Military creates new "doctoral" residency program for PAs

[MacGyver]

Well, there goes the neighborhood. I thought the PAs were better than NPs because they wanted to work under the supervision of doctors. Guess that went right out the window.

http://www.physicianassistantforum.com/forums/showthread.php?t=13478


Let this be a lesson to you folks who think that PAs are "cool" because they are happy with their scope of practice and not trying to achieve independence. EVERYBODY wants independence. Nobody is content with their practice as it stands now.

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[core0]

Well, there goes the neighborhood. I thought the PAs were better than NPs because they wanted to work under the supervision of doctors. Guess that went right out the window.

http://www.physicianassistantforum.com/forums/showthread.php?t=13478


Let this be a lesson to you folks who think that PAs are "cool" because they are happy with their scope of practice and not trying to achieve independence. EVERYBODY wants independence. Nobody is content with their practice as it stands now.

Typical McGyver. Ignore any inconvenient facts. Just promote your agenda. Make sure you disparage soldiers that are out on the pointy end of the stick to get your misguided point across.
For people who actually would like the background behind this including the not universal approval from the PA profession:
http://physician-assistant.advanceweb.com/Editorial/Content/Editorial.aspx?CC=101913

David Carpenter, PA-C

 

[MacGyver]

Typical McGyver. Ignore any inconvenient facts. Just promote your agenda. Make sure you disparage soldiers that are out on the pointy end of the stick to get your misguided point across.
For people who actually would like the background behind this including the not universal approval from the PA profession:
http://physician-assistant.advanceweb.com/Editorial/Content/Editorial.aspx?CC=101913

David Carpenter, PA-C

that article just reinforces my point, namely that PAs want the "doctor" title for their own selfish interest. They are scared by the DNP programs that are coming out.

 

[core0]

that article just reinforces my point, namely that PAs want the "doctor" title for their own selfish interest. They are scared by the DNP programs that are coming out.

Yes and ignore quotes that don't help your cause like:
"Our graduates will not call themselves ‘Doctor’ to avoid confusing patients and out of respect for physicians who remain the gold standard for medical practice, with extensive postdoctoral training and at least twice the medical training of our PAs"

There is no discussion about independence. There is no discussion about using the title "doctor". It is about the US Army finding the appropriate level of degree for a post graduate training program that includes a significant research component.

Unfortunately the ARMY PAs compete with other medical service providers such as PharmD and PT for promotion. The DScPA puts PAs in the Army on parity for promotion with these other groups.

David Carpenter, PA-C

 

[MacGyver]

"Our graduates will not call themselves ‘Doctor’ to avoid confusing patients and out of respect for physicians who remain the gold standard for medical practice, with extensive postdoctoral training and at least twice the medical training of our PAs"

Yeah that really sounds like a legally binding statement to me.

Is this guy going to follow all of his graduates around to where they place and make sure they arent using the doctor title? Is he supporting legislation to legally bar PAs from using this title? I ****ing seriously doubt it.

 

[MacGyver]

There is no discussion about independence. There is no discussion about using the title "doctor". It is about the US Army finding the appropriate level of degree for a post graduate training program that includes a significant research component.

Thats funny, the NPs said EXACTLY the same thing when their whole gig got started. Its always funny how that stance changes over time, isnt it?

 

[undecided3yr]

"It was difficult for us to ask PAs to go through 18 months of incredibly rigorous, demanding training and then give them a certificate, as was done with our previous 12-month residency upon which this is based, and is done with almost all postgraduate (PA) residencies."

Nice way to water down the term doctor. It used to take years to earn a MD or PhD and additional residency/post-doc experience was necessary before working in the profession.

Now its available for just 6 additional months on top of a 12 month masters? (masters degrees used to be 2 years with a thesis)

12-18 months of glorified 3rd year of medical school gets you a PAC and now a Doctor of PA? WTF!!!

 

[undecided3yr]

Thats funny, the NPs said EXACTLY the same thing when their whole gig got started. Its always funny how that stance changes over time, isnt it?

"All this does is make a better PA to take care of patients and give PAs a tremendous professional opportunity that has never existed," Gruppo says. "This program is good for everybody concerned. It's good for doctors. It's good for patients. It's good for PAs."

Of course there is no interest in leaving physician supervision

 

[psychbender]

Nice way to water down the term doctor. It used to take years to earn a MD or PhD and additional residency/post-doc experience was necessary before working in the profession.

Now its available for just 6 additional months on top of a 12 month masters? (masters degrees used to be 2 years with a thesis)

12-18 months of glorified 3rd year of medical school gets you a PAC and now a Doctor of PA? WTF!!!

The PA school itself is still 2 years. The "residency" is after the PA-C has been granted. The DScPA would take a total of 3.5 years after undergrad...still a little short of most other forms of doctorate-level education. Other 12 month residency programs in the civilian world already exist, though without the DSc. The PA student I currently work with has mentioned something about online DScPA programs opening up in the near future, but I haven't done any digging on that subject.

 

[core0]

"It was difficult for us to ask PAs to go through 18 months of incredibly rigorous, demanding training and then give them a certificate, as was done with our previous 12-month residency upon which this is based, and is done with almost all postgraduate (PA) residencies."

Nice way to water down the term doctor. It used to take years to earn a MD or PhD and additional residency/post-doc experience was necessary before working in the profession.

Now its available for just 6 additional months on top of a 12 month masters? (masters degrees used to be 2 years with a thesis)

12-18 months of glorified 3rd year of medical school gets you a PAC and now a Doctor of PA? WTF!!!

