What do YOU think the PA profession will be like in the future?

[Bubo101]

Hi!  First time poster here.

 

I want to start off by saying that I got accepted into PA school and am extremely excited for the opportunity, it truely is a dream come true!

 

I have been doing a lot of research into the future of the profession and I would like to hear your thoughts about where you see the profession heading.

 

1.  Do you believe that within the next 10 or 20 years specialty certification will be required for all specialties and employment opportunities?  If so do you think it would be a positive change?

 

2.  All you read about nowdays is that PAs are needed more than ever with projected growth into the future...but what happens when the baby boomer generation passes away?  What happens when all of the new PA schools that have been pumping out thousands of new graduates reach a point where there isn't a great need anymore?  Will this day come of complete saturation, if so how long?

 

3.  NPs have moved into doctoral degrees and seem to be trying to set themselves up as a superior choice to a PA, do you believe that they pose any danger to the future of the profession?  Will PA Masters programs transition into PhD programs?


Thanks in advance for your answers!  I chose to be a PA because of the flexibility, stability, opportunity to help others, and have never met a PA that wasn't happy...I just don't want that to change down the road!  

[EMEDPA]

 

 

I think 20 years from now PAs will do a 3 yr doctoral program after undergrad program followed by a 1 yr specialty internship. they will then take a specialty exam to become certified. there will never be enough providers. everyone in medicine will always have a job.

 

[Gaijyn]

Within 10 years we are looking at CAQ/Residency requirements for many specialties (ER, CT Surg, etc) with progressive expansion until it is essentially required for most/all areas.  This has already somewhat begun and does not seem to be slowing down.  I also think there will be more PA >> DO Bridge Programs and perhaps/hopefully PA >> MD programs.  The profession will be transitioning towards a doctoral degree in some fashion.  HOPEFULLY the name change will finally have occurred.

 

Within 20 years I for see the above being extrapolated on.  EMEDPA's vision seems pretty accurate.

 

With regards to saturation, this has occurred in isolated (read: big cities with multiple programs) to the point of lowering of wages.  While jobs are generally out there in those places, the wages are often low and thus reflect the saturation levels.  Nationally though, I think that saturation will occur if we as a profession do not start ensuring we get a bigger piece of the pie or increasing levels of autonomy in terms of being able to open PC practices or the like.  I understand the professions roots, but currently we are largely hamstrung by a number of laws and mandates as well as by the very physicians we are supposedly so closely tied to.  So eventually I see the profession reaching critical mass (already occurring in some states to various degrees) and pushing for more autonomy.

[Will352ns]

......and 5 years after the increase to 3 year programs, mandatory post grad residencies, and CAQ the phase-out of the career all together.  Why in the world would a person look at doing 4 years post grad for a job that will pay a fraction of the Physician salary when they could just go to med school and the only other requirement would be to do a residency?

 

It would also pretty much squeeze out many of the experienced applicants, crushing all notions that PA's are experienced health care providers.  If you think applicants have little HCE now....just wait until the vast majority have zero.  These plans feed the no HCE crowd.

 

 

Bridge programs are great, but again, will only reinforce the phase-out of the career.  PA schools are typically looking for folks who want to be PA's.  It isn't a stepping stone, it is a career in its' own right.

 

It is a self eating snake.

 

I personally think things will pretty much stay the same with the exception of more 3 year programs.  The AAPA (like them or not) has stated openly that they do not support the CAQ or mandatory residency.  We will see; I don't think the career will eat it self away.

 

Take it as you will, just my opinion.  I'm glad I am going to school now.

[Derbingle]

CAQ or doctorate but not both. Bridge to DO, to produce more physicians, as medical schools produce xyz a year, and the bridge depending on success of patients access to healthcare. Near future, PA into specilties, NP/DNP to primary care. Just my brief opinion and not nearly as informed as the above postsers which have some great points. Except for the self eating snake. Cant see that one! ;)

[Will352ns]

Except for the self eating snake. Cant see that one! ;)

What?  I thought it was a great analogy....  :)

[Bubo101]

Thanks for the fantastic replies, I want to make sure that I am well informed on these issues. 

 

It seems to me that everyone is on the same page in that things will be changing and moving towards more restriction and education. 

 

From my perspective (which is limited)...and from reading your comments, it sounds like unless PAs band together and are active in advocating for the profession down the road we may lose what makes being a PA so special.  Once I become a PA I want to be one of those voices.  Is there an organization besides the AAPA that you would recommend being active in?

[LT_Oneal_PAC]

Hi! First time poster here.

