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Doctoral Degree for PAs


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Lastly, it doesn't have to be mandatory, but many are against having the option at all. Why? I can't logically answer this.

 

Here's the problem -- you wont get it both ways.  When physicians switched to a doctorate degree, in a few years it became mandatory for everyone.  When pharmacists switched over to a doctorate, it became mandatory for everyone.  When physicla therapists switched to a doctorate, it became mandatory for everyone.

 

There's no such thing as 2 different educational pathways with the same credentials.  You introduce a doctorate and after a few years it will be no longer optional.  The DNPs are doing the same thing.

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Here's the problem -- you wont get it both ways. When physicians switched to a doctorate degree, in a few years it became mandatory for everyone. When pharmacists switched over to a doctorate, it became mandatory for everyone. When physicla therapists switched to a doctorate, it became mandatory for everyone.

 

There's no such thing as 2 different educational pathways with the same credentials. You introduce a doctorate and after a few years it will be no longer optional. The DNPs are doing the same thing.

Well you can. Other professions just decided to evolve and not stagnate. As far as the nurses, they have had multiple entry points for a while and continue to have them. NPs have yet to mandate a doctorate, though the AACN recommends it, after a decade of having the DNP existing. Nurse anesthetist are the only ones mandating an entry level doctorate but only by the year 2025.

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Put yourself in the position of an administrator who runs a masters degree PA program.  You are considering granting a doctoral degree.  Here are your 2 options:

 

1.  Just change the name of the degree, problem solved.

 

2.  Add a few months to the training, jack up tuition by a few thousand, get many millions of dollars in free money via student loans.

 

 

Please tell me why a PA administrator would choose option #1.  Even if he wanted to, the regents/board of directors wouldnt let him do it.  No way is a PA program going to turn down MILLIONS of dollars in free money from the federal government via student loans.  

 

Lets face it -- there's a lot of dreamers on this board who have conjured up some kind of unicorn/rainbow scenario where PA programs will ignore their own self interest and just hand out doctoral degrees for no added cost.  This thought persists DESPITE the fact that NO OTHER HEALTHCARE EDUCATIONAL PROGRAM has ever operated this way.  

 

You guys can keep dreaming in one hand and crapping in the other, and see which one fills up first.  

 

I'm not necessarily opposed to a PA doctorate, but you guys need to be honest.  Here is what will happen if we pursue this route:

 

1.  In a few years, doctorate will be mandatory for everyone

2.  Cost of school and debt load is going to increase

3.  Duration of school is going to increase

4.  PA training pathway will be a lot closer to MD

 

Maybe the benefit of the doctorate outweighs all this stuff, but I have to laugh when I hear people say that PA programs are just going to hand out doctorates with no additional work and no additional cost.  That makes ZERO sense from the PA program's point of view.  

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it's actually an MS level program with an optional DPAM postgrad residency. I know the director.

Yes - I know.  Lynchburg College is only a little drive east on 460 from here.  Our EM Fellowship Director went to AT Still with Jeremy. The website is a little ambiguous on the DPAM - but perhaps since it is so early that is by design. 

  • 9 months additional instruction post-master’s degree
  • Coursework in leadership training in area including healthcare management and law, organizational behavior, disaster medicine, global health
  • Clinical fellowship

We'll have two more PA schools in Virginia in the next 2 years (Lynchburg and Mary Baldwin)!

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I still fail to see why folks would go to a longer, more expensive PA school to get a DPAM and still have a restrictive license instead of completing another 6-15 mos of medical school, graduating as a physician, then completing a residency and becoming a fully licensed independent practitioner. Just don't get it.

 

Perhaps this is the REAL issue?  PAs are poised for independent practice and maybe we need to focus on an unrestricted license to practice medicine within our scope of training.  With all restrictions from insurance companies, medicare, government employers (IHS, VA, BOP,etc. ) lifted PAs could then practice to the top of their licenses.  There are however many PAs who want to remain dependent practitioners and like the supervised environment.  I guess it affords a comfort level to them and they may think the physician will take the fall for them if they mess up?   I am beginning to believe that the supervised surgical PA is much different than the supervised medicine PA in thought process and how we approach our profession.   I'm in the camp with the medical PA and with Ventana...

 

I'm a much "younger" PA in years of service (10) but older in age so my thought process is not from the 1980s.  

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Ok, so let's say I graduate from my 3 year PA program and in the future some legislation occurs to award all future PA graduates a doctorate. What are the chances that I would be retroactively awarded a doctorate? I'd think close to a 0%?

 

I don't think anyone is suggesting such a thing would happen.

