Advanced Practice Nursing Degrees to be Doctorate level after 2015

[JohnnyM2]

Perhaps many of you are aware of this, but it was news to me that starting 2015, The American Association of Colleges of Nursing has established that advanced practice nursing degrees will all be at the doctorate level. AP nurses include Nurse Specialists, Nurse Midwives, Nurse Anesthetists and Nurse Practitioners. This seems to mean that, within a few years after 2015, absent changes in PA education, newly graduated MPAS will be competing against newly graduated DNPs on a regular basis. Doctorate level PA degrees have been discussed in a number of posts on this forum but this change would seem to alter the potential status of PAs vs NPs.

Some posts on this forum have suggested that PAs who want to pursue a doctorate should become MDs. That is, of course, an option. My greater concern, though, is not how to allow the most ambitious of PAs to further their careers (I mean that in a positive way) but, rather, how to keep the entire profession from being eclipsed by AP nurses. At the moment, I don't see this being addressed by AAPA which still hasn't decided whether "assistant" should remain in the PA title even though most of us agree it should not.

My personal opinion is that AAPA needs to consider not just a name change but the entire future status of the profession, including promoting fellowships and other advanced training leading to more practice autonomy. This is not to suggest that AAPA should abandon the core idea of PAs working collaboratively with physicians as this has, historically, been one of the key contributions made by the PA profession. I am, however, making an appeal to AAPA to ensure that the medical team does not end up with a hierarchy that looks like MDs>AP Nurses> everyone else including PAs.

What are your thoughts on this?

 

 

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[PACdan]

I've seen nurses/NPs weigh in on this elsewhere and it seems that this is not a mandated change as of yet, it's a proposal. One which states, schools, and accrediting bodies would have to transition to in order to effectively enforce it. They seemed assured that NP programs would continue to be at the Master's level for years to come.

I hope this is the case anyway.


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[CorpsmanUP]

It is not mandated, it is left to the discretion of the universities.  They have being trying to make the BSN the entry level degree for RNs for decades and we have seen how productive that has been.

[EMEDPA]

for years nps were all ms level before pas jojned the degree creep from bs to ms. this is no different. eventually pa programs will find a way to grant a doctorate just to keep up. it may be through additional postgrad training or some other mechanism but we are headed there too.

[LT_Oneal_PAC]

I've seen nurses/NPs weigh in on this elsewhere and it seems that this is not a mandated change as of yet, it's a proposal. One which states, schools, and accrediting bodies would have to transition to in order to effectively enforce it. They seemed assured that NP programs would continue to be at the Master's level for years to come.

 

I hope this is the case anyway.

 

 

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Spot on. Only two ways to do it: states would have to make it law or BOTH the NLN and AACN would have to no longer accredit MSN NP programs, since nursing has two different accrediting bodies. Last time I checked, NLN was against the mandatory doctorate.

 

Honestly, I believe we don't need to go to a doctorate to keep up with NPs. We need to remove supervision so that we can be as hassle free to employ as NPs. Unfortunately to progress to that legislation, a doctorate would be helpful since lay people don't and will probably never fully comprehend medical and nursing education.

[mashlee]

Honestly, I believe we don't need to go to a doctorate to keep up with NPs. We need to remove supervision so that we can be as hassle free to employ as NPs. Unfortunately to progress to that legislation, a doctorate would be helpful since lay people don't and will probably never fully comprehend medical and nursing education.

I couldn't agree more and I like to hear those who realize that PA education going to the doctorate level is inevitable and the more we fight it, and fear change, the more damage we are doing to the profession. Like Oneal said, removing supervision is the most imperative thing to be done, but moving to a doctorate level of education will likely be very helpful. Now my question is, how did I get involved and have my voice heard? I feel like the vast majority of PAs at least would agree with me on removing supervision, so why isn't that something being fought for. What can we do to get the AAPA to listen?

[SocialMedicine]

Few thoughts

1) PA education needs to be Masters level, PERIOD

2) The solution for ambitious PAs is not "go to medical school" our profession must work to retain the most aggressive and successful of us through advancing practice.

3) Just because someone has a DNP, PhD, Dr of PA does not mean much. You have to look at what the degree entailed and where it is from. It will be quite clear when someone completed a DNP from a tuition mill online school how worthy the degree is. Individuals in academic and hospital positions of power will likely understand this.

4) PAs should be careful bc public opinion is VERY impressed with titles and letters after names. If nursing pushes they are DOCTORS it could be an issue in the public opinion. We need out own campaign to show how our MEDICINE model education is superior.

[PACdan]

I feel like the vast majority of PAs at least would agree with me on removing supervision, so why isn't that something being fought for. What can we do to get the AAPA to listen?

