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Sums it up far better then I could ever hope to..... well done Dave

 

And BTW - he is running for AAPA Board  (If you really want to make SURE he gets it vote for ONLY him!)

 

https://www.doximity.com/doc_news/v2/entries/6948772

 

  The PA Doctorate: Is It Needed or Not?
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Clinician Today · March 17, 2017 Original Article

It is ten years from now.

You are a patient. Or, better yet, your two-year-old daughter is a patient. You know just a little about medical people, including that the pharmacist you see, the physical therapist you see, and the NP you see all practice at the “doctorate” level. You appreciate that, and you expect people who make decisions that affect your child’s health to practice at that level. Do you want to see “Ms. Assistant” or “Dr. Practitioner”? Not knowing anything more, I know who I would want. I know who I would pick to guide my healthcare decisions, and my daughter’s.

If I am a PA, I have to realize that sooner or later, all “advanced” health professionals will have a doctorate. Do I want to find myself in the above situation? PAs spend more hours on their clinical training than almost any other profession, and they at least deserve what PTs, OTs, DATs, AudDs, PharmDs, DNPs, and others achieve for their many hours spent learning. This is especially true when most PA doctorates will be earned after even more hours in on-the-job clinical training with an emphasis on leadership and/or education.

You are an insurance company. For decades, you have let all other professions know that people who practice at the doctoral level will have a much easier job being credentialed for reimbursement than those with master’s degrees. I am the company, and in some cases, unfortunately, I get to choose. Why not do what has been the customary way to measure a professional’s competence, and ask if they have a doctorate? PTs, OTs, audiologists, dentists, and others have found this out. So will we.

You are a legislator, and PAs are coming in asking for full practice authority. Or, let’s bring it down a notch. The legislators realize you can write orders for other professions. PT, OT, and speech therapy order different therapies. You choose the medications people take for their illnesses, telling the pharmacists what to dispense for them. At the hospital you write “orders” (a poor team-based word) for nurses, nutritionists, and others. Sooner or later, the logical question will be, “How can you expect, as a master’s-prepared professional, to tell four doctorates what to do?” One profession or another will balk.

In many states, the podiatrist is now the podiatric physician, the optometrist is the optometric physician, and the chiropractor is the chiropractic physician. Yes, they changed their titles to help elevate their status. This is not going away. The problem is the law says you are a physician(’s) assistant. Our scope of practice is and will continue to be broader than the above professionals’, yet to insurance companies, legislators, Medicare, and patients, it seems logical that we would be “assisting” them. A doctorate would help even the playing field and aid in helping people understand that we do much more than what our title implies. (So would a title change, honestly, but that’s a conversation for another day.)

This is not about, “If you wanted to be a doctor, you should have gone to medical school.” This is very much about a profession that either fits into the 21st century and recognizes that it is no longer 1975, or a profession that will stay misunderstood and undervalued for what it brings to the table. It is very much about a train that has left the station. Ask the pharmacist, or the dentist, or the psychologist, or the chiropractor, or the DPT, or the DNP, or the AudD whether they want to be a physician, and the answer will be “No, why?” Why would PAs not want to be PAs educated to the highest level they could be?

Twenty years ago, I thought wanting a doctorate was more ego than anything else. It had no place in my clinical world. It would not get me a larger paycheck. I became a PA in part to show the world that “nondoctors” could deliver the same care as “doctors” did. I know how good we are and never wanted to take a boat the Caribbean to become a physician. I bleed PA blue. I thought only academic PAs and NPs needed doctorates. But times change. Professions change. People change. We are, like it or not, part of many professions that practice in the same or similar spaces, and if we are expected to advance, we had better at least consider change. Especially when we are the only profession ignoring that change. Again, ten years from now, we will be the “odd ones out.” We are not making the rules, only following the same ones followed by almost all other professions. Healthcare changes, and like it or not, we must change also.

I have never met a PA or NP who has obtained a doctorate and has not said that it made them a better all-around clinician. It filled in some holes. It gave them greater understanding and appreciation. I hear these sentiments often. I believe them.

The transition for the PA profession to become a doctorate profession will take decades. It will hardly affect most PAs today unless they are in their first or second decade of practice. Some may have to eventually do “at work, on the job” bridge programs. The NP profession has tried to push the doctorate as the initial degree earned at graduation from NP school, with mixed results. We should learn from them. Keep programs at the master’s level, adding clinical doctorates earned through more clinical experience plus an emphasis on other tracks. NPs are already feeling some positives from their shift. Doctorates are opening doors and giving them seats at the table. Doctorates expand their understanding of topics not stressed in NP school. Doctorates open their eyes.

