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I think 12-24 month residencies would be a good way to standardize post-graduate training. Definitely better than working for a doc or a hospital system for a year without dedicated time to focus. This amounts to 12-18 months of didactics and 2-3 years of structured clinical training. Most non-surgical post-graduate training for MD's (at least in NYC) is learned in the first 2-3 years. After that it seems to be about resource management, leadership, honing deficiencies and developing your own style of practicing medicine.

Clinically, RPA-C's have a medical license as well and function as junior residents. Of note, the national re-certifying exam tests understanding of general medicine not the specialty of the RPA-C. So basic medical knowledge is continually refreshed. While MD/DO's need to renew their medical license, they currently do not have to repeat step 3 every time. If MD/DO's are board certified, they just need to maintain certification in their practice specialty. Meaning a cardiologist only needs to re-board in cardiology, not general IM or retake step 3.

Academically, most RPA-C's carry the rank of clinical instructor - a few have higher rank. Would anyone be satisfied by calling post-residency or otherwise trained RPA-C's "clinician" or "-insert specialty here- + practitioner" (e.g. critical care practitioner)? I do think "doctor" in a clinical setting should be reserved for clinical specialists with a MD/DO but I would also add that "physician" should refer to those with an MD/DO, a medical license and have completed an ACGME approved residency. The term physician assistant should be updated to reflect how RPA-Cs are currently used. I also believe the degree itself should be standardized - currently there is the MPAS, MHS, MMSc, MPH, MSHS, MS, and the like. How about just M.S.M. (MS in Medicine) or MMSc?

Matt Fauster,  PA-S with a PhD in Neuroscienc,  HospitalDecember 14, 2015
Brooklyn , NY



I think that rather than changing PA's to a Dsc or creating specialty rotations/training for them there is a much easiest solution. The four year undergraduate degrees PA and MD/DO's are getting are not significantly contributing to their education. In Britain a bachelors degree will make you a physician. I don't see the US dropping the undergraduate degree for PA's MD/DO's entirely but why not allow students to complete their prerequisite courses and apply to start after their junior year of college, or even sophomore year (if they took some AP classes)? People don't often mention that some of the classes PA's don't take in PA school (as opossed to medical school) they are required to take a version of that class as a prerequisite. A lot of PA programs are getting closer to 3 years long.

Why not get rid of PA and NP programs. Have medical school only. Complete three years. Two didactic take STEP 1, one of rotations. Take a test (STEP 2 (I know its normally after your fourth year)). If you want you can be done right there, but you have the credentials and training to continue later in life. I am sure the temptation to stop and work for a while or be done forever would have plenty of people stopping there. Those who wish to continue can do so (mandate another year of specialties rotations “4th year” if the “PA” has 3 years of practice remove the requirement for an internship year.. Those who stop earlier will have one title and those who continue on will have another. PA programs keep getting longer anyways. This will insure everyone is getting the same level of education and they can go back and finish if they so desire later in life.

The elimination of an extra year of undergraduate school and “adding” another year to “PA” school will have the time to completion the same but leave a large pool of graduates ready to go back to medical school if their life situation or goals change.

This plan does not work for AA/CRNA's

Greg ,  AA studentNovember 11, 2012
Cleveland, OH



Just to put it out there, PA curriculum is certainly not easier in any way, shape or form. - from faculty who teaches both medical students and PA students.
And also, those who are in the PA program are not those who didn't get into medical school. It is actually harder to get into PA program these days with PA's being more efficient in this economy. Most of the students in the PA program DID NOT want to go to medical school.
And a note on the curriculum - Imagine 4 year medical school combined into 1 year.. Of course 1st year PA students are not required to know all the pathophysiology as a 4th year medical student but they are required to diagnose and treat just like any 4th year medical student. I am not saying PA's should be called as doctors with 2 years of school but as with experience, a physician assistant and an MD will have same depth of knowledge and then a bridge program after certain years of experience will be logical for those who want to advance their careers.

AJ JacDecember 05, 2011



As someone who completed pre-med undegrad and had steeled my innards for medical school, I think I can understand what resistance I read from the Doctors. While some are genuinely concerned for the possible patient confusion and compromising of quality care that 'handing out' doctorates to PA's may cause, I believe at the end of the day, the strongest fight is against being cheated.

After all, medical school was and is an enormous physical, emotional and financial hell, that once you make it through, you want to rest secure in the knowledge that you have THE bragging rights. You are special, and hard-core. You paid dearly to get there, but nobody's going to deny now that you are in that 99th percentile of bad-ass.

For PA's to get closer to being called 'Doctor' robs you. The public isn't too informed; most won't know the distinction between a PA-doctor and YOUR 'actual' doctor. And if those PAs get the same admiration and privileges as you, then you, who spent so much sweat and money, are made to look like a fool.

It's understandable, and to a certain extent, legit. I think any PA that is in it for the short-cut to 'glory', and I'm sure there are some, as there are in any field, do deserve scorn. Forget the idea of PA programs that last maybe 3 years and give an extra year of intership counting as Doctor as well. I think that’s also stupid, because frankly, it shouldn't and won't equal the 7+ years it takes to earn an MD.

However, I'd like to revive some thoughts that were swallowed up in the torrent of righteous debate. First, this immediate assumption that those who pursue PA are not 'hard-core', 'intelligent', 'ambitious' or 'strong' enough to handle Doctor needs to be done away with. It is a ridiculous assumption that the only reason someone interested in the medical field would not pursue an M.D. is because he/she lacked the ability for it. Those who do not choose Econ must be terrible at math then. Those who don't get accepted into Harvard must be stupid. Those who do not become researchers must not be problem-solvers. It is alarming to think that Doctors might carry this arrogant assumption into the work place, and treat their fellow PA's as of lesser intelligence and quality, failing to appreciate the amount of work that can be accomplished by accepting them as an equal team-member.

Which leads to the second thought, more simply expressed but even more important: What is best for the patients?

Doctors receive admiration ultimately in recognition of their wide stores of knowledge and extensive experience. 'Doctor' means, pardon my language, that you know your sh!t. The traditional way to 'prove' that you have so much knowledge is of course, to go through medical school. But does not a PA with years in the field, also have extensive clinical experience and medical knowledge? Why shouldn't that be acknowledged, respected? Granted, there are areas where the PA would need to be re-trained, and parts of his/her education fine-tuned, added upon, so on and so forth.

Which is why a bridge program that allows a long-time PA, with qualifying performance and experience, to receive the recognition and autonomy of doctorate, is not only FAIR acknowledgment to PA's, respectful of the effort needed to wear Doctor, but ultimately best for the patient.

Entering PAs are excellent, skilled professionals able to take on a patient load with a Doctor, increasing the care given without compromising quality. There can be no doubt however, that after a certain amount of experience and time, a PA's potential is limited by the restrictions on him/her, and his/her knowledge and leadership ability wasted. Patients and younger medical professionals would benefit from a bridge program that allows these elder PA's to enter into a position of command, and, again, this would not disrespect what it takes to earn Doctor.

Although I think the bridge program is pretty self-explanatory in why it's a good reason, and perhaps unnecessary to explain, I only bring it up because even such a reasonable proposal will likely rub some MD pride the wrong way. Some must still stubbornly feel that because it was not medical school, it just can't deserve Doctor. And to those, I say that as intellectuals, this is where you must admit you are being unreasonable. If you protest the sacred difficulty of the knowledge given in Medical school, isn't it because of how sacred and difficult health care is? How important it is to give the patient the absolute best, in quality? In which case, wouldn't a PA with years upon years of his/her life given to the field of medicine AND additional rigorous in-depth schooling have earned that trust?

If you obstinately still say "But MEDICAL SCHOOL!" then you are clinging to an experience for the sake of the experience, and not its intended purpose of producing qualified health-care providers. To cling so is not only unreasonable, it's harmful to the nation's future. The amount of people falling sick increases near exponentially, while the amount of medical schools and the graduating rate of doctors has remained steady. You doctors, at the very front of this losing battle, should be the FIRST in the search for ways to fill hospitals with more health care professionals, more doctors. You should be cheering PA’s that enlist and lighten your patient load, and you should be proud and relieved when they earn the promotion to Doctor and are able to lead alongside you.

Once upon a time, doctors were respected for their knowledge, and trust to put the patient first. Don’t contribute to the growing stigma that doctors are egotists after glory and salary. If you wanted to be a resented leader manipulating the lives of thousands for bucks and giggles, go into business.


Jane ZSeptember 15, 2011



Hi,

As a Doctor of Divinity I think traditionally I have the highest doctorate here. Actually it goes DivD, DLLB, DMus, PhD and THEN Medical Dr if memory serves. But none of it matters.

Being a Doc of Divinity also means I know an awful lot about bullshit. And title clasping is bullshit. Lets all be Doctors but make a clear definition between "Mid Level Practitioner" for DNP and DPA's, MBBS Physicians and Gp and higher specialists. Clearly marked on the badge, brochure's in the waiting room explaining it all, colour coded. There are so many more important protocols that need review over this nonsense. And a massive health care GAP is good for no-one.

They are just bringing in physician clinical associates over here (AUS)now (2011), through a masters program with a required degree in health sci and some form of clinical experience for entry.

NPRx's have also only just come in. They are just RN's, however there is a Masters program for them now as well. There are some very scary graphs in Australia of the medical cover gap projections up to 2014 and beyond. There are a lot of old sick people and not enough medical staff nor the time to train them under the old paradigm. And it can't be just RN's and Para-meds leaving their jobs because that leaves the same style of gap.

I know nurses and radiographers that know more than specialists in area's of clinical practice, but then i and they do not report MRI. There is a place for all of it.

Doctor means teacher and if you have completed an MBBS or BMCH (med and surg or churg; an MD over here is a post MBBS medical PhD)or a PhD in poetry or special effects; you have earned the title of Dr.

You must not misrepresent yourself, that goes without saying and they don't let me do any surgery, not even pics or stents with my Theology Doctor but I think that's fair enough.But my degrees in neuro/pharm and psych and Masters in Criminal Psych allow me certain duties in risk assessment profiles ect that others wouldn't be able to do.

And I would certainly rather a nurse deal with a line or cannula than a specialist (exception; anesthetist) and rather a pharmacist (clinical) balance my meds over any MD.

I may be in the first lot to do the MPA over here and our program is a streamlined medical degree used in war times when medico's are needed at a standard but quickly, and still with some supervision from senior physicians if there are questions (over here physician is a practice specialist, not used interchangeably with basic MD like over there. Wow, we do need an integrated system.)

But lets stick to our corner of expertise, like all specialists fellows do anyway (ask a cardiologist a neuro question if you don't believe me or an ENT to coil an aneurysm)and lets all be happy as a team.

If you do you UG and graduate with hons 1, complete a Master of practice and a Doc of research then you are a Doc. It can't be viewed any other way.

Bless

Dr Raphael Rose

Raphael  Rose,  Dr,  DiagnosticsSeptember 03, 2011
Brisbane, CA



Why are you MD and PA fight over the title? I think a mature man would not leave such a mean comment to prove that he actually holds a MD title. People can join whatever program they desire and it has nothing to do with Adam or Mosso. Why not encourage and make peace instead of criticize????? You men sure have EGO issue!

Love January 25, 2011



I'm an MD, Ph.D. and I couldn't be more pleased to have 2 PA-C practitioners on my team. I'm working in an oncology research role and see patients. My PA colleagues are have increased the number of patients I can see and they provide OUTSTANDING care to our cancer patients. Physicians with the MD credential, like PAs are really professionals who have completed "trade school." It wasn't until I completed a Ph.D. that I realized what true academic rigor was all about. To my colleague MDs don't feel threatened by the PAs - they are a great asset to our profession. And to the PAs -- keep up the great work you do to help people and to help keep the cost of medicine down by providing the same level of care as MDs.