To get into the residency you have to have a masters. This is 18 months of full time work past a masters. The old program was one year. The new program is similar but has a six month research component. Remeber this is full time 50-60 hour work. Not I'm going to take 12 credits until I graduate. Also most if not all of these PAs have done multiple tours in Afghanistan and Iraq so they know what the real deal is. If you look at the article the time spent on the degree compates favorably to the other clinical doctorate (DPT, DPharm or DNP) and exceeds most of them.

David Carpenter, PA-C

 

[kamehame]

If this isn't about being "doctors" then why create the "doctor of science physician assistant (DScPA) degree"? The article says that 2/3 of PAs polled said that the degree would "significantly affect their decisions to stay on active duty." If they cared that much about the extra training, they could just extend the amount of time they get trained. But nobody wants to train longer for no good reason. In this case, it is clear that the reason is to attain a "doctoral" degree where the reward is to inch ever closer to proclaiming that you are a "doctor."

 

[kamehame]

Also, what's with the long name? It reeks of inferiority complex. "Doctor of science physician assistant (DScPA) degree"? How about PAs next create a "Doctor of Master's and Arts Bachelor's Science Graduate Professional Physician's Assistant Cum Laude Sigma Alpha Master of the Universe (DMABSGPPACLSAM) Degree"? How about the "Why Don't You Just Go To Medical School If You Want To Be A Doctor So Badly (WDYJGTMSIYWTBADSB) Degree"?

 

[LADoc00]

Until you do something about the 1,000s of FMG that flood into residencies each year with an English vocabulary of little more than hello/goodbye, this point is moot (to be fair tho many FMGs are excellent but alot are crap and used by hospitals and insurers to "lower healthcare costs" because they will work for far less than AMGs...). People act like having an MD is somehow ordained by the supreme being.

 

[MacGyver]

Until you do something about the 1,000s of FMG that flood into residencies each year with an English vocabulary of little more than hello/goodbye, this point is moot (to be fair tho many FMGs are excellent but alot are crap and used by hospitals and insurers to "lower healthcare costs" because they will work for far less than AMGs...). People act like having an MD is somehow ordained by the supreme being.

FMGs just brings up the hypocrisy of the PA community. Years ago, FMGs tried to lobby to become PAs. Of course, the PA community brought a lawsuit against it and blocked them.

The AAPA constantly puts out this line of bull**** about how PAs are vital for increasing "access" to medical care and helping "underserved" areas. Thats obviously a line of BS given their aggressive stance against allowing FMGs to work as PAs if they pass the appropriate licensing tests. They wont even let them take the test.

 

[MacGyver]

PAs lengthening their residency training is not the real issue here. They could have easily done that without trying to add a BS doctoral degree to it.

The real issue is that PAs are full of **** and are being totally disingenuous about why this program was created. It has absolutely NOTHING to do with "increasing access" or becoming better clinicians. They are scared of the DNP programs and they hate it that the other allied health fields all have doctoral degrees now.

They wanted that "doctor" degree and this was a means to that end.

I keep telling you guys, everybody and their brother wants that "doctor" title. Thats the ONLY reason they are doing this.

 

[Faebinder]

Until you do something about the 1,000s of FMG that flood into residencies each year with an English vocabulary of little more than hello/goodbye, this point is moot (to be fair tho many FMGs are excellent but alot are crap and used by hospitals and insurers to "lower healthcare costs" because they will work for far less than AMGs...). People act like having an MD is somehow ordained by the supreme being.

Mmm... I dont get it. How does the 1000s of FMG flooding residency affect the PA issue of the PAs wanting a doctoral degree and the NPs wanting a DNP? As far as I know, FMGs can't become PAs and NPs, so unless they get into a residency, they wont be able to compete with physicians for work. Heck, in most states they need to finish 3 years to even be able to moonlight, so still not in the radar. Of course you might feel particularly threatened because you dont see pathology PA/NPs? I'm sure a residency can be created for them.

On the other hand, I do believe there should be a path from PA to MD, but not from NP to MD and the PA residency thing should be just abolished. If you wanna specialize more as a PA then the next step is an MD, not a residency PA

 

[DiveMD]

DScPA!? HAHAHAHAHA!

 

[kamehame]

Mmm... I dont get it. How does the 1000s of FMG flooding residency affect the PA issue of the PAs wanting a doctoral degree and the NPs wanting a DNP? As far as I know, FMGs can't become PAs and NPs

That's the point. Lots of FMGs come to the U.S. looking for residencies and don't get them. We're not debating whether that's good or bad here, it just is. So what is their alternative? To them, one is to work as a nurse or PA. But you can't do that because the nurses and PAs have totally locked them out. In contrast, the opposite (nurses and PAs increasingly doing physician work and getting paid physician salaries without physician training) is being pushed for. You can see that it's totally hypocritical. PAs and nurses can see that once they allow intrusion into their profession it opens the doors for lots of problems. They know this because they're trying to do it to us. Get it now?

 

[Pinkertinkle]

God I hate midlevels that push to expand their scope, all of them.

 

[Faebinder]

That's the point. Lots of FMGs come to the U.S. looking for residencies and don't get them. We're not debating whether that's good or bad here, it just is. So what is their alternative? To them, one is to work as a nurse or PA. But you can't do that because the nurses and PAs have totally locked them out. In contrast, the opposite (nurses and PAs increasingly doing physician work and getting paid physician salaries without physician training) is being pushed for. You can see that it's totally hypocritical. PAs and nurses can see that once they allow intrusion into their profession it opens the doors for lots of problems. They know this because they're trying to do it to us. Get it now?