 

I want to start off by saying that I got accepted into PA school and am extremely excited for the opportunity, it truely is a dream come true!

 

I have been doing a lot of research into the future of the profession and I would like to hear your thoughts about where you see the profession heading.

 

1. Do you believe that within the next 10 or 20 years specialty certification will be required for all specialties and employment opportunities? If so do you think it would be a positive change?

 

2. All you read about nowdays is that PAs are needed more than ever with projected growth into the future...but what happens when the baby boomer generation passes away? What happens when all of the new PA schools that have been pumping out thousands of new graduates reach a point where there isn't a great need anymore? Will this day come of complete saturation, if so how long?

 

3. NPs have moved into doctoral degrees and seem to be trying to set themselves up as a superior choice to a PA, do you believe that they pose any danger to the future of the profession? Will PA Masters programs transition into PhD programs?

 

 

Thanks in advance for your answers! I chose to be a PA because of the flexibility, stability, opportunity to help others, and have never met a PA that wasn't happy...I just don't want that to change down the road!

1. Yes, but not for primary care. Yes, it will further establish our clinical skill superiority.

 

2. Baby boomers had kids too. Usually more than one, so the pool won't be shrinking. In 1900 there was something like 3.1 million geriatrics and now we have over 35 million with only about 1 million providers (PA, NP, and MD/DO combined). Before you say that's only 35 elderly patients per provider, realize that not all of that 1 mil are practicing in one specialty, or even practicing at all since that is just active license numbers for docs and total grads for NP and PA. Plus plenty of those are peds, surgical, ect and multiple specialties are needed for one patient. Plenty to go around. Plus you can go into any specialty so it's not as if we are all trying to cram into one. I don't see saturation becoming a problem unless we keep supervision and supervision ratios.

 

3. I see them posing a threat, but not because they are doctorate prepared. If they become the provider of choice it will be because they have become independent and no one wants to take the extra (supposed) liability for supervising a PA and not having to bother with supervision ratios. I do think there will be a transition to DMS programs or more bridge programs. Which one wins out will be the one that comes along the fastest.

[LT_Oneal_PAC]

Thanks for the fantastic replies, I want to make sure that I am well informed on these issues.

 

It seems to me that everyone is on the same page in that things will be changing and moving towards more restriction and education.

 

From my perspective (which is limited)...and from reading your comments, it sounds like unless PAs band together and are active in advocating for the profession down the road we may lose what makes being a PA so special. Once I become a PA I want to be one of those voices. Is there an organization besides the AAPA that you would recommend being active in?

PAFT. Physician assistants for tomorrow.

[EMEDPA]

PAFT. Physician assistants for tomorrow.

the A in paft could be something besides assistant...in fact I don't think you will find the word assistant anywhere on their site.....:)

[EMEDPA]

.  Why in the world would a person look at doing 4 years post grad for a job that will pay a fraction of the Physician salary when they could just go to med school and the only other requirement would be to do a residency?

 

it's a difference of 3 yrs. 4+3+1 for pa=8 vs 4+4+ MIN 3 for MD/DO=11.

and in primary care a PA is making around 50% what the doc is. that's a pretty big fraction...

[LT_Oneal_PAC]

the A in paft could be something besides assistant...in fact I don't think you will find the word assistant anywhere on their site.....:)

You're right. Sorry. Force of habit.

[Will352ns]

it's a difference of 3 yrs. 4+3+1 for pa=8 vs 4+4+ MIN 3 for MD/DO=11.

and in primary care a PA is making around 50% what the doc is. that's a pretty big fraction...

Not sure if half the salary for the benefit of not doing 3 more years of a paid (albeit low) apprenticeship is much of a factor. 

 

Given the choice, if I had to do 7 years of school plus one year of post grad to become a DHC....I would rather just go all the way and be a MD. The extra lost income will recoup itself as I would be getting paid double....much more if I didn't go FP.

 

If this was the current model of PA, I wouldn't be going anyhow.  No way could I justify being out of work that long.  I am the old "traditional" now "non-traditional" type of student.  I have great HCE, but unfortunately I have baggage.  As I said before, this model squeezes many folks like me out....which would be a shame.

[Bubo101]

Not sure if half the salary for the benefit of not doing 3 more years of a paid (albeit low) apprenticeship is much of a factor. 

 

Given the choice, if I had to do 7 years of school plus one year of post grad to become a DHC....I would rather just go all the way and be a MD. The extra lost income will recoup itself as I would be getting paid double....much more if I didn't go FP.

