PA Doctorate- It's all about public perception

[Grinder993]

I have been struggling for some time to understand why the PA profession is so stubborn. The nursing lobby has made a strategic move to the DNP. The PA is now the ONLY allied health profession without a doctoral degree. We are behind the curve...as usual...thanks AAPA.

The substance of the DNP is irrelevant. What is relevant is that in the arena of public perception, the DNP appears more qualified than a PA with a Master's degree. When the nursing lobby goes before congress, who do you think the lay congress people will automatically believe are more qualified? A Doctoral NP or a Master's PA? We are losing the fight in the arena of public perception and ultimately because of that will lose in the arena of congressional favor, licensing and priveleges.

 

I do believe if the PA profession does not move to advance itself, I can see a day where the Doctoral NP, after much lobbying by the ANA, gets approved to supervise the lower degree MS PA-C. The DNP is now licensed to be a fully independent practitioner in 16 states, how long do you think this will take before we are working for DNPs?

 

So let me propose a pathway for redemption. Leave the MS degree as the graduating degree. But encourage and develop more Doctoral level PA residency programs. That way the Doctoral degree for the PA actually represents something, represents more knowledge and training in an area of specialty. Also this pathway would further mirror the training pathway that MD's endure thus further exemplifying the bond between the PA and MD, like minded in training and education. The program the Army and Baylor have instituted should be studied and repeated. I understand it is hard to get PA residency programs because unlike MD residency programs, PA residency programs are not subsidized by Medicare. Maybe the AAPA should focus some energy there?

 

I am just so tired of hearing the old timer PAs saying "we don't need degree creep, the BS was just fine or the certificate is just fine" these PAs have no idea that none of that matters. What matters is public perception and right now the DNP is kicking our a$$.

[EMEDPA]

 

So let me propose a pathway for redemption. Leave the MS degree as the graduating degree. But encourage and develop more Doctoral level PA residency programs. That way the Doctoral degree for the PA actually represents something, represents more knowledge and training in an area of specialty. Also this pathway would further mirror the training pathway that MD's endure thus further exemplifying the bond between the PA and MD, like minded in training and education. The program the Army and Baylor have instituted should be studied and repeated. I understand it is hard to get PA residency programs because unlike MD residency programs, PA residency programs are not subsidized by Medicare. Maybe the AAPA should focus some energy there?

I am just so tired of hearing the old timer PAs saying "we don't need degree creep, the BS was just fine or the certificate is just fine" these PAs have no idea that none of that matters. What matters is public perception and right now the DNP is kicking our a$$.

 

agree with this concept. a doctorate level residency is a good idea.

I think this is where the profession is headed:

step 1: pa programs become 3 yrs (like usc) to add clinical time as many current students have poor prior hce.

step 2: required specialty exams("optional" nccpa exams start next week)

step 3: required residencies for everything but primary care

step 4: residency required to take specialty exam

Emedpa

Current DHSc student

[physasst]

As a current DHSc student, I have a different view, although I completely respect yours EMED....

 

#1- I am strongly, strongly opposed to the entry level degree for PA's being made to be a Doctoral. While students lacking clinical experience is a problem (I have been vocal on here about that before) I do not think that degree creep is the answer. Making the degree longer and more expensive is NOT the answer. Physicians don't care...and to be honest, I don't think the public gives a rats a** either.

 

Most MD's think the DNP degree is a joke. NP's are not under the Board of Medicine, and, although I think they should be (I also think that they should have to take their certification exams on a recurrent basis) it's not going to happen.

 

Because of this, a DNP will never be allowed to supervise a PA....reductio ad absurdum....

 

#2- I am opposed to the new NCCPA exams and will not take the EM one. I refuse to, as I do not think it is in the best interest of my profession. I attend many workforce conferences and meetings, and from a strict researcher perspective, the most attractive thing about the PA profession as a commodity item, is the ability for providers to move between specialties....I worry that this latest move takes us in the wrong direction....

 

#3- This is an interesting item E....only because I think that primary care may require a residency in many respects more than any other specialty....

 

Also, who will fund all of these residencies? How will they be paid for? Who will oversee them? ACGME? We recently increased medical school enrollment (by 2018) by 30%....but there is no money to increase the number of ACGME slots, and in fact, there is some recent news that we might lose some with cuts to Medicare. So what did we do? We didn't increase the number of physicians in the least.....all we did was homogenize the workforce....

 

I'm not opposed to the concept, but I can't see it happening any time in my career...unless we find some very large pool of money just laying around....

