Advanced Practice Nursing Degrees to be Doctorate level after 2015

[Guest Paula]

The other creative way to solve the problem is to convince medical schools and their regulatory boards to convert PA schools to family medicine/primary care medical schools and graduate Physician Associates as PCPs.  Make it 3 years long with an 18 month residency included.  Then medical schools become open only to those interested in specialization.   Medicine is getting to be so elite in technology, genomics, mechanization, 3-d mapping, pharmaceutical advancement that the information far outweighs what a PCP does.  So leave the specialization for the brainiacs and us Physician Associates will take care of patients and refer to Physicians. 

 

DNPs will then be left behind or applying to Physician Associate school. 

 

Why are we so entrenched in old models of education?   

[CorpsmanUP]

I agree with the above if it was effectively lobbied to the med accrediting board and the AMA we could have an end run around the whole NP issue in relatively short order and possibly even kill NPs as a viable alternative to the practice of medicine.

 

 

[Maverick87]

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?

 

Wow! That is doctorate work, for sure. I didn't have to do nearly as much in my school.

[PACdan]

Wow! That is doctorate work, for sure. I didn't have to do nearly as much in my school.

 

All of the programs I was accepted to have similar requirements for graduation. They are all 100+ credit hours, all three have a thesis paper with a presentation and/or defense, and some kind of community health education project.

 

Edit: http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/68607

 

It isn't a new debate obviously (9-year old article).

[CorpsmanUP]

Same here, the graduate research project has become pretty standard at all of the schools I looked at and they were all 100+ credits.

[2234leej]

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.

 

I've looked at a lot of PA programs and you guys do pull in a lot of credit hours. No doubt about that. Just curious but what PT school did your brother in law go to? My DPT program was 120 credit hours; seems a little on the low end.

 

1. I don't think a doctorate in PA studies will solve anything for the profession.

 

2. I agree with everyone that semantics are very important and words like "collaborative" are much more positive than dependent. 

 

3. Who is in charge of getting the word out there about Physician Assistants? Is that not the AAPA's job? If they did a better job of explaining the kind of training that they go through they'd be much more utilized. The fact that people still do not know what a PA is pretty bad. 

[Will352ns]

The other creative way to solve the problem is to convince medical schools and their regulatory boards to convert PA schools to family medicine/primary care medical schools and graduate Physician Associates as PCPs.  Make it 3 years long with an 18 month residency included.  Then medical schools become open only to those interested in specialization.   Medicine is getting to be so elite in technology, genomics, mechanization, 3-d mapping, pharmaceutical advancement that the information far outweighs what a PCP does.  So leave the specialization for the brainiacs and us Physician Associates will take care of patients and refer to Physicians. 

 

DNPs will then be left behind or applying to Physician Associate school. 

 

Why are we so entrenched in old models of education?   

Then why be a PA at all?  3 years plus 18 mons.....for 1/3 of the compensation?  That's a pretty hard sell.  Not to mention that PA's would have to stay in FP.  

[Guest Paula]

I meant 3 years total including the residency.  You make a good point regarding salary, but if PA schools no longer exist and are considered primary care medical schools we would not have a PA salary.  

 

I just am beginning to think PAs will either be assistants no matter what and dependent and third tier, or we will cease to exist altogether.  

[ventana]

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?

 

Not ever sure where to begin as it seems that you are not aware of what is going on in the entire medical field right now

 

MOST 'allied health professions" are going to a terminal doctorate degree - this is NOT an MD or DO but instead a doctorate in the field you study.  All the other fields 20-30 years ago were at the BS level and with minimal change to their academic programs (usually at most adding one semester) they have become doctorate level programs.  The bus has already left the station and is flying down the road at 65mph while AAPA sits in the garage trying to fix a flat tire....

