Center for the Future of the Health Professions Dec. 2024 digest
Posted: December 17, 2024
The Center for the Future of the Health Professions, dedicated to providing policymakers and healthcare stakeholders with comprehensive data for effective planning, presents our final op-ed column for 2024. This edition focuses on a transformative development in healthcare education: the emergence of post-professional doctorate programs for physician assistants/associates (PAs).
The PA profession’s educational requirements have evolved significantly since its inception over 50 years ago with the transition from bachelor’s to master’s degree programs approximately 35 years ago. Now, with 311 PA programs across the United States and more in development, the profession faces new challenges. Today’s healthcare environment demands sophisticated leadership skills, quality improvement expertise, and advanced clinical knowledge extending beyond traditional master’s level training.
In response to these evolving demands, the profession introduced doctor of medical science (DMS or DMSc) programs in 2016. Unlike traditional research-focused doctoral programs, these professional doctorates address practical challenges while providing opportunities for career advancement and specialized expertise. The rapid growth to 26 PA-specific doctoral programs reflects the profession’s commitment to meeting contemporary healthcare needs.
This paper examines how these doctorate programs are shaping the future of PA education and practice in an increasingly complex healthcare landscape, analyzing their development, structure, and impact on the profession.
Our guest authors this month are:
Albert F. “Bert” Simon, DHSc, PA-C Emeritus, who is professor and associate director of the DMSc program at A.T. Still University-Arizona School of Health Sciences (ATSU-ASHS). His tenure at ATSU began in 2005 as PA program chair and director. He served in leadership roles at ATSU’s School of Osteopathic Medicine in Arizona, including associate dean and vice dean (2006-2012), before returning to ATSU-ASHS as chair of Physician Assistant Studies and PA program director. In 2019, he became associate director of the DMSc program, which he designed. Dr. Simon has contributed extensively to the PA literature and co-edited Appleton and Lange’s “Q&A for the Physician Assistant.”
Beth Poppre, EdD, MEd, who serves as administrative manager of the DMSc program at ATSU-ASHS and assistant professor. Her career in medical education began in 1996 at the University of Arizona College of Medicine. She joined ATSU’s Student Affairs in 2005, serving as assistant and associate vice president before transitioning to her current role. Dr. Poppre holds a master’s in student affairs from Arizona State University and a doctorate in educational leadership from Grand Canyon University.
We look forward to your feedback and comments as we continue to explore the dynamic landscape of healthcare professions. Please direct any comments or feedback on this month’s digest to cfhp@atsu.edu.
Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA
Professor and Director
The Center for the Future of the Health Professions
A.T. Still University
Elevating care: The rise of doctorate programs for physician assistants/associates in a complex healthcare landscape
The physician assistant/associate (PA) profession has experienced significant growth over the past 50+ years (see Table 1). Approximately 35 years ago, PA programs began transitioning from a bachelor’s degree to a master’s degree. The move was driven by the desire to increase the level of education and clinical training for PAs. Currently, there are 311 PA programs in the United States, with more in development. The increasingly complex healthcare system in the U.S. relies on quality improvement, advanced leadership skills, professional development, interprofessional collaboration, patient outcomes, health policy legislation, and advocacy. These factors go beyond traditional master’s-level education, leading to the need for PAs to acquire additional skills.3,4
Post professional doctorate (PPD) degrees are specifically crafted to enhance career progression for individuals who have already obtained professional credentials. For healthcare professionals seeking to advance beyond entry-level positions, PPDs can provide opportunities for expanded clinical practice or open doors to faculty roles, leadership positions, health policy avenues, and other significant professional fields. Disciplines such as physical therapy (PT), occupational therapy (OT), audiology, and nursing offer PPD programs tailored to their respective professions. Additionally, specialized PPD programs for PAs are beginning to emerge, although research on their effects on PA career growth is still limited.5,9
Research by Taylor and Maxwell, and Lee, Green, and Brennan suggests workplace demands require practical knowledge for daily professional duties. This led to the development of doctorate-prepared practitioners who can apply theory to real-world problems. PPD degrees provide advanced training for practitioners to offer specialized services in complex environments.6,7,8
Introducing professional doctorates, such as the doctor of medical science (DMS or DMSc), has become a popular alternative to traditional research-focused doctoral programs for PT, OT, audiology, and nursing, and now PAs. These programs prepare practitioners to address practical issues in their field rather than focusing solely on academic research. The emergence of DMSc programs began in 2016, and there are currently 26 PA-specific doctoral DMS/DMSc programs in the U.S. and growing (see Table 2). Additionally, three doctorate and doctor of science in PA studies (DPAS/DScPAs) programs have emerged in recent years. These longer programs focus on traditional doctoral research (see Table 3).
In 2022, a number of DMSc/DMS PA leaders established the Consortium of DMSc/DMS Programs to promote collaboration and knowledge-sharing among DMSc programs. This collaboration was created to work toward standardizing the curriculum, share best practices, and provide networking opportunities for faculty members. By fostering a community of educators and researchers, the consortium aims to improve the quality of post-professional PA education. The consortium is also a special interest group (SIG) within the Physician Assistant Education Association (PAEA). The consortium conducted a survey in fall 2024 on program information, including current student and alumni data (see Table 4).
