There's a new PA degree in town, and its name is "Doctor."

The U.S. Army and Baylor University have created the first clinical doctorate degree for PAs. Army PAs will receive a doctor of science physician assistant (DScPA) degree after successfully completing an 18-month residency in emergency medicine at Brooke Army Medical Center at Fort Sam Houston in San Antonio.

The first four DScPAs will graduate in a few weeks, followed by a fifth in early 2008. Eight more Army PAs began the 18-month program in July 2007, and 10 are scheduled to start in July 2008.

"The Army needs more emergency-medicine-trained, trauma-trained PAs for the battlefield," says Maj. Leonard Gruppo, MPAS, PA-C, who is the director of postgraduate education for the U.S. Army. "It was difficult for us to ask PAs to go through 18 months of incredibly rigorous, demanding training and then give them a certificate, as was done with our previous 12-month residency upon which this is based, and is done with almost all postgraduate (PA) residencies.

"We wanted to recognize their training and expertise, and there is no other way to do it right now. There is no board certification for advanced (PA) training or specialty certification (for PAs). There's no way to recognize advanced training in a way other people (outside the PA profession) would understand. We feel that the training is doctorate-level. When we compared (the PA doctorate program) to (doctorate programs for) other professions such as pharmacy or physical therapy, it compared favorably. This (PA doctorate training) is even more robust than many other (doctorate) programs."

The Army conceived of a PA clinical doctorate program in 1999 and began development of the initial program in earnest in 2003. The Army plans to convert all of its PA residencies in emergency medicine and orthopedics to doctorate programs, Gruppo says.

In addition to being the appropriate degree for advanced clinical training, these PA clinical doctorate degrees should also be a strong incentive for PAs to remain in the military and possibly for civilian PAs to consider military service, Gruppo says. The Army needs a large number of well-trained and experienced PAs to care for soldiers injured in combat.

"We did a study of Army PAs and two-thirds of the respondents said that the availability of these (doctorate-level PA) programs would significantly affect their decisions to stay on active duty," Gruppo says. "That's a pretty enthusiastic response."

The PA Profession's Reaction
The announcement of this groundbreaking doctoral program has created a furor in a profession that is still having trouble adjusting to a de facto master's-degree standard. Discussion of the Army/Baylor program prompted long, spirited debate at the Physician Assistant Education Association meeting in Tucson in October. PAEA leaders say they will explore the implications of this PA doctorate program on the profession and will invite other groups to participate in the discussions.

"It was a topic of extensive conversation (in Tucson)," PAEA president Anita Glicken, MSW, says. "We want to look at this with representatives of other organizations, with other stakeholders. That will help us look at the meaning for the profession as a whole and the future of PA practice, so we can look at where PA education is going."

The Army/Baylor program isn't necessarily profession-changing by itself, although the development of a clinical doctorate specifically and only for PAs is a unique approach.

But any mention of PA and doctorate in the same breath seems to alarm some segments of the PA profession. For years, there has been preliminary discussion of and substantial anxiety about the possibility of the doctorate becoming the entry-level degree for PAs, just as it has for so many other health professionals, including nurse practitioners, physical therapists, occupational therapists, pharmacists and audiologists.

"People are worried that this may be another step in that direction. I don't think it is. That could very problematic for a number of reasons," says Patricia Kelly, EdD, PA-C, associate professor and director of the Doctor of Health Science program at Nova Southeastern University in Fort Lauderdale, Fla., an academic doctorate degree program that enrolls quite a few PAs and has already graduated about 75 PAs.

But, Kelly adds, "There really isn't another (similar) profession not going in the direction of an entry-level doctoral degree."

Gruppo is aware of the issues surrounding PAs and doctorate degrees, but sees the DScPA program a logical next step in the natural evolution of the PA profession.

"All this does is make a better PA to take care of patients and give PAs a tremendous professional opportunity that has never existed," Gruppo says. "This program is good for everybody concerned. It's good for doctors. It's good for patients. It's good for PAs."

"Our graduates will not call themselves 'Doctor' to avoid confusing patients and out of respect for physicians who remain the gold standard for medical practice, with extensive postdoctoral training and at least twice the medical training of our PAs," Gruppo says. "By associating a doctorate degree with residency training, rather than entry-level training, we avoid direct competition with MD and DO programs and follow more closely the physician training model of medical school, residency and fellowship. It just makes sense, especially considering the marketplace forces that have steadily asked more of PAs."