I see one side of your point but you may not be seeing the other which is.. just like the PAs and NPs are preventing FMGs from coming into their fields, we prevent them as well by imposing the rule of 3 years after residency to practice. In primary care, you don't compete with an FMG who has not gone through residency (the 1000s of FMGs applying), you compete with a PA and an NP. If you had to complete with an FMG, it would be for a residency spot (but that's not a competition, that's like a car (FMG) trying to challange a tank(AMG), in primary care it's hardly a competition).

How hard is it for an FMG to become a PA? All they gotta do is go to PA school for a couple of years. I am sure they will pass the medical exams. But you are right, the PAs and NPs are definitely protecting themselves well. The PAs are partially the doctor's fault, because the medical boards control the PA licenses as well.

 

[kamehame]

In primary care, you don't compete with an FMG who has not gone through residency (the 1000s of FMGs applying), you compete with a PA and an NP.

Um, right. That's the problem. A physician is competing with a PA/NP? This doesn't disturb you in any way? You say that an FMG can just go to PA school. OK, but why do they have to? A PA doesn't have to go to medical school, they just say, "I think I can do colonoscopies." PA/NPs degrade medicine from an art into a technical field, like welding. Anyone can perform a colonoscopy or an operation. You could literally take any fifteen-year-old high school kid and teach them to do these things within a few months max. However, it is now just a bunch of people going through the mechanics and not understanding what to do with the information or caring about it. If PA/NPs can replace even primary care physicians, ask yourself if you want a PA being your primary care provider or a physician? If you care, why? Are you just biased for no good reason? Or is there something else?

I've interacted with PAs and even I can tell that they think essentially like nurses. Everything is algorithmal and based on protocol. If that's all you need to practice medicine, then we should all just stop going to medical school, train for two years or whatever, work strict three-day shifts, and unionize. Just like nurses and PAs. The fact is that the only reason they have the luxury of doing what they do is because they have the physicians who are around. I mean, essentially it's backwards where we're like PA-extenders because we work the hours PAs don't want to. How stupid is that?

 

[DiveMD]

God I hate midlevels that push to expand their scope, all of them.

Can you say OD's?

 

[Pinkertinkle]

Can you say OD's?

Oh definitely.

 

[core0]

FMGs just brings up the hypocrisy of the PA community. Years ago, FMGs tried to lobby to become PAs. Of course, the PA community brought a lawsuit against it and blocked them.

The AAPA constantly puts out this line of bull**** about how PAs are vital for increasing "access" to medical care and helping "underserved" areas. Thats obviously a line of BS given their aggressive stance against allowing FMGs to work as PAs if they pass the appropriate licensing tests. They wont even let them take the test.

Typical McGyver BS. Once again don't let the facts get in the way.
Fact - FMGs are not trained as PAs. They are not trained to work under supervision. They are not trained on knowing when to defer to their SP.

Fact - Canada is allowing FMGs to train as PAs. The training time for FMGs is longer than for PAs who enter without an MD.

Fact - Florida allowed FMGs to practice as PAs. They developed their own test for these FMGs. Not one FMG was able to pass the test despite being allowed up to five years to pass it. The FMGs continue to practice as PAs under "temporary license".

Fact - These are MDs. Why not just let them open a practice anywhere as an MD if you care so much. Oh that means that you would actually have to compete with them.

Fact - PAs extend physician practice. While you have complained before about the fact that the majority of PAs do not practice in primary care, this is dictated by physicians. PAs work for physicians in actual practice as opposed to whatever you do. These physicians that actually practice medicine see a value in PAs and see how they enhance physician practice.



PAs lengthening their residency training is not the real issue here. They could have easily done that without trying to add a BS doctoral degree to it.

The real issue is that PAs are full of **** and are being totally disingenuous about why this program was created. It has absolutely NOTHING to do with "increasing access" or becoming better clinicians. They are scared of the DNP programs and they hate it that the other allied health fields all have doctoral degrees now.

They wanted that "doctor" degree and this was a means to that end.

I keep telling you guys, everybody and their brother wants that "doctor" title. Thats the ONLY reason they are doing this.

PAs as a group are not scared of the DNP. We continue to be competency trained. There are a number of PAs already out there with doctorates. About 2% according to the last report. Mostly these are in academics where a doctorate is important for tenure and promotion.

This is the Army. If you don't believe the Major please go call him a liar. PAs have been doing a majority of the battalion and company medical work since the war started. The operate with a high degree of independence but always with medical supervision and as part of the team. PAs are frequently the "doc" just the way that line medics are. But they are not the doctor (or physician). Make sure you tell them that also McGyver. That under no circumstances should a member of the infantry ever refer to a medic as a doc. That is obviously disrespectful to yourself and you will gladly fly to Iraq to lecture them about this.

The Army looked at this, and decided this was the appropriate degree. This is not an institution that treads lightly on tradition. This is a retention tool and a research tool. There is no discussion about increased independence here. That exists only in you tiny little fearful soul. There is no expansion of practice. It simply is the result of the professionalization of the second largest group of government PAs. The Army recognizes that the doctorate will help retain and promote a select group of PAs. Nothing more and nothing less.

David Carpenter, PA-C

 

[kamehame]

PAs as a group are not scared of the DNP. We continue to be competency trained. There are a number of PAs already out there with doctorates. About 2% according to the last report. Mostly these are in academics where a doctorate is important for tenure and promotion.