 

If this was the current model of PA, I wouldn't be going anyhow.  No way could I justify being out of work that long.  I am the old "traditional" now "non-traditional" type of student.  I have great HCE, but unfortunately I have baggage.  As I said before, this model squeezes many folks like me out....which would be a shame.

 

I tend to agree with you.  Adding 2 more years of education when many people go into the PA profession because of its expedited training would turn many people away. 

 

PAs are already able to do 80% of what a physician can do without needing those 2 extra years of training, that would be 2 more years of time and money, and PA school is already expensive! 

 

Is 8/11 Years of training worth it to only get paid half the amount?  It is close to 75% of the total training of a physician, should PAs be compensated more at that point?  Also, will employers prefer new doctoral PA graduates over PAs with masters who have been working in the field for some time?

 

[Bubo101]

PAFT. Physician assistants for tomorrow.

Thank you.  I will be sure to look into Physician Associates for Tomorrow  :)

[EMEDPA]

Thank you.  I will be sure to look into Physician Associates for Tomorrow  :)

They go by PAs for Tomorrow not to ruffle any feathers....

pasfortomorrow.org

[Bubo101]

They go by PAs for Tomorrow not to ruffle any feathers....

pasfortomorrow.org

Absolutely, my apologies.  I actually don't have an opinion personally over a name change but was referencing one of the earlier posts.    

[Derbingle]

Questions questions....Are the DNPs looking to be on par with MDs? If that happens, PAs still have the niche......docs arent going to pay higher salaries for a DNP first assist, or clinic post op visits, paperwork, filling RXs. NPs will likley want to work for themselves or as equals with a doc after all that education? What will be the alure to a NP? If its private prac, Less pay, more education, sole liability as if another doc had been hired? Or maybe paid as a doc, hired by institutions which would likely work very well, treated as an independent provider, exchanged in the same way MD and DO are? This is why i see NPs going In to group practices with each other in primary care or organizations. (hopsitals)

[ICRob0351]

Questions questions....Are the DNPs looking to be on par with MDs? If that happens, PAs still have the niche......docs arent going to pay higher salaries for a DNP first assist, or clinic post op visits, paperwork, filling RXs. NPs will likley want to work for themselves or as equals with a doc after all that education? What will be the alure to a NP? If its private prac, Less pay, more education, sole liability as if another doc had been hired? Or maybe paid as a doc, hired by institutions which would likely work very well, treated as an independent provider, exchanged in the same way MD and DO are? This is why i see NPs going In to group practices with each other in primary care or organizations. (hopsitals)

If you actually sit down and look at the curriculum of the new DNP programs out there... the classes added for the Doctorate are all leadership, advanced nursing theory, and some other fluff courses - there is no significant extra clinical education when compared to the APRN masters degree. So regardless of the NP degree, PAs will still maintain significantly superior clinical training out of school.

[MedicalRN]

If you actually sit down and look at the curriculum of the new DNP programs out there... the classes added for the Doctorate are all leadership, advanced nursing theory, and some other fluff courses - there is no significant extra clinical education when compared to the APRN masters degree. So regardless of the NP degree, PAs will still maintain significantly superior clinical training out of school.

 

This is correct for some programs, but not all of them. I was discouraged when I looked into the DNP curriculum - I was hoping it would increase clinical knowledge but it turned out to be, as others have said, nothing but fluff. As I continued researching, though, I realized that that isn't entirely true. For one thing, a DNP program does increase the minimum clinical hours of an NP program, which is great. Beyond on that, though, some schools have really increased clinical education in the DNP portion. Take Columbia for example:

 

Their DNP programs is two years, to be completed AFTER a Master's, and contains the following classes listed below. In addition, there is a FULL YEAR supervised "residency" in the students field. This STRONGLY increases clinical hours/knowledge of students that complete the program and I imagine other programs will follow suit eventually. The DNP minimum clinical hours + the full year residency would actually surpass the hours of a PA program. Obviously, this is not the case at all schools, but if the "Columbia Model" spreads, it would be a major boon to NP education.