 

If we want to tie "clinical doctoral" degrees (I could really argue that the DSc IS NOT a clinical doctorate [neither, BTW, is the DNP, despite their claims] and is really an academic/research doctorate that is completed WITH a clinical residency - doesn't make the Dsc a clinical doctorate) to optional residencies already in existence, I would not be opposed.....

[EMEDPA]

 

#1- I am strongly, strongly opposed to the entry level degree for PA's being made to be a Doctoral. While students lacking clinical experience is a problem (I have been vocal on here about that before) I do not think that degree creep is the answer. Making the degree longer and more expensive is NOT the answer. Physicians don't care...and to be honest, I don't think the public gives a rats a** either.

 

Most MD's think the DNP degree is a joke. NP's are not under the Board of Medicine, and, although I think they should be (I also think that they should have to take their certification exams on a recurrent basis) it's not going to happen.

 

If we want to tie "clinical doctoral" degrees (I could really argue that the DSc IS NOT a clinical doctorate [neither, BTW, is the DNP, despite their claims] and is really an academic/research doctorate that is completed WITH a clinical residency - doesn't make the Dsc a clinical doctorate) to optional residencies already in existence, I would not be opposed.....

 

I am not for entry level doctorates either.

the problem isn't with md's re the doctorate it's with insurance companies and paper -pushers who think a doctorate is always better than an ms and a "practitioner" is always better than an "assistant". doctors don't run medicine anymore, hospitals(run by nurses and paper pushers) and insurance companies do. they don't know/care what a pa is or in the case of nurse admin folks have a conflict of interest and always choose np over pa because they are nurses. I would agree with you that a DSc is an academic degree. still looks good to have one if you and a DNP apply for the same job.

[EMEDPA]

#3- This is an interesting item E....only because I think that primary care may require a residency in many respects more than any other specialty....

.

I think we can argue effectively that our basic pa training prepares us to do primary care day 1 out of school. it's a bit harder to say we can do derm, neurosurg., nephrology, hospitalist, etc when many pa's have no exposure to these things in school. some folks go out of their way to get extra training in specialties through electives but many do not.

[Grinder993]

I am not for entry level doctorates either.

the problem isn't with md's re the doctorate it's with insurance companies and paper -pushers who think a doctorate is always better than an ms and a "practitioner" is always better than an "assistant". doctors don't run medicine anymore, hospitals(run by nurses and paper pushers) and insurance companies do. they don't know/care what a pa is or in the case of nurse admin folks have a conflict of interest and always choose np over pa because they are nurses. I would agree with you that a DSc is an academic degree. still looks good to have one if you and a DNP apply for the same job.

 

AMEN EMEDPA!! Thank you for further making my point...very well put. This is exactly what is driving my concern.

[winterallsummer]

From the perspective of a pre-PA, if getting a PA degree required 3 years and a residency, why would I not just go MD? I mean at 3 years plus 1 residency you are getting closer to actually being med school. Just my two cents feel free to disagree.

 

And yes I'm aware med school is 4 + 4, vs 3 + 1, but if you are going to do 4 years of professional medical training, why go on to be a PA instead of an intern?

[EMEDPA]

if you are going to do 4 years of professional medical training, why go on to be a PA instead of an intern?

no o-chem, biochem, physics, upper level math and mcat are reasons(those were mine-they weren't very good ones then or now but they are reasons).

no living on 40k/yr for 3-7 years as a resident is another.

pa at 3+1=4 is still around half of md at 4+3(min)=7. some folks just want to get working and making $ and the difference of 3 years is a big deal.

[Grinder993]

From the perspective of a pre-PA, if getting a PA degree required 3 years and a residency, why would I not just go MD? I mean at 3 years plus 1 residency you are getting closer to actually being med school. Just my two cents feel free to disagree.

 

And yes I'm aware med school is 4 + 4, vs 3 + 1, but if you are going to do 4 years of professional medical training, why go on to be a PA instead of an intern?

 

Becoming a PA is not a short cut to a medical career. It is a career in and of itself. If you want to be a PA then 2+1 (residency) better prepares you for that career. If you want to be an MD then go be an MD. I don't believe that there is a magical number of years of PA training that at which people who were going to go to PA school will suddenly decide to go to MD school. You are still saving several years the PA route vs MD. I think most of the people who even consider the "well if it's 3 or 4 years to be a PA then why not just go 3 or 4 more and be an MD" are likely representative of the new phase of very young and very inexperienced people that are filling our PA programs today, that do in fact see it as a short cut to $$.