This is the Army. If you don't believe the Major please go call him a liar. PAs have been doing a majority of the battalion and company medical work since the war started. The operate with a high degree of independence but always with medical supervision and as part of the team. PAs are frequently the "doc" just the way that line medics are. But they are not the doctor (or physician). Make sure you tell them that also McGyver. That under no circumstances should a member of the infantry ever refer to a medic as a doc. That is obviously disrespectful to yourself and you will gladly fly to Iraq to lecture them about this.

The Army looked at this, and decided this was the appropriate degree. This is not an institution that treads lightly on tradition. This is a retention tool and a research tool. There is no discussion about increased independence here. That exists only in you tiny little fearful soul. There is no expansion of practice. It simply is the result of the professionalization of the second largest group of government PAs. The Army recognizes that the doctorate will help retain and promote a select group of PAs. Nothing more and nothing less.

David Carpenter, PA-C

If you read your entire post, it's just a huge attempt to act like this is nothing. "This is a retention tool"? Yeah, OK, we all agree on that. But why is that? What's so attractive? You say PAs are not scared of the DNP. OK, so why the new degree? There is no expansion of practice? OK, so if nothing changes except how long you train, why not just train longer?

The fact of the matter is that everyone here recognizes that this is an attempt at encroachment. If it's "just a name" and PAs don't even want to be called doctors, then how about the opposite? What if we did everything the same and called the new degree "the Physician's Assistant Higher Degree of Assisting Physicians"? I'm sure you'd be outraged and angered and start posting about how PAs aren't really "assistants" and so on. We've all read the posts by other PAs. So, let's not pretend here. We all know what this is about. If you support it, at least stop shoveling the dung about it.

 

[LADoc00]

My point is: If I had to choose between giving American physician extenders more responsibility and pay OR foreign trained MDs excess jobs/residencies, I would chose the former, hence why I mentioned it.

Im not being merely protectionist, I firmly believe highly efficient and accurate communication is absolutely critical to healthcare and many FMGs seriously lack in this area. I dont care how many standardized tests they have to pass....

 

[core0]

If you read your entire post, it's just a huge attempt to act like this is nothing. "This is a retention tool"? Yeah, OK, we all agree on that. But why is that? What's so attractive? You say PAs are not scared of the DNP. OK, so why the new degree? There is no expansion of practice? OK, so if nothing changes except how long you train, why not just train longer?

The fact of the matter is that everyone here recognizes that this is an attempt at encroachment. If it's "just a name" and PAs don't even want to be called doctors, then how about the opposite? What if we did everything the same and called the new degree "the Physician's Assistant Higher Degree of Assisting Physicians"? I'm sure you'd be outraged and angered and start posting about how PAs aren't really "assistants" and so on. We've all read the posts by other PAs. So, let's not pretend here. We all know what this is about. If you support it, at least stop shoveling the dung about it.

In the grand scheme of PAdom it is nothing. If all of the Army residencies (a name that I personally feel is dishonest since it equates them with physician residencies) go to the DScPA as they say they are doing you will have about 20 PAs every year getting their doctorate. This is out of 65,000 plus PAs plus another 3600 or so new grads every year. So this will not add materially to the number of PAs with a doctorate (in other words this is far outpaced by the number of PAs entering the profession with either a clinical or academic doctorate).

The Army response is really specific to the Army. While promotion policies are complex for the group that the Army looks at as the competition with PAs is essentially medical officer service corps, Pharmacy, OT/PT and in some cases nursing. Promotion to general officer is essentially a combination of time served, where you served, joint service command and education. PAs have traditionally been disadvantaged here because most came into the officer ranks when the decision was made to move PAs from warrant officers to commissioned officers. Most of these PAs had bachelors only. The Interservice PA program only changed to a Masters program during the last few years. In that time most of the other professions have either moved to a clinical doctorate or are administrative positions that allow their members to pursue a doctorate on the Army dime. Because of that PAs have been significantly disadvanteged not only in general officer promotion but also field grade officers. This has become an issue with retention. The Army had three choices. They could continue to lose highly qualified PAs. They could take the PAs out of operational positions and send them to graduate school like Army Nursing does. Or they could create an operational graduate program. Obviously the Army chose #3. Given the small number of slots available I would anticipate the Army using this for two groups. Senior Company grade officers being looked at for field grade promotion and senior field grade officers slated for General officer promotion. This will make both of these groups more competitive as well as retain these soldiers. The EM and Occ med focus of these positions has the added benefit of promoting research in two important areas to the Army and Army PAs.

I can't do anything to change your misperception about what PAs do. The Army had a scope of practice that is more rigidly defined and at the same time is operationally dependent than any state. Any change will not become because of a title. There will probably eventually be a civilian PA doctorate. It will not change how PAs practice, the scope or independence one iota. That is set as always by state medical boards. Composed, for the most part of physicians that will set the limits on how a PA works under the supervision of a physician. There is not now or will there be in the foreseeable future any desire for independence.

I feel that the appropriate degree for the PA is the Masters. There may be continued degree creep that we have seen in other professions, but I and most PAs would be against it for the same reason that many NPs are against the DNP. It adds nothing to the profession or practice except increased cost.

David Carpenter, PA-C

 

[Taurus]

The issue comes down to, which poison do you choose? The DNP or the DScPA? Between the two, I would pick the one that falls under the board of medicine. Although, the RN on steroids looks better and better each day.