Doctorates are not needed because those professions need to compete with, or want to “be,” physicians, but because professions need to let the public, legislators, insurance companies, and other health professionals know that their postgraduate education offers the level of education and sophistication needed to take on the responsibility they have. Doctorates give that guarantee.

Eventually, PAs will realize this.

Dave Mittman, PA, DFAAPA, has been a PA (and NP) leader for more than 39 years. He co-founded the LIU PA Program student society in 1973, was president of the New York State Society of PAs in 1979, and served on the American Academy of Physician Assistants (AAPA) Board of Directors from 1981 to 1983. Dave has also won the AAPA Public Education award for leading the march in Trenton, NJ, to establish PA practice. Dave was introduced to medicine as a medic in the USAF. He later had the distinction of becoming the first PA in the USAF Reserves permitted to practice.

 

 

 

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Love the concept and see the need. I hate that it will cause us to incur more debt during the initial education and require additional training for us 3rd/4th generation PAs (lots of us now). My PA program had enough credit hours and a research project to be a valid doctorate program, but it was not awarded. I've done the work already and kind of understood that this was coming when I signed up, but it is still time and money out of my pocket eventually.

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Well said.  I have gone through the same evolutionary thought process about earning a doctoral degree and have experienced the range of reactions from patients and employers from misunderstanding to respect and appreciation.   External forces are shaping our destiny.  Personally, I wish there was one "training track"  in medicine in which individuals get get off and on as their life needs and desires changed that was seamless.  Alas, unlikely.  Currently I am in a doctoral program in workforce development and education after 36 years of clinical practice.  It is a LOT of work and should be if it means anything.  I have the resources to pursue this but it is not for everyone.  Generally, I would say a clinical doctoral track for PAs would be a lot more meaningful and useful for PAs and their patients (and more fun).  This is the way of the future and we need to accept and adjust to it. 

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Until getting a masters or doctorate changes my reimbursement for a 99203, 99204, 99213, 99214 etc - there is no logical reason for me to pursue further education at 25 years into my career.

 

When I graduated in Texas, PAs didn't even have licenses. We were told by the then 3 existing schools in Texas that were all Bachelors that the ONLY THING that mattered was passing NCCPA and keeping it. 

 

Military PAs got certificates, some schools were only Associate at that time and we were a Bachelors. 

 

I have never been asked why I don't have a masters and it hasn't changed my billing or employment ever.

 

At 25 years in - yep, I have 15-20 more years to work but have no time, desire, or monetary funding to pursue an expensive degree that seriously will not change my income one bit. 

 

The PA programs where I live now are state schools. You can look up anyone's income. They require a Masters to be on staff. Their incomes are ridiculous - over $25K below what I make now AND I don't make median for what I do with a solo private doc.  The folks on staff who have PhDs don't even break $100K - not kidding.  So, any desire to move to academia has left me since there is no financial benefit and, in fact, a detriment. Most folks I know who work for the programs have to have second jobs. 

 

So, maybe new grads will need an doctorate. It is an evolution. BUT.....

 

What about us folks who have been in the trenches all these years chalking up experience but don't have an MS or MA behind our names???? Are we dispensable for someone half our age with 1/5 of the experience? 

 

This is a serious question for me. I face more career time but don't want to be discriminated against for not having spent another $10-25K on a degree that doesn't change my billing capacity.

 

What do we do about us old folks who know what we are doing regardless of all the little letters behind our names?

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The problem isn't that PA doesn't have a doctorate. problem is unnecessary rebar ding every ten years, not a single state with independent practice and the title assistant. Fixing all of the aforementioned will not require a doctorate. AAPA needs to focus on the three most important issues, independent practice, elimination of reboarding and name change. I am always curious about someone from the PA education industry selling more worthless product.

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It's inevitable that it will happen, partly because of his points above but mainly because there is too much money to be made. For minimal costs in program infrastructure, PA programs can add 1 year of extra revenue per student.

 

Nothing against Mr. Mittman, but anyone aspiring for that level of office is essentially a politician and has to support (or appear to support) the changes that are most relevant/progressive and will ostensibly benefit the constituency.

 

I suspect many other PAs agree but it will be a cold day in hell before I go into more debt for a mandated 'doctorate'. Let that be the next generation's path.

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It's inevitable that it will happen, partly because of his points above but mainly because there is too much money to be made. For minimal costs in program infrastructure, PA programs can add 1 year of extra revenue per student.

 

Nothing against Mr. Mittman, but anyone aspiring for that level of office is essentially a politician and has to support (or appear to support) the changes that are most relevant/progressive and will ostensibly benefit the constituency.

