How will PA doctorates change the profession and what is problematic about them?

[@TheMedicineCouch]

A PA doctorate degree has its pros and cons and the topic is controversial. Tell me what you think!

[@michaelk294]

I saw your post on fb, so moved over to KZbin and subscribed. I really enjoyed your discussion. I didn’t realize there were so many different PA Doctorate programs with such different approaches. I graduated with a B.S. in Health Care Science, PA Studies in 1983 (UTMB Galveston) and I remember being annoyed when the programs started moving to the Masters degree. Fortunately I was able to have a great career with my original degree and I retired at the end of 2021, so I’m done, but it’s interesting to watch all this unfold. The world of healthcare is changing especially with the DNP coming on so strong, so this conversation is necessary for PAs to have, thank you.

[@TheMedicineCouch]

Thank you so much Michael! I really appreciate the support and congratulations on your retirement. Trust me, I probably have the same feelings about the profession going from a master's to a doctorate that you had when it went from bachelor's to master's. But, you're right, healthcare is certainly changing and we need to be aware of what's happening so the profession can whether the storms!

[@warriormom5843]

Me too!! You got my subscription 👏👏

[@TheMedicineCouch]

Thank you!

[@lizagarcia2117]

My daughter is wrapping up her BS in Human Bio. She was considering an NP path or a straight path with a PA which avoids her having to do a second BS in nursing for the NP. Any suggestions on how to decide? Sometimes I hear NP will be taken over by PA's other times I hear NP will continue. HELP

[@TheMedicineCouch]

This actually has become quite a difficult difficult question to answer, and I don’t think anyone really knows what’s going to happen with the professions. Right now, I would say that the NP path has lots of advantages. They have been able to get independent practice in over half the states and that often gives them preference over a PA when being hired. They also tend to have an easier route to the administrative side of medicine. However, PAs are starting to make some ground with legislation, and hopefully that will continue so we can at least stay on ground with NPs. Another thing people are concerned about is that it is very competitive to get into PA school, but pretty much anyone can get into an NP program, especially an online program. We are seeing new NP‘s that have come out of some of these combo NP programs where they’ve never even actually worked as a nurse, and sometimes they are incredibly unprepared. I have not saying this is a PA picking on NP, I’ve heard this directly from many NP’s that I know. So there is some concern that the NP profession is hurting itself in the long run by producing unqualified providers. If your daughter does choose to go the NP route, please make sure that she attends a very well respected mortar school. Having said all this, there are lots of amazing PAs and NPs and I do think both professions are going to continue to flourish. So, she should be just fine whichever route she goes and should pick the one that works best for her situation in life. The other thing I will caution is to make sure that she does lots of time shadowing and really understanding what it is like working in medicine today. There are people looking to get out of medicine as soon as they can, so, there’s definitely some problems within our medical system. She just needs to make sure that her eyes are wide open when choosing medicine. I hope this is helped some and I wish your daughter all the best.

[@randydanielsen3982]

Very interesting discussion! I would favor a discussion among the top DMSc programs to discuss the future of the degree!

[@TheMedicineCouch]

I love this comment Randy and I really hope this happens. I could certainly see the benefit of having uniform credentials. Maybe even a DMS for non- or semi- clinical programs and then a DMSc or DMS-C to denote a program that has a designated amount of clinical focus? I don't know, but it seems important that we somehow get on the same page?

[@OmarAbdulMalikDHEdMPASPACPAPro]

Hi. I'm a Washington, DC-based PA with a doctorate of Health Education (A.T. Still 11'). I've been a PA for almost 25 years. This is a GREAT discussion! 🙂👋🏽👨🏽‍⚕️

[@TheMedicineCouch]

Thanks! The issue certainly has many sides to it and many opinions! I see you got your doctorate EARLY!

[@kennedyjones1315]

I realize this is an old video but ive just come across it and and feel compelled to comment. As a PA myself I think changing the program to doctorate or not is not the main issue/debate. I think the issue is insinuating that with such changes we as PAs should then introduce ourselves as “Dr.X”.,Thats the part i have a problem with! it is not the patient’s job to try to decipher exactly who you are… we are PAs , will always be PAs and should refer to ourselves as such. Between 11:00-12:00 sums up pretty well your personal regrets but you dont get to apply that to everyone else. This thing people have with being called a doctor to stroke their ego is honestly getting played out!! Anyways i could go on and on but i will say my belief is the overwhelming majority of PAs are just fine and actually dont care to change anything so to any physician that is worried that PAs want to emulate your profession…we dont , believe me.

