Miles to go until I sleep....we still have so far to go as a profession.

[physasst]

Some of you, like Primadonna and LW already know this story, most of you do not. I'm not angry about this. But it saddens me to know how far we still have to go as a profession.

 

I graduated with my DHSc in 2012, and as some of you know, have been developing a research career. I've been invited to attend international research collaboratives, have applied for and gotten some funding (both internal and external), have published multiple papers (with 5 more in submission now) and am working clinically in our Spine Center. Externally, I have multiple collaborators, and my research is progressing well.

 

Clinically, my career has never been better. I have complete autonomy, and am treated as an equal by my PM&R colleagues.

 

Academically here, however, is another story. Part of this story requires the background. Our Spine Center is undergoing a massive re-design. As part of this, we would like to improve the care of our Spine patients, both in the Center, as well as in primary care.

 

We have a program here called the Healthcare Delivery Scholars program. It is a program for "doctorally trained clinicians" and is designed to provide some formal mentorship in specific areas of HSR for clinical providers. I am very strong, and actually have advised the program informally on theory, specifically economic and organizational theory. I am also strong on some methodologies such as patient reported outcomes and survey methodologies, but one methodology that I have some experience with, but wanted to develop further was the use of decision aids, and the development of clinical decision and prediction rules. I also wanted to become better with systematic reviews, and particularly the meta-analyses portion. 

 

So, I applied....My Chair was completely behind this and supportive of the time requirements. He wrote a raving LOR, as did some of my other colleagues. Everyone was supportive. I knew that they had never taken a non-physician before, but I was optimistic, I had a strong background, strong support, etc.

 

I was not accepted. While this was disappointing, I also accepted initially that perhaps my application simply wasn't good enough. But then, I learned more....I was told "You are in one sense over trained, and in another, under trained. The selection committee had a significant concern that you would not be able to advance into a scientific leadership role given the glass ceiling dynamics of the (institution)". It continued..."there have been the same concerns raised in the KL2 training program with nurse PhD applicants." I was told that my "proposal was outstanding. You raised several issues which will not be going away for the (institution) and need to be addressed"

 

This is difficult to hear. At first, I thought perhaps I was over-reacting....So I waited, and then I re-read it. The only conclusion I can come to is that I was turned down, not because of a poor application, not because of my abilities, but because I am not a physician. I am a PA. I was turned down because I was a PA. My Chair couldn't believe it....he's torqued, but not much he can do.

 

Additionally, we have a School of Health Sciences here. It's where the PA program, PT program, NP program, etc are all located. Recently, 2 Associate Dean positions were posted. Ironically, the posting said that only physicians would be qualified. So, I emailed the Dean (also a physician) to confront him about this. I noted that "it is somewhat concerning to note the qualification parameters listed for the Associate Dean positions. As this is the School of Health Sciences and not the Medical School, I have to wonder why such decisions were made. It would seem to arbitrarily limit the academic career progression of non physicians here". He replied. "Yes, that's true. We are not like your typical academic institution in that regard. While non physicians can be program directors or faculty, the Associate Dean position is considered a senior leadership role. At the (institution), these senior leadership roles will always be filled by physicians. I do not see this changing easily".

 

So, my career will progress elsewhere. In the midst of the academic job hunt now. I'm teaching research methods now. The reason for posting this isn't to blame this particular institution, this could have happened and probably would at many large physician led academic medical centers. I don't blame them, I'm not angry. This is their culture, and it has been this way for decades. They aren't ready to make this change in thinking.

 

The reason for posting this is to just show how far we still have to go as a profession in making inroads in these arenas.

[skyblu]

I'm so sorry. That sounds incredibly frustrating. I hate when the letters after your name matter more than how much you know and what you can bring to the table!

 

 

[PACdan]

I'm sorry to hear that. This rings of typical turf protection by the physicians. Even as a collaborative team, they still seemed to get irked when a clinical provider (PA) with a doctorate tries to branch out in research or academia.

 

I fully understand their desire to be the leads in patient care, and rightly so; but it seems to me that a medical degree in no way validates or prepares one more for an academic or research leadership position than a PhD or DHSc.

[whoRyou]

I am not sure if I should be sad or be frustrated ... Keep up the faith

[gbrothers98]

physasst

you are a ground breaker, kudos to you. the profession needs more such as yourself, those who arent pigeon holed into the primary care manifesto and subservient role that has directed our profession for decades and arent afraid of butting up against professional limitations. keep on doing what you do, pas decades from now will appreciate the trailblazing.

best wishes in your future endeavors.

george brothers pa-c

[rpackelly]

You will probably have to leave the Big “M(othership)”.  Other PAs with doctoral degrees have been successful deans and associate deans at academic institutions, just not yours.    

 

One recent DHSc grad was successful at obtaining an academic position never before held by a non-MD at a major NYC academic medical setting.   He was told previously that it was going to be a no-go but he did eventually succeed.  

[SocialMedicine]

Let me start by saying my current academic boss completed a DHSc degree and I have learned much from her. I respect any degree which involves considerable time and effort , and from this board I know the DHSc degree equates to a considerable amount of knowledge and skills.