It seems to me that the only group of doctors who are oblivious to midlevels are the surgeons. They don't think that they pose a threat. If doctorate PA's begin to encroach on their turf, the surgeons will be singing a new song pretty fast! I'm all in favor of waking everyone up to the looming threats on our profession.

 

[Taurus]

In the grand scheme of PAdom it is nothing. If all of the Army residencies (a name that I personally feel is dishonest since it equates them with physician residencies) go to the DScPA as they say they are doing you will have about 20 PAs every year getting their doctorate. This is out of 65,000 plus PAs plus another 3600 or so new grads every year. So this will not add materially to the number of PAs with a doctorate (in other words this is far outpaced by the number of PAs entering the profession with either a clinical or academic doctorate).

I don't care about what happens in the Army. The more relevant question is, what happens when they start to leave the Army? How will hospitals recognize DScPA's in non-military healthcare?

Let's not downplay that the original PA concept is a military creation during the Vietnam war. The rest of healthcare recognized those individuals' credentials when they left the military. 20 DScPA's to start, but if the program is successful there will be many, many more schools opening. I have no doubt that we will have to deal with DScPA's for years to come.

Maybe this will knock some sense into those arrogant surgeons.

 

[MacGyver]

The issue comes down to, which poison do you choose? The DNP or the DScPA? Between the two, I would pick the one that falls under the board of medicine.

While its true that its easier for the NPs to expand scope than it is for the PAs, you are overestimating the power of BOMs over them. They can easily bypass it by proposing new legislation about specific scope expansions without getting BOM approval.

There are several states in which PAs got laws changed in state legislatures that changed the definition of "supervision" to ridiculous standards like remote chart review on only a small fraction of charts. And they did it thru the legislature with zero BOM involvement or approval.

It seems to me that the only group of doctors who are oblivious to midlevels are the surgeons. They don't think that they pose a threat. If doctorate PA's begin to encroach on their turf, the surgeons will be singing a new song pretty fast! I'm all in favor of waking everyone up to the looming threats on our profession.

Surgeons were smart by keeping smaller community based surgical programs and maintaining a presence out in smaller, more rural areas. That way, the NPs and PAs cant use the same "this county doesnt have any surgeons therefore we should let PAs and NPs do surgery" crap that they successfully used against other medical fields.

It would be very very tempting for surgeons to allow "remote" supervision of midlevels so they can have multiple cases going on in differnet ORs simultaneously. They could bill for the midlevel's services and massively increase their income. But they chose not to do that for whatever reason. Thats the single greatest reason why midlevels havent infiltrated their field. Every surgery in the United States has an MD/DO surgeon present.

 

[ForbiddenComma]

Never mind the military angle... I see a "doctorate of physician assistance," as ridiculous as it sounds, as inevitable. Not because that PAs are really trying to become doctors without the training the way NPs are... it's because PAs probably feel like they need a "doctorate" simply to compete with other midlevels who insist on calling themselves "doctors."

It's not their fault that all of allied health has become a comedy of degree inflation. Let it be said that PAs were the last to yield to this increasingly silly assortment of DNPs, DPTs, DOTs, ODs, DCs, PharmDs, PsyDs, and whatever other nonsense I'm forgetting at the moment.

 

[MacGyver]

In the grand scheme of PAdom it is nothing. If all of the Army residencies (a name that I personally feel is dishonest since it equates them with physician residencies) go to the DScPA as they say they are doing you will have about 20 PAs every year getting their doctorate. This is out of 65,000 plus PAs plus another 3600 or so new grads every year. So this will not add materially to the number of PAs with a doctorate (in other words this is far outpaced by the number of PAs entering the profession with either a clinical or academic doctorate).

Dont piss on my back and tell me its raining. We can all see the writing on the wall. I will bet $5,000 right now that within 3 years after this army program comes online, there will be at least one civilian residency program that copies this "doctoral degree" crap.

There will probably eventually be a civilian PA doctorate. It will not change how PAs practice, the scope or independence one iota. That is set as always by state medical boards. Composed, for the most part of physicians that will set the limits on how a PA works under the supervision of a physician. There is not now or will there be in the foreseeable future any desire for independence.

Again, I call BS. Every midlevel group, every allied health field, and every non-physician healthcare group that has ever existed has sought to be independent and increase their scope. Not just some of them. Not just most of them. Every single ****ing one of them.

 

[core0]

I don't care about what happens in the Army. The more relevant question is, what happens when they start to leave the Army? How will hospitals recognize DScPA's in non-military healthcare?

They will recognize them as every hospital recognizes the license - Physician Assistant. There is no difference between certificate PAs and Masters PAs. Each PA will need a sponsoring physician and their scope of practice will be defined by the sponsoring physician.

Let's not downplay that the original PA concept is a military creation during the Vietnam war. The rest of healthcare recognized those individuals' credentials when they left the military. 20 DScPA's to start, but if the program is successful there will be many, many more schools opening. I have no doubt that we will have to deal with DScPA's for years to come.

Maybe this will knock some sense into those arrogant surgeons.

Actually the reasons that PAs exist is that the corpsman coming out of Vietnam had a skill set that was not recognized by the civilian world. The skill set of the Navy corpsman was the genesis of the original PAs. The military did not use PAs for another six years in 1973. There is already a doctorate out there that PAs can avail themselves to. A number of schools offer a DHSc (Doctorate of Health Sciences) and have for more than 10 years. The number of PAs that have taken this is around 100. Almost all of them in academics.