 

Again, I am not sure you have a understanding of the way degree creap works - we are following other professions, and with in a profession everyone is grandfathered and there is many many bridge programs that come up to allow people to attain the 'desired' degree.  This is sort of the norm in every profession, so I am unsure why you are asking such a question

 

Congrats on your very prestigious PhD?, however I suspect it has created a bias in your perspective that is not beneficial.  Merely look around at other professions that are at the doctorate level (notice I am not saying PhD as that is different) and you will realize that this is truly a move to simply not get left behind.

 

What is a doctorate trained PT, OT, SLP, Audiologist, Pharmd, Chiro - they are all their respective professions - nothing more, nothing less

 

Also, the length of PA education really can not increase, as we are already at 7 semesters, with med school being 8 (and some done in 6-7 semesters in 3 years for PCP track or LECOM PA track).  But we certainly can add a fellowship to raise the bar......

 

The overriding fact is that we live in a political environment that could kill us.  In the time of 5 sec sound bites and creative and destructive advertising words matter, titles matter. There is an entirely new 'doctorate' level that has developed in the past 10-20 years that is merely a clinical doctorate and it is motivate mostly by perception and political activism - which the PA field as a whole desperately needs.  

 

 

 

Why do you think we were left out of HiTech?  Because we are "assistants" and not providers

 

Do you know that CMS calls us "NPP" non physician providers - ugh.......

 

Do you know that we can not give an order for a VNA to do a single thing - ie wound care

 

Do you know that we are unable to certify a patient for Hospice?  We might have cared for them for the past 20 years and cared for their entire family, and yet we are just the "assistant" so the DOCTOR needs to sign forms....

 

So you know that we are getting LEFT BEHIND by the NP lobby - case in point - in 2012 there was a great law passed that advanced PA practice in MA to contain 5 of the 6 points that AAPA pushes for.  We had multiple paragraphs in the law and some of them are yet to be fully enforced.  The NP lobby a single line in the law to the effect "NPs can sign anything that a physician can".   Now that is a law that I can get behind......  They also have followed through and put political pressure to get the reg changed ASAP.  Why the difference?  NPs are perceived as providers - no doctors but providers, and their political machine is much more effective. 

 

 

 

 

Solution - Vote for the PAFT endorsed candidates for AAPA

Allow the movers and shakers to motivate AAPA to realize that experienced PAs in the trenches are getting beat up and loosing battles due to ineffective advocacy on a federal level (why would I hire a PA and get no HiTech monies when I can hire a NP and get $44,000!)

Open you mind to the reality that many in your profession have a very different outlook then yourself and if it does not hurt you stance or employment it would be nice to stand behind the movement (yes this is a movement and it is gaining momentum rather quickly......  but we still need to follow through on it.....)

[wjm7]

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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In regard to the research, this sounds more like master's level work to me***, at least in terms of a typical MS --> PhD progression.  You can't do doctorate level research while taking all of these classes.  You just can't.  That's why PhD programs have a at least couple years of largely class free research time scheduled after the classroom training has occurred.  I worked with a lot of PhD students while completing my previous MS degree, and those guys lived and breathed their dissertation research for years.  I worked hard on my master's thesis, and I had a lot of time scheduled for it, but I spent nowhere near the amount of time that they did researching/writing/etc.

 

Someone mentioned this being a comparison of apples to oranges, and I think that is the case.

 

***Or perhaps a master's student semester research project, which might be a part of a larger thesis.

[ventana]

In regard to the research, this sounds more like master's level work to me***, at least in terms of a typical MS --> PhD progression.  You can't do doctorate level research while taking all of these classes.  You just can't.  That's why PhD programs have a at least couple years of largely class free research time scheduled after the classroom training has occurred.  I worked with a lot of PhD students while completing my previous MS degree, and those guys lived and breathed their dissertation research for years.  I worked hard on my master's thesis, and I had a lot of time scheduled for it, but I spent nowhere near the amount of time that they did researching/writing/etc.

 

Someone mentioned this being a comparison of apples to oranges, and I think that is the case.

