Physician Assistants—One Less Doctor(ate) in the House

Abstract

IN RECENT YEARS, NUMEROUS ALLIED HEALTH PROFESsions have adopted or are planning to adopt clinical or practice doctorates. Although some have transitioned to an entry-level doctorate (eg, pharmacy and physical therapy) and others (eg, nursing) recognize the doctorate as an advanced practice degree, the professions’ goals are the same—to replace the master’s degree with a professionspecific doctoral degree. Allied health care clinicians with these degrees now practice, or will soon practice, as “doctors” alongside their physician colleagues. These clinicians function as competent and effective members of the health care team and had done so before obtaining doctoral degrees. So why make the move to a doctorate? Those in favor argue that a doctorate improves professional image, promotes more autonomous practice, and serves as an appropriate response to advancing technologies and the increasing complexity of health care. Others argue that doctorates may confuse patients, that they represent “degree creep,” and that doctoral degrees are sought largely for professional status rather than for issues related to clinical competence and market demand. The additional tuition costs associated with doctoral degrees and the perception that doctorates are prestigious and will attract students create incentives for universities to offer the degree. The added cost, however, has the potential to adversely affect recruitment of low-income and minority students. In addition, requirements for doctoral degrees lengthen the time in school, vary from program to program, and have not been proven to enhance students’ clinical abilities. At a time when the country is working to keep up with increasing demands of health care, do the perceived benefits of a doctorate justify the additional expense, time, and delay in getting clinicians into the workforce? The physician assistant (PA) profession has said “no.” In March 2009, PA organizations conducted a PA Clinical Doctorate Summit that involved clinically practicing PAs, PA educators, students, army PAs, representatives of other allied health professions, workforce experts, and allopathic and osteopathic physicians. Summit recommendations, which also reflect the views of a majority of surveyed PAs, express opposition to an entry-level PA clinical doctorate and officially endorse the master’s degree as the entrylevel and terminal degree for the profession. The recommendations include support for PAs who choose to pursue postgraduate training beyond the master’s degree but limit this support to non–PA-specific doctoral degrees. Discussions during the PA Clinical Doctorate Summit revolved around a number of issues, including the effects a PA doctorate could have on the profession’s relationship with physicians (eg, would physicians perceive a doctorate as a move toward independent practice?), the additional cost for students, and the potential for the degree to diminish the profession’s diversity. Final justifications for concluding that a PA-specific doctorate is unnecessary were “the length and cost of the current educational model has resulted in a responsive accessible PA workforce . . . and has adapted over 40 years to provide high quality, cost-effective, patientcentered care,” and that “both physicians and PAs practice in the domain of medicine therefore the entry-level doctorate for the practice of medicine is the MD or DO.” Despite the final recommendations, significant pressure for PAs to transition to a doctoral degree persists, especially as other clinicians work to expand their prestige and scope of practice. Some leaders in the PA profession have suggested that the decision not to endorse a clinical doctorate “ . . . may be tantamount to committing professional suicide.” They argue that physicians’ and the public’s perception that nonphysician clinicians with doctoral degrees are better educated, favors nurse practitioners, and will cause PAs to become marginalized, weakening the profession’s status within the health care community. Physicians practicing today may be unaware that physicians established the PA model of education in the 1960s to train individuals with prior health care experience to rapidly meet the needs of medically underserved areas. Currently, most applicants accepted to PA school have a bachelor’s degree, including required coursework in the basic and behavioral sciences, and 3 years of health care experience. PA education, which is modeled on medical education, averages 27 months in length and typically includes a didactic year of instruction in the sciences and clinical medi-