 

N9300 Comparative Quantitative Research Design and Methodology I 3 N9400 Practice Management 2 N9412 Informatics for Advanced Practice 3 N9538 Advanced Seminar in Clinical Genomics 2 N9600 Legal and Ethical Issues 3 N9672 Principles of Epidemiology and Environmental Health 3 N9910 Translation and Synthesis of Evidence for Optimal Outcomes 3   Total Support Core 19 Clinical Core Courses     N9480 Chronic Illness Management 2 N9700 Residency for Doctor of Nursing Practice 5-10 N9700 Residency for Doctor of Nursing Practice 5-10 N9710 Doctor of Nursing Practice I 2 N9711 Doctor of Nursing Practice II 2 N9714 Field Experience: Doctor of Nursing Practice I 1 N9715 Field Experience: Doctor of Nursing Practice II 1 N9717 Seminar: Doctor of Nursing Practice 1 N9718 Seminar: Doctor of Nursing Practice I 1 N9719 Seminar: Doctor of Nursing Practice II 1

[tunafish]

This is correct for some programs, but not all of them. I was discouraged when I looked into the DNP curriculum - I was hoping it would increase clinical knowledge but it turned out to be, as others have said, nothing but fluff. As I continued researching, though, I realized that that isn't entirely true. For one thing, a DNP program does increase the minimum clinical hours of an NP program, which is great. Beyond on that, though, some schools have really increased clinical education in the DNP portion. Take Columbia for example:

 

Their DNP programs is two years, to be completed AFTER a Master's, and contains the following classes listed below. In addition, there is a FULL YEAR supervised "residency" in the students field. This STRONGLY increases clinical hours/knowledge of students that complete the program and I imagine other programs will follow suit eventually. The DNP minimum clinical hours + the full year residency would actually surpass the hours of a PA program. Obviously, this is not the case at all schools, but if the "Columbia Model" spreads, it would be a major boon to NP education.

 

N9300 Comparative Quantitative Research Design and Methodology I 3 N9400 Practice Management 2 N9412 Informatics for Advanced Practice 3 N9538 Advanced Seminar in Clinical Genomics 2 N9600 Legal and Ethical Issues 3 N9672 Principles of Epidemiology and Environmental Health 3 N9910 Translation and Synthesis of Evidence for Optimal Outcomes 3   Total Support Core 19 Clinical Core Courses     N9480 Chronic Illness Management 2 N9700 Residency for Doctor of Nursing Practice 5-10 N9700 Residency for Doctor of Nursing Practice 5-10 N9710 Doctor of Nursing Practice I 2 N9711 Doctor of Nursing Practice II 2 N9714 Field Experience: Doctor of Nursing Practice I 1 N9715 Field Experience: Doctor of Nursing Practice II 1 N9717 Seminar: Doctor of Nursing Practice 1 N9718 Seminar: Doctor of Nursing Practice I 1 N9719 Seminar: Doctor of Nursing Practice II 1

Exactly... a bunch of crapola! N9300 is a trimmed and dumb down statistics with hospital twist so they know how to do t test and annova. Advanced seminars in clinical genomics... what the heck is that? I guess so they have a clue what HER2 negative breast cancer even means... If it helps them to get tenure in nursing school faster - its ok, but we all know this is not the reason.

[MedicalRN]

Exactly... a bunch of crapola! N9300 is a trimmed and dumb down statistics with hospital twist so they know how to do t test and annova. Advanced seminars in clinical genomics... what the heck is that? I guess so they have a clue what HER2 negative breast cancer even means... If it helps them to get tenure in nursing school faster - its ok, but we all know this is not the reason.

 

Much of it is crap, yes. But, if you read some of the decriptions (like N9710, below) they actually do have "extra" clinical based content, as well as full year residency - all of this on top of the MSN degree, which if you look at the MSN curriclum at Columbia, you will see why they consistenly produce excellent NPs.

N9710

Doctor of Nursing Practice I

This course will examine clinical reasoning and utilization of evidence for best clinical practice in the provision of integrated accessible health care services across clinical settings to patients who present with ambiguous symptoms, multiple diagnoses and or comorbid conditions in the context of family, community and culture. Discussion will focus on sophisticated evaluation techniques, appropriate clinical monitoring, and therapeutic interventions including alternative therapies. Transitioning patients to the appropriate level of care following resolution of acute illness will be discussed. Cultural diversity, epidemiology, differing health belief models, accountability, shared decision making, and ethical dilemmas that arise in the facilitation and coordination of comprehensive care for a population of ambulatory and acutely ill patients will be emphasized.

[coloradopa]

This is correct for some programs, but not all of them. I was discouraged when I looked into the DNP curriculum - I was hoping it would increase clinical knowledge but it turned out to be, as others have said, nothing but fluff. As I continued researching, though, I realized that that isn't entirely true. For one thing, a DNP program does increase the minimum clinical hours of an NP program, which is great. Beyond on that, though, some schools have really increased clinical education in the DNP portion. Take Columbia for example:

 

Their DNP programs is two years, to be completed AFTER a Master's, and contains the following classes listed below. In addition, there is a FULL YEAR supervised "residency" in the students field. This STRONGLY increases clinical hours/knowledge of students that complete the program and I imagine other programs will follow suit eventually. The DNP minimum clinical hours + the full year residency would actually surpass the hours of a PA program. Obviously, this is not the case at all schools, but if the "Columbia Model" spreads, it would be a major boon to NP education.