Brian EatonAugust 01, 2010



I think it is quite simple. Go to medical school and then you are entitled to the word doctor. The sentiments expressed above are exactly the reason many of my colleagues dislike PA's. I like to think we work together towards the same goal, but my opinion has started to change about DNP's and PA's. You guys are trying to become doctors and unfortunately you do not deserve it.

Adam ,  Medical StudentDecember 12, 2009



The above comments are typical of alot of PA's. Yes, we didn't do the same premed coursework, MCAT, interviews, med school, internship/residency, BUT we're just like doctors. Sorry, if that's the case, it would be a tremendous breakthrough in education. Less education makes you betteer prepared.
No one wants to face the reality that IF you have the brains and the drive and you are interested in medicine, you will go to medical school. If you read the PA blogs, they're all looking for the easy way out. They want the glory, but none of the work.
Sorry, but seeing 50 back injury patients in the ED doesn't mean the 51st patient doesn't have something else going on.
Want to practice medicine? Man up and go to medical school.

Elliott Mosso,  MDDecember 11, 2009
Columbus, OH



As a retired P.A. I agree with the comments that among some MD's there is a big ego and and incredible sense of entitlement that has fueled the high cost of medicine. Sure, they struggle and were worked in their residency programs like cheap slaves. But The World should not have to keep "Paying a Penalty' for the rest of the doctors lives, so they can have their $1/2-million houses, and all the likings of the elite. Sure, they deserve a "decent" above average lifestyle. But when is "enough" really ENOUGH for a Medical Doctor?

It is MORE, more... MORE~ When some have milked it to the max and demand even more... the doc's go 'turn-coats' and turn their back on colleagues and patients... and become pawns for the insurance industry, as Medical Directors. Becoming "Dr. NO!"
works economically... while they peddle their influence to degrade the quality healthcare, to the benefit of "non-profits" like Blue Cross / Blue Shield. (That's a laugh! Right?)

The problem is, among other factors, that doctors are Spoiled. They have gotten their way for so long, catered to.... wielded their power and influence... enjoyed the Bounty of their efforts... without many limitations. They have learned how to "manipulate" The System to a greater advantage. Then, as things tighten, they cry foul.

They feel "robbed" and want to do even LESS to benefit patients, to create or preserve a greater "profit margin" for themselves.

THEY OUGHT TO HAVE TO WALK IN THE SHOES AND FEEL THEY STRESS OF THE ORDINARY AMERICAN OF TODAY, and endure it for a whole month. On the 31st day, they'd be damn glad to put back on their security coat of money, status, and ego. Things most "ordinary" people do not know what it feels like to have.

I knew a neighbor who has hypothyroidism, and no insurance. She took generic levothyroxine. The Rx ran out. Since it has been over a year since a TSH, the doc would not give her a refill or even Synthroid samples to tide her over until she could get funds for the TSH. Rather than renew "the last known appropriate dose" for her... the doc insisted she come in for a TSH. His office quoted $79 for the test cost. She saved and borrowed from kin folks to muster the $79, only to find that she would still be required to come back for the doc to "review" her test results and re-write a prescription. "How much more will that be?" she asked. "Anywhere from $65 to $125, depending on the length of visit!" She was NOT ABLE TO AFFORD that caliber of coercion and "extortion" of sorts.

She ran out of medicine entirely. While she could have afforded the generic med, how in the hell can a doctor be more comfortable with a patient being TOTALLY WITHOUT their medication... than to cut the patient a little slack, and work with them to achieve better care? It is ALL ABOUT GREED, and many docs are selfish and it's an "All-about-Me" attitude.

Would it not have worked for a $65 office fee, renew the generic Rx... and encourage the patient to return for a TSH as soon as funds are AVAILABLE, in order to confirm the correct dosage... or reveal what changes would be indicated?

Hey, how about CHARGING A PATIENT with NO insurance somewhat LESS that $75 for just a TSH? That's one hellova MARK-UP, don't you think? And ANOTHER $65+ to take 15-seconds to look at lab results, and write a script (or ask your Med Asst to call in the Rx!) ???! Even the office nurse can look at results and tell what is what in a TSH results, tell the doc in 10-words or less, and he either says one of three things: "Keep the dose the same" "Increase to ___" - "Decrease to ___." But for all that, the doc feels he is entitled to nearly $150 --- or the patient can just damn RUN OUT of Rx, and he couldn't care less?!! "Entitlement" "Greed." Of course, the patient paying 1/3, or 1/2 the fee, and paying the rest in monthly payments ober six months was out of the question. I mean, "pay due at time services are rendered" -- Right??

Sure, in the ideal world, with affordable insurance co-pays, an annual TSH (among other relevant labs) are done, a physical, etc. You assess the labs, make whatever adjustment in medicine doses that are indicated... and all is well. The doc gets his big bucks or practically no-brainer management a much less staffer could do. And, the patient gets their Rx, and confidence the dose is right for them.

Or, as in the case of my neighbors Doc... if you can't nickle and dime her to death and squeeze excessive funds from her... screw her! Reject her. Let her GO WITHOUT her meds, and allow the symptoms of hypothyroidism escalate. No big deal, right?

Common sense would tell the below average doc, that of you create an impossible situation where a patient has to go off her thyroid meds... IF and when she can afford your "(UN)ethical Protocol" ... a TSH after someone has been of their thyroid meds will be a USELESS expense for the patient. The doc would still likely resume the LAST KNOWN APPROPRIATE DOSE of the med... wait another 3-4 months... THEN, check the TSH again to see if the dose is optimized.

IF THE DOC would handle this, as I just described, WHY WOULD HE NOT BE WILLING to RESUME her dose, and keep her from totally running out? Then, allow her to gather funds for a TSH within the following couple of months of Rx continuation?

But GREED kept the Common Sense and empathetic thing from having a chance.

I have to say, many docs are NOT like this. MY personal physician is not like this. But ENOUGH ARE, that the FACE OF MEDICINE is seen through the eyes of this lady's experience.

Docs have TOO MUCH POWER.

As Consumers, patients are at a greater DISADVANTAGE in protecting themselves, as one would be with a shady used car salesman! You "buy" something without knowing the actual cost, there are no guarantees, if the service is bad or care does not remedy the disorder one entrusted their doc to manage. You can't seek a refund. You have to pay up front. You have little or no control over the length of visit. (We all know, if you have insurance, it gets bumped to the next higher level, if at all believable.)

YES... healthcare Reform is needed. But, every greedy person from one end of the healthcare industry to the other, will be trying to protect their turf.

I have attended many "Health reform" rallies etc. The public is very concerned and worried. But, they DON'T KNOW THE INSIDE SCOOP, like medical people do. IT IS OUR responsibility to guide Reform to a higher ethical level. PA's are crucial for this, as are NP's. There actually needs to be INDEPENDENT PRACTICE allowed for PA's as some FNP's already enjoy.

At least patients would have a CHOICE, of someone who will put their care ahead of money generated. At least more often, than with the typical physician mindset. Sure, PA's would be happy taking care of Medicaid and Medicare patients, the blue collar worker, occupational health needs. Doc's don't want to be 'bothered' by "Ordinary People" with any financial challenges, anyway. And the PA could enjoy some insurance covered patients in the mix for more stability.

Leave many the "goodie-goodie" patients to the elite docs, who will still find something to belly-ache about, if they see themselves maybe HAVING to work past age 55 or 60... or they can't stay at their SAME income levels AFTER retirement, because of the market. "Tough times, awe, Doctors?" Like I said, WALK A MILE in your Ordinary patients shoes? They THEIR DAY-TO-DAY REALITY and concerns be YOURS for a month. They struggle to make ends meet every week. (Not even able to THINK about the value of investments or lucrative RETIREMENT FUNDS, because Ordinary People probably don't have any of these to worry over, like YOU do.) Yep, Mr. Physician, YOU will be GLAD to return to your Privileged "NORM" again. So keep griping how you are struggling.

Your "struggle" just isn't Ordinary enough for most people to give a damn about. You WILL survive. Just keep denying reasonable fees to hardship patients, charge $75 for a TSH that you know is a tiny fraction of that. The rest of the fee, you POCKET at the struggling patient's expense. WHY do you feel it is NECESSARY, to make people endure your lavish mindset. But, you get away with it, because patients can't easily compare cost and fees. If patients were ENPOWERED with insight, the most fair and honest docs would be REWARDED in volume, even through several PA's on staff. The docs that are legally stealing from people, would be exposed, revealed to the public... and the "Buyer Beware!" mantra would prompt people to NOT ALLOW YOU TO EXPLOIT THEM, and you would be forced to cancel Country Club memberships for you and your wifie.

POINT MADE clear.

All in the healing arts have a lot to offer, and our rewards are financial. But we all have been entrusted not to exploit or take advantage of others. These difficult economic times make high ethics essential. Yeah, you struggled in medical school, put up with grouchy nurses which likely kept you from falling out of school. Yeah, you feel like the WORLD OWES YOU financial security for the rest of your life. But, you know what? "GET OVER IT!" You, by nature of your profession, Mr. Physician, do NOT have a license to STEAL. Just to Heal. Your rewards will come. Try treating and charging your Ordinary Patients, in the SAME manner you would hope another physician in another town would treat your most beloved family member. How ORDINARY would you want that doc to treat your more Ordinary kin?

WHY government intervention? No M.D. is going to freely of their own will, lower fees, and make care more accessible and economical. You all are too used to sucking the Nipple dry, to be satisfied with anything less. YOU ARE A HUGE PART OF THE PROBLEM in healthcare, and a prime reason for Reform. BUT, you can be a crucial part of the Solution, if you can diminish your greed, bury your ego, ignore your inflated sense of entitlement. Just be Real, and re-connect with the person you once were, who wanted to use your skills and willingness to help improve the lives of people. Back to the Basics.

Once, the public looked up to the M.D. as a God. One whom had the skill to make the difference between life and death.

Now, because of The Reality that patients know, are so like my neighbor. Who was shunned and denied because there was no immediate exorbitant PAY OFF to the doc. You know, prostitutes won't perform either, unless it is financially worth their time. But, for the right money, they will cater to you.

Healthcare Reform is all about getting away from being controlled by the Almighty Buck, and Get Back to the Basics of HONEST, ETHICAL, FAIR, and competent care.

Docs willing to take the moral and ethical step forward, will be the Survivors of Reform. The rest, will have to prey on the uninformed and take your chances. Get what you can, as it will eventually fizzle you out of the marketplace. Hardly anyone sees you docs as Gods any more. If anything a part of the Ghod darn problem, instead. A big difference you need to acknowledge, and let it humble you a few notches.

Now is a time America HAS to come together in a unity of purpose, to focus on Quality of Care. Not poor-mouth or give less of your insight and skill, because the patient can't afford to leave a tip on the night table.

And Tort Reform? Yes, there's a need to MAKE IT EASIER for patients to detect when you screw up, because you discount the value THEY are entitled to, and you are negligent because you KNOW you can Get Away with It. Some CAPS are needed. But, as consumers, patients are disadvantaged enough. You screw up too bad, you GET screwed. That's justice.

Too bad that the public has no way to ASK A NURSE what doctor SHE or HE WOULD RECOMMEND, and what doc they wouldn't take their DOG to. Nurses HAVE a qualified Opinion, which patients are not privy, and usually see a doctor blindly, because an office is convenient to get to.

