There is always so much emotion in this topic. This emotion almost always leads to speculation that may or may not have data to support it. As a PA and Dean, I prefer to approach this from topic based on research. Also, I DO NOT look at it as a (1) degree creep or (2) method for increased university revenue. So, before I provide research data on this topic let me talk for a minute about the author, me.
In 1993 I completed PA training at MEDEX NW and was certified in the field. I had no degree (bachelor or otherwise). I firmly believe the field is competency based and did not agree with moving to a graduate degree. But we made the move.
I don't agree with how the move was made. I believe a PA graduate program NEVER met criteria for a Master's degree. I believe it always met criteria for a doctorate. Given this, I am not proposing any change in our present program structure, pre-requisites, curriculum, cost, or outcomes. My thoughts are simple. If we are a graduate program, we should award (or allow programs the option to award) an appropriate graduate degree and that is a Doctorate.
My supporting argument follows:
Based on academic workload alone, PA graduates have earned a doctorate degree (not to be confused with a Medical Doctorate or Doctor of Osteopathic medicine degree). Note: Regardless of the degree earned, it would NOT change state law or medical board mandates or pose a threat to the physician/PA relationship. This is about academics, not status in an exam room. This is about awarding the level of degree a student earns.
Quick PA Certification to Degree History
PA education is a competency-based concept that prepares health care professionals to qualify and pass the national certifying examination to meet state licensing board requirements.
In its early years it was considered a certification process and graduates were NOT awarded any academic degree.
In 1970, Alderson Broaddus College awarded the first PA academic degree based on 2 years of general college and a 2 years professional phase.
In 1973 the University of Colorado’s Child/Health Associate PA program awarded the first PA master’s degree.
Presently, programs accredited prior to 2013 – that do not currently offer a graduate degree – must transition to conferring a graduate degree before the 2020 cohort matriculates (ARC-PA’s Accreditation Manual, 4th Edition, 2014).
ARC-PA Wordage on the Graduate Degree
Accreditation Manual, 4th Edition (December 2013)
ARC-PAs Accreditation Manual, 4th edition (under the ‘Introduction’ heading, page 17), states, “Institutions that sponsor PA programs are expected to incorporate this higher level of academic rigor into their programs and award an appropriate master’s degree.” This is more specific than what is found under the ‘Eligibility’ section.
ARC-PAs Accreditation Manual, 4th edition (under the ‘Eligibility’ heading, page 18), states.[The institution] must be accredited by a recognized regional accrediting agency and must be authorized by this agency to confer upon graduates of the PA program a graduate degree.
Sponsoring institutions applying for provisional accreditation of a new PA program must be accredited by, and in good standing with, a recognized regional accrediting agency and must be authorized by that agency to confer upon graduates of the PA program a graduate degree.
ARC-PA Accreditation Manual, 4th Edition (under the ‘Program Review’ heading, page 18), states, “Accreditation of PA programs is a process initiated by the sponsoring institution. It includes a comprehensive review of the program relative to the Standards and it is the responsibility of the PA program to demonstrate its compliance with the Standards. Accreditation decisions are based on the ARC-PA’s evaluation of information contained in the accreditation application, the report of site visit evaluation teams, any additional requested reports or documents submitted to the ARC-PA by the program and the program’s accreditation history.
ARC-PA Accreditation Manual, 4th Edition (under the ‘Standards Degree Issue Clarification’ heading, page 18), states,All students who matriculate into any currently accredited PA programs after December 31, 2020 will be awarded a graduate (master’s) degree upon successful completion of their PA curriculum and graduate degree requirements. (The definition of “matriculate” is to enroll or register. Thus, students who matriculate after December 31, 2020 are those who first enroll or register in PA coursework on or after January 1, 2021)
Currently accredited PA programs sponsored by institutions that can, but at present are not awarding a graduate degree, will be diligently working toward compliance with the degree requirement, within the institution, state and regional accreditation bodies, as appropriate. The institution should work within its framework to evaluate the PA program curriculum and adjust it as necessary for suitability, such that the institution will be able to confer a graduate degree to PA students who matriculate after December 31, 2020 and successfully complete the PA program.
ARC-PA Policies, Version 6 (01.15.14), states, “ARC-PA is the recognized accrediting agency for Physician Assistant entry-level program education leading to the professional credential (PA) and provides accreditation services to institutions that sponsor PA programs.” What the Words Mean
The crux to ARC-PA’s stance on this issue is most likely seen when they apply the word, “master’s” in parenthesis between graduate and degree (in the ‘Standards Degree Issue Clarification’). They also refer to a “master’s degree” in the introduction to the accreditation manual (pg. 17). Elsewhere, however, the wordage is more liberal, stating the institution must qualify to award a graduate degree.
Ultimately, ARC-PA accredits an institution-based on compliance with standards (see ‘program review’ on preceding page). The question, therefore, must be, is the master’s degree a limiting standard for PA program accreditation? If it is, then this conversation is moot.
