Recommendations
Jay: Thank you very much. That seemed like a productive round of work. How did that feel for you?
So, I'd like to hear the reports in this order. Team 1 - then 8. Teams 2/3 then 4 and then 5/6 and then 7.
Assignment
Your assignment is to flesh out the recommendation from the list below that you have chosen to work on:
A) We recommend that there should be no change to the Entry Level Degree for PAs.
B) We recommend that the Masters Degree should be promoted as the Entry Level Degree for PAs.
C) We recommend that there should be no Post-Graduate Clinical Doctorate offered for the PA Profession.
D) We recommend that the PA Profession should support the development of an optional Post-Graduate Clinical Doctorate degree.
E) We recommend that the PA Profession explore a MD/DO Bridge Program.
F) We recommend that the PA Profession explore the “Stem Cell” model.
Your assignment has three steps.
1) Edit the recommendation itself to say what you think it should say.
2) Explain the justification for your recommendation – why is this the best path forward? Why is this better than other options that have been considered?
3) Develop an action plan for your recommendation. How should this recommendation be communicated and promoted? Who needs to learn about it? What should those groups DO with the recommendation, and how can the summit participants (or other organizations) influence that?
Write your work on a marker board in your breakout area. You will have about 90 minutes to complete your work. We will report the boards in the large group.
Short cuts to the result of each team's work:
Team 1 | Teams 2 & 3 | Team 4 | Teams 5 & 6 | Team 7 | Team 8
Team 1: No Change to Entry-Level Degree
Report
Rebecca had the courage to stand alone and create the insight that we needed here. The way I interpreted this to be was that there is no change to entry level degrees. That it would be market driven. But we said we wanted to maintain this because there are needs that are under served, community based PA programs should be flexible in their pre-requisite requirements.
Programs that don't fit the traditional model need to be supported. Maintaining diversity is the important part.
What we discovered was that this is what we are really wanting to say. Rebecca interpreted this as requirements to entry into a PA program. What we are endorsing is multiple entry points, tracking and articulation of PAs and all programs should be awarding a Masters degree as the entry level degree - while maintaining diversity and flexibility.
We recommit to the diversity of the profession.
We want to help community based programs articulate with colleges to award masters degrees in a way that maintains diversity. We want to actively recruit diverse groups of people into the profession.
This recommendation could be attached to any recommendation about entry-level or post-graduate degrees.
Discussion
Question: in absence of a definitive statement the standards say the sponsoring institution has to be able to award a Masters degree and that's not consistent with that recommendation.
The ARC's action was a response to the profession. We need to think this through.
The institution has to be able to award a baccalaureate. What it says it is at the graduate level the institution has to be able to award a degree requisite with that level. No one in the profession has said that.
If another group is recommending the Master's degree that's great. No matter what we say maintaining the diversity and multiple ways of entering the profession has to be maintained.
Can I get a sense of the commons? Is this a recommendation you would make? YES.
Are programs in community colleges accredited and linked to other colleges? YES.
A significant proportion of the nursing schools don't want a specialty.
PharmD accrediting body said they would not accredit programs that didn't give a PharmD. They had been debating the various routes and suddenly decided (and told us) they were looking like nursing and that was a knife to the heart.
Team 8: No Entry Level Doctorate
Report
We recommend we oppose an entry level clinical doctorate for PAs.
The length and cost of our current training results in a responsive and accessible PA workforce. This educational model has adapted over 40 years to provide PAs who provide high quality cost effective patient care.
The practice of medicine remains the domain of physicians and PAs. Physicians and PAs practice medicine. The entry level doctorate degree for the practice of medicine is the MD/DO.
The model we have currently supports the profession and the results are a confirmation of that. If you were to think about moving in a direction of a doctorate for PA practice it gets things muddied.
Maybe re-wording the second level to say that a PA can practice medicine.
We are not saying there cannot be a post-graduate degree.
Do you see that as a stab at our colleagues in nursing? Nurses and nurse practitioners do practice a blend of nursing and medicine. Don't worry about this now.
We're saying the PA profession shouldn't have an entry-level doctorate degree for the practice of medicine.
DNP stands for the doctorate of nursing practice and that is their prerogative for how they define that.
We are saying physicians and PAs practice medicine.
Are we comfortable with this recommendation directionally.
The action planning was important to engage the physician community to work with us to develop a policy for our profession. We communicate it to everyone internally and externally. We promote the adoption of this statement and develop a state and local level support. Enlist the support of organized medicine to endorse and advocate for this.
These encouragements could have a negative effect on the current engagement and the pipeline so we need the physician colleagues to support this. Also re-engaging them to promote the PA role in active care giving and creating access to care.