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Ok, so let's say I graduate from my 3 year PA program and in the future some legislation occurs to award all future PA graduates a doctorate. What are the chances that I would be retroactively awarded a doctorate? I'd think close to a 0%?

 

No one forced you to go to a three year program.  Three years for a masters is ludicrous.

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I still fail to see why folks would go to a longer, more expensive PA school to get a DPAM and still have a restrictive license instead of completing another 6-15 mos of medical school, graduating as a physician, then completing a residency and becoming a fully licensed independent practitioner. Just don't get it.

 

I would think the hope is that the doctorate can be tagged onto the masters at a later date, at your convenience, and potentially online.  Also, the aura surrounding residencies is incredibly punitive.

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a nice compromise might be to do what happened when pa programs went from BS to MS. add one course without extending the duration of training. students pay for an extra class(so program is happy) and get a DMS for their efforts. in the grand scheme of things an extra 3 unit class on "doctoral writing for the health sciences" probably won't break the bank for anyone already in pa school. programs can then also sell a MS to DMS bridge program like the current BS to MS programs.

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This is such a button pushing issue.

Not sure why. Those whom are practicing clinically right now wont be affected by it. Similar to when the move to a master's degree occurred. I have been able to practice for 15 years with a bachelor's and a certificate of completion.

It is likely that I could continue to practice with these qualifications for the next 10 also. But if I wanted to do something else, teach, admin, etc, I would probably run into roadblocks due to degree deficiency, particulary the masters. It is the world we live in, like it or not.

 

So I am in the process of getting the masters. It will take some time and money but what doesn't today?

 

The PA profession is behind though. We relish in our supervision but the reality is that the supervision isn't all it is cracked up to be. The expectation is for us to function very independently in many cases and situations. Since that is the case, why not fully realize our due?

 

We are also behind in comparison to other professions. NP, PT, Pharm. Their terminal degree is the doctorate. Most of these programs are a 3-4 year add on to a bachelor degree. I do feel that an extension of PA program training is needed especially in the clinical area. I do get a kick out of writing orders to have all these doctors do things for my patients, but this little insular world will only last so long. We also got left behind because we were wrongly categorized with HITECH monies. I also wonder why my services are only worth 85% to medicare, especially when the physician who was going to get 100% sent their patient to me in the ED to evaluate?

 

This will work itself out in the future just like the change from BS to MS did. Programs will benefit financially, debt will rise, there will be some students that are good candidates but wont become a PA due to this. There will be some PAs who wont agree, they will keep their MS degree, wont advance to a doctorate. That is their right. It will also put a damper on program establishment, limit the number of graduates. A supply and demand imbalance will lift salaries. I dont see that as a bad thing.

 

As for MD being a terminal degree, that is misplaced. I always look at becoming a PA this way: I chose an alternate route to practice medicine, one that has given me more flexibility than the usual MD pipeline. Our goal is to maintain this flexibility despite the increasing degree requirements. We are in the midst of much change in our industry. We need to stay ahead of the curve so that we are not left behind. What isnt important to this generation of PAs will likely be very important to the next several. Foresight today will lay the successful path for those following. We need PAs with doctorate degrees. They will be leaders who can sit at the healthcare table equally as a decision maker.

 

Regards

G Brothers PA-C

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I'm torn.  I believe, as others have said, that the doctorate degree for medical practice IS already available, the MD/DO. Having said that I also see that we are "getting left behind" by our contemporaries in healthcare and "see" where the Doctorate for PAs would try to fit in. So, I don't know. I suppose if the Doctorate became available (and yes it should be DMS vs DPAM or some other Doctorate of Assistance or studies or whatever...) I would consider it. 
 
ANd having said ALL that...I would still rather focus on getting the name changed! but perhaps getting a Doctorate past is easier than getting a PART of our name changed. 

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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:

 

Introduction

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

  • 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. 

Closing Remarks

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. 

 

NOTE

 

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….

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I'm torn.  I believe, as others have said, that the doctorate degree for medical practice IS already available, the MD/DO. Having said that I also see that we are "getting left behind" by our contemporaries in healthcare and "see" where the Doctorate for PAs would try to fit in. So, I don't know. I suppose if the Doctorate became available (and yes it should be DMS vs DPAM or some other Doctorate of Assistance or studies or whatever...) I would consider it. 

 

ANd having said ALL that...I would still rather focus on getting the name changed! but perhaps getting a Doctorate past is easier than getting a PART of our name changed. 

getting our name changed will be easier with a DMS than a lower level degree. not too many "assistants" out there with doctorates....

