A physician assistant entry-level doctoral degree: more harm than good?

Abstract

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.

Developing and Evaluating an Instrument to Assess Perceptions of an Entry-level Physician Associate Doctoral Degree

“…Using a randomized sample of 1,500 American PAs, Ohlemeier and Muma (2008) conducted a cross-sectional study investigating perceptions of the entry-level doctoral degree of practicing PAs and found that the majority of the respondents did not support moving toward an entry-level doctorate for the PA profession [9]. Similar ndings were also reported in subsequent studies [10][11][12][13][14]. Consequently, the national PA organizations such as AAPA and PAEA have opposed several motions to adopt the entry-level terminal doctoral degree for PAs due to increased debt burden and potential adverse impact on the diversity of the workforce [15].…”

“…As the health care milieu continues to change, the quest for doctoral education for PAs has continued at various levels. As of 2022, about 11 institutions have established post-professional programs such as Doctor of Medical Science [6, 7,12,16,17].…”

“…Recently a study sponsored by the PAEA investigated the potential risks and bene ts of the entry-level doctoral degree for PAs. The results from this study were mixed, with some people advocating for the entry-level doctorate, whereas others were against it [12,16]. Similarly, the AAPA research commission has undertaken a study assessing current perceptions and give guidance to the professions [18].…”

Developing and evaluating an instrument to assess perceptions of an entry-level physician associate doctoral degree

“…The data used in this study is part of large study exploring perceived benefits and impacts of an entry-level PA doctoral degree. Detailed study and data collection procedures have been previously described [ 12 ]. This study was approved by the Institutional Review Board (IRB) of the University of Maryland Baltimore.…”

“…38 participants who participated in the semi-structured interviews included 19 PA association leaders and members (50%), nine PA program directors and faulty (24%), six non-PA academic leaders (16%), two physicians (5%), and two employers (5%). Sample characteristics were previously described in detail [ 12 ]. Based on the findings from the interprofessional literature review, a semi-structured interview guide consisting of 11 items was developed to assess feasibility, benefits, and risks as well as the impact of an entry-level PA doctorate degree.…”