Is there a New Doctor in Town: Doctor of Medical Science (PA Medicine)
The following is a satire. Or is it?
So here I sit on my way back from Hong Kong and that dreaded announcement came overhead: “Is there a doctor on board.” As I pondered my fate and whether or not I should get up and identify myself as a physician (MD), 5 people jumped up ahead of me and rushed to the front of the plane. I was thinking, wow, so many doctors on one flight. Good. The poor victim is in good hands and I can relax with my kids. The poor flight attendant staff however, was not aware of what was about to happen though. They were thankful. The first doctor, a PhD in mathematics politely dismissed himself as he realized it was a medical emergency and his formulas and equations would be of no use. The 2nddoctor, Doctor Theological Studies offered a prayer which other passengers and flight staff found comforting. The 3rddoctor, a Juris Doctor offered a business card to the victim and a free on site consultation. The 4thdoctor, a Doctor of Nursing Practice (DNP) offered medical advice but the perplexed flight attendants couldn’t understand why a nurse would come when they paged a doctor. They politely requested overhead again for a doctor on board. The 5thdoctor who had responded was confusing to the flight attendant staff as they identified themselves as a Physician Assistant, Doctor of Medical Science (PA Medicine). They wondered why an assistant would respond when they requested a doctor. The 6th, 7th, 8thand 9th doctors on board didn’t respond as they saw no use and knew their limitations – the Doctor of Pharmacy, the Doctor of Physical Therapy, The Psychology Doctorate, and the Doctor of Occupational therapy. Finally with frustration, the Captain/Pilot came overhead and informed the passengers for all the doctors to sit down and would a physician if any on board please come assist. That’s my cue………….. gotta go……. Not really, but it made for some entertaining writing while passing my time.
I really am on a flight from Hong Kong and thankfully there is not a medical emergency. But you have to wonder, is it this way for patients in the hospital. Whereby once the term “doctor” was revered and it’s implicit meaning was that of physician especially in health care settings. Now everyone is becoming doctors of something. Take the new Doctor of Medical Science (PA Medicine) – as advertised, a 6 semester/24 month program for PAs. I’m not trying to disparage anyone here, but what’s the point? Is this the full doctorate program, or is this a doctorate for the current PAs with a Master’s degree already. What’s the curriculum? Is this medical school type basic sciences or is this theory and research courses like the diploma mill DNP programs? Upon further review of the website, it’s unclear as to if the doctorate degree can be attained in 24 months, whereby elsewhere it indicates 136 credit hours which is more like it, but to think a doctorate degree can be done in 24 months is ludicrous. In addition, it does appear there are good admission standards requiring GRE, good GPA bachelors degree, and pre-requisite courses and other items. This is a good thing for quality, however I’m still stuck on a doctorate degree in 6 semesters. It appears it’s actually a Master’s degree curriculum repackaged and called a doctorate degree.
“The Doctor of Medical Science (DMSc) curriculum occurs over six consecutive semesters (24 months), covering 136 graduate semester hours. The program has three phases which include (1) pre-clinical also known as didactic, (2) clinical phase, and (3) the summative phase. The 12-month-long pre-clinical phase is conducted on campus and prepares the student for the clinical hands on portion of training (clinical phase). The clinical phase is 11 months long and is conducted at hospitals and clinics where students are exposed to supervised clinical experience. The one-month summative phase evaluates student attainment of graduate competencies and occurs during the last month of the program.”
What really irks me more is, it’s bad enough DNP’s are hijacking the primary care role from physician’s, we now have another avenue of attack with the PAs encroaching in physician territory. Everyone seems to want to solve the primary care physician problem and I continue to profess that it is a physician problem to address. I respect both NPs and PAs as I use to be a mid-level provider myself for 8 years before becoming an MD. I always served on Physician Led Multi-disciplinary Health Care Teams.And not to knock PAs, but isn’t it in the title “assistant” thus requiring supervision and collaboration?
In response to a growing state and national physician shortage, particularly in rural and medically underserved areas, George Fox University has proposed a new six-semester, 136-credit Physician Assistant (PA) medicine program, which will award a doctor of medical science (DMSc) degree.
I suspect this is just the beginning of their plight in joining NPs for independent full practice authority. I suspect developing this new doctorate is part of this cause. Moreover, as I sit here and look out over the Pacific Ocean, it makes perfect sense – follow the money as with the DNP diploma mills. The PA schools want a piece of the action. With the physician shortage in large part due to Medicare caps on resident training slots, it seems unlikely that we physicians will be able to offer any solutions outside contacting congressmen in support of current bills supporting an increase in residency training slots. This does produce a gap, and just as NP schools rushed in to try to capitalize, PA schools are now doing the same thing. Makes sense from a business model. Identify a gap, find a way to fill the need, exploit it. Honestly it hurts to be taken advantage of as a profession sitting ideally by helpless while others take advantage of a situation.