[@TheMedicineCouch]

I agree, I don't think most PAs care. We just want to do our job and get paid what we're worth. However, the point of the video to me, is that we can't be the lowest credentialed provider and still stay competitive in the job market. Besides, many PAs are realizing the amount of credits we take in PA school are the same, or more than other professions receiving a doctorate, and are becoming very frustrated and angry. Now, the issue of introducing ourselves as doctors in the clinical setting is a whole different matter. I have always firmly been against it. Mainly out of respect to the schooling MDs go through, but also because it is confusing to patients. However, my position has been wavering lately. When my guest pointed out that we already refer to other non-physicians by Dr., that had me thinking. I can definitely see a future where all kinds of people introduce themselves as doctor in the clinical setting, then specify what kind of doctor they are. I don't know. It might be fine, it might be terrible. Regardless, I do think it's important to always be clear about your role and letting patients know you are a PA or NP. They do have a right to know and not have to work to figure out what you are. Anyway, I'm glad you took the time to comment and share your thoughts. It's a complicated topic and I love to hear what other's think about it!

[@regularlyirregular8876]

If I wanted to be called "Doctor" in the clinical setting, I would have applied to MD/DO schools. What about pride in the PA title and profession instead of cosplaying as a physician? I'd rather do a PA to MD/DO bridge program and go through residency than waste money and time on a DMSc program. Even if I had a DMSc degree, I definitely wouldn't introduce myself as "Doctor" to a patient as it's misleading. I've met people who think their chiropractor can be their PCP because it's literally misleading in every single way. Also, your guest at 15:06 doesn't understand that ENTs go through medical school and residency (+/- fellowship, too), ENT is a surgical subspecialty, so of course they can call themselves doctors. I also feel like his reason of "doing it for the patients" really falls flat after he said his program didn't require any time off work and it was just "brushing up on skills" -- that really illustrates that these programs aren't about clinical education or patient safety at all, it's a money-grab for these universities and I really hope more PAs are smart enough to not fall for this trap. BSNs are all over administration and leadership without having to even go toward DNP school, so there's really no need to feel inadequate in that realm with a master's degree. Love your channel though, regardless! I'm glad you covered this topic and I feel this guest did an excellent job of exposing what these programs are really all about.

[@TheMedicineCouch]

I was firmly in the same camp as you about not being called doctor in the clinical setting. However, I am now more on the fence. I can definitely understand arguments on both sides. I think if I had my DMSc, I would not refer to myself as a doctor while practicing medicine. When my guest was referring to the ENT during that section, he was making the point about non-physicians being called doctor clinically. He was comparing non-physician "Dr.s" in similar specialties to their physician colleagues. So, an ENT (MD) vs an Audiologist (non-MD). Trust me, he is well aware that ENT's are MDs. I don't know how well it came across in this edited down video, but I agree that the DMSc is problematic and I feel like we are doing ourselves a disservice by not making it clear whether the doctorate is clinical or more "professional development". And if it is to be clinical, I think there should be also incorporate actual onsite advanced clinical training. Although, I do think an experienced clinician going through the same books and didactic training as physicians who are being board certified in Family Medicine is nothing to put down. As far as the BSN's being in administration, I agree, but feel like they have been sprinkled with "magic dust" or something. How they have worked their way into power positions over physicians and other providers is impressive, but baffling. I feel there is much more resistance to PAs doing the same thing, especially without a doctorate. We will just have to see. Thank you so much for your support of my channel and for taking the time to leave a comment!

[@rodhooker1]

I listened to a talk on the PA doctorate for 30 minutes. This is someone with a new degree but not once did I hear any mention about research that supports any of the opinions that a doctorate for a PA is beneficial to anyone other than the one holding it. Are PA doctorates in society's best interest? Are PAs with doctorate better clinicians? Many of the views expressed were self supporting.

[@TheMedicineCouch]

Hi Rod. Thanks for watching and commenting. I actually don't know if there is research regarding the PA doctorate, but I also don't know if there was research done for the DNP, DPT, or MD degrees for that matter when they first started. In the video, the PA stated he wanted to get a doctorate for his own personal growth and that we both feel like the PA profession is in the position that it has to move to a doctorate lest we get left behind. Does it make PAs better clinicians? That depends on which track they pursue and which school they go to I guess, which is one of the concerns we have with the DMSc, as we pointed out in the video. In this PA's case, I would think anyone would agree that if a PA, who already has a great base training in medicine, goes through the entire ACP MKSAP board prep curriculum, that they would certainly become a better clinician. Now, as I also stated in the video, I wish the PA doctorate had more hands on, bedside training. So, in summary, I agree that we should be asking questions about the PA doctorate in order to make sure it is a substantial, worthwhile degree and that we as a profession are clear about what the learning objectives are. However, I will say that PA education is notoriously rigorous and I believe the doctorate programs will continue that standard.

[@amygregg1658]

Yes, Rod! We can count on you to raise the important questions. Thank you!