[EMEDPA]

I think most of the people who even consider the "well if it's 3 or 4 years to be a PA then why not just go 3 or 4 more and be an MD" are likely representative of the new phase of very young and very inexperienced people that are filling our PA programs today, that do in fact see it as a short cut to $$.

yup. totally agree.

[andersenpa]

Perception is critical.

We won't end up being supervised by NPs.

If the issue is insurers and legislation, then we need a mandatory doctorate AND independent practice because if you are trying to keep up with the NPs, as soon as you claim parity with their degree they will claim superiority with their independent practice. And we will not get independent practice as long as we are in the BOMs.

Residency associated doctorates are a nice idea but not a cure all for the problem you are posing.

[Beorp]

pa at 3+1=4 is still around half of md at 4+3(min)=7. some folks just want to get working and making $ and the difference of 3 years is a big deal.

 

The place where this math becomes weaker is when we look internationally as the PA concept is taken up by places like the UK, Australia and New Zealand when we include undergraduate education. Undergraduate entry medical education means that the "time in school" math doesn't work as well.

 

PA would then become 4 (undergrad degree) + 3 (PA school) + 1 (residency) = 8

Physician would be 6 (medical school) + 3 (residency) = 9

 

This would obviously not matter to the more traditional PA applicants with tons of high quality HCE from a real health profession that they probably got an undergraduate degree to enter. The group who it would seem to affect are those who do CNA or whatever the quickest HCE they can get while doing their undergrad degree just to check the HCE box and go to PA school. So maybe it isn't a bad thing...

[Grinder993]

Perception is critical.

We won't end up being supervised by NPs.

If the issue is insurers and legislation, then we need a mandatory doctorate AND independent practice because if you are trying to keep up with the NPs, as soon as you claim parity with their degree they will claim superiority with their independent practice. And we will not get independent practice as long as we are in the BOMs.

Residency associated doctorates are a nice idea but not a cure all for the problem you are posing.

 

Let's not mix point of this thread. I am not advocating independent practice. We can actually make quite a statement with the Doctoral residency programs. We all know the DNP does nothing but add a title for the NP's. But it is a very important title in today's title driven business that we call medicine. A Doctoral degree is better than a Master's degree...or so the lay people think. The "lay people" are congressmen/women, legislators, insurance firms, lawyers....policy makers. A DSc-PA, residency trained in an area of specialty will acuire the degree to keep the field level but also allow PA's to become better educated in a more rigorous didactic and clinical residency environment that will expedite the learning curve of your chosen field of specialty. Therefore the DSc would actually stand for something and signify a higher level of training. Unlike the DNP which indicates a few extra theory papers online got them a doctorate title.

[andersenpa]

Let's not mix point of this thread. I am not advocating independent practice. We can actually make quite a statement with the Doctoral residency programs. We all know the DNP does nothing but add a title for the NP's. But it is a very important title in today's title driven business that we call medicine. A Doctoral degree is better than a Master's degree...or so the lay people think. The "lay people" are congressmen/women, legislators, insurance firms, lawyers....policy makers. A DSc-PA, residency trained in an area of specialty will acuire the degree to keep the field level but also allow PA's to become better educated in a more rigorous didactic and clinical residency environment that will expedite the learning curve of your chosen field of specialty. Therefore the DSc would actually stand for something and signify a higher level of training. Unlike the DNP which indicates a few extra theory papers online got them a doctorate title.

 

I'm not saying that you are advocating independence. The OP states that we suffer because NPs are ahead: "The nursing lobby has made a strategic move to the DNP. The PA is now the ONLY allied health profession without a doctoral degree. We are behind the curve...as usual...thanks AAPA." I don't think the doctorate will hurt, but if competition for parity with NPs is the problem then you still have to face the hurdle of independence, which they have.

 

A doctorate may (not sure) mean something to the lay public (to me lay public means patients and folks reading the paper), but it means nothing to our physician colleagues (SPs, BOM, independent physician lobby). Hopefully it will open doors for PAs who have been shut down thus far by the degree. Add in the name change and it only helps, especially to legislators who know nothing of medicine and see our name/letters only.

 

Residency training is great; I did it, and I think it makes us a better profession clinically. The seats aren't there for everyone unfortunately. Personally I think it means a lot to PAs and far less to everyone else simply because they know nothing of general PA training, let alone postgrad PA training.