When I was dating, there was a social dinner at the home of friends. One who participated was a nurse. We chatted, and she listed local surgeons whom she felt were HORRIBLE. they had more patients DIE, more with post-op infections. Important things beyond bedside manner. Things that impact survival and prognosis. Things patient Consumers never get to hear about.

Yes, Reform is L-O-N-G overdue. Everyone will have some sacrifice to make. It’s about time. And the insurance and pharmaceutical industries ought to take the lead that ACTUALLY can benefit patients.


B. Dotridge,  Ret'd P.A.October 12, 2009



A few points:
The contemporary degree for the highestlevel of medical provider in America is what we have by tradition only come to call "doctor". In fact, as we all know he/she has a doctorate level degree in medicine. The word "physician" - a person who practices healing arts has been inappropriately commandeered, by tradition only, to mean a "doctor".
Luke, dear and beloved physician, apostle was not a "doctor". In his day and up until JUST RECENTLY physicians did not have near exclusive rights to the word "doctor". I hate to break it to you MD's whose ego's are so very fragile but PA's ARE already 'physicians'. They may not be 'doctor's' as per traditional understanding of the words but technically they are already 'physicians'. I would be very upset if I were a doctor of any other sort, music, history, physics etc. As it is Medical doctors, by way of default via tradition have inappropriately commandeered the term 'doctor' for their own as it is generally believed to be so among the general populace. As far as any notion of superiority is concern, real or imagined, medicine is a trade in every sense of the word. Med school consists of 2 years of basic sciences - the vast majority of which is promptly forgotten after graduation which leaves 2 years of on the job training (if you want to actually call it that) on the wards and in clinic - residency is no less the same. Not to denigrate the educational process and all the hard work, often incredibly hard, that goes into becoming a doctorate level, residency trained physician but none the less those words "doctor" and "physician" should not and in fact do not belong exclusively to that group of people that we, by tradition call 'doctors' who cling so steadfastly to the posession of those words and have no real right to them - (how's that for a run on sentence?). I am a PA and have 31 years of experience. I have my own practice. I am not limited to what and who I see. I have 'been there and done that'. I have seen hundreds of thousands of patients over that 31 years. I have thousands of hours of CME. I have, and still do, read and study the practice of medicine. I have had my own version of 'residency'. The 'bridge to doctor program' is a farce and an insult. One more minute, much less 2 more years, of basic sciences is unecessary and in fact would be a waste of time. Time on the wards??? I have done that 'in spades'. Doctorate degree's for PA's? Why not. Those nay sayers are typical turf building control freaks who want to limit trade possibilities. Oh for sure their needs to be close regulation on this profession but limitations based upon degree of some sort of not so subtle belief that 'doctors' are somehow superior intellectually or otherwise is nonsense. The truth of the matter is that traditional views of medical providers is in transition, as it has been throughout history. The 4 years pre-med, 2 years basic sciences paradigm is too long and not profitable, cost efficient, time efficient and does not produce better doctors. Neither, for that matter, now that I am on a roll, is it nor has it ever been appropriate that those with mathematical aptitude be given preferance as far as medical school entrance is concerned. That paradigm needs to be shut down and I mean right away. Those with mathematical aptitude do better in the sciences that have a mathematical leaning. They do much better on the MCAT's and have dominated the medical profession. Awful, unfair, not justifiable, unneccesary and inappropriate. The whole medicine training paradigm and practice of medicine paradigm is being challenged and rightfull so. It needs to be reworked, redone - safely, wisely and prudently. It's time has come. This has been quite a ramble on - I'm in a rush, I have patients to see.

Michael Stone,  PA-C,  TMAJune 09, 2009
Greeneville, TN



The PA with 15 years experience would need more training (dependning on experience) to just go straight into residency. Medical students have one more year of clinical rotations thru all areas of medicine. Also, the PA degree was just recently (within the last 10 years) changed to a Masters level as opposed to the BS. But I agree with the overall premise of a bridging step to the MD/DO. I say require one year of rotations (credit can be given for prior experience but most pa's don't have experience in all of surg, er, peds, fm, im, cardio, pulm, OB, etc.). Take Step 1 and Step 2. Then apply to residency. Then that would the the equivalent in undergraduate medical training.

Andrew SimpsonMay 30, 2009



So the question is really this: who is in charge of patient care? If it were me or my child I'd want whoever had the most education/training/experience in treating their problem. That just happens to be medical doctors. This is not rocket science. Don't be fooled by educational scams that make you feel fancy. Degrees are meaningless except for what they represent. I don't care what you call yourself, just be competent! People's lives are no joke!

Sam April 28, 2009



I think that instead of steering PA's towards a non MD/DO "terminal" degree, we should be offering a chance for PA's with enough educstion, training and experience to be able to eventually "bridge" the gap to becoming full medical doctors. If they are licensed to practice medicine and write scripts under a doctor's supervision, then we already place a lot of trust in them.

Right now I have a realtive that is in his first year of medical school. In his class is a woman who has been a PA for 15 years, and she is having to start medical sschool as if she just graduated with her bachelors. She is top in her class and is dominating the group with her knowledge. I think it is a ridulous waste of not only a slot in the class, but also of her time and money. Why not allow a certain number of PA's to enter a residency program each year and upgrade to full MDs at the culmination?

Eric ColsonApril 24, 2009



I am interested in the Doctorate program for PA's. What schools offer this program?

D. BrooksApril 22, 2009
OKC, OK



Concerning the question of higher education and highest degree in a field, I do not see the problem really. Let me elaborate on this. Is it wrong for a student or any individual to want excellence? If yes is the answer, what is wrong in getting a master degree in a field, or any terminal degree like a doctorate. We may not want to accept it. People look at the value of a profession not only by what someone can do but by the title/ degree attached to that profession. What is wrong for a LPN to be willing or working toward a RN title? I really do not understand why this is such a big deal for a PA with a BS to want his MS and so on such his doctorate. Let me point out that getting a highest degree opens doors that can otherwise closed. In conclusion, I think that is a very good idea to let PAs know that it is not impossible to work toward a highest degree and I see the difference that a higher degree created in almost all aspect in the society. I am willing to contact by anyone who like to discuss this topic. PA is PA and will always be PA, but there is nothing in getting more Knowledge. There is nothing wrong in preparing some willing leaders to represent our profession among others

ACHILLE ANTOINE,  PA,  .December 23, 2008
BROOKLYN, NY



I am actually interested in becomming a PA. I have actually been looking at the BS and MS degrees. The thing that I don't agree with is not being able to say I'am " Dr. ??? ". That is a lot of dedication, I would want the right to say " I'am Dr. ???, I am a PA ". What would be wrong with that? Any ideas or commentts on that?

Nick MDecember 18, 2008



I am interested in pursuing a Doctorate in science. Where do I start? I don't believe Michigan is offering any programs for Doctorates for PA's.

nicole mckenna,  PA-CNovember 11, 2008
ORION, MI



I personally think that it is time for our PA profession to move forward and upgrade to a Doctor Degree level as other health related profession such as PT, OT, aud, Dr.NP etc.

I will be willing to go for a Doctor of Physician Assistant in the near future if there is a program available.

Chang

Chang Ping,  PA-C,  selfOctober 28, 2008
St. Paul, MN



Can a non-military person attend the doctorate program? I am too old to be accepted in the army but think all PA's should be considered whether miltary or civilian. Please let me know if non-military PA's can apply and where.

Coralee Loberg,  PA-C,  KaiserSeptember 24, 2008
Lancaster, CA



I am currently a PA student in the Army and I think this new program is great. I want to eventually specialize in emergency medicine. This new doctoral program is an incentive to do that. Sure you could do that before but you did not get any thing except the training/education. That alone is enough for me because I love taking care of soldiers and want to do it to the best of my ability. However, I am not going to stay in the Army forever and having some more letters to add to the alphabet soup after your name helps you get a better job. After all the people doing the hiring don't understand a cetificate for advanced training, but they do understand a doctoral degree. As a combat medic with two tours in Iraq under my belt I agree that more training in trauma/emergency medicine is good for the Army. If this degree entices more PAs to stay in Army then I say it is great for the Army and for the profession. PAs are under utilized in the ER, but that is changing and will continue to with more programs like this.

Gregory Giesecke,  PA StudentAugust 03, 2008
San Antonio, TX



Who gives a rat´s #@*...too much focus on a damn title, just do your job, do it with pride and do it well. Worry about your own life and don´t worry what anyone else think about you being a PA, Dr, NP...F#@* it! there are bigger things to worry about...know your limits that´s all

Pili CarvalloJuly 20, 2008



I am a recent graduate of UNE with a B.S in Medical Biology. I want to pursue PA school in the near future once I have acquired the needed hands on patient hours. I don't know much about this Doctoral program, but I DO WISH the academy would change the title from Phys. ASSISTANT to Physician ASSOCIATE, or something similar. No one in my family seems to understand the importance of this field of work and all compare it to a CNA!!

Amy Johnson,  Histology lab asstJuly 03, 2008
Portland, ME



As an MD/PhD student, I think it's a mistake to be making "doctoral" level programs that are non-research focused. I am Asian but have follow the European medical curriculum closely and as you may know, they only give "MBBS" not MD, and I think the reason for doing that is legitimate. Be it that MDs go through so much pain and suffering in med school, boohoo, cry about it, but their occupation doesn't further academia unless they do research and publish papers. Giving out doctorates to clinical practitioners degrade the sanctity of the doctorate degree and makes it a joke. I believe that a doctorate degree should be awarded to people who have made a significant impact in enhancing knowledge and not as a sympathy award for working so hard. I feel like this because my family has a mix of professional doctors and academic doctors and it's not fair that people are being put in an equal footing even though they are not (MD = DscPA = DNP; i dont think so, but it certainly makes that impression).

1st year  med studentJune 28, 2008



I am concerned that any PA will think that he is equal with a physician. I have been a PA for many years and have no desire to be on an equal footing as a physician. I actually enjoy the fact that I have someone that I can go to when I need guidance. I am in favor of having more training and have no problems with the DsPA programs. Note that the DsPA program is for additional training in a specialized area not the qualifying degree of becoming a PA. On the other hand the DNP is a qualifying degree for the NP and they do want to be independent in some cases. I think your concern is pointed at the wrong profession. I do not know of any PA that wants to go around giving the impression of being a physician. When I see a patient they always know that I am a Physician Assistant. I am proud of my profession and say it loud. I agree what someone else mentioned. We need to let patients know our profession when we are seeing them as patients. Introduce your self as physician, nurse practitioner, physician assistant and get away from the word DOCTOR. After all your Biochemistry teacher is a DOCTOR (PhD).

Mike ,  PA-CJune 13, 2008



Unlke most of the cowards commenting on this site, I will publish my full name.

First of all, any new idea will be resisted by the status quo and greeted with some degree of skepticism. I have practiced medicine as a PA for ten years, and I will match my clinical acumen and medical knowledge base with most physicians, and in some cases would surpass them.

The primary difference in MD and PA training is one of esotericism. I would submit that the didactic portion of medical and PA education is the primary difference in the overall training. Of course the few courses MD students take which PA's do not are largely forgotten in the later part of medical school because they are not clinically applicable to practicing medicine for the most part. Take biochemistry or medical genetics for example. Two facinating areas of study required by the MD cirriculum and not PA's. Not only do most med students forget most or all of that information by the time they graduate, but a significant portion of it is obsolete due to the exponential nature of the maturity of our understanding of the priniples of this knowledge. MD graduates learn their art during residency and much of what they learned in med school is purged. Ask an opthamologist to diagnose a heart condition by 12 lead EKG(except perhaps AMI or other major problem). Ask a general surgeon to diagnose central retinal vein occlusion. I could go on and on. The point is, if one is capable of being a PA, they certainly possess the intellectual capabilities necessary to be a physician.