I think the "fight" right now is to remove terminology like supervision and replace it with collaboration. Which seems like a good idea.

 

You cannot remove all physician oversight/partnering though; we are attached at the hip. To try to do is tantamount to independent practice; at which point we become pure competition to them.

 

Regardless of how you feel about the AAPA, it's all about politics & money. There won't be sweeping changes overnight, as this is a slow waltz through a political minefield. Waltz softly.

 

 

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[ventana]

Few thoughts

1) PA education needs to be Masters level, PERIOD

2) The solution for ambitious PAs is not "go to medical school" our profession must work to retain the most aggressive and successful of us through advancing practice.

3) Just because someone has a DNP, PhD, Dr of PA does not mean much. You have to look at what the degree entailed and where it is from. It will be quite clear when someone completed a DNP from a tuition mill online school how worthy the degree is. Individuals in academic and hospital positions of power will likely understand this.

4) PAs should be careful bc public opinion is VERY impressed with titles and letters after names. If nursing pushes they are DOCTORS it could be an issue in the public opinion. We need out own campaign to show how our MEDICINE model education is superior.

 

 

In a perfect world I agree, however we live in an imperfect world.

 

1) PA education needs to be at a doctorate level., I just had a discussion with a few other PAs in they really thought that the doctorate level nurse practitioner was better prepared. Startling but true. These are full-fledged longtime PAs that certainly should be aware that the doctorate is a fancy piece of paper for a nurse practitioner. Certainly laypeople will never understand the difference, they will just see Dr. versus Masters. Congresspeople are no better, and in fact may be worse. We either need to get out in front of this and become doctorate level, or be left behind.  Sorry but thinking that it is not critical I do believe is wrong.  PT, OT, SLP, pharmacists, nurse practitioners, are all referred to as doctors now.

 

2)  number two actually contradicts what you say in number one, working aggressively is being aware of the political and social environment.

 

3) in theory what you say is correct, however in the age of soundbites, creative advertising, and basic misunderstanding it is simply not true to say that if we do a better job keep up with the nurse practitioners. The reality is society and its thoughts matters.

 

4)  again confused by her point. Society does matter, yet you say it does not in 1+2.  Laypeople, Congress people, most everybody besides a politically active PA, simply is not going to dedicate the effort and resources to figure this out. Just look at the mess that our entire medical system is in, people simply don't care. Advertising works. Name recognition works.

 

 

 

I really do believe this is a very cut and dry process at this time. We are one of the few nonphysician professions in the healthcare realm that are not embracing a doctorate level. Why is there such resistance to this?

 

I still laugh when a physical therapist calls me up and refers to themselves as Dr. and me is Mr.  -   I truly don't care what I get called, but I do truly care about barriers to practice in legislation/regulations. This resistance to a doctorate level degree is fostering ongoing resistance to collaborative practice and practicing at the top of our license.

[PACdan]

@ventana

 

Why create separate doctoral programs for PAs then? My master's program is in the average doctoral range for credits anyway. Let's just up-convert all the existing Master's degree PA programs to doctoral level. Wouldn't have to change much.

 

 

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[cc56]

I think I am still on topic.  I came from the West coast and did PA school there, then moved to Illinois to work.  In the midwest I find people monthly who do not know what a PA even is.  On the West coast I never had to explain who a PA was!  I personally think fighting masters vs doctorate is a mute point if people STILL don't know who and what we are.   With the way things are going I don't see why you would want to go to PA school if it is a doctorate, same for the nurses?  I see it this way 4-5 years for a BA, 1-2 years masters, then a 2 year doctorate PA program.   If you want to make it a doctorate then you need to fast track some of this stuff.  With the price of school and current salary it is not going to be worth it.  You will be so deep in debt that it will keep most from it. 

[2234leej]

I've explored and read this site for quite some time now. I have wrestled with applying to both PA and NP school. In the end, I chose NP school; however, if a doctorate was required, I would never do it (the same goes for PA school).

 

A doctorate for either profession is a waste in my personal opinion. Adding additional schooling negates some of the profession's biggest strengths. The PA is such a valuable profession because of the short time it takes to complete compared to medical school. Tacking on additional years adds more financial burden with no change in independence or practice. You would be paying more money for no extra benefit.

 

A residency makes sense because you are getting paid for the training and are specializing in some type of practice. A PA who is residency trained should be looked highly upon compared to a newly graduate.

The DNP is honestly not gaining a lot of steam within many nursing communities. They are shooting themselves in the foot with no extra clinical curriculum. Much of the added classes are statistical in nature which is pretty stupid.