[@AA-nl5bl]

Hi! I decided to take the doctorate plunge as well. Needed to be able to remain in the market with our competition. I actually caught the bug as all my NP friends were in that boat. All my PA friends poo- poo the doctorate program. I believe that to stay in competition and to be recognized by insurance companies, VA and C-suite. PA’s need to learn from NP’s. They are ahead of us in the game of recognition by all leading authorities. My two cents. Independent practice is a dicey issue. I appreciate collaboration. Being tied to a physician is not good for our bottom line. If your physician supervisor losses his license for whatever reason or dies or moves out of state or retires- I as a PA essential can not work. My livelihood is tied to MD license. That’s not safe for any of us. It is hazardous to our profession. With the influx of “corporate and Tech” firms in medicine- lots of tele health or remote jobs listed for NP. Little to none for PA- I suspect due to need for supervising MD. Also lots of tech companies don’t recognize our profession. Ex Amazon has job listing for NP- I did not see any for PA. Our PA training is unbeatable but the license and job restrictions is a battle. NP trumps PA when it comes to job opportunities, leadership in hospital administration, VA, clinical research and pharma. They have cornered the market.

[@TheMedicineCouch]

You are so right. I find it interesting that both profession started in 1965, but have had different trajectories. I'm sure it's because nursing has such an illustrious history and because they have strong nurse organizations. Still, with our rigorous schooling, it is surprising that we haven't been able to stay competitive and that we aren't better known. It is alarming to see all the opportunities that exist for NPs, but where PAs are excluded! In my mind, that is the direct result of 2 things: independent practice for NPS and aggressive NP marketing! We certainly need to learn from NPs when it comes to steering the profession!

[@bcaiqs]

As someone who has been a PA for over 25 years and watched the NP go from certificate to where it is now . Newer PAs are paying too much attention to NPs . PAs are not NPs . Our collaboration with physician is what has helped with the training of PAs have today .. NPs are driven by foreign medical graduates. PA is a great profession and the doctorate is great but the collaboration should be kept at least for the first 5 years in practice . We are much better off than NPs , doctorates or not . NPs are threatened by PAs and now the new trick in their bag now is calling all of us APPs so that no one knows whether you are a PA or not . Tread cautiously. PAs are shooting themselves in the foot and watch NPs use their nursing platform to push out PAs. The physician relationship is changing because of the lack of respect for them and their training . We can make this doctorate work for us by working with the physicians and have a collaboration similar to optometry and ophthalmologist. We do need to standardize the degree.

[@lizagarcia2117]

My understanding a PA is a masters program with a possibility of a doctorate level. You can not be a PA with only a BA or a certificate (Minute 8:43) but I may be mistaken....but not in California.

[@TheMedicineCouch]

You are correct that the PA programs are now masters as the minimum degree. However, PAs who in the past graduated from PA programs that were bachelors, or even further back in time, where a certificate program, are still able to practice as PAs. They were essentially grandfathered in.

[@presto900]

Just for sake of where I am as I enter this discussion -- I am starting medical school in the fall. I am all for additional training. If a PA or NP wants to train longer and get better at their job, I think that is incredible. However, it seems to me abundantly clear that NPs and PAs that are lobbying for more autonomy and the ability to acquire doctorates are deliberately attempting to muddy the waters between their professions and that of a physician. A PA or NP has far less clinical training and expertise than a physician. That does NOT mean that they are not good providers or dumb or anything else that people seem to assume comes with that statement. Their training is supplemental and the professions are, by design, a way to lighten the load on a physician and handle the more routine and less complicated cases that a physician would see. To fight for the title of doctor and autonomy is to go directly against the purpose and mission of NPs and PAs -- the mission that was accepted during matriculating to a mid-level program. If you want to be a doctor and provide autonomous care then you go to medical school. It is that simple. For the safety of our patients we should not allow a profession who is far less trained to call themselves doctor to a patient and solely manage their care.

[@TheMedicineCouch]