 

Could the issue be your doctoral degree preparation as opposed to the PA vs. MD/DO ? I am leaving my current practice and academic position for more of a full time academic post in the next few months and I know that inst would unlikely promote or recognize the DHSc in the way you desire bc it lacks what is considered a "formal research preparation and mentorship". I know this bc I asked out of curiosity. I am not saying this viewpoint is with the times or correct, HOWEVER,  I suspect many inst. outside of health sciences or PA schools would have issue with promotion based on this credential. Especially if someone is not a well established researcher. It is interesting how doctoral remote learning is increasing UNC chapel hill has an online Dr PH program. However, you do not need to be in a large medical school/health system to make a huge impact on society. What about public health schools ? or some well known/strong PA or NP programs that are not associated with a medical school ? Many PA schools are trying to expand research agenda and you would be an excellent fit. I know at least 1 program that is looking for a dedicated researcher on PA workforce issues.

 

If you love your clinical work keep doing it ... see if a PA school near you will bring you onboard .... perhaps that could create a special arrangement for you ... ALSO you have experience with remote education .... perhaps you could teach a course and be affiliated with a PA or PH school farther from home.

[physasst]

Actually no. They were impressed with the DHSc, and never had any issues or qualms with the degree. In fact, they said that I was "overtrained" for the program as a result of the DHSc. Remember, they said they have the same issues with nurses who have PhD credentials applying to these programs. I was "undertrained" as a PA.

 

I am already teaching in a PA school with remote education. There are no PA programs near me, outside of the one affiliated with this institution, and they only do clinical rotations here.  

 

This institution felt that the DHSc was a formal research preparation, in fact, I got many questions about it, and they were impressed with the applied focus. I am always careful not to give the impression that the DHSc prepares one for bench or translational sciences, but rather, is an applied science research degree. For my areas of focus in HSR, the DHSc is perfect. If I wanted to be an epidemiologist, or a bench scientist, a DrPH, or a PhD would be much better.

 

I am considering my options, and have talked with a number of mentors. Basically, I could stay here, and spend the rest of my career trying to change this culture. OR, I could move on, and move into formal academia. Which is likely what I will do.

 

I am currently working on collaborative projects with authors in Arizona (one project), England (new theory project), and Australia (response shift project) as well as a national PA study, and developing another one with a well known PA researcher.

 

Again, I'm not angry. It is what it is. It's just reflective of the barriers that we still face. That's all.

 

Mike

[True Anomaly]

Mike- while I know it would be tough to leave a place you know well and have established a reputation in, I would think that if you continued your professional growth elsewhere it would be another example of PA's excelling in true leadership roles, which adds to the pressure of Mayo eventually allowing non-physicians into those same leadership roles.

 

Best of luck to you- you deserve whatever you can get

[jmj11]

When I came to your fine institution, my boss (and he meant it) told me, "Mike, here we measure people by the care they give not by the letters after their name."  However, he only spoke for himself.  We do live in a medical caste system, and that system of course is not based on logic, on evidence-based decisions and certainly not on our performances. It is about securing one's own self-image by distinguishing yourself from and pushing down on others, to secure your own self-image.  Those physicians who are secure, like my SP was, is not threatened by someone of a different "Caste" doing things well.  Those who are insecure want to continue the farce that our caste is indeed inferior.  We do have a long ways to go.

 

Here in Washington, what was touted as an opportunity for PAs to improve their laws, also became a farce. It was dominated by a lawyer, who is now introducing legislation to ban PAs from clinic or any business ownership in the state.

[blueridge]

"I was turned down because I was a [mere] PA. My Chair couldn't believe it....he's torqued, but not much he can do."  So, so sorry your hopes have been dashed, for now.

 

The dynamics and particulars differ, but, sadly, the mindset of certain leaders at your institution is much the same as thus:

 

"In the early 1870s Pasteur was well renowned and respected in France and beyond by the scientific community but was regarded as a “mere chemist” by the medical establishment, which had difficulty accepting the germ theory of disease. Nevertheless, in 8 years, Pasteur developed immunizations against fowl cholera, anthrax, swine erysipelas, and rabies, all of which helped to promote the germ theory of disease. "

 

http://www.asm.org/ccLibraryFiles/FILENAME/0000000236/611195p575.pdf

 

 

 

[rev ronin]

Here in Washington, what was touted as an opportunity for PAs to improve their laws, also became a farce. It was dominated by a lawyer, who is now introducing legislation to ban PAs from clinic or any business ownership in the state.

Why have I not heard about this from WAPA?

[Guest Paula]

Why have I not heard about this from WAPA?

WAPAs letter was posted on C1.

[Guest Paula]

@rev ronin:  New thread started on Washington state legislation. 

[EMEDPA]

PhysAsst- Have you thought about a paid post doc fellowship? Some grads from my program at Nova have landed prestigious post doc fellowships at the cdc, vanderbilt, etc.

[physasst]

E,

 

I have...the problem is financial. A traditional postdoc fellowship would be at least a 50% cut in pay. I can't do that. Not without ending up homeless and divorced.

 

There are certain financial realities we all must face. Which is why this HEDER Scholars program was ideal. It was a research postdoc, but designed for clinicians, and allowing them to continue with their clinical salary support.

 

Mike

[whoRyou]

Mike, FWIW, I just found some funding guidelines on Stanford University's website postdoctoral scholars.

[physasst]

Mike, FWIW, I just found some funding guidelines on Stanford University's website postdoctoral scholars.

That's just it. Even using their calculator, I would be earning a salary of 49,000.

 

That would be a 62% pay cut.. I can't do that.....not and stay married at the same time. I have a family, and financial obligations.

 

I know that moving into academia will necessitate a pay cut, I have no issues with that. But a small pay cut of 10-20% is likely manageable. A large pay cut of that amount is simply not possible. When I was in my 20's, or even in my early 30's? Sure. I'm in my mid forties now. Not possible.

 

Mike