David Carpenter, PA-C

 

[kamehame]

you will have about 20 PAs every year getting their doctorate. This is out of 65,000 plus PAs plus another 3600 or so new grads every year.

Honestly I don't care if there's only one every year. The argument that there will only be 20 is irrelevant because it's the concept that's repugnant.

The Army response is really specific to the Army.

You were very detailed and descriptive on what you mean here and it helps. But your own argument backfires. Look, if the Army wanted to provide a means to promote PAs, they'd just...promote PAs. To say that the Army cannot decide to promote a PA because the PA doesn't have an advanced degree, which the Army requires for promotion is really silly. Really.

It's rather curious that everyone except you, who are a PA, can recognize that this is the start of a power grab. And you're sitting around acting like this is actually a burden on PAs because it will "increase costs" but the poor PAs will somehow soldier through it. Could you please stop insulting our intelligence and at least have a serious discussion?

 

[deleted6669]

an important point to note in this discussion is that our colleagues the np's are REQUIRING a doctorate to practice after 2015 while pa's don't have any required level of degree, just passage of our national board exam. several states(around 18) require a bs level degree to practice while 2 require an ms.
there are still certificate, a.s., b.s., and ms level courses being taught all over the country. the difference between a certificate and a masters program is not clinical content as this is the same for all levels of pa program but research components and required prior degrees. an army medic with a high school diploma and a yr of science prereqs can still get into a certificate pa program but if he ever wants to get any significant rank he needs to get a grad degree at some point in his career. that is why this program was created so that pa's can become staff level officers in larger numbers as other health professionals with doctorate degrees in the armed services have done for years. this will not change any clinical responsibilities or rights just as obtaining an ms degree does not give a pa any additional rights over a certificate, a.s., or b.s.
I have an ms and a 1 yr postmasters cert . the senior pa in my group has an entry level certificate and no degree of any kind. all the pa's in my group(12 of us) do the same job and make the same salary regardless of degree. a pa in our group has a phd in health care management. he is only "dr jones" when he lectures. his lab coat says pa-c, phd but no one in the hospital calls him doctor and he does not expect this.nothing would change if his degree was DHSc instead of phd. it's just an academic credential. he is not a physician.

 

[MacGyver]

Good grief this is getting ridiculous.

Are you seriously telling me that the "doctoral" degree granted by the residency program is the same thing as a DHSC? Dont insult my intelligence.

Nurses have had doctoral degrees for a long time, but the DNP programs that are coming online now are a DIFFERENT KIND OF DOCTORATE DESIGNED FOR CLINICAL PRACTICE, NOT TEACHING/ADMINISTRATION.

The PAs posting on here know better. They are purposefully obfuscating the issue and playing dumb.

Dont give me this crap about how its "just a doctoral degree like DHSC." Again, quit pissing on my back and telling me its raining.

 

[MacGyver]

an important point to note in this discussion is that our colleagues the np's are REQUIRING a doctorate to practice after 2015

Thanks for proving my point. Just like I said above, the PAs are scared of the DNPs and want to continue the arms race for no reason other than ego and the independent practice thats the same goal as the DNP.

 

[kamehame]

The PAs posting on here know better. They are purposefully obfuscating the issue and playing dumb.

Ten years from now when we're all forced to refer to PAs as Doctor So-And-So, they'll all come back to SDN and say "whoops, our bad!" And it'll all be better.

 

[deleted6669]

"Are you seriously telling me that the "doctoral" degree granted by the residency program is the same thing as a DHSC? "

reread your original link-that is the degree confered by the residency.....

a grad from this residency will have a nametag that says:
joe blow, PA-C, DSc.
emergency medicine physician assistant

not too confusing for you?


OR CHECK THIS AT BAYLOR...SEE THE DEGREE: DSc...
http://www.baylor.edu/graduate/index.php?id=2843

By the time someone completes this they have 7.5 yrs of college( bs=4, ms=2, DSC= 18 mo= 7.5 yrs).
there are plenty of other doctorates out there(say md) that you can get in around the same time or less(JD, pharmd, dpt, aud, psyd, many science phd's, DRPh, etc)

 

[OnPump]

Thanks for proving my point. Just like I said above, the PAs are scared of the DNPs and want to continue the arms race for no reason other than ego and the independent practice thats the same goal as the DNP.

MacGyver, you need some facts to back up your claims.

It always amazes me that we practice in a world of EBM yet our discourse is rife with the "culture of opinion".

PAs are trained up from ground zero that they are not physicians, not "mini-doctors", not independent clinicians. The far overwhelming majority of PAs want to retain this practice relationship. The AAPA and state chapters follow the party line as well.....CAPA held tight with their physician colleagues as NPs were pushing for further scope in retail clinics. PAs know where their bread is buttered. There is no conspiracy to gain independent practice (other than the one that you are offering here).

Additionally it is illegal (and not to mention a serious faux pas) for a PA to misrepresent oneself as a physician. Given the considerable corssover in our clinical roles, this is a position that PAs are put in on a daily basis. Disclaiming that we are not physicians is old hat; PAs want their strong work to represent PAs, there is no need to scurry up the ladder of hierarchy for it's own sake.

Ironically it is the folks posting here about the sanctimony of the "doctor" title who have the biggest issue with it. You must realize that as NPPs we respect the time and effort physicians put into earning their stripes. The only time animosity arrives is when certain individuals trash-talk PAs and NPs out of ignorance. The clinical doctorates discussed here are meant to acknowledge work at the bedside and in academia which produces a certain level of clincian. To deny the term doctorate is not only selfish, but it takes away from similar levels of achievement in other health disciplines.