HI Presto. Thanks for your comment and for the respectful way it was written. These conversations are actually important to have. I for one, would have been perfectly happy to come out of school and work with a physician mentor, learning and growing in my practice. However, and unfortunately, that is not how medicine works today. Doctors and healthcare groups understand they can make quite a bit of money from having PAs & NPs work at full capacity while they (Dr.s) also see a full load of patients. New grad PAs & NPs are being EXPECTED to carry their own patient panels and see their own patients independently. Asking questions, of course, when we need to. So, while PAs may have envisioned kind of working under a physician's direction when they went to school, the reality is that the system demands they operate basically on their own. In all the jobs I've had since graduation, I have always made all the decisions for my patients, unless I asked for help. I would say this is true for over 85-90% of all practicing PAs & NPs in family practice, UC, EM, IM, Peds, etc. The specialties obviously vary based on many factors. So, there is that problem. All this, I might add, with no alarm bells going off or patients having problems en mass. In fact, studies show our care is comparable. Next, I'd like to adress your thoughts on PAs & NPs looking to expand their practice. Actually we are not looking for any increase in scope of practice. The push for autonomy is mainly due to burdensome administrative factors. Honestly, most supervising physician agreements are nothing more than something written on paper. In the real world, there isn't much supervision given by physicians. They are so overworked and burned out themselves that reviewing charts and having performance meetings are very low on the totem pole. So, then our licenses are encumbered for no good reason. If we are practicing in a small practice and the physician dies, or something happens to them, we have to immediately stop practicing until we can find another supervising physician who wants to sign on. Not always easy. So, all the work we've been doing without supervision anyway, comes to a halt. We can't volunteer to work a first aid tent at a charity event, unless we go find a physician who will write up an agreement. Working locums is a paperwork nightmare, having to draw up endless agreements. Right now I am working locums occ med. Admittedly, the onsite clinic is very slow, but because the supervising physician doesn't want to give locums providers prescribing rights, I have to call her every time I want to prescribe. Seriously? I've been to school for 6.5 years, worked for 7, and I can't write for a muscle relaxer because a physician doesn't want to deal with it? It's those type of things that get so frustrating. Those and a million more examples. Now, speaking for PAs specifically, we never pushed for independent practice. In fact, what we are asking for now is OTP, Optimal Team Practice. And one of the main reasons we are forced to do this now is that we are having a hard time getting hired in states where NPs have independence. Hospitals, healthcare systems, and independent doctors often favor NPs because there is less paperwork and the physicians have less liability. So, what are we to do? Watch our profession disappear, or fight for OTP so we can survive. Anyway, these are only a few of the issues in this very complicated problem. I deeply respect doctors and the massive training they go through. I would suggest that you look deeper at PA training, just for your general education. Out programs are quite intense and I would wager that you would be surprised to understand exactly what our training entails. I'm not saying it equals physicians, I'm just saying most med students would be surprised. Goodness, I've already written a book and haven't even gotten to the doctorate question. But I will let what we discussed in the video speak for itself instead of reiterating those points. Again, I appreciate you watching and commenting and best wishes to you in med school!

[@raphaeltoussaint59]

@presto900 What you mentioned is the outward perspective that most entering PA and even Physician professions expect. But it can be far from the reality of what happens in practice, specifically in primary care roles. From experience, the dynamic between a physician and PA/NP in primary care more resembles peer to peer and less supervisory. Experience level and competence rather than title dictate that relationship in most cases. Good luck in med school. Stay humble

[@Wellness-Wealth-Wisdom]

In your opinion, what is the best DMS program out there currently?

[@TheMedicineCouch]

Honestly, I don't have a lot of first hand knowledge about the different programs, so It would be hard for me to answer that. What I can tell you is that most all of the programs offer different tracks within the doctorate. So, your options narrow down when you identify what you want your doctorate in. Meaning, it could be something like enhanced clinical medicine knowledge, leadership, public health, or education. Once you have decided what you actually want to get out the degree, then I would start identifying the programs that will give you what you want. Once you have that narrowed list, then I would look at cost, time commitment, and specific curriculum. I bet at that point, you would only have a few programs to consider. Then you can ask around about those particular programs.

[@imthrillz5255]

Sorry to say, all these problems could be solved/prevented if the person in question would simply stick through 2 extra years and become an MD/DO. A doctorate PA degree just seems like an overcomplicated med school route.

[@TheMedicineCouch]

I understand the point you’re trying to make, but it is more complicated than that. I chose PA school because I was already in my 40s and couldn’t afford to take on the kind of debt that happens when you go to med school. Even just finishing my undergrad and then going to PA school left me $149,000 in debt, it would’ve been at least double that going to med school . Also, it’s not just the two extra years. If you go the MD route after you finish med school, do you then have to do a residency for several years and maybe even a fellowship depending on the specialty. I didn’t have that kind of time or money, so I chose PA school. However, beyond that, I’ve come to appreciate that the PAs can have a more versatile career than MDs. we have the ability to switch specialties, which is something that I find very appealing. Of course, others have different reasons. So, there is more to it than just choosing 2 or 4 years.

[@thegottschalks3432]

We have options. That is the great thing about the PA profession. I believe the clinical doctorate is not the only degree that helps make a PA a better clinician. Understanding the leadership, administrative, and other aspects of the healthcare arena allows the PA better serve their community and their patients.

[@TheMedicineCouch]

Yep! The flexibility as a PA is amazing. I agree that more knowledge of healthcare does help you become a better clinician, and as I said in the video, administrative and Ed based PA degrees are great. However, I do think there should be a degree designation to denote a graduation from a rigorous clinical program.

