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FROM THE PA EDITOR-IN-CHIEF

The Professional : What Are We Waiting for?

he increasingly complex health care it matured from the “first-generation” con- system in the United States relies cept (which was quite similar to the PhD in T heavily on quality improvement, in- structure) to “second-generation,” which is terprofessional collaboration, patient out- more focused on discipline and workplace comes, health policy legislation, and advo- realities.3,5 In general, these professional cacy. While important, most of these factors can be earned in less time are outside the scope of the traditional mas- than a PhD and do not require original ter’s-level program—necessitat- research. ing the development of methods to help Over the past two decades, more than advanced practice providers, including NPs 500 unique professional practice doc- Randy D. Danielsen, and PAs, obtain additional skills. The solu- torate programs have emerged across PhD, PA, DFAAPA tion of choice, for many , has the US, in fields ranging from to been the introduction of the “professional bioethics. One of the most prominent is doctorate” as a complementary alternative the of Nursing Practice (DNP), to the typical research-focused doctoral designed for RNs seeking a post-profes- program, such as the PhD. sional degree in nursing. In 2004, follow- Traditional PhD curricula prepare in- ing three years of research by a task force, dividuals to perform re- the American Associa- search that is typically tion of Colleges of Nursing specialized and confined †To be recognized (AACN) endorsed the DNP, to their field of study.1 as a full professional, with the goal that it would While this research does one must be equipped become the minimum produce new knowledge, educational standard for it usually remains in the to address practical advanced practice nurses realm of academia and problems. by 2015.6 According to the often does not address AACN, there are 289 DNP any specific “real-world” problem.2 But to programs in the US, with an additional 128 be recognized, compensated, and identi- in development.6 fied as a full professional in modern society, The PA has lagged behind one must be equipped to address practical not only our NP colleagues, but also many problems. other health professions, in the adoption of Analysis by Taylor and Maxwell and by a discipline-specific, doctoral-level degree. Lee, Green, and Brennan has shown that, Our counterparts in audiology, physical rather than theory, the workplace demands therapy, , and athletic the application of knowledge geared toward training have been part of the exponential daily professional duties.3,4 They envisioned growth in second-generation health care a doctorate-prepared practitioner who had doctorates.7 While these programs may dif- less skill in pure research but who would be fer in concept, they share several similari- able to apply theory to everyday problems ties: They do not require original research; in the workplace.4,5 Rather than devalue they include a clinical component; and they the contributions of classical PhD train- promote knowledge in the context of the ing, this model proposed the creation of a workplace.5-8 hybrid curriculum that would prepare in- In the past five years, PAs have started dividuals to use “applied research.”3 As the considering (or debating, depending on professional doctorate gained acceptance, your perspective) a professional/clinical

