Summit Participants Recommend No Entry-Level PA Clinical Doctorate

Recommendations Support Non-PA-Specific Postgraduate Professional Doctorates

By Steven Lane

The 45 PAs and others who attended the PA Clinical Doctorate Summit in Atlanta last week had been asked to address the charge: “Is the clinical doctorate appropriate to the profession as an entry-level degree, as a postgraduate degree, or not at all?”

Their answer was that a clinical doctorate is not appropriate to the profession as an entry-level degree and is appropriate as a postgraduate degree only if it is not specific to PAs. The preliminary recommendations generated at the summit are as follows:

1. The PA profession endorses the master’s degree as the single, entry-level, and terminal degree for the profession.
2. The PA profession opposes the entry-level, PA-specific clinical doctorate.
3. The PA profession supports advanced professional development and education, including the option of non-profession-specific postgraduate doctorates.
4. The PA profession should explore with physician education groups the development of a model for advanced standing for PAs who desire to become physicians (sometimes called a “bridge program.”)

The third recommendation allows for the possibility of PAs pursuing non-PA-specific professional doctorates, as well as the more academic doctorates (PhD, EdD, etc.) that many of them already do. Some summit participants felt that a PA-specific doctoral degree, even as a postgraduate option, would set up a de facto doctoral-level terminal degree for the profession, which would conflict with the clear endorsement of the master’s degree as both the entry-level and terminal degree for the PA profession.

The Summit Process
The summit was coordinated from the beginning by an independent sponsor group, consisting of PAs, PA educators, and staff from PAEA and AAPA. The group selected participants to represent as diverse an array of perspectives as possible; these included practicing PAs, PA educators, PA students, physicians from allopathic and osteopathic medicine, administrators, workforce experts, and representatives of physical therapy, nursing, and other health care professions.

Guided by the consulting firm Innovation Labs, the participants went through a series of exercises designed to allow them to examine the issues from as many perspectives as possible and to identify decision points for further debate. Activities included:

• Scenario Planning. Each group was given two variables, each plotted along one of two intersecting axes representing a continuum from one extreme to the other, such as cost of PA education and quality of health care. Groups were asked to create a scenario for each quadrant of the square.
• The “Forced Fit.” Each group was given an existing model of a clinical doctorate, such as for physical therapy or nursing, and asked to generate a model of what a PA clinical doctorate would look like if that model were followed.
• Continuum Implications. Groups represented particular stages of a PA’s career — during entry-level education, mid-career, etc. — and asked to consider the implications for people at that stage of the continuum of (a) a mandated entry-level clinical doctorate for PAs, and (b) a postgraduate clinical doctorate for PAs.

Each activity was followed by reports to the larger group and open discussion by all. At each point the group refined the set of decision points, which ultimately funneled into a set of concrete recommendations.

Many participants hailed the rigorous, collaborative group process as a welcome new approach to complex issues. “This was a landmark, sentinel event,” said PAEA President Justine Strand. “The sponsor group was so thoughtful in bringing in a diverse group of stakeholders.”

“What this set of recommendations shows is the maturation and development of our profession,” noted AAPA President Cindy Lord. “What we achieved at this summit is that we have grown as a profession to be able to have the confidence, the credibility, and the qualifications to be able to look at ourselves, with other health care professionals, and come out with a series of very important recommendations.”

The Clinical Doctorate Issue
The “clinical doctorate issue” has been debated in the PA community for the past few years, driven primarily by professions like advanced practice nursing, physical therapy, and occupational therapy moving toward entry-level doctorates. The issue came to a head for PAEA at the 2007 Annual Education Forum, when a motion was passed charging the PAEA Board of Directors to create “a mechanism to address whether the Physician Assistant Education Association should or should not consider endorsing an entry-level doctorate and the implications of this change for our profession.”

Wanting to expand the debate beyond the Association, the PAEA board invited the Academy to cosponsor a broad-based summit of all stakeholders in the PA educational process. Structured interviews were also conducted, to incorporate the perspective of stakeholders who could not be present at the summit, such as the sociology of the health professions. And a diverse group of PAs was invited — from clinical practice and administration; entry-level and postgraduate education; with certificates, bachelor’s, and master’s degrees — to ensure that the profession was well represented.

“We felt that this was such an important issue that we wanted to be sure all voices were heard,” said Strand. “Any PA could feel confident that someone here was speaking for them.”

Two related themes ran through the summit: the importance of lifelong learning and the needs of patients. “We maintained our commitment to lifelong learning, access to care, and the physician-PA team,” said Strand. “And we did it in a way that is consistent with our unique education model. Instead of being a follower of other professions, we are looking at multiple ways to preserve access to care and maintain our adaptability to the complex health care world, without limiting the options of PAs.”

Debate at the summit was always robust and was occasionally heated, as might be expected for such a complex issue. But in the end consensus on the recommendations was reached fairly easily.

“No matter where your personal opinion lay or stood those three days, everyone in that room had a passion for the profession,” said Lord. “In the end, we all worked in concert to enable the PA profession to impact health care in positive ways, and that was really exciting.”

Further Information
The complete statement released immediately following the summit can be read here. Members are also encouraged to review the comprehensive summit Web site, which captures the group’s activities and decisions in a real-time sequential format that allows anyone to see the process as it unfolded, including images of the white board activities, photos, and summaries of each session.

A more comprehensive report on the summit, including a set of more detailed recommendations, will be released within a week. The summit participants’ final recommendations will then be sent to the national PA organizations and other stakeholders for them to debate and act upon according to their own governance processes. PAEA will tackle the issue at its Annual Business Meeting in Portland this November, and it will almost certainly be on the agenda for the AAPA House of Delegates in May.