We need to engage the larger community as one of the solutions to the healthcare workforce problem that they are not able to address. That would take too long otherwise.
Are we comfortable with this recommendation? YES.
Teams 2 and 3: Masters as the Entry-Level Degree
Report
What you see represents both groups.
We recommend the PA profession adopt the MPAS as a single and terminal degree to be implemented by 2020.
We want to re-emphasize the generalist preparation. That's an important part of us. The timeframe is a long time away to do this. If we agree on a singular degree it might take time to switch even if you have a Masters degree now.
We facilitate the branding of the profession and we create standardization. It clarifies the identity we have. We are looking for something respectable for our profession.
This provides clarity for all stakeholders. It still supports advanced degrees plus or minus specialty practice degrees. It still values that.
It maintains the flexibility of the profession. It enables specialization if we want it.
We called it a Master of Physician Assistant Studies - as we wanted to include the PA name in it.
2020 allows adequate time to transition. Having the Masters as the terminal degree assists the process. It avoids the doctor argument.
What is the justification for asking PAs to switch?
I certainly understand the motivation. It's problematic to name it MPAS. It's associated with other programs and we should come up with a new title that no one has used yet.
With the exception of programs giving an MS degree - they are professional degrees. They are all somewhat equivalent.
Some programs will have a problem being told they need to go a certain way. The title is in quotes and up for conversation.
I think that's a sticking point. That's an emotional issue. The key is having a singular degree.
It's not a singular post-grad degree. It's an entry-level degree, it's singular, and it's terminal. It's entry level into practice. We need to devise multiple pathways to get in there.
The recommendation should include the process so that we can get in as many people as possible. That's in our action plan.
When you look at the action plan the national organizations are the same. They handle legislative and regulatory issues, they handle standards; they have to assist the non-masters programs to switch. We have to do PR to all PAs to promote the brand and the physician groups as well.
We have in the plan to develop and maintain diversity. The three things we want to do that are financial, educational and social support. Financial support for students of diversity, educational options and social support.
We have to get the grand fathering process together. We need to work with licensing and credentialing as well. Who needs to learn about this? Lots of people.
We need to engage in conversation with the educational community. We need to engage them in conversation so they understand this whole thing.
We need to continue to develop specialty and advanced learning opportunities. Continue to work on lifelong learning and all those non-clinical areas as well.
Did you talk about international programs? We didn't address that.
Maybe there are people that don't have a bachelors and we need a bridge for that? Yes, that's what we were talking about here.
Is degree completion programs all the same as well? YES. That would make sense. In addition to this we would urge degree completion programs to do this.
There would be some grand fathering. We need a process. You wouldn't need to go back and get a degree.
What are the suggestions for what the term should be?
I have a Masters but it's not the one that we are saying the brand should be. Will there be a process for this? It won't change our degree title will it? NO
Some of these relate directly to another issue. Skill development and diversity - we didn't want to lose them but they are there. Should there be a separation of those issues?
Maybe we need to change this or separate it out as a recommendation?
Diversity has dropped as we moved towards a masters level. We want to keep diversity as we move towards a Masters degree. The average applicant for a Masters degree is a twenty something white female. The concentration is that masters are predominantly white and the baccalaureate is more diverse.
I think we are assuming that diversity is there but it's concentrated in certain programs.
One of the questions is that diversity across the health professions doesn't mirror this. We need more research here.
There are common threads we can't lose site of. I would ask that we do not separate this and make it peripheral to our main issue. Perception among many is there was a negative impact but don't separate it out as that will send an unintended message.
It should be embedded in each of these recommendations where appropriate.
Put it in everyone of these recommendations! It is a common theme that we will see in every recommendation.
Understanding this will get another iteration. This is currently the recommendation. Are we comfortable with this recommendation moving forward? YES.
Team 4: No Post Graduate Doctorate Option
Report
We were thrown by the idea of looking at a terminal degree. We came to similar conclusions.
The first part is our recommendation: We declare that the terminal degree is a singular degree at the masters level. It is critical we address specialties as well.
While we encourage continued learning and skill development we recommend no clinical doctorate as a post graduate degree.
The entry level stuff - it provides a statement for the profession and fundamental elements of the curriculum can be standardized. We are saying that's a strong statement.
In terms of the post-professional doctorate. There are no identified degree gaps while there may be knowledge and skill gaps. Adding a post-grad doctorate provides confusion between physician and PA.
We felt some of the challenges of having that title might create strains on our relationship with organized medicine. Skills and knowledge training needs to go forward. An additional degree might come with additional time and cost and some extraneous expectations.
Negotiated autonomy is the key and not independence.
Actions - part of this is to firmly make the masters a terminal degree. Link arms with those that want a post-graduate doctorate and make friends with them.
