In Medical News

Clinician Reviews. 2017 June;27(6):7-9
Author(s): Randy D. Danielsen, PhD, PA, DFAAPA

The increasingly complex health care system in the United States relies heavily on quality improvement, interprofessional collaboration, patient outcomes, health policy legislation, and advocacy. While important, most of these factors are outside the scope of the traditional master’s-level education program—necessitating the development of methods to help advanced practice providers, including NPs and PAs, obtain additional skills. The solution of choice, for many professions, has been the introduction of the “professional doctorate” as a complementary alternative to the typical research-focused doctoral program, such as the PhD.

Traditional PhD curricula prepare individuals to perform research that is typically specialized and confined to their field of study.1 While this research does produce new knowledge, it usually remains in the realm of academia and often does not address any specific “real-world” problem.2But to be recognized, compensated, and identified as a full professional in modern society, one must be equipped to address practical problems.

Analysis by Taylor and Maxwell and by Lee, Green, and Brennan has shown that, rather than theory, the workplace demands the application of knowledge geared toward daily professional duties.3,4 They envisioned a doctorate-prepared practitioner who had less skill in pure research but who would be able to apply theory to everyday problems in the workplace.4,5 Rather than devalue the contributions of classical PhD training, this model proposed the creation of a hybrid curriculum that would prepare individuals to use “applied research.”3 As the professional doctorate gained acceptance, it matured from the “first-generation” concept (which was quite similar to the PhD in structure) to “second-generation,” which is more focused on discipline and workplace realities.3,5 In general, these professional doctorates can be earned in less time than a PhD and do not require original research.

Over the past two decades, more than 500 unique professional practice doctorate programs have emerged across the US, in fields ranging from nursing to bioethics. One of the most prominent is the Doctor of Nursing Practice (DNP), designed for RNs seeking a post-professional degree in nursing. In 2004, following three years of research by a task force, the American Association of Colleges of Nursing (AACN) endorsed the DNP, with the goal that it would become the minimum educational standard for advanced practice nurses by 2015.6 According to the AACN, there are 289 DNP programs in the US, with an additional 128 in development.6

The PA profession has lagged behind not only our NP colleagues, but also many other health professions, in the adoption of a discipline-specific, doctoral-level degree. Our counterparts in audiology, physical therapy, occupational therapy, and athletic training have been part of the exponential growth in second-generation health care doctorates.7 While these programs may differ in concept, they share several similarities: They do not require original research; they include a clinical component; and they promote knowledge in the context of the workplace.5-8

In the past five years, PAs have started considering (or debating, depending on your perspective) a professional/clinical doctorate as the next step in our post-professional journey. It’s about time, when you consider that 16.8% of newly certified PAs intend to pursue additional education or clinical training, according to a recent report from the National Commission on Certification of Physician Assistants.9

There are already a few doctoral programs for PAs. Among the earliest clinically focused doctorate programs was the US Army/Air Force-Baylor DScPAS-EM program, designed to educate military PAs at the doctoral level upon completion of an 18-month emergency medicine residency.10Lincoln Memorial University has a Doctor of Medical Science (DMS) program, comprised of one year of online advanced clinical medicine coursework and one year of online coursework focused on primary care, hospital medicine, emergency medicine, or education.11 And Lynchburg College in Virginia has just launched a post-professional doctoral program for PAs; this DMS program includes a clinical fellowship, as well as coursework in leadership training, health care management and law, organizational behavior, disaster medicine, and global health.12

While not strictly created for PAs, the Doctor of Health Science programs at Nova Southeastern University and A.T. Still University have been educating PAs at the doctoral level for more than 10 years.13,14 Later this year, A.T. Still University plans to introduce a post-professional Doctor of Physician Assistant Studies that will provide a pathway for PAs wishing to become leaders and scholar-practitioners, develop core leadership abilities, and/or enter PA education without the location-specific requirement of a clinical or academic residency.

When the push for professional practice doctorates started, pundits claimed they were just an attempt at a “cash grab” by universities looking to bolster their rosters (and their coffers). But advocates have long argued that these degrees provide practitioners with the knowledge and training required to offer advanced services in increasingly complex social and technologic environments.7 No less than The Institute of Medicine, The Joint Commission, and the Robert Wood Johnson Foundation have called for the reinvention of education programs to equip today’s health professionals with the highest level of scientific knowledge and practice expertise.

Why? First and foremost, to ensure quality patient outcomes. Beyond that, better prepared clinicians can help to address provider shortages. Those with doctorates can also serve as faculty, educating the next generation of health care providers. And practically speaking, for those seeking advanced education, holding a doctorate will create opportunities for increased decision-making and upward mobility in the workplace.

There is no question that our current health care environment is driven by the regulations and costs of the Affordable Care Act, as well as quality management systems and strategies. NPs and PAs are in a unique position to cost-effectively direct the care of, and advocate for, diverse patient populations. NPs and PAs who recognize this opportunity to serve need doctoral-level training tailored to this milieu.

Do you agree? Share your thoughts on professional doctorates with me at PAEditor@frontlinemedcom.com.

References

1. Carnegie Project on the Education Doctorate. Founding literature. www.cpedinitiative.org/?. Accessed May 8, 2017.
2. Costley C, Lester S. Work-based doctorates: professional extension at the highest levels. Studies in Higher Education. 2012;37(3):257-269.
3. Taylor N, Maxwell T. Enhancing the relevance of a professional doctorate: the case of the doctor of education degree at the University of New England. Asia-Pacific J Coop Edu. 2004;5(1):60-69.
4. Lee A, Green B, Brennan M. Organisational knowledge, professional practice and the professional doctorate at work. In: Garrick J, Rhodes C (eds). Research and Knowledge at Work. Perspectives, Case-studies and Innovative Strategies. London: Routledge; 2000.
5. Maxwell T. From first to second generation professional doctorate. Studies in Higher Education. 2003;28(3):279-291.
6. American Association of Colleges of Nursing. DNP fact sheet. www.aacn.nche.edu/media-relations/fact-sheets/dnp. Accessed May 8, 2017.
7. Zusman A. Degrees of change: how new kinds of professional doctorates are changing higher education institutions. Research and Occasional Paper Series. 2013;8(13):1-20.
8. Kumar S, Dawson K. Exploring the impact of a professional practice education doctorate in educational environments. Studies in Continuing Education. 2013;35(2):165-178.
9. National Commission on Certification of Physician Assistants. 2014 statistical profile of recently certified physician assistants: an annual report of the NCCPA. www.nccpa.net/Uploads/docs/RecentlyCertifiedReport2014.pdf. Accessed May 8, 2017.
10. Baylor University. Army-Baylor emergency medicine physician assistant (EMPA) program. www.baylor.edu/graduate/pa/index.php?id=936090. Accessed May 8, 2017.
11. Lincoln Memorial University. Doctor of medical science announcement. www.lmunet.edu/academics/schools/debusk-college-of-osteopathic-medicine/dms. Accessed May 8, 2017.
12. Lynchburg College. Doctor of medical science. www.lynchburg.edu/graduate/physician-assistant-medicine/doctor-of-medical-science/. Accessed May 8, 2017.
13. Nova Southeastern University. Doctor of health science program. http://healthsciences.nova.edu/healthsciences/dhs/. Accessed May 8, 2017.
14. A.T. Still University. About the college of graduate health studies – online. www.atsu.edu/college-of-graduate-health-studies. Accessed May 8, 2017.

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