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. 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.

Whither the PA doctorate?

“…5 Overall, these two studies revealed that support for an entry-level doctorate was weak but that some respondents did support a doctorate as an option for PAs. 5,6 These fi ndings are consistent with previous studies that found that practicing PAs and PA students were not supportive of an entry-level doctorate for the PA profession. 12,13 For those who support an entry-level PA doctorate, the anticipated benefi ts are in the areas of professional development, clinical competency, scope of practice, autonomy, leadership, and research.…”

“…6 More than 80% of the survey respondents disagreed that an entry-level doctoral degree should be required. 6 A majority supported the notion of offering the doctoral degree as an option but not a requirement; and some disagreed even with the option of offering the degree. 6 Another study by Brown, Quincy, and Snyder found that most of their survey respondents believed that the master's degree was enough for clinical practice and that PAs provide a high level of patient safety.…”

“…6 A majority supported the notion of offering the doctoral degree as an option but not a requirement; and some disagreed even with the option of offering the degree. 6 Another study by Brown, Quincy, and Snyder found that most of their survey respondents believed that the master's degree was enough for clinical practice and that PAs provide a high level of patient safety. 5 They also showed that a signifi cant portion of the survey respondents believed that a terminal doctoral degree was a barrier to increasing workforce diversity.…”

“…1,2 These initiatives have led to the publication of new data and perspectives on the issue and spurred continuing formal discussions by the PAEA Board of Directors and the AAPA House of Delegates. [3][4][5][6] Although the AAPA House has made its position clear in terms of opposing a mandatory entry-level doctoral degree, numerous constituencies within the PA profession appear to support this notion. 7 Among them are the Academy of Doctoral PAs, dedicated to advancing the doctorate as the terminal degree for the PA profession.…”

An Exploration into the Physician Assistant Entry-Level Doctoral Degree: Lessons Learned From Across Health Professions

“…8 AAPA's primary concern is that an entry-level PA doctorate will create the perception that PAs are moving away from team-based to autonomous practice; PAs are concerned about increased debt burden and negative impact on the diversity of the workforce. 9 Outside the PA profession, other healthcare disciplines have successfully transitioned to an entry-level doctoral degree-namely nursing, pharmacy, and physical therapy. Those transitions were motivated by specific goals, such as "direct access" in the case of the physical therapy 10 profession and independent practice in the case of the nurse practitioner profession.…”