The PA Clinical Doctorate Summit: A Personal Account

A Historic Event and a Proud Moment for the Profession

By Ted Ruback, MS, PA-C
President Elect

By now, I hope you have taken the opportunity to review the final report of the PA Clinical Doctorate Summit, as well as the coverage of the summit in the Networker and the remarkable real-time record of the summit put together by the consulting firm InnovationLabs. These documents provide an excellent overview of the planning, implementation, and results of the two-day historic event. If you haven’t reviewed this material, I would encourage you to do so.

I was honored to be one of the nearly 50 individuals invited to participate in the summit. I wish each of you could have been there. You would have been proud of the way our profession, with the help of a group of very creative facilitators, examined a highly sensitive and emotion-laden issue in a very rational, straightforward manner.

Work began immediately after dinner on Wednesday, the first evening of the summit. No time was wasted on introductions. The facilitators were obviously confident that with the numerous activities they had planned for us, we would get to know each other well over the span of two days. We heard from the director of the doctoral program in PA studies developed by the Army and Baylor University and from the executive director of the American Association of Colleges of Nursing, who shared with us the nurse practitioners’ journey toward adopting the doctor of nursing practice degree. Much of the first evening was spent reviewing selected comments from the month-long Web-based dialogue on the clinical doctorate that had been posted on the PAEA Web site.

Each of the next two days began early. InnovationLabs uses a very interesting approach. Over the nearly two days of work, we never took an “official” break! Even for lunch, we were given our assignments, went to our team areas, and then, one team at a time, we were sent through the buffet line. When we returned to our assigned areas, a table had been set up for us to eat while we continued our work. I actually found myself not wanting to take a break and when I did, I hurried to get back so that I wouldn’t miss anything. This was a very efficient technique that clearly reflected the value the facilitators placed on our time. I’m not sure it would work in the classroom, but it was certainly effective in this context, given the high level of motivation among the participants.

The activities in which the group engaged over the two days were relevant and well orchestrated. Teams were continually reconstituted based on the interest of the participants in the variety of problems and scenarios posed by InnovationLabs. The basic pattern was that following lively debate in individual groups across the large room, conclusions reached by each team were then shared with the larger group. The whole group then discussed the broad themes, which provided direction for the next set of small-group exercises. Over time our discussions became more focused and you could sense consensus building.

Themes and Recommendations

Throughout the debate, a few themes emerged that may not be entirely obvious when reading the final report, but that I think are worth mentioning. First, you’ll all be proud to know that the best interest of our patients was considered as a part of every discussion. There was a similar level of commitment to our continued team practice with physicians, a strong commitment to diversity and maintaining multiple models for entry into the profession, and finally a commitment to maintaining the generalist focus of PA education. 

Ultimately, I think our recommendations, specifically our rejection of the doctoral degree as either an entry-level or terminal degree for the profession, represents a bold step. Recommendation #1 states emphatically that we are not going to jeopardize our relationship with our patients or our supervising physicians by adopting an advanced degree solely on the basis that everyone else is doing so. Inherent in this declaration is the hope that organized medicine will stand with us and actively support our unique commitment to work for and with physician-led teams to provide quality care at the lowest cost possible to our patients.

At the same time that the summit participants rejected the doctoral degree as either the entry-level or terminal degree for the profession, we did recommend the formal adoption of the master’s degree as the appropriate degree for both. The participants went a step further by suggesting that the time has come for the profession to align itself with a singular degree that hopefully in the future will be as well recognized as the MPH or the MBA. The suggestion of the master of physician assistant practice (MPAP) was actually arrived at with little debate. This appropriate title acknowledges our practice rather than our field of study. Perhaps if we can all agree on a single degree title that we can effectively “brand,” we can then move on to other ways in which we can emphasize our similarities rather than our differences (i.e., prerequisites, curriculum).

Recommendation #3 clearly represents support for the profession to grow and evolve. It encourages individual PAs to expand their knowledge and skills beyond their initial PA education in any area appropriate to their career paths, whether that be clinical (through professional doctoral degrees, i.e., doctor of health sciences) or academic/research-oriented (PhD, EdD).

The PA Clinical Doctorate Summit ended right on time, mid-afternoon on Friday. I think I can speak for the majority of the participants in saying that at the conclusion of the meeting; the recommendations reached came as no surprise to anyone and clearly represented the consensus that evolved over the previous two days of work. Although the recommendations came fairly easily, in retrospect, I wish we had had more time to develop a more complete set of action plans for implementation. It is now up to the profession, through its various professional organizations, to move the debate forward. I assume there will be much talk in San Diego, and certainly PAEA members will be debating these issues at our meeting in November in Portland (we’re excited to have you come visit the state!).

Finally, some kudos. First, to the sponsor group that brought together a very engaged group of people, representing varied and unique perspectives, and prepared the participants through background readings, survey results, Web comments, and other relevant materials. A sincere thanks to those outside of the PA profession (physicians, nurses, physical therapists, health workforce experts, etc.) who were willing to take the time to share their valuable experience and actively engage in our profession's debate. Thanks to InnovationLabs for a yeoman’s job of facilitating and reporting on the event and to those PAs and PA students who participated directly in the meeting or indirectly by contributing to the Web-based dialogue or the pre-summit survey. We should all be extremely proud of the proficient and reasoned approach taken by our profession to address a matter of significant importance to our future. Let the dialogue continue.