We talked about how we can work together to define the content that would prepare us for primary care as well as specialties and surgery disciplines.
We need to promote what we are and what we stand for. There is confusion out there. We want to be sure that grand fathering. could occur.
The need to fill gaps in knowledge and skills - we talked about the perception that PAs have certain gaps we need to be sure that all practicing PAs could be doing self-assessment to find out what those gaps are.
Research - there are best models of physician / PA team practices. There might be certain settings that drive certain PAs to be successful in those settings.
What is the role of post-graduate education versus CME versus something else?
What is the most innovative and best method to get the needed education to you as the world around you changes?
We would need to secure agreement on the singular title.
The role and function of PAs - ARC PA is looking at that. Other people are looking at that and we need to coordinate that and get clear on the knowledge and skills needed to be successful.
Discussion
One of the challenges about the body of knowledge needed for specialists there are some gaps for those specialties and there are means for filling those gaps. PA schools might not be able to fill those gaps. Figuring out various mechanisms to fill these gaps is important.
Teams 5 & 6: Post Graduate doctorate as an option
Report
We recommend the PA profession accept and endorse the option to obtain a post graduate clinical doctorate degree.
We have the opportunity to start at the ground level so we can standardize on what that degree could be.
Increasing demands of the healthcare system demand this. PAs deserve to practice at the highest level. This facilitates a true terminal degree.
We control our own destiny and we should start that now.
One thing is to communicate with the five organizations and request they develop policy positions to support these recommendations. This could take a few years.
A committee should be formed to develop the standards for credit hours, curriculum, and what that should be called.
There should be a variety of people on that committee. The post-graduate association should form that committee. Within that request we need to ask them to involve other individuals in figuring this out.
We needed to give this a timeline - 12 months to 24 months in the long term - to come up with a recommendation and those would be given to schools proceeding with a doctorate degree.
Post-graduate programs should be at the lead. Other organizations should be involved too.
No one thought this should be mandatory. There are programs that are various durations. Some programs may fulfill an educational need but it might not qualify as a doctorate degree.
There are places that couldn't offer a doctorate degree.
Would they be expected to take a single exam? This is not tied to certification and a board exam. Just like you have exams now but this wouldn't impact certification. These could be specialty or primary care. They could all be different. The degree name should be a single name.
The committee would provide recommendations for standardizing on hours and credits and curriculum, etc. It would help to standardize but not insure standardization.
Would they still take re-certification exam? Yes. We didn't see any change to certification.
CME could be the same as well. NCCPA might require some specialty requirements.
Discussion
I worry about this on academic promotion. We can't assert we have two different terminal degrees. I would take that out. Once you say this is a terminal degree that's it. You can't have two of them.
It appears that these degrees are linked to a body of knowledge that is specific. I'm concerned about encompassing a profession in a degree.
How is that different from a PhD? Those domains are educationally grounded but we are talking about a skill set that defines an actuation of practice. When you give it a generic doctoral degree title it infers one thing but it's a very defined practice.
When this whole conversation started I was open to the option but this is pushing me against it now.
With all due respect to the post-graduate group I would suggest we go to the group with the most educational resources to figure this out.
Thank you. I think it's really important that we work through this. I like to bring things together. The idea we've been working towards is to develop growth and options for PAs. Maybe with one small change - doctor of health sciences - could change everything?
Take out the PA part from the title. Maybe it's not a doctor of physician assistant. You've mastered a body of knowledge but not the PA body of knowledge.
Within the current reality in the academic world this would have problems. Departments give degrees but not programs. There is a department of nursing that gives a degree. The PA programs exist within departments. If they are not in a medical school they are outside the medical school structure and can't grant these degrees. This is not within the reality of the world we live in. This would create all kinds of problems and could lead to us being wiped out.
The academic institution would confer this. A post-graduate training program must be affiliated with a department.
Could there be a group that looks at the creation of another terminal degree? It reverts to the highest degree on the books. Part of this action plan should be the investigation of the reality in the academic world. One is the terminal degree that is awarded to all graduates and one that is post-graduates.
If we went to the doctor of health science it would do what you want to do.
You do have oppositional recommendations and you have to resolve that. The implications and how you title this could be addressed then.
One group you may want to add is the council of graduate schools. You may want to bring in their participation.
The other issue is establishing core curriculum standards. It's what we've done with DNP and we have a core set of standards that cut across all programs and the rest of the specialized learning should be the domain of the specialty groups.
There is a doctor of health sciences and people are doing that. This has the impact of endorsing that as the terminal degree.
It's not that we are scared of post-doctorate or post-graduate degree. One of the problems is I would not have the ability to hire people that didn't have a doctorate and I would have to fire people that didn't have a doctorate.
