Thoughts on the PA doctorate.

Abstract

I am writing about the February commentary “Whither the PA doctorate?” by James F. Cawley, MPH, PA-C; Gerald Kayingo, PhD, MBA, MMSc, PA-C; and Violet Kulo, EdD, MS, MA. As a PA leader for almost half a century, I was against a doctorate-level degree for PAs for many years because I wanted to show the world one could do much of what physicians did without a doctorate, but the world kept changing. My thoughts have now changed considerably, and let me tell you some of the reasons why. All are significant reasons we should look towards a slow but steady shift toward doctoral-level PA education in the future. Our profession now earns more graduate credits than many other professions that already receive doctorates. Mainly, we are not recognized for the graduate work we do, and we deserve to be. We are cheating our students compared with other professions. If we want to be considered clinicians in our own right, our evolution will have to include doctoral-level education. Nothing stays the same, people evolve, and professions also evolve. The same arguments now being made against the doctorate were made both against the bachelor's degree, and later the master's degree. In retrospect, the arguments turned out not to be correct. Insurance companies prefer to reimburse doctoral-level trained clinicians. Most professions that the insurance industry reimburses are at the doctoral level. Physical therapy (PT), nursing, pharmacy, audiology, occupational therapy (OT), psychology, and many other professions have seen the advantages of doctoral-level education. None of these professions diagnose or prescribe at the level PAs do. How long before all NPs are doctorally prepared and fully join the list? How long before legislators question how a master's-prepared clinician can write orders to a doctorally prepared clinician? Why put ourselves in the position of being the only master's-level clinician with such a significant scope of practice? Why create another anchor we will have to bear? We can certainly devise a plan to grandfather in people. We did with both the bachelor's and the master's; surely we can do it again. Although I could go on, I would like to make one final point. The article raised the problem of attracting minority applicants to the profession if we went to a doctorate. I firmly believe the doctorate would do just the opposite. If I were a young person with a 3.8 grade point average and could get into psychology, optometry, PT, OT, pharmacy, or podiatry school and to my community become a doctor, which in itself would allow me to enter a profession without the considerable baggage the PA profession still has; why would I consider being someone's master's-level doctor's assistant, which is how much of the community would recognize me? I would have little reason to. One must realize our tuition is probably close to equal or more than some doctorates. The time spent in study and work hours is possibly more in PA master's-level education, and ultimately PAs will be perceived as helping someone do a job, rather than as the person who does the job. I believe most people would choose a doctorate-level profession where one might start a practice or enter a group of other same-minded professionals as an equal. Most who do not know much about PAs see the profession in a way we do not see ourselves. I genuinely believe full practice, a doctoral-level education, and our new title will open up the eyes of many who would not have considered the profession in the past. I believe a slow but steady move to the doctorate will significantly raise minority PA applicants. We are on the right path and must continue to grow and meet others not where we want to be but where healthcare has moved to. David Mittman, DSMc (honorary), PA, DFAAPA Adjunct faculty member University of Lynchburg Lynchburg, Va. Past president, American Academy of Physician Associates and New York State Society of PAs The debate around the PA doctoral degree is an important one, and it is essential to consider the effect it may have on women and Black, Indigenous, and people of color (BIPOC) PAs in the field. Historically, these groups have faced barriers to accessing and advancing in healthcare careers, and a change in the educational requirements for the PA profession could either serve as an obstacle or an opportunity for greater representation and equity. PA organizations must actively seek out and incorporate the perspectives of women and BIPOC individuals in their discussions and decision-making processes around the PA doctoral degree. Ensuring that the voices and experiences of these groups are taken into account can help to create a more inclusive and diverse PA profession. Studies have shown that minority faculty often receive poorer evaluations and receive less mentorship compared with their White peers. Women receive poor and sometimes hostile evaluations from students of all genders. This can have a significant effect on their career progression and promotion opportunities. Minority and female faculty frequently engage in service-related tasks and experience a disproportionate amount of emotional labor in the workplace. This results in reduced time for publication and fewer chances for advancement. Female and BIPOC faculty can be treated as junior faculty even with extensive seniority and experience. Will obtaining a doctoral degree solve the issue of career advancement for PA academics? One outcome is that without guidance, White males will obtain doctorates at a greater rate than women and minorities. The other possible outcome is only those with personal resources, both time and money, will be able to obtain a doctorate. Finally, will women and minority PAs have more to gain with the doctorate, especially an entry-level doctorate? Will an entry-level doctorate save time and money or increase the time and money devoted to what will be for the majority a clinical and not an academic degree? Although some PA organizations have initiated research on the topic of the PA doctoral degree, the results have been equivocal in the implementation of an entry-level doctorate. The findings suggest that the perceived benefits and risks of the doctorate vary based on the perspectives of different stakeholders. Moreover, the experience of other healthcare professions with clinical doctorates may not serve as a relevant model for the PA profession. An entry-level doctorate could raise the professional status and credibility of PAs, leading to greater recognition and opportunities. Those who lack recognition might benefit more from a doctorate. PA organizations must consider these differing perspectives and make a well-informed decision on the future of PA doctoral education. In terms of leadership for PAs, obtaining a doctoral degree can provide PAs with expanded academic opportunities, increased career prospects, enhanced expertise and credibility, and a broader understanding of the academic field that can be applied ultimately to teaching and curriculum development. Without a doctorate credential, women and BIPOC PAs may face challenges in attaining leadership positions, which could further hinder progress toward pay parity. Understandably, colleges and universities may have economic interests in offering new types of degrees, but the decision on the PA doctoral degree should ultimately be made by the PA profession rather than being deferred to academic institutions. Jennifer Myers Coombs, PA-C, MPAS, PhD Professor and Director of Graduate Studies Division of Physician Assistant Studies University of Utah School of Medicine Salt Lake City, Utah