Physician Assistant Doctorate Degree Debate

I am of the opinion that higher education  and expierience  compose a Profession. The times dictate that  PAs should have Masters and even Doctorial Degrees to compete.

Any thoughts on a good Program for a Doctorial Degree in PA science.?

PAs should go further into the Doctorate world for we are Clinically trained and so will our Doctorate in PA.  As opposed to Doctorate in NP (Nurse Practitioner) which is a non-clinical degree.  DNPs are now allowed to take the Step 3 exam offered to MDs by the NBME exam board.  Why can’t the CACC (a Nursing lobby group) board create their own exam for the DNP?  Why do they always cling on to MDs, their ideals, their exams, their way to surpass them or to equalize with them? Envy?  If a ‘Nurse’ wants to be like an MD, then go to an MD school.  Stop using an MD as your goal or crutch to hop on.  And stop using Doctorate degree created by a Nursing school (hmmm..) and convince a NBME exam company that you need an equivalent exam as an MD, so that you’ll be respected in the medical community.  For the CACC board to approach the NMBE exam about a Step 3 exam, says a lot about the validity of a DNP (Doctorate degree) to stand by itself.  Come on CACC, create your own exam and be proud about it (unless you don’t have the knowledge or expertise).

I always chuckle when NPs ask me if I have a Masters degree, as if that makes me something special. My answer is, it's irrelevant what degree I have, I am trained in the medical model, I was trained by physicians to practice medicine. OK, yes, I have a Masters degree. And then they nod and say, good. Then I say, my Masters is in music appreciation. I can't play an insturment of any kind by I critique those who can.

So, how many PAs out there who have masters degrees have degrees that added to their clinical skills? My Masters is in public health. I didn't do any training in diagnosis or treatment. Nothing in wound care, suturing, casting, etc. I did write a few papers and I can argue about teenage pregnancy. That's interesting stuff.

The AAPA HOD had a very good debate about this subject a few years ago and it was pointed out that when the NPs decided to make the Masters degree the recognized entry level degree what happened is that Medicare and Medicaid then stopped reimbursement of all the Associate and Bachelor degree NPs. So, with one stroke of the pen the NP leadership declared that all those NPs were no longer competent and not worth being paid.

Today, a person can go from highschool to a BSN program, then a MSN, then a DSN. They will have very minimal clinical experience, yet they have the degree. Does this imply competence? An MD or DO will spend over 20,000 hours in residency training, is the DSN degree equal to that in terms of clinical competency?

So, back to me. Now that I have 13 years of experience, 5 years as a faculty member, and practice Family Medicine, if I don't have a clinical doctorate, what do I do? Go back to school?

If I want to be a doctor, I'll go to medical school!

The degree creep in the possibility of the PA Clinical Doctorate is a very real and concerning issue.  Particularly in states like Florida, where physician groups continue to hold down PAs and tighten restrictions for fear we will follow the lead of the doctorate, independent seeking ARNP if they loosen our chain a little bit.  And I disagree that this is about looking into the future or needing to "change" with the times.  We as a profession are competency based in our training.  Each of us who have earned advanced degrees, whether they be Masters or Doctorates, are well aware that the training involved for those degrees did not contribute one iota to our competency levels when caring for patients.  We are trained universally to practice medicine at the highest quality possible as dictated by guidelines set by the ARC-PA, an organization made of physicians and PA leaders.  And this is across the board, whether we are certificate, bachelors or masters.  When we participate in this degree creep process, we validate claims by other professions, including the ARNP profession, that the more advanced the degree, the more competent the practitioner.  In our field, that is simply NOT true.  I know some certificate trained PAs who could run clinical circles around my Masters trained abilities as well as around any "doctor" NP.  I think our time would be spent more wisely educating the public as well as physicians, hospitals and insurance companies as to the true meaning of competency based PA training and why more advanced degrees only offer an advantage in research and education models, not clinical care of patients.

Many leaders familiar with this debate have remarked that the true push behind it is likely coming from organizations like the NCCPA, and this is probably more of a financial issue than a issue of professional advancement.  I sincerely hope that is not true and that we would not allow anyone to prostitute out our profession for financial incentive.  Meanwhile, the pursuit of the clinical doctorate potentially offers to do serious detriment to our Physician/PA Team mantra and everything many of us in our constituent organizations are working toward to improve PA practice rights.  Physicians are becoming increasingly aware that PAs and NPs are going to the front line of primary care, and many of them are beginning to accept that.  But all of our professions need to respect that even primary care medicine is a team effort that must involved physician collaboration and participation.  Let's not lose sight of why our profession was born in the first place and who granted us that birthright.  And lets not water down our true purpose in medicine by following the heels of the independent seeking ARNPs.  

Eric S. Smith, MMS, PA-C

Immediate Past President

Florida Academy of Physician Assistants