A poster here has a signature about the future of medicine and NPPs role in it.....as young physicians & physicians in the making, it behooves you to understand the role of these professionals and the way they will undoubtedly participate in your future career. Saying that you will never hire one won't cut it. PAs and NPs, like it or not, will play a major role in the future of primary care, not to mention as components of specialty care teams. Bemoaning a loss of power serves nothing except your own ego.

And until you can offer some data about the inefficacy of PAs, you'd be better served to keep your comments in the "inside voice", lest you look foolish.....

OnPump, PA-C

 

[core0]

Here is an article just for McGyver. This I think demonstrates the difference between PAs and NPs. While the PA article clearly stated that PAs would not refer to themselves as Doctor this article makes quite a different claim.

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html?partner=alerts

David Carpenter, PA-C

 

[MacGyver]

Here is an article just for McGyver. This I think demonstrates the difference between PAs and NPs. While the PA article clearly stated that PAs would not refer to themselves as Doctor this article makes quite a different claim.

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html?partner=alerts

David Carpenter, PA-C

Whats your point? that we should ignore what PAs are doing because the NPs are being more aggressive about it?

PAs and NPs have the same aspirations.

 

[brightness]

Eek. Even as somone who strongly supports midlevels, I have some major issues with the article core0 linked to. A few of the best snips:

" Rather than a physician, that comprehensive-care provider may very well be a nurse--who also happens to be a doctor."
This is misleading, because the DNPs won't ever be MD/DOs. Its a different training, different skillset, and a weaker foundation in the hard sciences.

"These clinicians are peerless prevention specialists and coordinators of complex care. In other words, as a patient, you get the medical knowledge of a physician, with the added skills of a nursing professional."SOME of the knowledge of a physician, all of the nursing. I mean I am assuming these DNP programs are not adding in ALL the classes needed to make up for the discrepancy between doctor/nurse.

"Most important, research has demonstrated that DNPs, with their eight years of education and extensive clinical experience, can achieve clinical outcomes comparable to those of primary-care physicians."
Isn't this degree fairly new? I'm not saying there isn't research, but I'd like to see it.

"To that end, we are working to enable DNPs to take standardized exams similar in content and format to the test that physicians must pass to earn their M.D. degrees."

THIS I agree with, if the tests are truly standardized to equal the exams MD/DOs take. It almost seems better if there were no DNPs and no doctoral PAs, and instead legitimate bridges from PA- MD/DO and NP- MD/DO that require applicants to make up all the coursework they don't have as midlevels. At least then the standard of education is as guaranteed to be at least as good as someone from a foreign med school, because these people will need to pass their boards, ect. I am a proponent of nursing and maybe an NP candidate someday, but I don't want to see medicine watered down, either.

 

[kamehame]

"Most important, research has demonstrated that DNPs, with their eight years of education and extensive clinical experience, can achieve clinical outcomes comparable to those of primary-care physicians."
Isn't this degree fairly new? I'm not saying there isn't research, but I'd like to see it.

I'm a big fan of people putting their money where their mouth is. If DNPs with clinical experience are equivalent to MD/DO PCPs, then nurses and the people conducting that study should all be only allowed to use DNPs as their PCPs. It shouldn't bother them because the outcomes are equivalent. Also, the Army should move towards only having DNPs as PCPs because I'm sure it's more cost-effective. (Other than the fact that DNPs would never take call, whoops. Like I said, that's how backwards it is, where physicians are essentially nurse-extenders, taking hours and holidays where the less-dedicated people won't or will only do with double-overtime pay and an extra day off elsewhere.)

 

[ForbiddenComma]

Agreed, brightness. The dean of the Columbia DNP program has no problem watering down medicine in order to funnel even more money to her particular program.

One other thing she neglects to mention: it is far easier to get into NP school than it is to get into an American MD school. People with far less discipline and, I hate to say it but, intelligence than the family docs of yesteryear will be your primary care "doctor" if these people get their way (and they probably will).

This is not to say that there aren't some fantastic NPs. I've met a couple that could put most MDs to shame in their intelligence and their breadth of knowledge. But the majority I've worked with are simply not possessed of the same mental faculty, nor the same training. They would get eaten alive by the MCAT, let alone the USMLE. Which is, of course, precisely why many of them went the NP route instead.

(I'm going to assume that any DNP standardized exam will not exactly have the teeth of the USMLE, or the COMLEX for that matter.)

You mention a bridge program, and I always thought that would make the most sensible option. Let nurses/NPs/PAs/whatever that have what it takes upstairs get a good MCAT, combine that with a good resume, and let them attend a special 2 or 3 year program complete with the same USMLEs that every other real doctor takes.

If such a program ever were created, it would instantly weaken the DNP program and its underqualified, less intelligent wannabe-docs. Patients could simply ask, "yeah, but why did you go into DNP school instead of the NP-to-MD school?" for which they would have no real answer other than the honest one, which is, "Because I couldn't cut it in med school."

 

[OnPump]

Whats your point? that we should ignore what PAs are doing because the NPs are being more aggressive about it?

PAs and NPs have the same aspirations.

Are you blind or just willfully ignorant?
NPs seek independent practice. PAs do not.
Different aspirations.
PAs seek to maintain their alignment with physicians.

BTW we PAs seek to practice medicine, not advanced nursing.......

 

[core0]

"Most important, research has demonstrated that DNPs, with their eight years of education and extensive clinical experience, can achieve clinical outcomes comparable to those of primary-care physicians."
Isn't this degree fairly new? I'm not saying there isn't research, but I'd like to see it.