 

***Or perhaps a master's student semester research project, which might be a part of a larger thesis.

 

 

This is NOT a PhD

 

this is a clinical doctorate

 

VERY big difference - you have to go look, not at the PhD programs, but instead the clinical doctorate programs to compare apples to apples instead of apples to oranges.

 

Look over DPT, PharmD, Doctorate in SLP, or even DNP (which is by far WAY below the standards of PA and yet they are moving to DNP by 2015!)

 

 

Once again - we are not talking PhD - that is yet a different degree 

[taotaox1]

So NPs are the least educated app but also the only one with independent practice privileges. This has little to do with their degree and nothing to do with their education. It is almost purely a function of effective lobbying and the way they skirt around being under the BOM.

 

I personally am strongly for a name change and maybe mildly for a doctorate (only if the program length is not changed though) but these issues are notl anywhere as important as better lobbying.

 

My real fear (maybe unfounded?) with all of this is that the NPs push the docs too far and they decide to start letting start letting MDs practice as some form of midlevel with no residency to undercut them. Competing directly for jobs with MDs sounds like a nightmare.

 

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[wjm7]

This is NOT a PhD

 

this is a clinical doctorate

 

VERY big difference - you have to go look, not at the PhD programs, but instead the clinical doctorate programs to compare apples to apples instead of apples to oranges.

 

Look over DPT, PharmD, Doctorate in SLP, or even DNP (which is by far WAY below the standards of PA and yet they are moving to DNP by 2015!)

 

 

Once again - we are not talking PhD - that is yet a different degree 

 

 

Agreed.  I was referring specifically to the research aspect.  He was qualifying his PA training as doctorate worthy largely (at least in part) by noting the research he was performing.  I have a hard time seeing that research as justification for a doctorate.

 

To your point, I agree completely that we should note requirements for clinical doctorates in other fields.  I'm not saying a clinical doctorate for PAs is unreasonable, but attempting to justify the switch based on research performed in PA school makes for a weak argument.  Our intense classroom/clinical training, on the other hand, is a different story.

[BruceBanner]

My opinion?

 

I think the "doctorate" level non-physician degree (PT, NP, PharmD) is a big political dick-measuring contest used to fluff up the public perception of a profession and garner more money for schools. That's it. If a PT referred to him/herself as "Dr." I'd laugh in their face.

 

Unfortunately, however, the PA world is likely going to forced (slowly) into conforming to this new standard, and in 5 or so years we will probably see either a new professional title, the "doctorate" evolution, or both. Sadly I think this is what it is going to take for us to get independent practice rights from an insurance and state legislation perspective. Lawmakers are not going to understand medical training any better than the lay public, and they will want to see some form of extended training or "higher" degree.

 

**** the NPs. I see them as our professional nemesis. On an individual level they run the spectrum like any other clinician, but on an organizational level they are after power, period. 

[Joelseff]

 

**** the NPs. I see them as our professional nemesis. On an individual level they run the spectrum like any other clinician, but on an organizational level they are after power, period. 

 

 

Man, I wouldn't wanna see you when you're angry!  LOL  Sorry couldn't resist.

[wjm7]

Bruce, it's so hard to get a sense of how you really feel.

[BruceBanner]

Bruce, it's so hard to get a sense of how you really feel.

 

I'm working on it.

[CorpsmanUP]

Hahaha....

 

It is interesting in that I only picked up my RN as it was on the Navy's dime and only a few tests to take so it was a no brainer, yet I readily admit that when I finish PA school a NP won't be far away simply for the practice rights. I think another way we could keep some connection with the heritage of the profession allowing upward mobility of healthcare providers is to look at the PharmD. Move EVERY program to CASPA with a uniform admissions process and required PreReqs, which could be around 60+ credit hours even, but then allow for direct admissions where you pick up the BS, MS, and Doctorate over the next three years. It would allow moving from a two year curriculum to three years but would cut out additional costs due to time and the need for a BS before admissions. Go to one year didactics, one year rotations, one year residency.

