A lot is happening in PA-dom these days. Previous columns have discussed each of the following topics. Here are some updates and further thoughts.

Specialty Certification

The NCCPA's bold announcement that it would offer five specialty certification exams has led to continuing controversy and concern. Certification in one of these specialties-emergency medicine, orthopedic surgery, cardiovascular surgery, nephrology and psychiatry-would be voluntary, time-limited and not linked to licensure.

The outcomes and ultimate effects of specialty certification examinations remain uncertain. A key point is that the AAPA has existing policy that clearly states its opposition to PA specialty certification examinations. The AAPA position is based on the concept of preserving PA clinical mobility among specialties and discouraging the erection of what have been termed barriers to the entry of PAs into clinical specialties.

Despite its official anti-specialty certification examination policy, the reality is that the AAPA can do little to halt the progression of specialty certification. The hope is that at the formal organizational level, the NCCPA and the AAPA will try to work together to design the specialty certification system in such a way that maximum clinical flexibility is maintained.

A challenge to this effort is that specialty certification's ultimate impact on the profession is uncharted territory and will not be evident for at least five to 10 years, until its value is tested in the medical marketplace by hospitals and medical practices.

Doctoral Education

While the profession's organizations have held a PA Clinical Doctoral Summit from which was issued clear and bold conclusions, the discussion on the entry-level doctoral degree for PAs has only begun.

Leaders in PA education are weighing in on this debate, with a few prominent authorities calling for an entry-level doctorate.1 Maintaining equivalent status in the health system with perceived rivals such as nurse practitioners appears to be the major reason for this advocacy.

In response, P. Eugene Jones, PhD, PA-C, the capable editor of the Physician Assistant Education Association's Journal of Physician Assistant Education, not only has reiterated his strong opposition to a PA doctorate but also has added an important practical point: Even if we wanted to institute an entry-level clinical doctorate, the faculty infrastructure to do so does not exist in most programs. Jones calls attention to the anemic state of PA scholarship (e.g., 74% of PA faculty have had no peer-reviewed articles published over their entire career) and that insufficient doctorally prepared faculty are currently in place. With so few doctorally prepared PA faculty, it likely is not even realistic to consider the notion of a legitimate entry-level PA doctoral degree.2 Such an impediment, however, may not deter some institutions, and there is a sense of inevitability about the initiation of such degree programs.

Health Workforce Policy

While some see the prospects of Congress passing a health care reform bill diminishing, there is still strong anticipation about the enactment of legislation that would strengthen the health care workforce. Such legislation almost certainly would be aimed at strengthening the primary care workforce and would include incentives designed to attract more providers (including PAs) into primary care and generalist practice. This could result in substantially increased funding for PA educational programs through the Health Resources and Services Administration.

While attaining this highly desirable policy objective would be a plus on one level, the downside could be the strings that likely would be attached to the awarding of such funding. Federal health workforce policies for PAs almost certainly would aim for the achievement of longstanding workforce policy objectives-specifically, more primary care providers, more care in medically needy areas and more workforce diversity. PA programs would be called upon to develop strategies to respond to these funding targets-a task that many programs have not given high priority. Thus, with the influx of additional federal funding, PA programs will face the challenge of ramping up efforts to address these workforce policy priorities. Are programs and their faculties up to the task?

References

1. Rahr RR., Blessing JD, Barese S. The physician assistant clinical doctorate: professional suicide in the making? J Physician Assist Educ. 2009;20(2):6-7.

2. Jones PE. The dead-end clinical doctorate idea. J Physician Assist Educ. 2009;20(2):4-5.

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.