[@thegottschalks3432]

@@TheMedicineCouch I understand what you are saying, but traditionally, the general feeling nationally was we don’t want to create “different classes” of PAs. In other words, those PAs that have “more” formal clinical qualifications than others. Traditionally, “clinical experience” has been the thing that gave a PA “extra” qualifications when they were going for a new job. However, I think the CAQ and fellowships have already started the process of some PAs having more formal clinical experience than others. I also think we should have one doctorate with a distinguishing letter at the end of DMSc. Such as DMSc-L (leadership) DMSc-C (clinical) and so on. My opinion stems from my experience at ATStill. At ATSU we all take the first year together and then break into areas of interest in the 2nd year. Great discussion!!

[@TheMedicineCouch]

Yes! That's why I love these discussions. I see your point that our entry level training is already top notch and if we start distinguishing those who have received extra training, it may lead others to think our initial training wasn't adequate. Obviously these topics are very deep and multifaceted! I do like your suggestion for the DMSc-L/DMSc-C.

[@jt3013]

How about DCM? Doctor of Clinical Medicine. Perhaps that could distinguish PAs with extra clinical training. Also medicine should really be more competency based - as it stands now most medical training is time-based, you do your time you pass your exams and you’re a provider. I have heard of studies that show big differences in quality and competency even between physicians who trained at the same medical school and residency. I think competency based education should be the future and could potentially level the playing field by allowing those with the appropriate competencies to quantify/qualify those competencies via evaluations or examinations developed by experts in that particular competency/field, etc. As PAs once we accumulate a certain number of competencies then we could practice independently, or something to that effect

[@TheMedicineCouch]

I would like to see greater demonstrated competency before graduation. Exams, of course, can test your competency regarding things like diagnosis and medication, but I think there should be a list of skills that you have to be checked off on in order to graduate, or maybe in order to practice independently?

[@thegottschalks3432]

When I became a PA, there was a hands on skills portion of the initial exam that was done at the PA program by the PA instructors. . It was discontinued, I believe, because of the lack of control over the grading. Meaning, one person grading that portion would not grade the same as another at a different program.

[@wjsb437]

Great representation, Russell!!

[@TheMedicineCouch]

Yes! I really thought I knew where I stood on some of these issues, but I have to say that he had some very interesting points that have given me much to think about!

[@lilylife4426]

Am I the only one who thinks these doctorate degrees for PAs are unnecessary? Or maybe new grads can be more competitive with those degrees, then why not just go to med school? There's also a PA-DO bridge program, which makes sense. It would be nice to have more of such bridge programs in the country.

[@TheMedicineCouch]

No. You are not the only one. I think I mentioned in the video that to me, if you’re going to get a doctorate from the get-go, you might as well just go to med school. However, as I also said, unfortunately, I think this is going to become a necessity in order to stay competitive. I do think that a bridge to MD or DO is a much better option, unless you want to get into administration or teaching. I’m actually not sure if any bridge program still exist. I did a little searching, and I thought that none existed anymore. I could be wrong if anyone knows of one, please drop the link in the comment section.

[@jordang8317]

@@TheMedicineCouchadmittedly I’ve only just started looking into going back to school so I don’t fully understand the conversation but, as someone in their mid thirties, does this mean that going to PA school now would be putting me at a disadvantage in 10-15 years? It seems a lot of PA programs are about 2 years out + the time it would take to get pre-reps & patient care hours…. Am I better off just trying to go to med school? I don’t really understand the impact that the new doctorate programs will have. Is it going to mean that PAs with doctorates will basically be able to do everything an MD can and with pay to reflect that? Or is it just a title and PAs still won’t have autonomy to practice on their own & still paid roughly half?

[@TheMedicineCouch]