Personally, in all honesty I chose to become a PA for expediency of starting my career and earning a good living a few years earlier with less exposure to the headaches unique to physician practice.

In retrospect, I made the right choice based on the circumstances at that time, and probably would not participate in a bridge program if one were to exist. Based on medical experience, if dentists are allowed to transition in the scope of an OMFS training program, competent PA's should be allowed and be subjected to the same rigorous requirements demanded of all MD's.

If you are against such a program, ask yourself why and the answer will be found somewhere between low self esteem and narcissism.
I think that it would behoove us all to step back and

Stafford Long,  PA-CMay 10, 2008



I have enjoyed the debate on this board. Several comments have been made that I feel I'd like to respond to. First, let me say that my PA and I work as a team both in the OR and in the office. She is recognized as the best PA in the region by hospital personnel and patients. She is an outstanding surgical assistant who I feel comfortable tackling any case with.
With that background I would like to say that some of the hostile comments above concern me. The argument that PA programs and PA skills are the equal of many MD's are always going to be true on a large scale. My PA has the hands and brain that are the equal of most surgeons. In fact, there are several "hack" surgeons in our area who I would never allow to serve in my PA's role (by the way I never call her "my PA" but for anonymity purposes will do so here.)
But just because she is highly skilled and some surgeons aren't doesn't justify blurring the distinctions that set our professions apart. Some of the comments above suggest that independence and even equal footing are the major goals of the doctorate degree. Be careful what you wish for.
In my community a PA can make more money working with a busy MD than they would be able to make on their own. Our PA's make well over 100K (including benefits) while primary care MD's often are in the 75-90K range. My PA's total reimbursement does not cover her expense (it's close.) It is worth the expenditure to me because she is so good and makes my job much more efficient. She is an excellent Physician Assistant, as the title says.
In exchange, she takes no night call, does not go without sleep because of repeated phone calls every third night, and did not come in to help me with the 4 AM appendix I did yesterday. She also pays 15% of my malpractice rate and does not lay awake worrying about office overhead, politics, or managed care contracts.
In response to Mr. Booth above, I think the idea that after 10- 15 years you will be as competent as any doctor is a dangerous and cocky idea. First, by your training you should already be a more competent PA than your MD associate could be right now. The jobs are different, and serve separate, important roles. This is not a contest. It is a team model.
Surgery residencies are 6 years for a reason. It takes much more time to develop judgement and patience than it does to operate. Although your "sword" may be sharper with time, it is knowing when to use it and when to put it away that is important. And if you don't know that there are many attorneys around who will be happy to set you straight if you have a bad outcome.
And Dr. Ross, please spare the "Epidemic of Medical Mistakes" stuff. The 80 hour work week only exists in protected Ivory Tower environments. It is the reason we can't find surgeons to work in the community where 5 out of 7 call weeks are common, and if 3 patients are lined up in the ER we tackle them one at a time through the night until the work is done no matter whether we've been at the hospital for 24 hours or not. The real world does not work by the 80 hour restrictions. The way to prevent errors is to train residents that they cannot turn it on or off depending on an artificial time restriction.
Please don't take these comments as negative toward the PA profession. In fact, the doctorate is a great educational goal. But using it as a tool to become a free-standing quasi-doctor I think is a mistake. I think people who aspire to this would be better served by the "bridge to MD of DO program" mentioned by some above.

Thanks, John MD

john ,  MDApril 16, 2008
MD



I am all for any field trying to further their education and standards. This is just to point out a few mistakes and comparisons made here.

1) In many states, it is indeed illegal for one to introduce oneself as "Dr. so-and-so" to patients without holding a licensible clinical doctoral degree (ie MD, DDS, DPM, PsyD or licensed clinical psychologists etc). Just citing laws of my own state, this is covered under California Business and Professional Code 2054. So, for a PA with an non-clinical doctorate, or a DNP (again, primary licensure is not based on a clinical doctorate) to introduce himself/herself to patients as "Dr. so-and-so" without a lengthy qualifying explanation as not to confuse patients, it is indeed illegal. The difference here is the basic licensed clinical degree - what it takes to achieve the minimal requirement for basic/entry licensure in a clinical setting. To use optometry and psychology analogy is silly. A patient knows when he/she is seeing a non-MD practitioner in these fields. Where as in a hospital/clinic/ER, patient may not know who he/she is seeing.

2) I am surprised that Dr. Collin, a porported MD by his signiture, did not know that the title of "Diplomate" is only granted after board certification. A Diplomate in American Board of Internal Medicine means a physician who is currently board certified in internal medicine. There is no difference between the title of "diplomate" and "board certification."

Now, the remaining deals with PA's who feel their education/ability is equal to that of a physician (as claimed by many posters here):

3) A DPA's training is roughly 50% of a board certified physicians training. DPA is now granted after an 18-month Emergency Medicine residency. An MD-level emergency medicine residency is actually 4 years. Let's count - let's start on equal footings of a 4-year BS/BA degree. A DPA has 2 to 3 years of school, plus 1.5 year of EM training. That equals to 3.5 to 4.5 years of post-BS/BA training before "independent practice." Since DPA is only available in EM, we will look at a MD in EM training - 4 years of med school (longer than some DPA's entire training of 3.5 years). 1 year internship, and 3 year residency, plus 1 to 2 years in trauma if interested. That is a minimum of 8 to 10 years post-BA/BS training before independent practice.

4) Exam requirements. For a PA to practice, the only required test is a 6-hour PANCE exam. For an MD to practice, the exam is a 5-day exam divided into 4 separate exams, including a clinical skills exam on standardized patients. Many states require additional exams beyond the 5 day exam.

5) For board certification on the MD side, it's not just taking the final exam. The entire residency program is evaluated. Every residency program goes through strict re-accredidation eval every 2 to 5 years. In order to even sit for the final EM board exam, a resident's medical school record and residency records are first scrutinized. Then, a two part, multiple day final exams including written and oral exams, are administered. As far as we can tell, no similar standards currently exist on the EM-PA side. Keep in mind, a full EM residency is 4 years, not 18 months. A MD-EM resident in his/her 18th month of training is still consider a very junior resident barely out of internship, and not independent by any stretch of imagination.

6) Using DO's as a comparison is silly. DO schools are essentially the same as MD school. DO graduates face the same regulatory, licensing, and training requirements as MD's. In fact, DO and MD residencies are interchangible. There are plenty of DO's in MD residencies and vis versa.

7) a 200 hour per month residency is also much less than a typical MD resident who typically works 320 hour month (often longer). Count that over 18 month, A DPA's EM training is about that of an emergency medicine intern, not independent on the MD side.

It is fine to further one's education. But, trying to compared two obviously unequal training regimens and trying to present to patients as equals is unethical. A PA may think that "going home at 3a.m." does not further one's training -- how do you know if you haven't done it? There is talk now to cut residency training hours to 56 hours per week. Most specialty boards have said that if the hours are cut to 56 hours per week, the length of residency will need to be increased so that residents receive the same amt of training. A DPA level 200 hour month training works out to less than 50 hours per week... ummm.

It's interesting how PA's say that they do not want to be physicians... yet they want to be treated as physicians... You simply cannot have it both ways. If PA's want to function as physicians, then PA needs to complete the same training as physicians. A DPA program falls short - 50% short. How would you like to fly on a plane with a pilot whose training was only 50% of that's required to be a pilot?

- A medical school professor.


Zefram CochraneApril 16, 2008



Enjoying this blog and other healthcare blogs I read from time to time. I understand the viewpoints stated. I would also like to add the following:

If PAs are to now obtain a doctorate level degree with more training just as the NPs are currently starting to do, then so be it. However, they need to make sure they tell the patient immediately upon meeting the patient for the 1st time that they are either a doctor of physician assistant or a doctor of nurse practioner. Otherwise, the patient may falsely believe the doctor is an MD or DO.

Also, if PAs and NPs are to obtain doctorate levels now and go by the title doctor, then it seems like states should now begin to increase their level of medical liability and increase their malpractice insurance rates to similar or close proximity to the rates of allopathic and osteopathic physicians.

Also, in my class there are PAs,NPs,RNs,PTs,PhDs, PharmDs,OTs,chiropractors, etc, who all have to go through 4 years of grueling intense medical school. There should be no PA-to-medical school bridge, because one would miss all the core required classes necessary to become an allopathic/osteopathic medical doctor and also would have to take the required USMLE or COMLEX steps 1,2, and 3 to be able to become a licensed allopathic/osteopathic physician.


med studentApril 13, 2008
FL



I would just like to add that if PAs are to begin obtaining a doctorate level degree with completion of more training as the NPs are currently starting to do, then they should make sure they tell the patient when meeting the patient for the 1st time that he or she is a doctor of physician assistant or a doctor of nurse practioner should as well. Otherwise, the patient may falsely believe the doctor is an MD or DO.

Also, if PAs and NPs are now seeking to obtain doctorate levels and go by the title "doctor", then states should then increase their level of medical liability and increase their malpractice insurance rates similar to allopathic and osteopathic physicians. If you want to be called doctor and practice independently , then be prepared to pay higher costs!
Also, I can tell you currently now as a med student, that there are RNs, NPs,PAs, Chiropractors, pharmacists, physical therapists, dentists, and podiatrists all in my class and they have to go through 4 grueling years of medical school just like every one else. So my point is that there should not be a way PAs or anyone else can get "credit" and matriculate into a medical school without doing the 4 full years! Remember, you have to take USMLE (allopathic) and/or COMLEX (osteopathic) tests - Steps 1,2,3 to become a licensed medical (allopathic,osteopathic) doctor. Ergo, 4 years of medical school is the only way to be a medical doctor period.


med studentApril 12, 2008



Thank you Dr. Ross for your insightful examplke of the number of other porfessions in the "healthcare community" which are not MDs but which are properly addressed as Dr. I have made the same argument myself many times in defense of professions which I am not a member (but hopefully soon will be either an NP or a PA - just try getting into an Allopathic Medical School if you're over the age of say 26 . . . . I passed that long ago - I'm not going to say my age, but even an Osteopathic school would probably think hard about admitting me - despite the fact that my current GPA has earned a Phi Theta Kappa and the youngsters are hurting to keep up with the old man. And frankly, I don't think it would be a wise expenditure of resources on my part either - it would take too long to get it all paid back. I am perfectly happy pursuing either NP or PA school programs. My experience with PAs in the military though would have me chaffing at the restrictions put upon them in the civilian world - and I am more philosophically inclined to the holistic approach taught in the NP programs. This too comes from personal experience, due to poor treatment by impersonal MDs who could not see the whole patient - who could not bother to check that the drug they just prescibed was listed in the PDA as having dire interactions with other drugs already prescribed . . . . and then denying that their prescribed drug was the problem. While this is only one example, my general experience has been all too often that most MDs don't really care to take the time to be fully acquainted with their patient - their "god-complex" belief system that they are infallible is downright dangerous. The biggest difference I see between MDs and DOs is not the question of musculoskeletal manipulation and whether or not it is beneficial; the real difference is whether or not the physician cares to treat the whole patient and not just address specific symptoms. Frankly, the DO's approach is much better - but I will say the best MD's that I have known are also those who are wise enough to see that they must treat the whole patient - they care enough to spend that little extra bit of time.

