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.