 

I'm not saying you have a bad idea but there are innumerable obstacles, mostly related to ignorance, to overcome. A long road ahead!

[physasst]

Let's not mix point of this thread. I am not advocating independent practice. We can actually make quite a statement with the Doctoral residency programs. We all know the DNP does nothing but add a title for the NP's. But it is a very important title in today's title driven business that we call medicine. A Doctoral degree is better than a Master's degree...or so the lay people think. The "lay people" are congressmen/women, legislators, insurance firms, lawyers....policy makers. A DSc-PA, residency trained in an area of specialty will acuire the degree to keep the field level but also allow PA's to become better educated in a more rigorous didactic and clinical residency environment that will expedite the learning curve of your chosen field of specialty. Therefore the DSc would actually stand for something and signify a higher level of training. Unlike the DNP which indicates a few extra theory papers online got them a doctorate title.

 

But again, not to nitpick, but the DSc won't represent additional clinical training. Anyone, even non medical, will recognize that it is a research degree. It's academic. You, with a DSc degree, could never use the title "Doctor" in a clinical setting...It's the same as being a PA with a PhD. The residency would, but you have to remember, for any DSc degree to be accredited, the academic work is SEPARATE from your residency. That's the way the Army-Baylor program works. They are merely completing a DSc in ADDITION to the residency.

 

So you wouldn't be able to use the title clinically......

 

Not unless you are trying to deliberately mislead your patients that is. The smart, educated patients will know right away....So, I'm not sure what it would do from a "perception" standpoint....the name change would likely have a much larger impact...

 

Also, insurance companies will know that the DSc is a RESEARCH doctorate....not sure it would help with them....

 

Heck, my institution won't let you even have PhD on your name tag, unless you work directly in research. MD's can have both, but no one else (yes, this is one of my current battles). One of my better friends has her DNP, and she is not allowed to use the title, or even have the initials on her name tag. Not in the clinical setting.

 

Just some thoughts.....

[GeneValgene]

PAs are trained in medicine and practice medicine

the highest degrees earned in medicine are MD and DO

IMHO, MD/DO bridge or bust

doctorate in PA sounds absurd

if a doctorate becomes entry level in PA, i'd feel forced to go back to medical school :(

[treejay]

Think outside the box a little. For one, many proposing a doctorate for PA's aren't advocating for it to be the entry-level degree. Rather, many if not most are advocating for it to be the TERMINAL degree. Big difference. Secondly, the path for a PA is different that that of an MD/DO, obviously. Sure the curiculum is modeled from med school, but it's a different path. Every path has an end somewhere and there are those who are proposing to extend the trail for those who want to take it. For those who want to stop at MS, more power to 'em. Sure PA's practice medicine, but we're just one cog in the healthcare wheel. Each healthcare cog has it's terminal degree and there are those who are advocating to broaden the PA's. I'm not saying I'm for it or against it. I just have the ability to see both sides and keep an open mind.

 

But to me the concept that PA's practice medicine and if they want a doctorate they should become doctors is bunk. Closed minded, unimaginitive and unambitious. And it doesn't address the issue of staying up with nurse practitioner trends, our biggest competition for jobs.

 

PAs are trained in medicine and practice medicine

the highest degrees earned in medicine are MD and DO

IMHO, MD/DO bridge or bust

doctorate in PA sounds absurd

if a doctorate becomes entry level in PA, i'd feel forced to go back to medical school :(

[EMEDPA]

Kind of interesting that 3 of the most vociferous folks on this thread have doctorates ( grinder), are almost done with one(physasst), or are just starting one(me).

[physasst]

Kind of interesting that 3 of the most vociferous folks on this thread have doctorates ( grinder), are almost done with one(physasst), or are just starting one(me).

 

Yep..LOL. A doctorate has to have a focus....Most in academia will be very quick to point out that a DSc is NOT a clinical degree, no matter how you slice it. It is a research doctorate, very similar to a PhD.

 

BTW, I'm thinking of doing a second doctoral when I am done with this. Although my wife is threatening me with bodily harm should I even consider it, so I don't know if it would happen....LOL.

[LIPPER]

As another put it "alphabet soup".... could be just as easily argued will be relevent only to the academia-based crowd.... I see RN's working with mail-order doctorates....and snicker. If obtaining an adanced degree just for the title, with no PRACTICAL application...simply to keep up with the heard....necessary maybe...But I think that's sad.