clinicianreviews.com JUNE 2017 • Clinician Reviews 7 FROM THE PA EDITOR-IN-CHIEF

doctorate as the next step in our post-pro- looking to bolster their rosters fessional journey. It’s about time, when you (and their coffers). But advocates have long consider that 16.8% of newly certified PAs argued that these degrees provide practi- intend to pursue additional education or tioners with the knowledge and training clinical training, according to a recent re- required to offer advanced services in in- port from the National Commission on Cer- creasingly complex social and technologic tification of Assistants.9 environments.7 No less than The Institute There are already a few doctoral pro- of , The Joint Commission, and grams for PAs. Among the earliest clini- the Robert Wood Johnson Foundation cally focused doctorate programs was the have called for the reinvention of edu- US Army/Air Force-Baylor DScPAS-EM cation programs to equip today’s health program, designed to educate military PAs professionals with the highest level of sci- at the doctoral level upon completion of entific knowledge and practice expertise. an 18-month emergency medicine resi- Why? First and foremost, to ensure qual- dency.10 Lincoln Memorial has a ity patient outcomes. Beyond that, better Doctor of Medical (DMS) program, prepared clinicians can help to address comprised of one year of online advanced provider shortages. Those with doctorates clinical medicine coursework and one year can also serve as faculty, educating the next generation of health care providers. And †These degrees provide practitioners with practically speaking, for those seeking ad- the knowledge and training required to offer vanced education, holding a doctorate will create opportunities for increased decision- advanced services in increasingly complex social making and upward mobility in the work- and technologic environments. place. There is no question that our current of online coursework focused on primary health care environment is driven by the care, hospital medicine, emergency medi- regulations and costs of the Affordable Care cine, or education.11 And Lynchburg Col- Act, as well as quality systems lege in Virginia has just launched a post- and strategies. NPs and PAs are in a unique professional doctoral program for PAs; this position to cost-effectively direct the care DMS program includes a clinical - of, and advocate for, diverse patient popula- ship, as well as coursework in leadership tions. NPs and PAs who recognize this op- training, health care management and , portunity to serve need doctoral-level train- organizational behavior, disaster medicine, ing tailored to this milieu. and global health.12 Do you agree? Share your thoughts on While not strictly created for PAs, the professional doctorates with me at PAEdi programs at [email protected]. CR Nova Southeastern University and A.T. Still University have been educating PAs at the REFERENCES 13,14 1. Carnegie Project on the Education Doctorate. Founding lit- doctoral level for more than 10 years. erature. www.cpedinitiative.org/?. Accessed May 8, 2017. Later this year, A.T. Still University plans 2. Costley C, Lester S. Work-based doctorates: professional extension at the highest levels. Studies in . to introduce a post-professional Doctor of 2012;37(3):257-269. Physician Assistant Studies that will provide 3. Taylor N, Maxwell T. Enhancing the relevance of a profes- sional doctorate: the case of the degree a pathway for PAs wishing to become lead- at the University of New England. Asia-Pacific J Coop Edu. ers and scholar-practitioners, develop core 2004;5(1):60-69. 4. Lee A, Green B, Brennan M. Organisational knowledge, pro- leadership abilities, and/or enter PA educa- fessional practice and the professional doctorate at work. In: tion without the location-specific require- Garrick J, Rhodes C (eds). Research and Knowledge at Work. Perspectives, Case-studies and Innovative Strategies. ment of a clinical or academic residency. London: ; 2000. When the push for professional practice 5. Maxwell T. From first to second generation professional doc- torate. Studies in Higher Education. 2003;28(3):279-291. doctorates started, pundits claimed they 6. American Association of Colleges of Nursing. DNP fact were just an attempt at a “cash grab” by sheet. www.aacn.nche.edu/media-relations/fact-sheets/

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dnp. Accessed May 8, 2017. pa/index.php?id=936090. Accessed May 8, 2017. 7. Zusman A. Degrees of change: how new kinds of profes- 11. Lincoln Memorial University. Doctor of medical science sional doctorates are changing higher education institutions. announcement. www.lmunet.edu/academics/schools/ Research and Occasional Paper Series. 2013;8(13):1-20. debusk-college-of-osteopathic-medicine/dms. Accessed 8. Kumar S, Dawson K. Exploring the impact of a professional May 8, 2017. practice education doctorate in educational environments. 12. Lynchburg College. Doctor of medical science. www.lynch- Studies in Continuing Education. 2013;35(2):165-178. burg.edu/graduate/physician-assistant-medicine/doctor-of- 9. National Commission on Certification of Physician Assistants. medical-science/. Accessed May 8, 2017. 2014 statistical profile of recently certified physician assis- 13. Nova Southeastern University. Doctor of health science pro- tants: an annual report of the NCCPA. www.nccpa.net/ gram. http://healthsciences.nova.edu/healthsciences/dhs/. Uploads/docs/RecentlyCertifiedReport2014.pdf. Accessed Accessed May 8, 2017. May 8, 2017. 14. A.T. Still University. About the college of graduate health stud- 10. . Army-Baylor emergency medicine physi- ies – online. www.atsu.edu/college-of-graduate-health-stud cian assistant (EMPA) program. www.baylor.edu/graduate/ ies. Accessed May 8, 2017.

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