The funny thing is the author (who is not an NP) was at Columbia when the only study that ever directly compared physicians to NPs in practice was done. The original study published in JAMA showed no difference but was not long enough to properly look at the outcomes (HTN and DM). The follow up four year study could not be done since there were not enough patients remaining to follow up. Basically there is no study to show equivalence and she knows it.

"To that end, we are working to enable DNPs to take standardized exams similar in content and format to the test that physicians must pass to earn their M.D. degrees."

THIS I agree with, if the tests are truly standardized to equal the exams MD/DOs take. It almost seems better if there were no DNPs and no doctoral PAs, and instead legitimate bridges from PA- MD/DO and NP- MD/DO that require applicants to make up all the coursework they don't have as midlevels. At least then the standard of education is as guaranteed to be at least as good as someone from a foreign med school, because these people will need to pass their boards, ect. I am a proponent of nursing and maybe an NP candidate someday, but I don't want to see medicine watered down, either.

This is where I would like to see them put their money where their mouth is. Have a class of NP students take the step tests and see how they do. The basic prerequisites to practice as a physician in the US are to pass step I, II (CS and CK) and III. If they can't pass those and the board certification for their "specialty" then they shouldn't practice independently period.

David Carpenter, PA-C

 

[OnPump]

I'm a big fan of people putting their money where their mouth is. If DNPs with clinical experience are equivalent to MD/DO PCPs, then nurses and the people conducting that study should all be only allowed to use DNPs as their PCPs. It shouldn't bother them because the outcomes are equivalent. Also, the Army should move towards only having DNPs as PCPs because I'm sure it's more cost-effective. (Other than the fact that DNPs would never take call, whoops. Like I said, that's how backwards it is, where physicians are essentially nurse-extenders, taking hours and holidays where the less-dedicated people won't or will only do with double-overtime pay and an extra day off elsewhere.)

At least one flaw with your statement, how is the RN who decided to go on to an advanced degree as an NP "less dedicated"? Level of dedication is not determined by "didn't choose the same career path that I did".

Also midlevels don't function in the role you describe in specialty services. Do you see surgical PAs working the "day shift" with the docs on call? Are you even aware that PAs take primary call ahead of docs in many different surgical disciplines?

 

[OnPump]

One other thing she neglects to mention: it is far easier to get into NP school than it is to get into an American MD school. People with far less discipline and, I hate to say it but, intelligence than the family docs of yesteryear will be your primary care "doctor" if these people get their way (and they probably will).

How do you know this? Have you measured their intelligence, or is this just your "opinion"???

This is not to say that there aren't some fantastic NPs. I've met a couple that could put most MDs to shame in their intelligence and their breadth of knowledge. But the majority I've worked with are simply not possessed of the same mental faculty, nor the same training. They would get eaten alive by the MCAT, let alone the USMLE. Which is, of course, precisely why many of them went the NP route instead.

No, they were already nurses and were smart enough to see more value in NP education vs. MD education.....

(I'm going to assume that any DNP standardized exam will not exactly have the teeth of the USMLE, or the COMLEX for that matter.)

You mention a bridge program, and I always thought that would make the most sensible option. Let nurses/NPs/PAs/whatever that have what it takes upstairs get a good MCAT, combine that with a good resume, and let them attend a special 2 or 3 year program complete with the same USMLEs that every other real doctor takes.

If such a program ever were created, it would instantly weaken the DNP program and its underqualified, less intelligent wannabe-docs. Patients could simply ask, "yeah, but why did you go into DNP school instead of the NP-to-MD school?" for which they would have no real answer other than the honest one, which is, "Because I couldn't cut it in med school."

....................................................

 

[brightness]

I agree with you on some points. I don't, however, feel that nurses/NPs are less intellgent or that they chose nursing because they are less intelligent. In some cases, people simply don't have the flexibility in their life to undertake medical school but they are still interested in a career in medicine.
That said, with less sacrifice and education comes less autonomy and less privilege. And with more education and sacrifice you get all the autonomy, all the privilege, and a large share of the responsibility...

Agreed, brightness. The dean of the Columbia DNP program has no problem watering down medicine in order to funnel even more money to her particular program.

One other thing she neglects to mention: it is far easier to get into NP school than it is to get into an American MD school. People with far less discipline and, I hate to say it but, intelligence than the family docs of yesteryear will be your primary care "doctor" if these people get their way (and they probably will).

This is not to say that there aren't some fantastic NPs. I've met a couple that could put most MDs to shame in their intelligence and their breadth of knowledge. But the majority I've worked with are simply not possessed of the same mental faculty, nor the same training. They would get eaten alive by the MCAT, let alone the USMLE. Which is, of course, precisely why many of them went the NP route instead.

(I'm going to assume that any DNP standardized exam will not exactly have the teeth of the USMLE, or the COMLEX for that matter.)

You mention a bridge program, and I always thought that would make the most sensible option. Let nurses/NPs/PAs/whatever that have what it takes upstairs get a good MCAT, combine that with a good resume, and let them attend a special 2 or 3 year program complete with the same USMLEs that every other real doctor takes.

If such a program ever were created, it would instantly weaken the DNP program and its underqualified, less intelligent wannabe-docs. Patients could simply ask, "yeah, but why did you go into DNP school instead of the NP-to-MD school?" for which they would have no real answer other than the honest one, which is, "Because I couldn't cut it in med school."