[PACdan]

Agreed. I was referring specifically to the research aspect. He was qualifying his PA training as doctorate worthy largely (at least in part) by noting the research he was performing. I have a hard time seeing that research as justification for a doctorate.

 

To your point, I agree completely that we should note requirements for clinical doctorates in other fields. I'm not saying a clinical doctorate for PAs is unreasonable, but attempting to justify the switch based on research performed in PA school makes for a weak argument. Our intense classroom/clinical training, on the other hand, is a different story.

How is it ANY different than the level of research performed in a 3 year PT doctorate? Similar amount of credits, time, etc.

 

Again, not a PhD by any means. But you're some how excusing a DPT program with the same level of research while stating that a PA shouldn't award one?

 

 

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[wjm7]

How is it ANY different than the level of research performed in a 3 year PT doctorate? Similar amount of credits, time, etc.

 

Again, not a PhD by any means. But you're some how excusing a DPT program with the same level of research while stating that a PA shouldn't award one?

 

 

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I doubt it is, and I suppose you make a good point.  That being said, I'm not "excusing a DPT program."  I don't think either programs should be awarded doctorates because of the research performed by their students.  But as someone was mentioning, that's not what we're discussing, and that's not what these programs are doing.  They are awarding a clinical doctorate.  And, as I said, that's a different story.

[wjm7]

Hahaha....

 

It is interesting in that I only picked up my RN as it was on the Navy's dime and only a few tests to take so it was a no brainer, yet I readily admit that when I finish PA school a NP won't be far away simply for the practice rights. I think another way we could keep some connection with the heritage of the profession allowing upward mobility of healthcare providers is to look at the PharmD. Move EVERY program to CASPA with a uniform admissions process and required PreReqs, which could be around 60+ credit hours even, but then allow for direct admissions where you pick up the BS, MS, and Doctorate over the next three years. It would allow moving from a two year curriculum to three years but would cut out additional costs due to time and the need for a BS before admissions. Go to one year didactics, one year rotations, one year residency.

 

Hi Corpsman,

 

Can you explain what you mean by "look at the PharmD"?  I'm just a little confused by what that means.

[PACdan]

I doubt it is, and I suppose you make a good point. That being said, I'm not "excusing a DPT program." I don't think either programs should be awarded doctorates because of the research performed by their students. But as someone was mentioning, that's not what we're discussing, and that's not what these programs are doing. They are awarding a clinical doctorate. And, as I said, that's a different story.

I'm with you on the doctorate aspect as a whole. I think it's silly and I don't want to NEED one. As almost everyone starts their reply here "it's ridiculous...but in X number of years we'll be forced to go that route".

 

But at the same time, if PT, OT, and NP are gonna run around waving their clinical doctorate (and enough people are suckered by it) by gum I want one if I did just as much or more work, sheesh.

 

At the end of the day I know I'm entering a very challenging program that awards a master's degree. I just don't want to graduate in 2.5 years and get out only to be snidely told by someone "well we see you don't have a doctorate".

 

 

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[CorpsmanUP]

Hi Corpsman,

 

Can you explain what you mean by "look at the PharmD"? I'm just a little confused by what that means.

 

When Pharmacy moved to a doctorate they realized it would no longer be economical to continue practicing at their pay rate if you were "required"to get a BS and then move onto a doctorate with the required debt load of multiple degrees. So for pharmacy you are required some 60 odd hours of prereqs and can then move into a full time 3-4 year program and leave with your doctorate. They are one of the few professional schooling programs set up like PA programs, where school is a full time job. You can go directly from community college to getting your doctorate in Pharmacy in 4-6 years flat.

[wjm7]

I see.  I didn't know that.  I'm wondering how common it is for students to take that route.  I've only known people to take the BA/BS --> PharmD path.

[CorpsmanUP]

While it can be more competitive to have the BS done, I know a lot who nailed their AS degree with a 3.7+ GPA and solid exp and moved on to their PharmD program.