Degree Creep, Indeed

  It was a shot heard ’round the PA world.advanceforpa

The U.S. Army and Baylor University created a stir when they announced their PA clinical doctorate degree residency program in emergency medicine at the Physician Assistant Education Association forum in Tucson, Ariz., in November 2007.

Doctorate degrees have been increasing among health care professionals for more than a decade. Audiology, physical therapy, occupational therapy and pharmacy, for example, have all moved to the entry-level doctorate degree. The nurse practitioner profession adopted the entry-level doctorate degree in 2006, and the DNP will be mandated for all advanced practice nursing graduates by 2015.

Even though the specter of doctorate degrees has been hanging over the PA profession for years, the formal announcement of the Army program brought the controversy to the forefront. News of the Army’s program roiled educators at the PAEA forum and sparked furious debate about clinical doctorate degrees and PAs

It’s a very well-written article, and the included sidebar points out one of the biggest problems with a ‘midlevel doctorate’ for PA’s: they’re dependent on their relationship with Physicians in a way NP’s definitely aren’t.  No support for this from docs=real problems for the PA programs (and not just the doctoral programs, all of them).

We live in interesting times.


  1. Interesting article. Very curious as to how a PA doctorate program would work out considering their dependence on physicians.

  2. I’m not entirely sure why this is considered necessary — PAs are amazing assets & people, in general, and they are extremely capable in their primary role. Won’t this sort of pit them against their physician preceptors, in a way?

  3. Gruntdoc
    I am a PA and do not necessarily agree with this program. In a sense it will force the PA out of the role in which we were created and that was to be physician extenders! We are NOTHING without the Physician relationship nor would I want to be. I didn’t want to go to more academia. If I did it would have been MED SCHOOL! Why all the extra expense and time if we cannot be more than we are? I love being a midlevel provider and love the relationship I have with my ER (ED, whatever) docs. Thanks for doing what you do and you will have to visit my site once its up.

  4. The only reason it makes sense to have PAs or NPs treat patients instead of physicians, as far as I can tell, is cost (equivalently, supply of doctors). (Is that right?)

    The cost of getting a doctor to treat patients ultimately comes down to the difficulty of becoming a doctor (which limits how many doctors are in the market for jobs, which determines the price), and to how much you spend to become a doctor–that is, how much tuition you end up spending, and how many years you’re making either nothing or a pittance.

    Given those two, why does it make sense to increase the educational requirements on NPs and PAs? It seems like this inevitably means they will cost more to employ, because they’ll now have a harder process to become NPs/PAs, and will have to spend more on tuition/defer making a living longer before beginning to make money.

    What’s the upside? If we need less expensive medical professionals to treat the simple cases, it seems like making those professionals more expensive defeats the purpose.

  5. The upside? The universities will be able to get more $$$. Who do you think make these degree creep decisions? Academia intellectuals. Upside for clinicians? Not much IMO.

  6. Interesting article, we could all use more PA’s, they are important to the medical field. Protecting a PA’s income should be just as important.

  7. If these DNPS (Doctors of Nursing Practice) and DScPAs (Doctors of Science Physician Assistant) want these doctorates, then so be it and please let these midlevels share same burden of malpractice and pay as much as physicians have to pay and not fall under the umbrella of physicians anymore! Go for it midlevels, but ergo, be careful of what you midlevels wish for…