Richard W. Dehn, MPA, PA-C, DFAAPA
The profession’s natural maturation toward less-restrictive state regulation and more collaborative practice environments, currently branded as optimal team practice (OTP), was the centerpiece of the recent AAPA conference in Las Vegas. As we celebrate the 50th anniversary of the profession and review some of the historical manuscripts recently published that describe how we as a profession have progressed, it appears to me that for its entire existence, the profession has followed a trend of widening scope of practice and
increasing independence. This trend began with the early days of the first state practice enabling legislation, followed by prescribing legislation, followed by enabling legislation in all 50 states, and now includes the incremental removal of practice barriers on a state-by-state basis. The trend has been one of consistent improvement in the practice environment, resulting in PAs practicing much more autonomously now than in the early days of the profession.
However, painful compromises often are a byproduct of progress, and that will likely be true of implementing OPT to attain a more independent practice environment. The profession will continue on its 50-year trend of widening scope of practice and increasing independence by implementing OPT; in fact, doing so may be the profession’s only real option to remain vibrant and growing. However, there will also be costs. In my opinion, OPT is likely to increase specialization, reduce specialty mobility, and increase the length and cost of training. Additionally, I expect the implementation to pressure to profession to move toward adopting a doctoral degree as the entry academic credential. Some of the rationales often given that support an entry-level doctoral degree include keeping up with other professions that grant doctoral degrees, changes in healthcare delivery and reimbursement systems that favor providers who do not require supervision, and state practice regulations and institutional processes that serve as barriers to PAs practicing at the top of their capabilities.
I read comments and frequently have conversations with PAs, PA students, and PA applicants who strongly support having the profession move toward an entry-level doctoral degree. These conversations often contain the assumption that increasingly independent PA practice will simply require a doctorate because a doctoral degree fundamentally is a prerequisite for independence. If the profession were to require this change universally, most likely through a change in the accreditation standards, the short-run consequences would be substantial.
First, the most serious consequence of a quick mandated move to the doctoral degree would be a substantial decrease in diversity in the profession. In 2000, PA education supported a gradual move to an entry-level master’s degree, which the Accreditation Review Commission on Education for the PA integrated into the fourth edition of its accreditation standards by requiring that all new programs be developed at the master’s level and all existing programs grant a master’s degree by 2021. Currently, 92.2% of programs grant a master’s degree.1 Thus, PA education has been on a 20-year odyssey to implement the master’s degree as the entry-level degree, which is still a work in process. This process was certainly not a painless one, as the diversity of students enrolled and graduating from PA programs has decreased since 2000, and several programs institutionally unable to grant a master’s degree that enrolled diverse student bodies have either closed or plan to close by 2021.2 Higher entry-level degree requirements would result in decreased student diversity, a phenomenon well documented in other healthcare professions that have raised their degree requirements.3
Second, PA education is not prepared to move to granting a doctoral degree. Most higher education institutions require that faculty possess at least the same degree they grant their students at graduation. However, only 17.4% of PA faculty hold a doctoral degree.4 Mandating that PA programs confer a doctoral degree would result in most programs being unable to comply with their institution’s expectations due to a lack of doctoral-trained faculty, resulting in a likely a precipitous decrease in PA enrollment. Additionally, many PA programs reside at institutions not regionally accredited to grant a doctoral degree, or not allowed to move to granting a higher degree without the approval of a state agency. Although I often hear the opinion that the PA education establishment would relish the opportunity to move to an entry-level doctoral degree, because lengthening curriculum and increased tuition would certainly make PA education more profitable, nothing could be further from the truth. Very simply, PA education is still in the process of adjusting to the recent move to the master’s degree, and most PA programs are ill-prepared to make the move to granting a doctoral degree at this time.
The profession’s long progression from its humble start to becoming an established member of the healthcare team has been a 50-year process, and the movement toward a more independent place in the healthcare system through OTP is the next natural extension of that process. However, the profession will most certainly encounter many challenges along the way, just as it did in its first 50 years. We must anticipate these challenges and address them rationally, considering in our calculations the greater good for our profession and our patients as we attempt to manage the inevitable costs of change.
1. Physician Assistant Education Association.
By the Numbers: Program Report 31. Washington, DC, 2016.
2. Coplan B, Dehn R, Bautista T. PA program characteristics and diversity in the PA profession.
JAAPA, in press.
3. Snyder CR, Stover B, Skillman SM, Frogner BK. Facilitating facial and ethnic diversity in the health workforce. Seattle, WA: University of Washington Center for Health Workforce Studies, 2015.
4. Physician Assistant Education Association.
Physician Assistant Program Faculty and Directors Survey Report, 2015. Washington, DC, 2015.
Richard W. Dehn is a professor in the College of Health and Human Services at Northern Arizona University's Phoenix Biomedical Campus, and a professor in the Department of Biomedical Informatics at the University of Arizona College of Medicine in Phoenix. The views expressed in this blog post are those of the author and may not reflect AAPA policies.