But what this program is also saying is that MDs/Dos are replaceable by PAs. By highlighting and exploiting the physician shortage:
“The present shortage has been predicted for some time. In fact, in 2006, the American College of Physicians stated that primary care was on the verge of collapse and unable to keep up with population growth, people with chronic disease, and long-term care of the aging. A 2012 study by Petterson, et al., estimates that 52,000 additional primary care providers will be needed by 2025.”
I’ve written about this topic previously in terms of disciplines staying in their own lane. I wrote in terms of NPs, but now will add PAs to this to. Physician shortage is a physician problem. We are not replaceable by PA’s. Get as educated as you want to get, but please please please stay out of our (MD/DO) lane. At least PAs are open to team based practice:
“As the paradigm of healthcare shifts, new models of care – like the patient-centered medical home – are ideally suited for the PA provider, who has a generalist education, team-based practice, and strong focus on wellness and prevention (AAPA, 2014).”
For now, I’ll close by stating I am in full support of mid-level providers on physician lead multi-disciplinary health care teams as are many of my colleagues are. I do not support the use of the term “doctor” in a healthcare setting by anyone other than physicians. I don’t support mid-level full practice authority and independence and believe in the physician supervision/collaboration model. I believe primary care physician shortage problem is a physician problem to solve and all other disciplines should bow out. I don’t believe in watered down NP or PA programs. It’s my believe here that this program being offered here with a doctorate degree in 6 semesters/24 months is a farce. This program isn’t even accredited:
“George Fox University has applied for Accreditation-Provisional from the Accreditation Review Commission on Education for the PA (ARC-PA).”
If physicians care about our profession, we may do ourselves a favor and contact the accrediting body and urge not to accredit a 24 month doctorate (not even post-master’s degree) program.
Have a great day.
REFERENCES:
I think this was a sincere effort at making some good points but devolved into hyperbole and smears in a fashion that seems like pandering to the audience.
The first thing I’d like to clear up is this. NPs and PAs are not the same thing. Not in training, not in philosophy, not in political goal or agenda. It is just lazy to paint us with the same broad brush because it is easy.
At one point the author says he doesn’t understand the PA doctoral programs after spending a couple of minutes looking at some web pages and then proceeds to denigrate the very thing he doesn’t understand. It seem poor work for someone well versed in research and using research to reach conclusions.
Further it is interesting that the author gives physicians a total pass for any of the current shortages in primary care. Yes the shortage of residencies is a big factor but physicians fled primary care and followed the money into specialty care. That doesn’t hurt my feelings but let us be honest about it. Also physician abdicated their control over health care to become employees. This left us all at the mercy of administrators and bean counters that think a health care organization can be run like a fast food franchise…which might be where your CEO was last CEO.
And finally….PA are not in any way seeking independent practice. We are trying to modernize our regulatory language to eliminate state mandated supervision in order to let organizations and care teams determine how we are utilized. It eliminates outdated regulatory burden, takes the physician out of the direct legal responsibility for supervision (unless assigned by their organization to do so) and permits intelligent use of PAs so they can work at their skill level rather than trying to have “one size fits all” rules for everyone from new grad to 30 year veteran and primary care to sub-specialty. We’d also like to manage our own profession. We are the only medical profession that doesn’t.
A small sub-set of PAs from a doctoral program tried very hard to make an entirely new profession of independent clinicians on the backs of the PA profession. This was opposed by virtually every PA organization that had a voice and the issue is, for all intents and purposes, dead. there are a few of the graduates still trying but the schools themselves abandoned the idea.
I’m president elect of what is probably the most progressive PA organization in the country. We do not and have not ever had any conversation about independence. Our national society does not discuss independence. But for a few outliers it isn’t a topic of conversation.
So if you want to bemoan the state of primary care please do. I’ll join you. I have worked in primary care first in the Army and, since retiring, in medically under served and physician shortage areas for 30 years. There is a conversation to be had and solutions to be found. Let us look at facts and real solutions and have real conversations and skip the yellow journalism.
Oh yea… I have had my PhD for more than 10 years. It is in Health Administration. I don’t use the title at work for the reasons you outlined. That is my choice.
So the nurse that was so desperate for the title of doctor that he attended Oceana University in Samoa (accredited in the Philippines) is accusing legitimate doctoral programs of being “diploma mills”? Don’t worry sir. Even if someone else earns a terminal degree, you are still special.
How does one in good conscience encourage a medical student to go into primary care? Who wants to have to compete with this crap?
“Education” in anything has really gotten off course. Big time.
Institutions chasing the buck.
My favorite was our local police chief working on his PhD, online, University of Phoenix. I mean, c’mon.
Next is the obtaining of nursing degrees, online. Again, c’mon.
Bizarro world.
Look at the authors bio- he has no room to criticize anyone’s education track. Looks like hue “finally” got an MD and thinks he has everything figured out