This is not to create a new terminal degree but to acknowledge the option and to help to create some kind of limit to the terminal degree.
You have to have some way to measure whether there is increased knowledge. You cannot confer that level of degree without a capstone project or an exam. PTs have gone through that dilemma. The person that created the program cannot teach because she doesn't have a doctorate degree.
If you go back to the recommendation we support the option for a post-graduate doctorate and that there be a singular degree.
What happens to the residency that can't get an articulation agreement with a university? Doesn't that disenfranchise them? The market will figure that out.
It's taken the masters programs some time to get this together.
We're talking about post-graduate clinical experiences and that will have a different kind of faculty. If you want to work in the emergency room will you be limited if you don't have the doctoral degree?
We just have to come at it that our recommendation is 'this' for the profession.
Thank you!
Jay: how many people think that doctoral programs are going to happen (beyond Baylor)? No one needs the endorsement of these organizations to do them.
Keep your friends close and your enemies closer. We're saying we're going to support the standardization of these programs (we're protecting our colleagues).
Since we can't get unstuck from this perhaps we could explore and study the implications and make recommendations at some time certain? More data can be obtained before then.
We have been pussy-footing around this issue for years. We've had opportunities to put our teeth into something and make a statement. This is our opportunity to do it now. If we don't we will run into the problem of programs just doing this.
What do you get a clinical doctorate in in the Army? Doctorate of Science.
Everyone knows that I'm the director of the orthopedic program in the Army. What I'm hearing is a bunch of people thinking about themselves in the now. We're not considering students 20 years from now. When an emergency department is hiring twenty years from now what will they need?
I'm the person that wrote a 'real' terminal degree. The Masters is not viewed as a terminal degree. No one asks you when you are going back to school when you have doctoral degree.
You have to think of the future of the profession. When there is a job offer that goes up it says PA or an NP. Consider students twenty years from now if we say we wanted to have nothing more than a Masters.
There are other options for education. I've changed my mind over the two days. If there is an option for a PA doctorate. If we are going to endorse it then maybe we should go all the way and make it the entry level?
What do you have your doctorate in? What about the clinicians? We're talking about a clinical doctorate. If they want this why not give them the option? We're making the decisions based on a smaller group of people.
A lot of people came to this profession to have mobility.
We are not standing still. There are educational opportunities and development options we can improve on. We're not going to let the degree creep and social influences determine what we do. We need to take responsibility for ourselves.
Are we OK with a differential in pay between a DNP and a PA?
We have the opportunity for one round of work if we end soon. There is also lunch too which could be a motivator.
Team 7: MD/DO Bridge Program
Report
We recommend the PA profession explore an MD/DO bridge program. There is some demand out there already. There are grassroots stirring and some interest in this. About 4% of PAs have done this already. We have a common medical model in our training. There is some unnecessary duplication of the curriculum.
We're wasting some resources today. If I went to medical school today I would be out of the workforce. The potential number of people entering medical school could increase. This could provide the doctorate that people are seeking.
Medical schools could be interested in this group of people.
Our action plan is to do some data collection and there should be a task force to do that. First that would be PA organizations and then we'd include other organizations. We'd look at the experience and the specialties they entered.
Have a pilot program. We would communicate this within the profession to let people know we've explored this and we need to engage the physician groups so they have some buy-in for this.
You already have an option to go to medical school but you would be an advance entrant into medical school (an articulation).
How many would support this exploration?
Is there a bridge program that exists already? There is one off-shore.
Next Round of Work
We had general support for team one, two/three, and team 7.
For the next round one team could write the full recommendation. Take the recommendations that have been largely approved. This could be a small group. Synthesizing the justification - writing a more final version of the recommendation document. Action plans put some of these things together to build a map of what needs to be done.
A post-summit statement group. A statement that we can agree to and then we could figure out the details. What do we want to say about this?
sCan we develop a plan for or at least understand what the terminal degree is?
The Masters is the terminal degree was not what we agreed upon but that the Masters degree would be the entry-level degree.
Could a group work on the plan for the research for a clinical doctorate?
What else could we work on? Advanced training that is not a doctoral degree? Maybe there is another option of how to name something that is advanced but not a doctorate?
Maybe there is some way to acknowledge extra training with a label that is not a doctorate? This is a Summit about a clinical doctorate. The conflict is about that topic. Everything else is around that topic.
Do you want to come up with multiple statements and vote on one? If we say, the development of a program will happen then we might need to make a statement about whether that's a good thing or a bad thing?
Sign up and see who wants to work on this. Can't we recommend whether a group continues to look at this if we say we are neutral. Could we look at what that might be to standardize a program.