 

[SocialMedicine]

would hate to see doctoral push for PA ... more tuition money ... and the way the landscape looks with an abundance of PA schools in the works .... you have people paying more to make less.

[mashlee]

Ok I feel like many of you who oppose the doctorate switch oppose it based on two main reason, extra tuition and longer schooling. Let me just point out that many PA programs have between 90-120 credit hours completed by the time of graduation. This is an acceptable number of credits for a doctorate degree. My brother in law is a physical therapist and he completed roughly the same number of credits (101 to be exact) as I do for PA school and he graduates with a doctorate. And while i'm on the subject of PTs, I want to add that 10 years ago and even less most PT programs were a masters and most of those have switched to a doctorate without adding much of anything in the way of extra work. 

I will say, even if I had to go to school 6 months longer in order to get a doctorate I would. I truly believe that the change will help out our career in major ways. The real obstacles that lay ahead for PAs are mostly political ones and the switch to doctorate level degrees give us as a profession very strong lobbying power.

[primadonna22274]

But what does a doctorate get you as a PA? Still a dependent provider. I don't see that changing. I can see collaborative practice over supervision, but independence as a PA is a totally foreign notion to me. In fact it's the reason I went back to medical school--to be INDEPENDENT.

 

[ventana]

I don't see a need to increase the length of school or the cost to attend - we are already educated to the doctorate level (will not go into here but credit wise we are there already)  I am not saying more schooling at more cost, but instead just change the degree given - the very same way PT went from a BS, to an MS to a DPT

 

As for independence - I think we need to get out from under the "supervision" and "assistant" rocks that we are so firmly stuck under right now, and in a perfect world have a tired level of practice - ie < 2 years out needs to have on site supervision, 2-5 some chart review, 5+ can be free standing with a collaboration agreement.

 

On an entirely different but related topic - we should be allowed to direct bill for our services, same as the NPs .  Forget all this convoluted incident to and bull on billing....  PAs should have their own pin and use it...

 

I don't totally agree with prima in that I think there should be some way for PAs to have more independence as they become proven and established, not full Independence (what ever that means), but more so then right now.

[PACdan]

I don't see a need to increase the length of school or the cost to attend - we are already educated to the doctorate level (will not go into here but credit wise we are there already) I am not saying more schooling at more cost, but instead just change the degree given - the very same way PT went from a BS, to an MS to a DPT

It's merely a label change. I don't know why this hasn't already happened with so many PA master's programs at 100+ credit hours.

 

We're not pulling sub-50 credits like many master's programs do. I can only assume that the degree conferred hasn't been bumped up to avoid rocking the boat with physicians. Any one know?

 

 

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[primadonna22274]

I do support a tiered system of practice where PAs can grow into progressively higher levels of autonomy. I do not support full independence for PAs and never have. Guess I'm an old fogey there, cast in the fine mold of RC Davis. PAs are great at what we do, but we are not physicians--unless we are. The line gets very hazy between PA and physician if there is no longer a distinction of "independence" for the physician.

I would NEVER support independent practice for a new grad green PA. The learning curve from just-graduated to well-seasoned PA is just too steep. Physicians take a minimum of 3 years in residency to become independent and it's under a systematically structured rubric of "graduated responsibility". This is to protect the patient and the physician from harm. If we think as PAs we don't need that graduated responsibility as well, under initially close supervision that gradually becomes collaboration to eventually loose association with physicians, then that is the worst kind of hubris I can imagine and we are no smarter than the DNPs in pushing for that kind of foolhardy risk.

[ventana]

I do support a tiered system of practice where PAs can grow into progressively higher levels of autonomy. I do not support full independence for PAs and never have. Guess I'm an old fogey there, cast in the fine mold of RC Davis. PAs are great at what we do, but we are not physicians--unless we are. The line gets very hazy between PA and physician if there is no longer a distinction of "independence" for the physician.

I would NEVER support independent practice for a new grad green PA. The learning curve from just-graduated to well-seasoned PA is just too steep. Physicians take a minimum of 3 years in residency to become independent and it's under a systematically structured rubric of "graduated responsibility". This is to protect the patient and the physician from harm. If we think as PAs we don't need that graduated responsibility as well, under initially close supervision that gradually becomes collaboration to eventually loose association with physicians, then that is the worst kind of hubris I can imagine and we are no smarter than the DNPs in pushing for that kind of foolhardy risk.

 

 

could not have said it better myself - okay I agree with prima!

[db_pavnp]

It strikes me as unlikely that a multi year, stepwise graduation into autonomy will become reality.  Why would any employer go through the hassle to generate a PA with autonomy equivalent to an NP?