[LESH]

A Modest Proposal

 

For parity with the NPs (for whatever purpose) then the currently accepted terminal degree is not going to be adequate is it? It’s only a Masters. We need a doctorate and we need to make it mandatory for practice. We should be gearing up (just like the DNPs) to have every entry level PA program confer a doctorial degree. That would cut down the number of programs considerably at the entry level; wouldn’t have to worry about oversaturation anymore. However, we may be able to convert some of the programs to specialty post grad programs that can award a doctorate.

 

If the NCCPA requires a doctorial degree as part of the eligibility to take the PANCE that may help with the state licensure issue, because the regulatory committees usually defer to NCCPA. The NCCPA would also help get the word out about the profession to the public, payers and credentialing committees. They have a vested interest being the sole owner of the “C”. I like it! And keep those specialty exams coming. Can’t have enough of them! We need more formative and summative data on the workforce. Think of the opportunities at Academic Health Centers for doctorial prepared PAs to start branching out into specialty board preps.

 

Just like our colleagues in Nursing, PA academia should start increasing the on line opportunities for the Doctorate. We should set a ten year plan for every PA practicing to earn their doctorate. Every BOM or PA regulatory committee should require a doctorate for licensure (like Mississippi and Ohio require a Masters now). AAPA has experience helping craft such state legislation

 

Exciting times for our Brave new PA world are ahead my friends. I am seeing the error of my ways. Terminal Degrees are the way to go.

 

What do you all think? :;;D:

 

LesH

[ventana]

I am not for entry level doctorates either.

the problem isn't with md's re the doctorate it's with insurance companies and paper -pushers who think a doctorate is always better than an ms and a "practitioner" is always better than an "assistant". doctors don't run medicine anymore, hospitals(run by nurses and paper pushers) and insurance companies do. they don't know/care what a pa is or in the case of nurse admin folks have a conflict of interest and always choose np over pa because they are nurses. I would agree with you that a DSc is an academic degree. still looks good to have one if you and a DNP apply for the same job.

 

100% support this!!!!!

 

clinicial doctorate - and I think primary care is the first one to go after - has the greatest #'s in one speciality and would toe off directly against NP's - remember this is a battle of perception, not fact....

[physasst]

100% support this!!!!!

 

clinicial doctorate - and I think primary care is the first one to go after - has the greatest #'s in one speciality and would toe off directly against NP's - remember this is a battle of perception, not fact....

 

Okay, well now you are talking about the creation of an entirely new degree..the PA clinical doctorate.....

 

Who's going to create it? PAEA? NCCPA? ARC-PA?

 

How will it be accredited? ARC-PA?

 

How will you validate it? Will you be able to convince 50 state medical boards to agree to change their requirements to a doctoral?

 

Who's going to fund all of this? How will it be paid for? Will there be a separate entrance exam (ala MCAT)? Who will create that?

 

You have to remember that the creation of the DNP was the result of the NP academic community working with the AACN. The AACN has a huge resource with money coming from 4 million nurses. They never really validated it. Accreditation is through a separate process for them as the AACN is granting a lot of the accreditation....

 

How will we do that?

 

Not saying it's impossible, but there are so many problems just on the surface that I'm not sure how it could ever happen...

[Contrarian]

Kind of interesting that 3 of the most vociferous folks on this thread have doctorates ( grinder), are almost done with one(physasst), or are just starting one(me).

 

Sure is... and fairly typical.

 

It the "bombshelter" mentality.

 

Back in the 50s and early 60s... lots of folks spent substantial sums of their income on elaborate, hearty bombshelters. They generally thought of themselves as smarter than everyone else, and therefore arrived at the notion of a bombshelter before the average citizen.

 

To cognitively and socially justify this expenditure, lots of them pushed their local, state, regional, and even federal officials to "Paternally" mandate bombshelters for everyone.

Seems they figured that folks would stop snickering, laughing and deriding them about their expensive backyard mass burial sites, if everyone was REQUIRED to do as they had already done.

 

Fortunately, bombshelters were not mandated as most of them simply caved in, or flooded from groundwater, became unsustainable/surviveable and were either dug up or simply filled in.

 

Point:

 

There is a tendency to decide that one's personal course of action is the exact and correct course/route for all to take...

Beware as it USUALLY isn't so.

 

YMMV

 

Contrarian

[LIPPER]

Point:

 

There is a tendency to decide that one's personal course of action is the exact and correct course/route for all to take...

Beware as it USUALLY isn't so.

 

YMMV

 

Contrarian

 

Very well said