As I have said, I have enourmous respect for PAs - and might possibly become one myself. But take this advice in the sentiment with which it is offered. A "physician assistant" is a job title - not a degree field. So long as Bachelors, Masters or Doctoral degrees in this area remain non-standardized (not all programs use the PAS - Physician Assistant Studies title in their degreees - but more importantly, so long as the degree granted the profession continues to emphasize "assistant" then PAs will never garner the full respect that they deserve. For pete's sake - demand a standardized degree with a more professionally relevant title - not MPAS or DScPA - but something that indicates that the holder is a competent healthcare practitioner; so just for thought - what about Master of . . . 0r Doctor of Medical Practice or ".. of Physican Arts or something that is more reflective of what you do. Even MDs when they are interns and residents are essentially supervised in the same manner as PAs - only after a sufficient amount of time and testing, they are ultimately permitted to practice independently. And to respond to a point made by Dr. Lime (aka Mr. Sour) what about the MD who misrepresents his status by inferring that he is a specialist that he is not -0 is that not just as misleading as the examples you cited - all of which were individuals purportedly misrepresenting themselves - or maybe they were just tired of having to constantly explain the differences to patients who didnot want to listen or who still subscribe to the antiquated belief that only a "Dcotor" has the knowledge and skills to treat them - when clearly that is not the case. I personally know of several MDs who prostitute themselves doing "independent medical exams" used by insurance companies to deny benefits and the MDs are representing themselves as specialists where they have no certification or residency - so for example, how can an Allergist really give a competent opinion on complex issues of Orthodpedics, Neurology and/or Rheumatology? They prostitute themselves by receiving huge fees to sign-off on whatever the insurance claims rep (who probably has a HS diploma) has come up with as their theory - and which undoubtedly denies benefits to the patient. So, who is more dishonest Dr. Lime? Or how about the Dr who says - I can't render an opinion without a year of exams and treatment - but if you pay me X-thousand of dollars on the side, I can review your medical chart and then form an opinion - that version is extortion in order to get an opinion that the Dr really should be able to give . . . its just that he's found a way to get a bigger fee from a desparate patient. So who is more immoral Dr. Lime? Its time for the "god-complex" of MDs to end and for patients to be the number one concern . . . not whether or not the "Dr." makes enough to support a decadent lifestyle. If a physician does not have the right attitude - he doesn't get my business - and significantly more of the population are thinking that way.

As for the independence issue - the experience of Military PAs has shown that they are competent to practice independently. But I have also heard tales of PAs jumping ship and enrolling in DNP programs. So, the profession can move forward or watch as more individuals leave the ranks. On that point - a bridge program that allows PAs to take a short-track to an MD or DO in recognition of their experience level might not be bad. As someone else pointed out - a good amount of what MDs learn in Med School, the NP's and PA's have to learn as undergrads before they can apply to their programs - its not as difficult as they (the MDs) would have us believe.

No one has mentioned it yet, so let me throw this out for consideration - some of the finest physicians in the world come out of an acadmeic community with centuries of distinguished accomplishments - in BRITAIN, where the first degree for a physician is a BACCALAUREATE degree, ie. either M.B. or B.M. depending on whether the school uses the traditional degree in Latin or the contemporary English. The M.D. degree is an advanced degree founded upon further graduate work and research. Yet the M.B.'s by tradition are called Dr. - the MD's by tradition are called Mr. Not that the titles are important - its the fact that the first degree is a bachelors degree . . . . oh, and its generally accepted for use if they move to the US.

A Future NP or PA -
depending on which program I am accepted to . . . .

D BelMarch 31, 2008



I'm gonna go on a tangent here for a little bit. Let's go back to the basic's folks. The PA profession was initially created for those highly trained/skilled individuals (Army Medics) who where not nurses nor doctors...every PA knows the story. However, the student demographics have changed. Most universities would accept an intelligent individual, without prior medical experience, who have certainly shown that he/she can survive the rigors of PA school. And there's nothing wrong with that. Does that make them any less or inferior to a graduate who has had tons of experience. Certainly not, if they pass the NCCPA board exam like everyone else. However, we have to remember that PA programs are designed to make you a Primary CAre provider.
When a new grad jumps into a specialty practice, this is where prior experiences matter. I have seen new grads (without prior medical experience)jump into specialty professions and make a bad name for PA's. It's not entirely their fault if their supr doctor was willing to train them, but learning on the job in a specialty setting is probably not the best place to start. When you're in a specialty situation, you have to talk to other MD's who wants a consult/your expert opinion. Or your pt who was referred by their PMD to see a specialist wants your expert opinion. As an astute PA, you should defer these situation to your supervising MD. If you misrepresent yourself, then you make a bad impression for the profession. I'm quite sure these seldom happens, but these are the situations that non-PA friendlies talk about. Hence, threatened/non-progressive MD's/gen.populace who had their first non-favorable encounter with a PA remains a stigma. Remember, as a fairly new profession we are under the microscope and labeled unfairly as a whole. Hence, my point is that, if you want to specialize or practice medicine outside of "primary care" it serves the PA community to go to a rigid residency program. Why, because the gray zone in reality medicine is way much wider that the books nor a year of clinicals can teach or expose you to. And if a "separate/Advance designation" is required then be it. It's only fair for those who embrace more knowledge/skills to be fairly recognized for their specialty. I remember when Emergency medicine was not a specialty. Any and all subspecialties could moonlight in an ER. Hence, there was no respect from their own for the ER docs. They had to CREATE the E/M specialty and board certification to get their colleagues respect. If you think your MD associates respects you because of you PA-"C". Think again...it's brutal in the real world. And if a DSc can give has an upper hand, I'm all for it. Would the MD's give you any more respect, probably not but argueably a start.
Speaking of advance degrees, i.e Doctorate, these PA programs thinking of offering such degree's should then consider a "PA-to-MD Bridge Program". These universities have their own medical schools, why not. If "you" took the PA route to see if medicine was for you, without spending all that time to go to med-school, and now know that medicine is indeed for you, then the transition should be a friendly one. There's nothing worst than a doctor with a bad bedside manner. In my opinion, these are the guys that went to medical school and found out later that they hate people...but they've spent half their life and are now stuck with it.
Remember, pt's initially don't care how much you know until they know how much you care...

Roy Ouano,  PA-CMarch 28, 2008
Burbank, CA



As a PA who is currently enrolled in a doctorate program, I have spent quite a bit of time considering this topic and obviously have strong feelings on this issue. I embarked upon this degree for purposes of academic pursuits and clinical research. Quite frankly, I believe that academia and/or research are the most sound and valid reasons for a PA or an NP to pursue a doctoral degree, not for clinical development. To make the argument that the clinical doctorate is necessary to improve our ability to better care for our patients is to assert that the current system of medical education for PAs is inadequate. History of the PA profession and our track record of clinical performance and gradual acceptance over the past 40-years by medical institutions, physicians, the public, and third party payers, would state otherwise. There are some, however, who believe that the PA education model is inadequate and have proposed post-graduate training, not a clinical doctorate degree, as a solution. While I may not agree that the current model of PA education is inadequate, I would agree that noncompulsory postgraduate training for PAs is a good thing and is more likely to translate to better clinical skills than a clinical doctorate degree. Baylor’s program, however, is comprised of both a post-graduate training program and a clinical doctorate degree. The logic behind this combination eludes me. One must pause and consider the motivation for the Army to offer such a degree in association with their program. Is it for altruistic educational reasons or professional betterment of our profession? Is it for the benefit of the patients? I do not believe that it is for any of the aforementioned reasons. In the above article, Maj. Gruppo states that prior to the initiation of the DScPA program, a survey was conducted of Army PAs in which “two-thirds of the respondents said that the availability of these (doctorate-level PA) programs would significantly affect their decisions to stay on active duty." It was further stated that “these PA clinical doctorate degrees should also be a strong incentive for PAs to remain in the military and possibly for civilian PAs to consider military service”. To me it seems apparent that retention and recruitment are the main motivating factors in offering this degree for PAs.

Encouraging our profession to advance to an entry-level doctorate degree defies one of the basic premises and arguments for utilization of PAs; cost of training. Furthermore, the argument that our nursing counterparts our advancing to entry-level doctorate degrees and thus so should we, allies us with a group who has blatantly stated that with a clinical doctorate degree, they will function as independent and completely autonomous practitioners and as such will directly compete with physician practices. We, on the other hand, have successfully allied ourselves with physicians since 1965 and have defined both our clinical and professional existence and growth on this alliance. We must remember this, protect this, and not jeopardize this. Entry-level doctorate degrees for PAs will be perceived by physicians as an attempt to compete with their educational training and to be a movement towards more autonomous practicing of medicine. This could ultimately serve to undermine the very relationship which has defined us for the past 43-years.

The argument that since other allied health professions are moving towards doctoral degrees therefore so should we, assumes a likeness between those professions and ours which is inaccurate. Physical therapists, occupational therapists, and pharmacists do not have a dependent relationship with physicians as we do and as such, implications of an entry level doctorate degree for them are vastly different than the potential implications for us.

Granting a doctoral degree for completion of a post-graduate training program is, in my opinion, inappropriate. The educational venues of a doctoral program and a post-graduate training program are too dissimilar to coalesce. We pride ourselves in the fact that our training is likened to the medical model, yet even physician training does not confer a degree upon completion of their residency training. Maj. Gruppo states that there was no way to recognize their graduates in a way that people would understand. Why is a certificate of completion inadequate for PA post-graduate training but not for physician residency training? It is not the board certification which acknowledges the physicians’ residency training, but rather the certificate of completion. It is that certificate which allows the physician to sit for the board examination.

In my opinion, the application of doctoral degrees for PAs are in the arenas of academia and research, not for the enhancement of clinical skills. If it is an improvement of one’s clinical skill set that is desired, one would best be served through post-graduate training or CME activities, not a clinical doctorate degree.


Christopher Nickum,  Chief PA,  Emory University HospitalMarch 23, 2008
Atlanta, GA



As a PA who is currently enrolled in a doctorate program, I have given quite a bit of consideration to this topic and obviously have strong feelings on this issue. I embarked upon this degree for purposes of academic pursuits and clinical research. Quite frankly, I believe that academia and/or research are the most sound and valid reasons for a PA or an NP to pursue a doctoral degree, not for clinical development. To make the argument that the clinical doctorate is necessary to improve our ability to better care for our patients is to assert that the current system of medical education for PAs is inadequate. History of the PA profession and our positive track record of clinical performance and gradual acceptance over the past 40-years by medical institutions, physicians, the public, and third party payers, would state otherwise. There are some, however, who believe that the PA education model is inadequate and have proposed post-graduate training, not a clinical doctorate degree, as a solution. While I may not agree that the current model of PA education is inadequate, I would agree that noncompulsory postgraduate training for PAs is a good thing and is more likely to translate to better clinical skills than a clinical doctorate degree. Baylor’s program, however, is comprised of both a post-graduate training program and a clinical doctorate degree. The logic behind this combination eludes me. One must pause and consider the motivation for the Army to offer such a degree in association with their program. Is it for altruistic educational reasons or professional betterment of our profession? Is it for the benefit of the patients? I do not believe that it is for any of the aforementioned reasons. In the above article, Maj. Gruppo states that prior to the initiation of the DScPA program, a survey was conducted of Army PAs in which “two-thirds of the respondents said that the availability of these (doctorate-level PA) programs would significantly affect their decisions to stay on active duty." It was further stated that “these PA clinical doctorate degrees should also be a strong incentive for PAs to remain in the military and possibly for civilian PAs to consider military service”. To me it seems apparent that retention and recruitment are likely the main motivating factors in associating this degree with this program.