The AAPA has made great strides in promoting PA over physician assistant and even today sent out a memo on the importance of spelling physician assistant correctly without 's, etc.

name change will happen someday. it's inevitable, along with future requirements for post-graduation training(internships, etc) AND more tests(CAQs, etc). the docs went through all of this 50-75 years ago. we are walking the same road that they did. I think lateral mobility will go away. I don't really see that as a bad thing. I see lots of PAs from other fields try to float to the ER and do a shift or 2 /month in addition to their regular jobs in dermatology, ob, etc. Some of them are ok. Most really are kind of scary when it comes to disorders outside their primary specialty, just like docs trying to wing it in areas outside their experience. too many docs and facilities feel " a pa is a pa" and that we are all interchangeable. I couldn't do the work of many on this forum who work in surgical fields or medicine subspecialties and most of them couldn't do my job.

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Above all things, a PA program seeking doctorate status MUST meet regional accreditation criteria and fulfill all ARC-PA standards to operate. 

 

 

Dean Davenport, are there enough PA faculty with the appropriate degree to teach during the didactic phase? Or be Program Directors according to the various regional accreditation criteria? Are clinical faculty required to have the requisite terminal degree? Sounds like this might be a good way to cut down on the proliferation of programs.

 

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Dean Davenport, are there enough PA faculty with the appropriate degree to teach during the didactic phase? Or be Program Directors according to the various regional accreditation criteria? Are clinical faculty required to have the requisite terminal degree? Sounds like this might be a good way to cut down on the proliferation of programs.

 

 

 

HI LESH,

 

You pose an excellent question.  I have had preliminary discussions with people heavily involved in my regional accreditation area.  According to them, if the change is simply a degree status, program faculty would be able to remain as it had before.  I will, however, need to do much more research on this specific question before I can give a definitive answer.  This includes a thorough review of the regional accreditation bylaws and mandates.  Excellent question.  

 

G

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HI LESH,

 

You pose an excellent question.  I have had preliminary discussions with people heavily involved in my regional accreditation area.  According to them, if the change is simply a degree status, program faculty would be able to remain as it had before.  I will, however, need to do much more research on this specific question before I can give a definitive answer.  This includes a thorough review of the regional accreditation bylaws and mandates.  Excellent question.  

 

G

I think you may find that the different regional bodies have slightly different criteria, or that the standards are worded in such a way that institutions feel more comfortable interrupting that the terminal degree is the only one acceptable to teach. Just saying. If I recall, that was (maybe is) a concern with the DNP.

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I think you may find that the different regional bodies have slightly different criteria, or that the standards are worded in such a way that institutions feel more comfortable interrupting that the terminal degree is the only one acceptable to teach. Just saying. If I recall, that was (maybe is) a concern with the DNP.

 

Thank you again for the discussion LESH. In reply, I must say, however, that your concerns have not materialized.  It appears our profession is the limiting player, not the regional accreditation body.  Speculation only goes so far.  The best answer comes from the subject matter experts.  Also, the doctorate option is just that, it does not force the profession (as a whole) to convert.  The world isn't that black and white.  

 

Again, good debate, good discussion.  Thanks.

 

G

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Thank you again for the discussion LESH. In reply, I must say, however, that your concerns have not materialized.  It appears our profession is the limiting player, not the regional accreditation body.  Speculation only goes so far.  The best answer comes from the subject matter experts.  Also, the doctorate option is just that, it does not force the profession (as a whole) to convert.  The world isn't that black and white.  

 

Again, good debate, good discussion.  Thanks.

 

G

Good point sir, but this is all specualtion isn't it? True I am not a subject matter expert, just curious. You are correct nothing is black and white even if printed in black and white. I only pose the question and speculated because WASC says this:

 

Indicator 3.2 The institution’s hiring process is marked by clear communication regarding job descriptions, expected job skills, and procedures for the selection of personnel.

 

Discussion Questions

To what extent do job descriptions accurately reflect position duties, responsibilities, and employer expectations?

 

By what means does the institution verify the qualifications of applicants and newly hired personnel

 

As you know ARC-PA says this: A single institution must be clearly identified as the sponsor of the program and must be authorized under applicable law to provide a program of post secondary education. It 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.

 

If an institution accredited by an organization like WASC, a regional accrediting body, must comply, as well as what ARC-PA requires the administrators are compelled to comply. If the doctorate degree for PA turned out to be the terminal degree (and employer expectations) wouldn’t a PA program have to comply? 

 

 

I'm not trying to start crap Gary, those days are soooo over for me. Lol.

 

Les

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I would assume any PA program granting a DMS would require at least one faculty member(likely the director) to possess a doctorate themselves. not every member of the faculty would need one. Many MS programs today still have folks teaching without MS degrees as they are "subject experts".

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