In an assertive step, the PA profession has made its statement on the doctoral degrees issue, declaring its clear opposition to entry-level PA doctorates.

March's PA Clinical Doctorate Summit yielded a joint statement representing the position of the American Academy of Physician Assistants and the Physician Assistant Education Association. It states, "The PA profession opposes the entry-level, PA-specific clinical doctorate."1 At its May meeting, the AAPA board of directors accepted this statement and is taking steps to widely disseminate this now-official policy.

Quick, Decisive Action

It is to the credit of the PA profession and its organizations that they were able to rapidly attain a broad consensus on this issue, establish a policy and disseminate it to all stakeholders. Unlike our history in the master's degree debate, the profession, the AAPA and PAEA have been thoughtful, proactive and decisive on the entry-level doctoral issue.

The summit was not just a meeting on an important professional issue but also was the beginning of a process in which the PA profession determines its vision of the future. The doctoral issue was a catalyst that sparked serious discussion about the profession's directions. The consensus was that the PA profession did not wish to go down the doctoral degree road like other health professions have.

Sending the message that the profession adamantly opposes entry-level PA doctoral degrees immediately serves as a deterrent to institutions in higher education who might have had interest in establishing such a program. Of course, there can be no binding or legal consequence if an institution starts one, but at least such schools will be fully aware of the profession's clear opposition.

Significantly, this statement signals that the PA profession is attempting to control its direction instead of merely reacting to events determined by U.S. higher education.

An Ongoing Debate

The clear statement of opposition also reassures physician groups that the PA profession is not attempting to use the doctoral degree as a vehicle to attain independent practice. And reaffirming the master's degree as the entry-level PA degree signifies that the profession prefers to stand on its own and not follow the fashionable trend of so-called clinical or professional doctoral degrees.

The policy also puts off, at least for the near term, the difficulties that could be encountered in the practice workforce and the medical regulatory arena in considering "doctor PAs." Anxiety continues about how doctorate-prepared PAs would function alongside physicians and DNPs. For instance, how should patients and staff refer to such PAs? Could such references be in conflict with state regulations that require PAs to clearly identify themselves as PAs?

It is also welcome to see the profession's organizations work together so swiftly and effectively. This has not always been the case, and several remaining issues such as specialty recognition/certification likely will test the collegiality of the four major PA organizations. And in truth, some level of conflict is to be expected, since these organizations have different missions and represent different constituencies.

The matter of the entry-level doctorate is not over and done with. Certainly, it is possible that somewhere an institution will begin an entry-level PA doctorate program, sparking competing institutions to offer such degrees to attract students in spite of the profession's policy position. The Accreditation Standards for Physician Assistant Education from the Accreditation Review Commission on Education for the Physician Assistant neither proscribe a degree from being awarded for entry-level PA education nor prohibit an institution from granting a PA doctoral degree.

There also is the special matter of PA-specific postgraduate clinical doctoral degrees. The summit's statement that "The PA profession supports advanced professional development and education, including the option of non-profession-specific postgraduate doctorates" supports the concept of the postgraduate emergency medicine program developed by the Army. It would be welcome and not surprising to see postgraduate doctoral programs develop in other specialties.

While clearly we will see more doctorate-prepared PAs, most will have obtained their degrees before or after their PA education. And, importantly, on this issue the PA profession is driving the bus and setting its own course.

References

1. PA Clinical Doctorate Summit: Final Report and Summary. Alexandria, VA: Physician Assistant Education Association, American Academy of Physician Assistants; April 15, 2009. http://www.paeaonline.org/index.php?ht=d/sp/i/66891/pid/66891. Accessed June 29, 2009.

James F. Cawley is professor and vice chair of the Department of Prevention and Community Health in the School of Public Health and Health Services at The George Washington University in Washington.