Encouraging our profession to advance to an entry-level doctorate degree defies one of the basic premises and arguments for utilization of PAs; cost of training. Furthermore, the argument that our nursing counterparts our advancing to entry-level doctorate degrees and thus so should we, allies us with a group who blatantly states that with a clinical doctorate degree, they will function as independent and completely autonomous practitioners and as such will directly compete with physician practices. We, on the other hand, have successfully allied ourselves with physicians since 1965 and have defined both our clinical and professional existence and growth on this alliance. We must remember this, protect this, and not jeopardize this. Entry-level doctorate degrees for PAs will be perceived by physicians as an attempt to compete with their educational training and to be a movement towards more autonomous practicing of medicine. This could ultimately serve to undermine the very relationship which has defined us for the past 43-years.

The argument that since other allied health professions are moving towards doctoral degrees therefore so should we, assumes a likeness between those professions and ours which is inaccurate. Physical therapists, occupational therapists, and pharmacists do not have a dependent relationship with physicians as we do and as such, implications of an entry level doctorate degree for them are vastly different than the potential implications for us.

Granting a doctoral degree for completion of a post-graduate training program is, in my opinion, inappropriate. The educational venues of a doctoral program and a post-graduate training program are too dissimilar to coalesce. We pride ourselves in the fact that our training is likened to the medical model, yet even physician training does not confer a degree upon completion of their residency training. Maj. Gruppo states that there was no way to recognize their graduates in a way that people would understand. Why is a certificate of completion inadequate for PA post-graduate training but not for physician residency training? It is not the board certification which acknowledges the physicians’ residency training, but rather the certificate of completion. It is that certificate which allows the physician to sit for the board examination.

In my opinion, the application of doctoral degrees for PAs are in the arenas of academia and research, not for the enhancement of clinical skills. If it is an improvement of one’s clinical skill set that is desired, one would best be served through post-graduate training or CME activities, not a clinical doctorate degree.


Christopher Nickum,  Chief PA,  Emory University HospitalMarch 23, 2008
Atlanta, GA



Mr. Wellman's commentary is not surprising coming from a PA-S perspective. However Mr. Wellman, I do want to be a Doctor, a Doctorate level PA, I do not want to be a Physician. I will be interested to know if your thinking changes after a few years in the workforce. You will find that the Doctorate level PA is absolutely necessary, if people of your view point do not wake up, then our profession will be doomed to a late realization that we missed the bus AGAIN!! We will spend the next few decades trying to play catch up the way we did with the Master's level degree. In order to maintain our market viability we must be able to produce the same training degree as our NP counterparts or they will jump at the vulnerability and bludgeon us to death with our "inferior" degree training! For you PA-S types....that means less money, fewer jobs and a deeper stigma. Let's stay ahead of the curve for once!!

Robert Booth,  EMPA-C,  MUHMarch 01, 2008
Memphis, TN



I think the idea of a doctorate level degree for PAs is novel, but I fail to see the point on a few levels. First, with this particular program, a PA has to graduate his program (PA school) which is roughly 2 years in length. Then he/she has to go through another 18 months of "residency" training, after which they will not be called doctor, and will probably not be paid more. I can't imagine the tension that will exist between a physican and a doctorate level-trained PA working in the same ER, trying not to step on eachothers' toes. Not to mention it is raising the degree bar, which will mean medics and other military trained medical personnel for whom the PA role WAS DESIGNED, will have a much more difficult time getting in. I agree with forward momentum for our profession, and it seems to be the trend among the other mid-level schools. But I disagree that doctorate level training is the answer. If you want to be a doctor, go to medical school.

Jeremy Wellman,  PA-SFebruary 18, 2008
UW School of Medicine, WA



I am ecstatic about the possibility of a Ph.D directly related to the clinical portion of PA profession. The fact anyone is threatened by advancement of knowledge that ultimately helps patients recieve more appropriate treatment is beyond me.
I would respect this Ph.D much more than Ph.D's earned on-line, require no dissertation, meet rarely in sunny locales and provide no true application of knowledge. For what purpose do these advanced degrees serve except to allow PA instructors/professors garner tenure?

I hope someday this degree will be offered to non-military PA's as well.


Sarah Boyle,  Physician Assistant,  HospitalJanuary 13, 2008
Hartford, CT



I keep fighting for PA's because I was a very abused PA, Morally, Mentally and professionally. I want to see my equally talented colleagues move ahead and elevate themselves to a level playing field. The medical health care system in the U.S and the world "CANNOT SURVIVE WITHOUT PA's". Here is a comparison of another talked about mid-level doctoral program. You be the judge.

PA Education NP Education
4 years BS degree 2 or 4 Years RN degree
4 Years MPS degree 2 Years NP degree
------------------ -----------------------
Total 8 Years Total 6 Years


PA Education NP Education
MEDICAL MODEL NURSING MODEL
-------------------------- ----------------
Allopathic Training Nursing Training


PA Residencies (DNP) Doctorate Of Nursing
and Years Practice curriculum
of Hospital based
training
----------------------- ---------------------------
Hospitalist 1-2 years YEAR ONE
Geriatrics 2 years Advanced Science, Economics
Surgery 1-2 years Biostatistics, Health
ER Medicine 1 year outcomes, Methods for
Internal Med 1 year evidence, Clinical Practice
Bioethics

YEAR TWO
Resource Management, Exam
of Practice, Clinical
Project, DNP Project,
Clinical Practice
--------------------- ---------------------------
1 to 2 Years Hospital Hospital training ???????
training



FINAL TALLY
------------------------------------------------------

DNP = Clinical Doctorate, "Doctor" title, Billing
directly for DNP services without an MD's name,
Independant practice, Respect and patient trust.


---------PHYSICIAN ASSISTANT UMBRELLA-----------------
Certificate, Bachelors degree, Masters degree, PHD
degree, MD degree.
Hospital training or no hospital training.
1 year in practice or 30 years in practice.
Misdemeanor if MD is figure head and PA runs/owns the
clinic.
Lab results arrive with MD's name, calling PA the
assistant, no name mentioned, just "the PA".
MD makes a mistake=Oversight, PA mistake=Incompetence
At the end of the day grand total-------------------

ASSISTANT.

Collin RossJanuary 07, 2008



Keep fighting the good fight. Thanks for your comments.

Rod Kelly,  PA-CJanuary 04, 2008
LA



"WEBSTERS DICTIONARY" Definition of Doctor
Etymology: Middle English doctour teacher, doctor, from Anglo-French & Medieval Latin; Anglo-French, from Medieval Latin doctor, from Latin, teacher, from docēre to teach — more at docile
Date: 14th century
1 a: an eminent theologian declared a sound expounder of doctrine by the Roman Catholic Church —called also doctor of the church b: a learned or authoritative teacher c: a person who has earned one of the highest academic degrees (as a PhD) conferred by a university d: a person awarded an honorary doctorate (as an LLD or Litt D) by a college or university
2 a: a person skilled or specializing in healing arts; especially : one (as a physician, dentist, or veterinarian) who holds an advanced degree and is licensed to practice b: medicine man
3 a: material added (as to food) to produce a desired effect b: a blade (as of metal) for spreading a coating or scraping a surface
4: a person who restores, repairs, or fine-tunes things

"WEBSTERS DICTIONARY" Definition of PHYSICIAN and SURGEON
Main Entry: phy·si·cian
Pronunciation: \fə-ˈzi-shən\
Function: noun
Etymology: Middle English phisicien, fisicien, from Anglo-French, from phisique medicine
Date: 13th century
1: a person skilled in the art of healing; specifically : one educated, clinically experienced, and licensed to practice medicine as usually distinguished from surgery
2: one exerting a remedial or salutary influence

Whats the confusion? So a PhD, Masters trained and Bachelors trained individual should all be called MR/MRS?
Collin Ross MD PhD MPH PA-C

Collin RossJanuary 03, 2008



I ended up on this web site while researching another topic and became very interested in this string of comments. I am a nurse practitioner with a PhD. I also teach nursing and take students into clinical settings. I do not introduce myself as "Dr. Hart" in the clinical practice setting because I do not want to confuse patients. In clinical settings I always introduce myself as a nurse practitioner. In the academic setting I am addressed as Dr. Hart and I think that is appropriate.

I often here physicians, PAs and ARNPs ( less often) refer to Medical Assistants in the office setting as nurses. Is this not also confusing to patients? The educational preparation for MAs is very different from that of an RN. I wonder if Dr. Lime refers to MAs as nurses? If so, would this be ethical?

Leigh Hart,  ARNPJanuary 01, 2008
Jacksonville , FL



I thank all of my "colleagues" PA,MD,DO etc....for your kind comments on this web-site. I encourage the percentage of the 68,000 PA's that subscribe to this great magazine to elect representatives who are progressive and have you in mind. STOP electing scared and out of touch administartors who advance legislature to move you 3 steps backwards for ever 2 steps taken fowards. Big deal if your administrators have lobbied for the right for a Physician to supervise 4 PA's versus 2. Why is this rediculous? This is called franchising. The same thing that Mcdonalds and any other business does to make money. You now have 4 assistants that can bill under your name as an MD instead of 2 . How in the world is that a benefit to you as a PA or your patients who prefer your expertise and style than your supervisors? . For those who don't get what I am saying look at it this way, $4 of passive income is better than $2 of passive income for any franchise or "PC" John Doe MD PC ever see this distinction? Well now you know why. This is just an example of how your PA administrators are short changing you and that has to stop. In light of the new Doctoral PA degree this is my progressive and contemporary reccommendation to a licensing scheme which looks out for PA's, Clinicians and patients. It doesn't matter what title you use in this scheme the "SUBSTANCE" of what I reccommend is what I hope drives home.

4 year degree, Bachelors of Physician Assistant Sciences (BPAS)

7-8 Year degree,(bachelors and 2-3 years of additional
training) Masters of Physician Sciences (MPAS)

7-8 Year degree, with Post-Graduate training,
Doctorate of Physician Assistant sciences (DPAS)

Distinction/educational level is clear in this scheme.
BPAS, MPAS and DPAS. In my proposed licensing scheme the
bachelors trained professionals are the only ones that
need to follow the current PA-Physician supervisory
model. MPAS and DPAS Should be "INDEPENDANT" practitioners. This scheme allows the
employer, hospital or physician to decide if they
would like to hire a clinician who needs supervision
or hire an independent clinician. This licensing
scheme leaves choice on the table. Here are the
advantages for each scenario;
1) For the individual who doesn't want to invest a lot
of time in the educational process and would feel more
adept practicing Medicine under a supervised
Physician/Mid-level model then the BPAS training model works
out quite well.
2) A Physician in Solo practice or a medical group
would probably prefer a clinician under the BPAS model.
A hospital, community/rural clinic I am almost certain
would prefer a DPAS trained individual who is "INDEPENDANT" under my
proposed licensing scheme. These are the medical facilities that need committed providers who will work and become part of the community.
Thank you for your time and kind responses.
Collin Ross MD PhD MPH PA-C



Collin RossDecember 31, 2007



Thank you Dr. Ross for making succinct response.
Dr. Lime I wish you well as your viewpoint is disturbing but not new to me. I am PA who met my spouse during her pre-med undergraduate training and followed her through the process to now being a board certified surgeon. Many of my undergraduate classmates and family have pursued medical degrees and I fully understand the process from my spouse, family, physician friends, and working in teaching hospitals.
I would be interested to see if you believe the 80 hour work week has weakened the current generation of physicians. The grueling training you mentioned has been regulated out of existence as it was found to hurt patient care and often the residents working those hours.
Also Dr. Ross comment was important to the fact that errors occur at all levels. Physicians are not infallible but you run on about your incompetent Midlevels you have met. I am sure in your time you have not met any physician who is not forthcoming about their abilities, their training, or the fact that they make errors.
I find your male comment intriguing. As I am male, and am constantly correcting my patients that I am not a physician but proudly a Physician Assistant, as you mentioned being proud to say your were a nurse.