 

N9300 Comparative Quantitative Research Design and Methodology I 3 N9400 Practice Management 2 N9412 Informatics for Advanced Practice 3 N9538 Advanced Seminar in Clinical Genomics 2 N9600 Legal and Ethical Issues 3 N9672 Principles of Epidemiology and Environmental Health 3 N9910 Translation and Synthesis of Evidence for Optimal Outcomes 3   Total Support Core 19 Clinical Core Courses     N9480 Chronic Illness Management 2 N9700 Residency for Doctor of Nursing Practice 5-10 N9700 Residency for Doctor of Nursing Practice 5-10 N9710 Doctor of Nursing Practice I 2 N9711 Doctor of Nursing Practice II 2 N9714 Field Experience: Doctor of Nursing Practice I 1 N9715 Field Experience: Doctor of Nursing Practice II 1 N9717 Seminar: Doctor of Nursing Practice 1 N9718 Seminar: Doctor of Nursing Practice I 1 N9719 Seminar: Doctor of Nursing Practice II 1

This implies that all programs are like this. Like NP programs there is no standardization. Also if the local programs are any example the "clinical hours" are done at work. Its hard to claim extra "clinical hours" when you are working. If you look at the BSN to DNP programs they have the same minimal clinical hours. 

[LT_Oneal_PAC]

Take Columbia for example:

 

Their DNP programs is two years, to be completed AFTER a Master's, and contains the following classes listed below. In addition, there is a FULL YEAR supervised "residency" in the students field. This STRONGLY increases clinical hours/knowledge of students that complete the program and I imagine other programs will follow suit eventually. The DNP minimum clinical hours + the full year residency would actually surpass the hours of a PA program. Obviously, this is not the case at all schools, but if the "Columbia Model" spreads, it would be a major boon to NP education.

 

You seem to put a little too much stock in Columbia.

 

The post baccalaureate program is 3 years in duration. The first 5 semesters focus on the advanced practice coursework and clinical which vary across the different specialties. In the remaining 3 didactic semesters, the curriculum is offered as a Friday Cohort followed by a mentored and supervised, 1-2 semester-long residency experience.

 

The post master's program is 2 years in duration and is offered as a Friday Cohort for 4 semesters followed by a mentored and supervised, 1-2 semester-long residency experience.

 

So it's 3 years, 2 years if you have a masters. 3 of the didactic semesters are Fridays only in the post bachelor, all of them are Friday only in the post-masters. The residency is 1-2 semesters. Perhaps they mean clinical experience. Not much, even if full time. However, to your credit, they do say in the FAQ there is full calendar year residency. This may very well be the case, but it isn't a real residency. It isn't a structured learning environment, no rotations, . It's normal job that you find in your own, and you attend seminars.

 

 

Can DNP students continue to work during the program?

Yes. Students in the post-Bachelor's program can work per diem or part-time. The post-Master's program offers classes only on Fridays allowing for work during the rest of the week.. Students are encouraged to negotiate a paid position for the ResidencyThe Residency must be in an approved setting which may or may not be in the New York metropolitan area. However, attendance at scheduled seminars is required during the Residency year.

I suspect it isn't really a calendar year though since it says they are EXPECTED to complete it in one calendar year. I suspect more complete it in less.

 

 

What is the Residency? How long will it take?

Upon completion of all coursework and field experiences, students enter the Residency. In this mentored and supervised experience, the students assume a full time position as a DNP with access to and authority for expanded scope practice to master the DNP competencies. All residencies must be at a level which will allow demonstration of the achievement of DNP competencies. Residency sites include hospital-based clinics, ambulatory centers, emergency rooms, acute care units, hospice care, home care, rehabilitation and assisted living settings. During the Residency year, students must participate in regularly scheduled scholarly seminars on site at Columbia. It is expected that students will accomplish the requirements of the Residency within one calendar year and submit a DNP Portfolio, including a published article in a peer reviewed journal, in partial fulfillment of the degree.

So, you can see it's really not better than any other program. Certainly not more clinical hours than a PA program, and certainly less didactic. The best program out there is probably Vanderbilt.

 

 

 

[EMEDPA]

So, you can see it's really not better than any other program. Certainly not more clinical hours than a PA program, and certainly less didactic. The best program out there is probably Vanderbilt.

 U. Of WA and UCSF seem to turn out solid NP grads as well.