Advancing toward a PA doctoral degree

FigureFrom its beginnings in the 1960s, the physician associate (PA) profession has moved steadily up the terminal degree ladder. Although the profession was created utilizing a competency-based educational model, where in theory competence is more important than academic degrees, the profession's terminal degree requirements have steadily risen. In the early 1970s, most PA programs conferred a certificate at graduation, and over the next 2 decades, the number of programs granting a bachelor's degree steadily increased. Although frequently debated in the 1990s by the Association of PA Programs (APAP), the bachelor's degree was never adopted as the profession's entry-level degree, and the terminal degree conferred by PA programs was not addressed in the accreditation standards of that era. The prevailing belief at that time was that since PA education was competency-based, the credential awarded at graduation was for the most part irrelevant. Moreover, it was felt that requiring a higher entry-level credential across the whole profession would financially and educationally disenfranchise potential students from diverse backgrounds as well as require higher academic credentials among PA faculty, creating a faculty shortage. In the APAP 13th Annual Report that describes in aggregate PA educational programs in 1996 to 1997, of the 89 PA programs reporting, 23 (25.8%) awarded a master's degree, 47 (52.8%) awarded a bachelor's degree, 6 (6.7%) awarded an associate degree, and 13 (14.6%) awarded a certificate as the highest credential awarded.1 As several other healthcare professions adopted higher entry-level degrees (for example, the NP, pharmacist, and physical therapist professions), support increased for PAs to follow suit. In 2000, an APAP task force recommended that the profession transition to the master's degree as the terminal degree, a recommendation that was subsequently approved by a vote of the APAP membership.2 The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) 4th Edition standards, which went into effect in 2010, required that all PA students matriculating into a program after 2020 be awarded a graduate degree. The 5th Edition of the ARC-PA standards, which went into effect in 2020, explicitly stated that all PA programs must confer a master's degree upon graduation. This requirement resulted in the closure of several PA programs at institutions, primarily community colleges, that were unable to award master's degrees. While PA education was in the decades-long process of adopting the master's degree, interest in a PA clinical doctorate had been percolating under the surface for many years. An entry-level doctorate for the PA profession was directly addressed at the 2009 PA Clinical Doctorate Summit conducted by the American Academy of Physician Associates (AAPA) and Physician Assistant Education Association (PAEA). This resulted in both organizations endorsing the master's degree as the entry-level and terminal degree for the profession.3 The National Commission on Certification of Physician Assistants (NCCPA) reported that in 2023, 2.4% of PAs possessed a doctoral degree, an increase from 1.8% in 2019, indicating a growing demand for doctoral degrees for PAs.4 Currently, although both the AAPA and PAEA maintain support for the master's degree as the entry-level and terminal degree for all PA programs and ARC-PA standards explicitly require it, demand is growing for doctoral education for PAs, particularly for those seeking PA faculty and leadership positions. The marketplace has responded with the establishment and expansion of PA postgraduate programs. Demand for PAs with a doctoral degree is currently concentrated in PA education and leadership positions; however, historical trends from other healthcare professions that ultimately transitioned to an entry-level doctoral degree indicate that demand for doctoral degrees will likely increase beyond these two employment options.5,6 With postgraduate degree programs currently the only practical route for PAs to earn a doctoral degree, the PA DMSc or DMS degree currently offered by a growing cadre of institutions has become a popular choice, likely because many PA DMSc/DMS degree programs are affordable and can be completed remotely while working full-time. The PA DMSc/DMS is offered in a variety of educational configurations, making these programs a viable option for many PAs who are considering obtaining a doctorate. The fast-changing landscape of PA DMSc/DMS programs can appear overwhelming to those investigating doctoral options. In this issue of JAAPA, you will find a description of the current PA DMSc/DMS educational landscape in “The PA postprofessional doctorate,” an original research article by McKenna and Hooker.7 The PA profession is currently divided over whether it should move to a doctoral entry-level degree, much like the divisions that presented over whether to move to the entry-level master's degree in the late 1990s. The profession has been engaged in similar discussions regarding the appropriate entry-level academic degree for most of the profession's history. The arguments supporting and opposing this decision involve important factors and values fundamental to the PA profession, including once again potentially contributing to a critical severe PA faculty shortage. The current rapid growth of PA DMSc/DMS degree programs is demonstrating in real time the growing interest of PAs in earning doctoral degrees and will accelerate the profession's move to an entry-level doctoral degree. However, the tipping point is likely many years in the future.