[Avalon]

So let me understand this argument.  We don't need to change anything about the existing PA curriculum; we simply need to say that we are earning a doctoral degree because the credit hours earned in a PA program approximate those earned in a bona fide doctoral program?  This is, as has been suggested above, intended to be only a change in the labeling of our education? What does that mean for the 80,000+ PAs who have previously been conferred master's degrees for the same work that would futuristically be considered doctoral level work  - so that we can "keep up with the Jones" of degree creep in other professions?  To our medical colleagues, might this not look a bit disingenuous?  My informal assessment of opinion concludes that most physicians find the DNP curriculum laughable at best, and gravely dangerous to patient well-being at worst.  What might be the risk to our colleagial relationships with physician partners if we emulate the DNP course of action?

 

I, by the way, have a doctoral degree.  It took me five full years or coursework and supervised internship experience, 126 earned credit hours, and the completion and subsequent oral defense of a dissertation that made an original contribution to my field (clinical psychology) to earn that doctorate.  I'm not sure I see the equivalency to my PA education.  It's comparing apples and oranges, really.

 

Finally, what exactly is a doctorally trained physician assistant? Not a physician, and no longer a "midlevel" (read "master's level") provider?  I'm simply not clear on how the role would change in ways beneficial to us with the proposed labeling change. If the concern is public perception, and the prevailing thought is that a doctoral degree is deemed superior to a master's degree, might that not backfire as the fluffed up DNP curriculum becomes more exposed?  Do we really wish to join that bandwagon?

[Guest Paula]

how to keep the entire profession from being eclipsed by AP nurses. At the moment, I don't see this being addressed by AAPA which still hasn't decided whether "assistant" should remain in the PA title even though most of us agree it should not.

 

 

No need to worry about NPs eclipsing us.....they already have.   

[Guest Paula]

I think the "fight" right now is to remove terminology like supervision and replace it with collaboration. Which seems like a good idea.

 

You cannot remove all physician oversight/partnering though; we are attached at the hip. To try to do is tantamount to independent practice; at which point we become pure competition to them.

 

Regardless of how you feel about the AAPA, it's all about politics & money. There won't be sweeping changes overnight, as this is a slow waltz through a political minefield. Waltz softly.

 

 

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It's actually a wading process through molasses. 

[CorpsmanUP]

Hence why I think there should be a second path to MD board certification. PA -> Residency that is twice as long. Pick up MD at three year mark while working, board eligibility at six year mark with normal PA salary range during that time period. While I accept there will be funding issues to work out with residencies being Medicare funded, overall with the push to NP independence there becomes less purpose behind the PA profession. Move to the stem cell model of medical education and be done with it.

[PACdan]

So let me understand this argument. We don't need to change anything about the existing PA curriculum; we simply need to say that we are earning a doctoral degree because the credit hours earned in a PA program approximate those earned in a bona fide doctoral program? This is, as has been suggested above, intended to be only a change in the labeling of our education? What does that mean for the 80,000+ PAs who have previously been conferred master's degrees for the same work that would futuristically be considered doctoral level work - so that we can "keep up with the Jones" of degree creep in other professions? To our medical colleagues, might this not look a bit disingenuous? My informal assessment of opinion concludes that most physicians find the DNP curriculum laughable at best, and gravely dangerous to patient well-being at worst. What might be the risk to our colleagial relationships with physician partners if we emulate the DNP course of action?

 

I, by the way, have a doctoral degree. It took me five full years or coursework and supervised internship experience, 126 earned credit hours, and the completion and subsequent oral defense of a dissertation that made an original contribution to my field (clinical psychology) to earn that doctorate. I'm not sure I see the equivalency to my PA education. It's comparing apples and oranges, really.

 

Finally, what exactly is a doctorally trained physician assistant? Not a physician, and no longer a "midlevel" (read "master's level") provider? I'm simply not clear on how the role would change in ways beneficial to us with the proposed labeling change. If the concern is public perception, and the prevailing thought is that a doctoral degree is deemed superior to a master's degree, might that not backfire as the fluffed up DNP curriculum becomes more exposed? Do we really wish to join that bandwagon?

The argument being that the bandwagon works for convincing most lay/government people. Sad, but more than likely accurate.

 

As for the current 80,000 PAs, not all of them have master's degrees; many have bachelor's, associates, or certificates. Some of them finding applying to current jobs a struggle with the degree creep. In theory, an abundance of future "Doc" NPs could harm PA opportunities.

 

As for your doctorate, congrats. I will be taking 108 credits, developing a community health project, executing it, conducting research, and writing and defending a thesis paper for my program. Along with all my classes and clinical rotations. How is that not doctorate level work?

 

 

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