PAEA Stance on PA Doctorate
This issue cannot be considered without also looking at the Physician Assistant Education Association stance of the PA doctorate.
In 2009, PAEA was asked, “[is] the clinical doctorate appropriate as an entry-level [PA] degree, as a postgraduate degree, or not at all.” PAEA response was, “The PA educational model has adapted over 40 years to produce PAs who provide high quality, cost-effective, patient-centered care. Both physicians and PAs practice in the domain of medicine; therefore, the entry-level doctorate for the practice of medicine is the MD/DO. Almost all PA programs now award a master’s degree or are planning to.”
A memorandum related to the 2009 forum stated, “Accordingly at the Education Forum in November 2009, PAEA adopted two position policies, which were consistent with the recommendations from the summit. These position policies specifically state that 1) PAEA endorses the master’s degree as the entry-level and terminal degree of the profession; and 2) PAEA opposes the entry-level doctorate for physician assistant.”
Should PA Education Seek a Doctorate Option (In Addition to the Master’s Degree)
Typical Master’s Degree
Most master’s degree programs average 30 and 36 semester hours of academic workload. Healthcare degrees, however, can often be more. For example:
Typical Academic Workload for a Master’s Degree in Healthcare
The University of South Carolina master’s degree in Acute Care Nurse Practitioner – 37 Semester Hours
The University of South Carolina master’s degree in Primary Care Family Nurse Practitioner – 45 Semester Hours
The University of South Carolina master’s degree in Public Health – 42
The Clemson University’s master degree in Family Nurse Practitioner – 46 Semester Hours
The Clemson University’s master degree in Adult/Gerontology Nurse Practitioner – 49 Semester Hours
The Loma Linda University master’s degree in Rehabilitation – 42 Semester Hours
Clearly, PA education far exceeds the typical healthcare master’s degree program.
Why PA Education Meets the Doctorate Muster
According to ARC-PA’s website there are 187 accredited programs. To determine statistical significance related to academic workload, a quick Internet search was performed and the following table created. An academic workload threshold of 120 semester hours was set and the search was stopped when 10% of programs supported this value or higher (19 programs).
This is significant given that the average academic work load for the before mentioned health care related master’s degrees is 43.5 semester hours. To put this into perspective, the PA programs listed here carry an academic load that is 2.8 times that of almost all other health related master’s degrees.
School Semester Hours
Bethel University 147
University of Oklahoma College of Medicine 139
Keiser University 138
UNT Health Science Center 134
Methodist University 131
Pacific University 131
Mercer University 128
Marquette University 128
University of Arkansas Medical Sciences 128
Touro College 127
Emory University 126
Murphy Deming College of Health Science 126
University of Nebraska 123
Georgia Regents University 122
University of South Alabama 121
Campbell University 120
University of Maryland 120
Idaho State University 120
Heritage University 120
The next step in this evaluation was to consider how the PAs academic workload and education complexity compared to other non-physician doctorate programs. The following list outlines similar doctorate programs in health care. Each has an equal or significantly less academic workload. In addition, it should be noted that most, like the PA, work with physicians and are regulated by a governing board and state laws.
Typical Academic Workload for a Doctorate in Healthcare
The South Carolina College of Pharmacy Doctorate of Pharmacy – 146 Semester Hours
The University of South Carolina Doctor of Physical Therapy – 124 Semester Hours
The University of South Carolina Doctor of Nurse Practitioner – 75 Semester Hours
The Medical School of South Carolina PhD in Nursing – 62 Semester Hours
Each of the preceding examples is bachelor to doctorate options (no master’s degree required). To help put this into perspective, minimum standards for a PhD at Clemson and the University of South Carolina were reviewed. In both instances, these requirements are much less than all operational PA programs. Granted these degrees are research and not applied doctorates but the significance of relevant academic workload cannot be overlooked.
Typical Academic Workload for a Doctor of Philosophy Degree (PhD)
At Clemson, the minimum requirement for a PhD is 65 Semester Hours post baccalaureate degree.
At the University of South Carolina, the minimum requirement for a PhD is 60 Semester Hours post baccalaureate degree.
In summary, this document supports a doctorate option for PA programs while suggesting no change to the existing pre-requisites, curriculum, cost, or outcomes. The option would not impact state laws or medical board mandates on PA practice and would not change the physician/PA relationship. It simply respects the work done and degree earned. Above all things, a PA program seeking doctorate status MUST meet regional accreditation criteria and fulfill all ARC-PA standards to operate.
Please do NOT let words on a diploma hold the PA’s academic accomplishments hostage. These words do not and will not compromise the strong and longstanding physician/PA practice.
During the upcoming PAEA annual conference, PAEA will debate the doctorate option on October 16, 2014 (Thursday) and vote to re-affirm the 2009 memorandum (supporting the Master’s degree and opposing the Doctorate degree) on Saturday October 18, 2014 (during the PAEA business meeting). If you are a voting member, you should let your voice be heard.
Finally, please, I ask all parties concerned to be civil about this debate and to use this time to work together. OK….