@@jordang8317 It's somewhat complicated, but I'll try to explain. First thing to understand is probably that a doctorate for a PA, does NOT make them equivalent to an MD. That degree does not affect PA autonomy one way or the other. Only state legislation can affect this. PAs have achieved autonomy in a couple of states. However, it will likely take 5-10 years before there is PA autonomy in a significant number of states. Also, having a doctorate may increase your pay slightly, but it would still be no where close to a physician's. So, if that is a big deal for you, then you would want to consider MD. The real point of the PA doctorate is to improve your knowledge to make you a better clinician, prepare you to teach, or prepare you for administration. (Depends on the program track.) Unfortunately, with so many NPs getting doctorates, it it likely that PAs will all be forced to get doctorates in the long run to stay competitive in the market place. It would seem that PAs getting doctorates would end up equally the time spend to go to med school, but it doesn't really. First of all, the pre-reqs are about the same, so that is a wash. Yes, you do need pt care hours for PA school. Usually people get these while in undergrad. Next is the school itself. MD=4 years (although there is very early discussions about condensing this to 3 yrs). PA courses already actually contain enough credits for the degree to be a doctorate, but for some reason, it's only a masters. So, there has been some talk that if the entry level PA programs become a doctorate, it may only extend the programs by 6-12 months. Also, if you decide to get your doctorate right after your PA degree, currently there are some programs that make it possible to get the doctorate in about 6 months. Otherwise, it's usually 1-2 years. Compare that to a physician at 4 years graduate program, then you still have to complete residency which usually range from 3-7 years. During residency, they don't make very much money at all. So, worst case scenario, you are kind of comparing possibly 3 years PA school then full salary, to 7-11 years for med school and residency before you make full MD salary. (Which would be at least double that of PA salary). I would say the most important thing to determine is if you TRULY want to work in medicine to begin with. Many clinicians are looking to leave, so you need to be as sure as you can be about that. Then, if the answer is still yes, then think about what you really want. If the answer is to be a doctor, then I would go that route. The money and the time seems like a lot (and it is), but the older you get you realize how fast time really goes. Last thing I will say is that there is never a RIGHT decision. There is no way to know all the variable that will happen in the future. So, give it some thought and go with your gut! Don't agonize over it! I hope all of this helped you some.

[@jordang8317]

@@TheMedicineCouch thank you! The clarification regarding the PA doctorate did help. It’s a bummer that they aren’t focusing on providing more PA to MD bridges-like maybe 1 extra year of school and then some form of residency and then sit for whatever the physician licensing exam is. Out of curiosity, why can hospitals afford to hire staff but not create their own residency programs by basically hiring the new grads as (relatively) poorly paid interns while they shadow the mentor doctor(s) for 3-7 years?

[@TheMedicineCouch]

@@jordang8317 Glad it was helpful! I agree, I am also surprised there aren't PA to MD bridge programs. I actually don't know of any that currently exist. It doesn't seem like it would be too difficult, especially if there was a requirement of x number of years a PA has to work before starting the program. Finally, I'm sorry, I can't help with the last question. I have no idea how hospital finances work!

[@NYHawdCoa]

I agree with the guest that there are myriad existing PA-specific post-graduate programs. Sadly, most of the currently-available programs are not clinically focused, thereby limiting their ability to significantly enhance PAs clinical acumen. This is should be an important consideration when PAs use the doctoral degree to justify increased clinical autonomy, as many PAs often do. Achievement of a doctoral degree, particularly via most of the currently-available programs by no means ensures that the individual is more clinically prepared. If we want more clinical autonomy, we should also be demanding training commensurate with that desired autonomy. But any program that fails to incorporate real-time mentorship during the direct provision of bedside care shouldn’t be called a “clinical” doctorate, IMO. Learning clinical medicine at the bedside is distinctively and often profoundly different than learning clinical medicine in a classroom or online, as it demands many different skills that are unobtainable in a classroom. Another topic worthy of discussion is the quality of these programs, the quality of their graduates, and their value to those we serve.

[@TheMedicineCouch]

Absolutely Jonathan and thanks for your comment. As I mentioned in the video, if I went back for a doctorate, I would want/expect more clinical training. Not only that, as you pointed out, I would want it to be hands on/bedside training. I really wish the PAEA would standardize these doctorate programs and firmly set the degree designations, differentiating between clinical and non-clinical programs. However, I do think that someone who has practiced for many years should already have the skills that justify clinical autonomy, especially as most of us already practice very independently. I recently had an interesting conversation with another PA where she said she wished she could go through clinical rotations again. I immediately realized that is exactly what I want as well. Now that I've practiced for several years, going through rotations at this point would really help me solidify my knowledge and skills. I've been thinking about this a lot, but can't figure out any way that could realistically be done, unless you went through a residency. Now that I think about it, I guess that's always what I thought would happen when you get a PA doctorate! Seeing all these PA doctorate programs pop up does give me pause. I worry that we are plunging ahead to quickly without thinking things through because there is just so much money to be made in higher education!

[@mike02ss]

I find it kind of funny how PA’s always say how they prefer their choice over being a dr yet they are fighting so hard to be called a dr.

[@TheMedicineCouch]

Well, I don't really know many PAs "fighting" to become "Dr.s". Right now, PAs are getting doctorate degrees out of personal fulfillment and the desire to be competitive for jobs in education and administration. Also, we as a profession are somewhat being forced to get doctorates or we will eventually lose out to DNPs for even our regular clinical jobs. What we discuss in the video is the ability to use the Dr. title when one obtains a doctorate degree. Which is the right given to every person who completes a PhD or other doctoral degree. Whether Dr. should be used in a clinical setting if one is not an MD is a difficult matter, which I am still on the fence about. However, my guest was pointing out that already happens with Chiropractors, Audiologists, Optometrists, etc. So, it seems inevitable that as more PAs and NPs get doctorates, they will use they title they EARNED in the clinic setting as well.

