more primary care PA directors, professors, but there's should be no mechanism to force their profession into primary care.