 

I suspect many other PAs agree but it will be a cold day in hell before I go into more debt for a mandated 'doctorate'. Let that be the next generation's path.

Bruce,

I have actually had converstations with Dave over the years and I can tell you he is not a professional politician. He does however have a vast wealth of experience and has seen the comings and goings long enough to be able to form an educated opinion on this topic.

 

I have been out for 15 years and am starting to truly understand the barriers (owning running your own practice is an eye opener) and where the PA profession is falling far behind. Dave is one of the good guys, he is forward thinking, experienced and taking the PA profession in the direction it needs to go to survive.

 

I can not say I know him outside a few conversation I have had with him, but he was open, professional and welcoming a converstiion and a good listener. If you have questions - call him up! If you have comments - call him up! If you want to see where he stands - call him up!

 

 

Let's not start classifying everyone who is trying to move the profession forward a a negative - lets instead stop and think where we have been, what is going on in the medical community (and this means in the entire community - not just each PA's little world - this is this forum is great as you can get a sense of what others are experiencing) and where we need to go to be able to control our own future...... If you do this I think you will end up at a spot very similar to Mr Mittman.... I did....

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The problem isn't that PA doesn't have a doctorate. problem is unnecessary rebar ding every ten years, not a single state with independent practice and the title assistant. Fixing all of the aforementioned will not require a doctorate. AAPA needs to focus on the three most important issues, independent practice, elimination of reboarding and name change. I am always curious about someone from the PA education industry selling more worthless product.

 

OTH - I agree with most of the points you make - I do however disagree with the doctorate issue - The politicians in the state house and congress and the insurance companies will not let us advance at a masters level. The doctorate level will allow us to come out from under the wing of AMA/established medicine/physicians. All you have to do is look at the allied health fields (which in fact are the professionals that we give orders to) to realize that they are almost all UNIVERSALLY an indpendent profession. There is no Doc's that control the PT's, SLP's or the other 1/2 dozen allied health professional credentials. We are the only ones that are "attached" to a doc and it is no longer needed and adds nothing to our profession. It does however place us at a distinct disadvantage to NPs who are independent and for the most part do not need a doc (save for DM shoes, VNA and a few other rare items-which are changing hopefully)

 

 

 

So, I 100% agree that AAPA needs to progress (and BTW Dave was one of the instrumental people to get AAPA to wake up and realize this!) I think the reality of the polictical, insurance and regulatory environment in this country essentialy dictates that we should be at a doctorate level. We are already trained to the clinical doctorate level - we just are awarded a Masters degree instead.... It should at most be one more semester - making most programs 3 years (BTW that this same length of many of the fast track med schools who are awarded a doctorate at the completion). So why should we not have the same? Especially if it preserves the future of our profession!

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Bruce,

I have actually had converstations with Dave over the years and I can tell you he is not a professional politician. He does however have a vast wealth of experience and has seen the comings and goings long enough to be able to form an educated opinion on this topic.

 

I have been out for 15 years and am starting to truly understand the barriers (owning running your own practice is an eye opener) and where the PA profession is falling far behind. Dave is one of the good guys, he is forward thinking, experienced and taking the PA profession in the direction it needs to go to survive.

 

I can not say I know him outside a few conversation I have had with him, but he was open, professional and welcoming a converstiion and a good listener. If you have questions - call him up! If you have comments - call him up! If you want to see where he stands - call him up!

 

 

Let's not start classifying everyone who is trying to move the profession forward a a negative - lets instead stop and think where we have been, what is going on in the medical community (and this means in the entire community - not just each PA's little world - this is this forum is great as you can get a sense of what others are experiencing) and where we need to go to be able to control our own future...... If you do this I think you will end up at a spot very similar to Mr Mittman.... I did....

 

Fair enough. I understand a doctorate transition is ultimately necessary for us to evolve and Mr. Mittman probably has the profession's best interest at heart. I just resent that it's necessary in the first place. More debt, more schooling, same pay. 

 

One of my good buddies is a newer-generation DPT. And guess what? He does the exact same work for equivocal pay as his BS and MS colleagues. He may be slightly more employable. I 100% guarantee it will be the same for PAs.

 

Personally that's where I draw the line. I'll go out on my own shield.

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Understand completely

 

And in a perfect world I think we all should have associates and be heavily populated by military medics.... problem is the darn politicians are just looking at the surface of things and truly do not understand us. For that matter I am not sure there are many people outside of PCP PA's that truly understand how an experienced PA functions...... hence our difficulties....

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