[@mike02ss]

@@TheMedicineCouch well to be honest a lot of PA,s think they are equal to a doctor, not all but a lot. Im a little biased because my son is a doctor and the schooling and clinical between a physician and a PA doesnt compare.

[@daniellem1008]

Coming w/all respect and as a person attempting to transition from a COTA to a PA. Every profession is moving to a Doctorate degree. Occupational therapist are now making that move too. So here is my question if we do the move to Doctorate. PA are the secondary provider that is seen by the patient. Why would a person even need a doctor if they are seeing a PA w/ a PHD. Is it phasing doctors out. Which was not the purpose of the PA profession. PA were created to help decrease the stress and assist in seeing the caseload of a doctor. I am personally not for it. Sorry I just don't

[@TheMedicineCouch]

I agree with the point you are making. Part of me honestly wishes it could stay at a master's and that the profession would continue to be what it started as with us working closely with physicians and helping them better serve patients. However, once you work for any length of time as a PA, you realize the reality today is much different. We have our own patient panels, we see see exactly the same type of pts the MD sees (same Dx, same acuity levels), and we see just as many patients every day. (Coming from a family medicine perspective here.) Supervision and mentoring is often little to non-existent. Yet, because of the laws, I have to be tied to a supervising physician, which often creates lots of administrative headaches and makes us less competitive in the job market compared to NPs. So, while I would actually love to work in a manner that resembles how the profession was meant to be, that's not realty. And in the new realty, you also can't be the lowest credentialed provider and expect to continue to command an equal salary.

[@AA-nl5bl]

PA profession has to evolve as medicine has evolved. We must remain relevant in the medical industry. We are excellent providers in every speciality. Whatever it takes to gain the respect and recognition we have all worked for. If it is doctorate so be it. If it is independent practice….so be it. We cannot trail behind NP. DO’s and MD ‘s receive different training in school but in the work place have access to same opportunities. PA’s must make sure we have also have all the bells and whistles NP’s have otherwise we will be seen as inferior providers. NP’s are our competition. We must stay right next to them and not trail behind them. My best friend is an NP and I am a PA. She was getting her doctorate and I decided to get mine too. All my PA colleagues say it wasn’t needed but I choose to disagree. Having a doctorate does not make a PA a physician. It makes you an “expert in the PA realm” . PA’s will continue to refer complex cases to physicians. Just like an internist will refer to a hematologist. There is a role for physician, PA and NP in the provider space. Each one brings value to the patient care space.

[@thegottschalks3432]

I disagree that we are “secondary” providers. I saw new patients. And although my supervisor may see my notes at some point, often they never saw the physician.

[@daniellem1008]

@@thegottschalks3432 I do not mean secondary as lesser than or that PAs do not preform the same work up or interventions or tx same dxs. I mean secondary meaning they work with the doctor or along the side of. I am not here to dis the PA profession. I am an inspiring one myself. I just feel like the advancing of the degree thing ( I feel) is something that every profession is doing to get more money. My example I am currently an occupational therapy assistant. OTR are moving to a doctorate and why? Has their job become more entailing? I do not believe so, did they get pay raises? ( nope they actually got pay cuts due to PDPM.) So why. I believe it's so university and schools can do two things. Number one charge more. A doctorate as we all know is more expensive and is the highest degree you can achieve in a field. And number two to weed out so many people who may not have the time, money or circumstances to attend college for such a very long time. In the video they compared NPs doctorate to a potential doctorate for PAs. But here's the thing NPs have various forms of obtaining their degree. There are tons of online NP programs. That's not the case with PA. NPs and PAs are apples and apples but grown from two different orchards.

[@thegottschalks3432]

@beatfaceDanni that is a lot of different issues. Pay cuts for the OTs because they have a higher degree? I very much disagree with that practice. OTs are known to make the smallest salaries in the APP world. Making the salaries even less would cause students to not even consider OT school. I also disagree the sole reason to create the a doctorate is to be make more money for the universities. Often when you are in legislative or administrated situations, if you are the only person without a doctorate, you are at a disadvantage. You are not treated equally or taken as seriously. Also, anyone that works for a doctorate, should be doing it for personal growth. In their career or even just for the education. PAs are prepared to practice medicine with a physician or in a team of experienced providers when they get out of school. You become more independant as you move forward clinically. Every provider, no matter which variety, should work within a team. As the PA in this video said, “medicine is a team sport”. Also most of the PA doctorates are online. So when or if you get a PA doctorate, IMO it should be after your regular PA training and a personal choice. However, there are a few programs that are offering the doctorate as part of the normal PA school.

