Background As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master’s to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. Methods A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data. Results Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p < .05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. Conclusions The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.

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Background: As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master’s to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. Methods: A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data. Bivariate analysis and binomial logistic regression analysis were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. For the semi-structured interviews (38 interprofessional stakeholders), deductive content analysis was used to analyze the qualitative data. Results: Six hundred and thirty six PA clinicians and PA students (46%) completed the survey. Most respondents (n = 457, 72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (n = 341, 54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p <.05). Based on the analysis of qualitative data, the most commonly cited perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. Conclusions: The perceived benefits and risks of an entry-level PA doctoral degree are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor, the proportion of those in favor is not insignificant and their views should not be ignored in future discussions. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.

BackgroundPhysician assistant/associates (PAs) are healthcare professionals whose roles expand universal access across many nations. PAs fill medical provider supply and demand gaps. Our paper reports a forecasting project to predict the likely census of PAs in the medical workforce spanning from 2020 to 2035. Methods Microsimulation modelling of theAmerican PA workforce was performed using the number of clinically active PAs employed in 2020 as the baseline. Graduation rates and PA programme expansion were parameters used to predict annual growth; attrition estimates balanced the equation. Two models, one based on data from the US Bureau of Labor Statistics (BLS) and another based on National Commission on Certification of Physician Assistants (NCCPA) data were used to estimate future annual PA census numbers. Results Asof 2020, the BLS estimated 125,280 PAs were in the medical workforce; the NCCPA estimate was 148,560 PAs in active practice. The BLS model predicted approximately 204,243 clinically active PAs by 2035; the NCCPA-based model predicted 214,248 PAs in clinical practice. Conclusions A PA predictive model based on four data sources projects that the 2035 census of clinically active PAs to be between 204,000 and 214,000: a growth rate of approximately 35%.

New perspectives have been brought to bear in the discussion of the topic of the physician associate/assistant (PA) doctoral degree in general and the entry-level PA doctorate in particular. Both the Physician Assistant Education Association (PAEA) and the American Academy of Physician Associates (AAPA) have sought and supported formal research investigations into the question. Evidence from studies shows that perceived benefits and risks are strongly influenced by the lens of the various stakeholders; that most PAs believe that the master's degree is enough for clinical practice; and that most clinical PAs and PA students are not in favor of an entry-level doctorate. Lessons learned from other healthcare professions that have transitioned to a clinical doctorate only marginally serve as a model for the PA profession. PA organizations need to fully own and embrace the task of leading the discussion and reaching a definitive conclusion in the determination of PA doctoral education. Failure of the PA profession to act decisively on the doctoral degree question would essentially default this decision to colleges and universities, which tend to have a vested economic interest in new types of degrees.

This article explores current trends in the ongoing debate about transitioning to an entry-level doctoral degree for the physician assistant (PA) profession and identifies lessons learned from the disciplines of nursing, pharmacy, and physical therapy, which have already transitioned to an entry-level doctoral credential. We conducted a mixed-method study that involved an interprofessional systematic literature review and an examination of publicly available databases. Based on lessons learned from other health professions, a model for imple-mentation of an entry-level doctoral degree for the PA profession is presented here. Recommendations for the profession include establishing a clear objective for doctoral degree transition, providing flexibility for options in program delivery, and transitioning through a phased approach. Further studies are warranted to explore risks and benefits in detail and to establish PA doctorate essentials, competencies, and an accreditation plan before the profession transitions to an entry-level doctoral credential.

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