I truly enjoy my working relationship with my supervising physicians. I have no interest in practicing indepently. Someday I may wish to continue my education and pursue my doctorate, but would still ask my patients to call me a physician assistant.

I think that a doctorate is a great idea for an option as an entry level degree or more important, as a continuing education option for all the practicing Physician Assistants who desire to continue didactic, clinical, and research training.

Daniel ,  PA-CDecember 24, 2007
NV



Here is the complete link for one of the factual studies regarding residency training for those mis guided individuals who think that the grueling residency system for Allopathis trained and Osteopathic trained physicians is an ideal system. I also should point out that Surgeons amoungst Physicians have the highest divorce rates. This is not to demean anybody but to educate Lime MD, who is probably a fine physician.

"Internal Bleeding: Our epidemic of Medical Mistakes"
Audio-Digest Volume 53, Issue 36, September 22, 2005
www.audiodigest.org

Collin Ross MD PhD MPH PA-C


Collin RossDecember 21, 2007



This is a response to Lime, MD in Melbourne Florida. These are some of the "HORRIFIC" things that Physicians do and please do not think that now because you are part of the club you have the right to say what is unethical and illegal.
1) Dermatology -VS-Dermatologist
A dermatologist is "BOARD CERTIFIED", but someone who practices Dermatology could be a general practitioner who did one year of post-graduate training. I find that mis-leading.

2) Diplomate-VS-Board Certified
A diplomate is someone who either failed their specialty boards or didn't complete them. I find that designation misleading.

3) Dr. Joe Smith (name tag)-Vs-Joe Smith D.O(Name tag)
You talk about people turning name tags around, then why do some DO's, Podiatrist,Optpmetrist list Dr.Joe Smith on their name tags and not their degree. I find that misleading.

4) So you think that "REAL RESIDENCY" means coming home at 3 am in the mornning makes one a "DOCTOR". Why then was legislation enacted to limit resident work hours to "80 HOURS a WEEK?" Why then was a residency float system created to rotate out tired residents and rotate in fresh residents? Why are progressive medical schools exposing their students to less and less of didactics and more clinical experience?

To my fellow colleague you of all people should know that medicine is evidenced based. For all the "ANECDOTAL" stories of people calling themselves doctor who were just bad practitioners I could equally point out a bunch of MD's who "FACTUALLY" were bad doctors. Just sign up at the California medical board for them to e-mail you daily the list of MD's with licenses revoked, suspended or surrendered. That is factual. Finally if you think our residency system is that great check out;

"Our epidemic of medical mistakes" by Audiodigest.

It is time for all people involved in health care to act and be treated as team players. We all bring something to the table in an effort to make our patients feel well. Gone are the days when being a "doctor" allowed one special priveleges to some social club, elitest organization or income bracket. Be careful with your anectdotal stories my friend this is a new era of patient care.
Collin Ross MD PhD MPH PA-C


Collin RossDecember 21, 2007



Dr. Lime,
First let me assure you that my RESIDENCY was every bit as excruciating as yours, all be it 1 year as compared to your probably 2 or 3. True, some PA residency programs are not up to par. However, mine at the University of Texas was absolutely brutal!! Run by the same MD's that ran the MD RESIDENCY at BAMC army hospital at Ft. Sam Houston. Daily grand rounds, exams, lectures, labs, and working close to 200 hours a month in the ER. Do not insult what you know nothing about.
Physician is a job title, Doctor is a degree title. I can only assume that your hostility towards PA's and midlevels as a whole stems from intimidation. As a PA in the ER, I can do every procedure the MD can do. With one exception, an open thoracotomy.....quite frankly they don't pay me enough for that one!! But I have been trained in animal labs on how to do them. Have you?? My diagnostic and patient care skills will only grow and improve, the sword will sharpen with time and use. I expect that when I have been doing this for 10 or 15 years I will be as competent as any MD. Though I would never introduce myself as Doctor, never have, never will. I am very proud to be a PA and even when I have a DSc I will introduce myself as PA Booth. Though I have every legal right to call myself doctor, Physicians DO NOT HAVE SOLE OWNERSHIP OF THE WORD! And with regard to that issue, I experience everyday in the ER, people I have been working with for over a year, whom I have corrected time after time, still call me Doctor Booth. You do in fact reach a point where you have made every reasonable to effort to keep the issue straight and you finally just let it go. People will call you what they want.
R. Booth, MS, EMPA-C is clearly on both my lab coat and my ID badge. But I am not going to continue correcting the same people over and over.
You're arrogance is clear and your disdain for the midlevel profession is obvious. Our need in the medical arena is concrete and we are not going away. If you choose to not work with PA's then so be it. We are PHYSICIAN EXTENDERS and we will help another PHYSICIAN see more patients, bill more, make more and ultimately be more successful.

Robert Booth,  EMPA-C,  Methodist Univ. Hosp.December 20, 2007
Memphis, TN



Dr. Collin Ross, you have the right idea about medical providers in general!

After being a PA for 10 years, I am convinced we are the only ones holding ourselves back. I think a DscPA is the logical and right degree for the PA profession to hold. I will not hesitate to call myself doctor when I acquire this degree, but I will represent myself as a "non physician".

I am willing and can't wait to go back to get this degree. I also would like to suggest that when the DscPA degree is earned, independent practice is also earned; similar to the nurse practitioners in subspecialties.

We all know that NP's are not entirely independent as they collaborate with the specialty physicians that they work with. But NP's are respected by physicians, and accepted because they are collaborating, and not "dependent" practitioners.

I agree that the NP doesn't seem to have the grueling medical training that PA's have, but they also acquire their skills on the job, and I have learned a great many things from my NP colleagues. Oh by the way , when will we overthrow the AAPA on the "assistant" title! I'm all for medical practitioner!




Jennifer Whitehead,  MPAS, PA-CDecember 20, 2007
Salt Lake City, UT



Wow, Mr. Lime. That's quite an ego you have there. So despite my years of training and education, I should not let patients refer to me as Doctor, even when requested by an MD for an evaluation or input? I think you poorly misjudge the amount of time and dedication it takes others educated at the doctorate level to attain that status. I agree with PA Flora that if one clearly states his or her area of expertise, then the title is warranted. It's an insult to assume that residency is the only thing that qualifies one to be addressed with that hard earned title. Shame on you sir.

David ,  PhDDecember 20, 2007
WA



I find it very amusing that any one group think they have the absolute right to be called a Doctor. Maybe we all need to do a better job in recognizing that the term is generally used to show someones academic achievement. You can be a teacher and still be a Doctor, a preacher and still be a doctor etc.
Maybe if we address our patients properly, there will be no confusion. I am Dr so and so, a physician or surgeon, I am Dr so and so, a nurse practioner, Dr so and so, a pharmacist, Dr so and so, a PA if you are qualified. If you are a doctor, I don't think you should be ashame of it and hide away from using it because some group think that they are the only rightful Doctors.

David KDecember 16, 2007



I read Dr. Ross' postings and I think it's an excellent way of looking at this issue. She's had both forms of education and thinks it doesn't matter. A doctor of medicine and a doctor of physician assistant studies is just a win - win situation for our patients.
Albert PA-C

Albert Massaquoi,  PA-C,  HospitalDecember 06, 2007
Philadelphia, PA



Again.... Lime, MD. Where is there a written LAW that states that if you have EARNED a DOCTORATE, you are not allowed to be RIGHTFULLY call Doctor......... Lets not misconstrue the issue at hand. I am a PHYSICIAN ASSISTANT and proud of it, AND ALSO BOARD CERTIFIED. I have my pts call me PA Wright....because thats MY title. It is the age old misconception that only PHYSICIANS are designated Doctor. If I had any doctorate - clinical or other, i'd introduce myself as Dr. Wright, the PA. It has become our own misguidance that being a Physician is the epitome of all careers, and apparently has been idolized by other individuals. You describe residency as some kind of pledge process that YOU decided to encounter. Some people decribe it as a walk in the park. So please don't minimize the education of others based on YOUR perception of what is harder and more significant.

PA Flora December 04, 2007



I am a physician board certified in my specialty and a subspecialty recognized by The American Board of Medical Specialties. Let me give you some examples of my experiences as a resident some of you may not like to hear.

When I was in anesthesiology residency I overheard a nurse anesthetist student refer to himself as “the resident” to a patient. This person was not even a CRNurseA he was a student! I asked the patient if any physician had spoken to her and she replied “yes the resident discussed my surgery with me”. Knowingly or not the student NURSE anesthetist misrepresented his status, educational level and experience level to that patient. This is unethical and illegal.

A patient ready for heart surgery was already interviewed for surgery by Dr. So-and-so. Who was this doctor? It was the NURSE anesthetist that had received an EdD or Doctor Of Education and was introducing himself as “Doctor” to patients. This is unethical and illegal.

A PA working for a neurosurgeon had deluded himself into thinking he was a physician and would not correct patients, nurses or real physicians when addressed as “doctor”. It is funny how he always wore his ID facing his lapel. He also would identify himself as the neurosurgery resident when answering the telephone. This is unethical and illegal.

A nurse practioner conveniently allowed patients to call him “doctor”. It is funny how he never wore his ID badge where it could be seen. This is unethical and illegal.

I will not bore you with many more examples of unethical and illegal behavior, rampant in US hospitals, borne from some need to skirt the system, take a short cut and represent oneself as doctor by omission or commission. Notice all the illegal misrepresentation as physician was committed by males. I will explain these phenomena.

Before becoming a physician I was an R.N. Daily while working in ER or the ICU’s I was called “doctor” by some patient. Never did I mislead the patient to thinking I was the physician. I always kindly corrected the patient and identified myself as a NURSE, with pride. I saw colleagues fall into the “doctor” trap and misrepresent themselves. This is unethical. Males are prone to this trap because our society largely thinks of males working in the infirmary setting as the “doctor”.

Under no circumstances should the patient be fraudulently misguided to believe a non-physician is a real licensed physician. I believe the above culprits are probably good people, except for the above Physician ASSISTANT who was a real pathological sort, who got caught up in this “permissive culture”. Permissiveness allowed to exist by the paraprofessional and physician groups alike.

Only the physician should be called DOCTOR so as not to delude the patient or the non-physician into believing otherwise. Also no known PA or Nursing education program has a real residency! Going home at 3 PM, taking your lunch break, not working on weekends, and not working overnight is NOT a real residency. I find people who are not physicians and claim to be in a residency insulting. You have no idea what residency is! It is a grueling insufferable endeavor tenaciously withstood by the physician for YEARS to learn and EXPERIENCE as much as possible to give the DEPTH and BREATH of knowledge needed to be called a physician – The Doctor!


Lime ,  MDDecember 03, 2007
Melbourne, FL



I am fully supportive of this idea. As with many other professions going toward a Doctorate degree, it certainly doesnt hurt. Pharmacists went from Registered Pharmacists to PharmD's and now work on the floors and round with the teams. Naturally, the older graduates were opposed and the younger supportive. At 26 years old, I say that most of us new graduates feel the need to secure our profession and are in support of residencies and advanced degrees.