[@yourfavoriten3rd]

You sign up for lifetime supervision when you go to PA school, that's the role. If you want graduated autonomy, if you want to be a doctor, all of those things are possible, just go to medical school. Your 1 year of zoom learning on internal medicine in that DMS program is not at all equivalent to either medical school, nor internal medicine residency. Totally agree that seasoned PAs are very competent providers and fantastic to work with (particularly over NPs), but buyer's remorse is not a compelling reason to blur lines and confuse patients. I disagree with you that patients don't care if they're seeing an MD or NP or PA or even a DO. Other doctorate professionals like DPTs and PharmDs don't call themselves doctor in the clinical setting, so you'll never see MDs chafing at them and they still make the same salary. One's that do call themselves doctor tend to occupy a space that physician's don't, audiologists for instance do a great many things physicians aren't trained in, similarly an optometrist knows a great deal more about an eye than I do. But PAs definitionally will not know anything a medical school graduate doesn't so this is a false equivalency you're drawing. Anyway, really dissapointing to see the same credential creep coming from NPs affecting PAs.

[@TheMedicineCouch]

I've started to reply to this so many times, but it's difficult because everything is so multi-factorial. First, I see both sides of the argument about being called doctor in a clinical setting. I have great respect for MDs/DOs and the amount of schooling and residency they go through. I use to be dead set against anyone calling themselves "doctor" in a clinical practice if they weren't an MD/DO. However, now I also see the argument that if someone earns a doctorate degree, they should be able to use that honorific. Yes, it should be made clear to patients what type of doctor they are, but it does seem problematic not to show respect to someone for the hard work they've put in and how they have enhanced their knowledge level. This is probably where I take the biggest exception to what you wrote. You completely dismiss a DMSc degree by implying that it's just one year of Zoom learning. When in reality, what is happening is that someone is studying the SAME board certification coarse as physicians after having gone through 6-7 years of schooling, (taking most of the same undergrad science courses as pre-meds) and then went through PA school (which is fairly intensive in case you've never looked in to it), then practiced medicine for 5-10 years, and having studied 100 hours of CME each year. The amount of knowledge THAT person absorbs, even doing home studying and online courses, is actually probably pretty equivalent to or even exceeds most medical students. Now, I do feel the lack of a clinical component is problematic, and as I said in the video, I wish there was more emphasis on this part. Overall, the video was not saying that a DMSc is equivalent to med school, but the degree is also not as trivial as you implied. So, what is the answer? I'm not sure. My heart does hurt for physicians. What has happened to them over the years in medicine is unfair. They no longer command the respect they deserve, and they, like every other front line worker in medicine, are being pushed to the breaking point. I understand how frustrating it must be to feel like you are being undermined from all sides. BUT, I also see it from the PA perspective. In family practice, and often in many specialties, we are seeing the EXACT same number of patients with the EXACT same acuity level, only we're doing it for half the pay, half the respect, and less than half the recognition. And, in reality, there is very little supervision happening. We are often working very autonomously and we collaborate and ask for help when we need it, just like any other person working in medicine. We are constantly being dumped on by vocal physician groups and being denied basics like having a say in the practices we are being the work horse for. Then, the nurse practitioners started gaining independence. So what has that meant for PAs? It means we are having a harder time finding jobs because hospital systems don't want to pay for a supervising physician and physicians don't want to supervise because they don't have time. Also, honestly, they no longer have skin in the game as many are now just employees and not practice owners. So, in many states and hospital systems, NPs are being preferred and PAs are being pushed out. In addition to that, don't you think it's kind of ridiculous that as a PA, who treats the same patients that a doctor does, I can't even volunteer for the medic tent at a fun run unless I find a physician who will agree to be my "supervising physician", even though they won't even be anywhere near me when I'm volunteering? And, if something happens to my supervising physician, I have to immediately stop practicing until I can get another one lined up! Somehow I was competent to see 20-25 patients a day autonomously one day, or another PA was competent enough to actually be training residents in the hospital one day, but neither would be able to continue their jobs the next day because something happened to someone else? Why does that make sense? So, like I said it's complicated when you look at the situation realistically and understand the pressures from all sides. I do believe the highest trained and most knowledgeable person should be the head of the team, and in 99.999% of cases that would be the physician. I do believe physicians deserve respect, but so do PAs and properly trained NPs. We all work hard and we all are often being mistreated by the healthcare system. I hope we (PAs, MDs, NPs, etc) can have healthy dialogue about the issues and somehow find a way to work together to change medicine for the better. We can, and will, disagree on things, but I hope that we will always do our best to treat each with respect. I really do appreciate you watching my video and for sharing your thoughts.