Matt BundyDecember 02, 2007
New York, NY



It's interesting to read all these comments about why there shouldn't be a DPA. Like Dr. Ross mentioned, we are short changing ourselves. Most of these arguments are against the advanced degree because "pt's will be confused and we will alienate physicians". Give me a break. Do you think that this was a discussion/issue at the nursing board when they decided to establish the DNP. Wake up people!!!!! A doctorate is a doctorate, and if there is an opportunity to get this ADVANCED DEGREE, then go for it. DOCTOR does not equal PHYSICIAN, you are a doctor of .........whatever profession you choose. DOCTOR is NOT a profession its a degree. PHYSICIAN is a profession. So if one say's "i'm a doctor", they are wrong. They are PHYSICIANS. So lets not miss this opportunity because we are AFRAID of hurting peoples feelings.

Flora ,  MPH, PA-CDecember 01, 2007



Why are the PA's getting a Doctorate? Is it to improve skills, as discribed in emergency medicine. Great that is very commendable.
Or is it to just say they have a doctorate. The professor comment ed that being a cert. PA had not slowed him down. What if in 1974 he had to have a doctorate to be a PA would he have still become a PA. The profession has to stop and think why are we pushing for higher education. If the PA profession is pushing for a higher degree to keep up with the RN etc. then that is not a good reason.
I have a master degree becuase I enjoy learning and it was offered by my employer. Part of the draw for PA's is the shorter time of training and use of past training or life experiences. I think rather than insisiting on a degree the PA socieity should focus on the skills of PA what they bring to the profession.
Not the number of letters behind their name.

Marie Rasch,  PA-C ,  South Central District HealthNovember 28, 2007
Twin Falls, ID



As member of the dinosaur generation. Grad:1974. I am alwasy proud to see the Profession keeping up with academic advances for the profession as a whole. Anyone who can't see the need for this has long been out of touch with reality. I still recruit youg people toward the profession when ever I can. One day I was talking to a Pharmacy Student who was in her last year. I asked the standard question That I always did, what are you going to do from here? Have you thought about the PA Program. Why? was her come back. I explained all of the the hands on clinical training, joy of direct patient care. and the kicker prescriptive priviedges, "you would have to go back and get your Pharm-D to have prescriptive privledges". She smiled there are no more Pharmacy Degrees. Every program now is a Pharm-D program. How quick and silent this came about. If we can't compete and offer the same acadmic credentials. How many prospective applicants are going to pass on the profession? We fear the unknown but as a certificate Grad: I welcome the Advanced entry level degree. Having a certificate never slowed me down even when the Programs became Masters Level.

Granville Collins,  Clinical Instructor ,  Baylor College of MedicineNovember 25, 2007
Houston, TX



I agree totally with Dr. Ross.
With nursing, physical therapy, audiology, pharmacy and others all moving towards the doctorate the DAYS ARE GONE WHEN DOCTOR MEANS ONLY PHYSICIAN. If we earn the title, we should use it.
Good Job Army and Baylor!


Dave Mittman,  PANovember 24, 2007
Livingston, NJ



I feel that this is a perfect plan for the small percentage of militaryPA's that are involved. Combat PA roles are among the very most challenging and lead to the skills of emergency care being perfected for the endpoint of saving a patriots life. We give our patriots ( all branches of the armed forces) so little, why not give them the most highly educated PA's and the best care available outside of a Mayo Clinic surrounding? I hear that the course for combat training at Ft. sam has become the most sohicticated of any kind in the world. Go Army, Go Navy, Go Air Force, Go Marines, Go Coast Guard.

Bob Blumm,  PA,  pvt practiceNovember 24, 2007
Long Island, NY, NY



A PA has to by Law Identify him or herself as a PA. Yiu cannot introduce yourself as Doctor so-in so. Do that in the state of Texas and your will lose your lic. If you want to be called a Doctor then go to med-school. the addition of more letters to the PA-C is just more confusing to the patients. Get rid of the ego's and do what you were trained and called to do and quit looking for justification. Why start into another designation when the general public doesn't for the most part understand what we are to begin with. Now if you ask them what an NP is they know. What needs to be done is educate the country on what a PA realy is.

Shelby church,  MPAS-PAC,  Private PracticeNovember 24, 2007
Silsbee, TX



“Our graduates will not call themselves ‘Doctor’ to avoid confusing patients and out of respect for physicians who remain the gold standard for medical practice”............... Gruppo says.

Too much pressure is placed on "Doctors" and maybe we should look at hard core statistics before calling any "TEST" or "PROFESSION" a Gold standard. Check out;

"Internal Bleeding: Our epidemic of Medical Mistakes"
Audio-Digest Volume 53, Issue 36, September 22, 2005
www.audiodigest.org

After listening to that it would be nice to know if "tradition" is best for patients versus practicality and progressiveness.
Collin Ross MD PhD MPH PA-C

Collin  RossNovember 23, 2007



I would love to see this come available to Internal Medicine PA's. With experience, many midlevel providers function at a level seen with "doctoral/doctorate" level skills, knowledge and decision-making responsibilities.

It unfairly and unnecessarily limits our profession when a doctorate is withheld or argued against.

Camille

Camille Rosenberg,  Phys. Asst.,  Henry Ford Health SystemNovember 23, 2007
Detroit, MI



I cannot tell you how excited I am about this new DScPA program. It is hopefully going to be followed soon by Baylor or other programs to allow for this degree to be obtained by those who wish it. I am a graduate of the Univ. of Texas PA Emergency Med. Residency, so I already have a third year of training, and want the title of DScPA. At this point, PA's are now the last bastion of non-doctoral professions. Trust me, we do not want this. Here in Memphis, the NP program at UT has already shifted to DScNP, and they are already weilding this new title like a hammer over us PA's. We have to fire back and get our own DSc . I promise you the nursing lobby will use this new title as a wedge issue to try and roll back PA priveleges and/or slander our profession by saying they are better trained because of the degree difference. We all now that is not true, but John Q public doesn't know that and that is where it matters. If some PA's don't want to go the extra mile for this title then fine, but like the residencies are available for those who want to do them, so should this degree. The AAPA should support this fully.

Robert Booth,  EMPA-C,  Methodist Univ. HospitalNovember 23, 2007
Memphis, TN



It all comes down to the bottom line. I'm convinced that PAs get hired because they can provide quality care AND do it for less money. The way health care costs are rising, there is no way I hired AND get more money because I have a doctorate over another PA with a BS or MS

Mark Schiffner,  PANovember 22, 2007
Bennington, VT



For anyone that is worried that a Doctorally earned and titiled PA will confuse patients and mislead the public I have a very simple solution to this percieved problem. In every Medical facility where patients are seen, we could provide small handouts that will clearly explain to patients the following;

1) The difference between an MD and a DO. Both are called Doctor.
2) The difference between an Opthomologist and Optometrist. Both are called Doctor.
3) The difference between a Psychologist and a Psychiatrist. Both are called Doctor.
4) The difference between a diplomate of the board of ???? And a Board certified ???? Both are called doctor.
5) The difference between John Doe MD Dermatology and John Doe MD Dermatologist. Both are called Doctor.

The doctoral title communicates to patients Training and expertise. MD is not the only profession which offers skilled expertise and training. Don't let politics sway anyone from the real issue at hand. Patients want good patient care and America needs hgihly trained and ready healthcare providers. When it comes to my personal health I will always choose an expert. Doctoral training communicates that expertise to patients and colleagues wether it is DC, MD, DO, OD, PsychD or PHD. Why should we capitate the training level that can be achieved by a Physician assitant, Physician associate or Physician extender? I have been on the PA and MD side and I can tell you from real world experience, PA's are short changing themselves, patients and the healthcare system if they refuse to have their hard work and education not recognized by a Doctoral title. When I did my ER rotation as a PA student and Post-Graduate PA-C we did 12 hour shifts with rounds. When I did My ER rotation as a Medical student we did 12 hour shifts with rounds. When I talked to a colleague who was in the DNP program, Doctorate of Nursing program, they were working on an internet based term paper. The DNP programs do not have grueling hospital based Internal Medicine, ER or surgery rotations built into them. PA's at the student level do these rotations. I am all for the Doctoral degree for PA's irregardless of whatever title follows the doctoral distinction. After 40 years and 68,000 people strong the only thing that can stop Physician extenders is themselves.
Collin Ross MD PhD MPH PA-C

Collin RossNovember 21, 2007



The NP's are going this way and just like they wanted to use their masters as a way to say they're better trained than us we better get ready to see them do the same thing with the doctorate. My wife is an NP and this is all the talk in her professional journals, newsletters, etc.

We should never be against advanced education and those who go through advance training are entitled to be rewarded for their hard work.

As far as addressing myself as doctor if I were to get a doctorate...I wouldn't. I see the physical therapist do this and all it does is confuse patients and alienate the physicians. Personally I could care less...I have my patients address me by my first name. I never felt like a lessor provider by doing that. Even when I tell my patients to call me by my first name, half of them still call me doctor anyway.

Greg Mete,  PA-CNovember 21, 2007



We are living in a time of healthcare crisis. Our system is in need of change to enhance access and quality of care as well as control costs to patients. We are also approaching a presidential election year and healthcare policy is at top of the list for debate. I still have 30 or more years to practice as a PA and I am excited about the development of a doctoral degree.

We live in a competative environment between healthcare providers and we all want to survive. The docorate degree offers many opportunities for PAs. I do not believe that we need entry-level doctorates, but combining the doctorate title with advanced training is fair and competative in the US market place. I think these doctorates should include training in healthcare policy, leadership, research and should be accompanied by a clinical outcomes research project suitable for publication. I enjoy helping patients and I am grateful to the profession for training me with the competancies needed to practice, but I would feel safer if policy makers and the public were more aware of what a PA does (the other article I read today). I am personally ready to see more research published with PA/MD/PhD teams, where the PA has earned a doctorate and has enhanced clinical skills. When we talk with policy makers or give a presentation as part of a speaker bureau, it would be nice to say "hello, I'm DoctorPA so and so and this is what I think." It isn't always important what WE think, sometimes it is just as important about how we are perceived by others. I don't need to have a MPAS title or doctoral degree, but policy makers and Mr. and Mrs. Jones next door may think it is important.

Many of the post-graduate training programs require research as part of the advanced training such as MD Anderson, why not combine that with an advanced degree. Let's not forget there are many types of doctors in the world, but the latin root of the word means "to teach". PAs are educators and skilled practitioners and we will have to defend ourselves or should I say strategically position ourselves in the next decades. We are here to stay and this does appear to be "a logical next step in the natural evolution of the PA profession". Remember, the doctorate should provide us with enhanced knowledge in healthcare economics, leadership, clinical skills, and research. The doctorate platform may also provide means to enhance utilization of PAs for the coming healthcare shortage and create new strategies needed to enhance the PA/MD relationship, etc... If a doctor PA just has additional clinical taining, then why bother. I am reminded of the respect I have for Hank Lemke and PA program at TCOM, where their students create substantial high quality research projects. Why have a master trained PA who goes through the same training as a bachelor trained PA with the same compentencies, just a higher degree. Masters training should go several steps farther and the DScPA dgrees should provide the PA profession with a strategic advantage in some way as well.

Once again, my opinion is that Doctoral degrees should accompany advanced clinical training, healthcare policy and leadership, outcome based or healthcare policy research, should strengthen the PA/MD and PA/patient partnership.

Thanks for reading,
David

David Kellenberger,  MPAS, PA-CNovember 21, 2007
Wharton, TX



Having recently retired as a program director, I have returned to full-time clinical practice and am more convinced than ever that the clinical doctorate is an incredibly bad idea. No matter how much you tell people not to use the "doctor" title there will be those who insist on doing it. This will only serve to confuse patients and alienate physicians. We shouldn't get so hung up on degrees AND we have to remember that PAs are dependent practitioners. If you want to be a "doctor," go to medical school, or get a PhD (DHSc, EdD or whatever) and be an academician.

Rich NenstielNovember 21, 2007




     

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