The consortium’s impact extends beyond individual institutions to enhance the PA profession. Well-educated and skilled PAs can improve patient care outcomes, institutional leadership, and healthcare research. As healthcare regulations and costs drive the industry, PAs with doctoral-level training are uniquely positioned to advocate for diverse patient populations and effectively direct their care.8
The current leaders for the DMS/DMSc consortium are Chair Jenna Rolfs (University of Lynchburg), Vice Chair Daniel Anderson (Lincoln Memorial), Vice Chair Kari Bernard (College of Idaho), Executive Secretary Andrew Stakem (University of Maryland), and Past-Chair Randy Danielsen (ATSU).
A study by Kilgore, et al published in 2024 is among the first to present data surrounding the characteristics and perceived career effects of PAs with a terminal DMSc degree. According to their survey of a particular DMSc program, most PAs who graduated from the DMSc program were between ages 30 and 49. A higher frequency of PAs of color completed the DMSc degree compared with their representation in the profession. The survey respondents self-reported they experienced increases in pay and promotions and changes in leadership roles. The survey respondents indicated that professional, career, and leadership development were the leading reasons for pursuing the doctoral degree.9
In 2019, ATSU became the third university to offer the DMSc degree. The program centered on cutting-edge professional curriculum tailored specifically for practicing PAs. ATSU’s DMSc program is designed to equip students with a profound understanding of contemporary healthcare challenges, to develop and enhance the leadership skills for PAs aiming for leadership roles within the medical field.10
ATSU DMSc program highlights
- Customizable curriculum: One of the standout features of the ATSU DMSc program is its flexibility. Students can specialize in various fields, such as education, leadership, sports orthopedics, sports rehabilitation, sports neurology and concussion, global health, emergency preparedness, and public health workforce. This ability to tailor one’s learning experience ensures each student can focus on areas resonating with their career goals and interests.
- Comprehensive healthcare focus: The program emphasizes a robust understanding of the nuances and challenges of the U.S. healthcare system. It prepares students to address contemporary issues effectively and fosters the development of leadership skills essential for navigating the evolving landscape of healthcare delivery.
- Flexibility and convenience: The program’s fully online structure is particularly advantageous for working professionals. With no requirement for on-campus attendance or clinical hours, participants can seamlessly balance their studies with their career responsibilities. Moreover, the program can be completed in an efficient 18 to 36 months, underscoring ATSU’s commitment to respecting the time and efforts of its students.
- Continuing education value: Participants can earn up to 60 AAPA Category 1 CMEs, demonstrating a significant commitment to ongoing professional development. This feature highlights the program’s recognition of the importance of continual learning in the medical field.
- Reputable institutional support: As part of ATSU-ASHS, the DMSc program benefits from the University’s well-established reputation for excellence in health sciences education. This backing lends elevated credibility to credentials obtained through this program.
Ideal DMSc candidates
The ATSU DMSc program is explicitly designed for certified or licensed PAs, including PAs from the U.K. and Canada, or who are retired. This inclusivity expands opportunities for professionals looking to advance their knowledge and leadership capabilities, ultimately benefiting the healthcare system at large. In a 2023 study conducted at Wake Forest School of Medicine, PAs without a PPD were surveyed to determine influencers for pursuing a PPD. The top influencers included ability to work while pursuing the degree, cost of the degree program, salary increases, professional advancement opportunities, and the length of the program. Respondents also cited the offering institution’s prestige, capstone requirements, and reputation of the program director.12
Implications for the future
The expansion of PA-specific PPDs from their initial offering in 2016 to 29 programs today represents a significant development in PA education. This rapid growth suggests substantial demand for advanced degree pathways within the profession. With the American Academy of Physician Associates (AAPA) reporting over 178,000 practicing PAs in the United States and more than 311 entry-level PA programs graduating thousands annually, the potential enrollment pool for PA-specific PPDs remains robust.
Current PA-specific PPDs primarily focus on preparing graduates for leadership and educational roles, with less emphasis on clinical skill enhancement. This alignment serves the pressing need for PA program faculty and addresses the growing demand for PA leaders in administration and the pharmaceutical industry. However, this represents a relatively narrow segment of the profession, as most PAs focus on direct patient care. A critical question facing the field is whether PA-specific PPDs will continue serving primarily niche markets in education and leadership, expand to attract larger numbers of clinically focused PAs, or develop new models to serve both administrative and clinical needs.
PAs currently have options for advancing their clinical credentials through residency programs, which focus on developing specialized medical knowledge and skills. While some PA-specific PPDs offer advanced credit for residency training, these educational paths generally remain separate. Programs could explore innovative curriculum models that create cohesive intersections between PPD education and clinical specialization. Such integration could develop pathways combining doctoral-level theoretical knowledge with advanced clinical training, while maintaining flexible frameworks that accommodate both leadership development and clinical expertise enhancement.
The accreditation landscape for PA-specific PPDs currently operates under regional accreditation through sponsoring institutions and may require state-specific authorizations, without discipline-specific accreditation requirements. As the field matures, programs should carefully consider several key questions regarding potential discipline-specific accreditation. These considerations include whether specialized accreditation would improve student education quality and how programs can maintain their current effectiveness while meeting new standards. Programs must also balance accreditation requirements with the need for innovation and flexibility to accommodate various student needs, including different time zones, military deployments, working professionals’ schedules, family responsibilities, and clinical practice demands.
The establishment and acceptance of PA-specific PPDs has created a foundation for discussions about entry-level doctoral degrees. With many other healthcare professions already requiring doctoral-level entry credentials, the PA profession must carefully consider its future educational requirements. Programs and professional organizations should evaluate the benefits and potential risks of transitioning to entry-level doctorates, including impacts on professional parity with other healthcare disciplines, effects on workforce development and career advancement, implications for educational costs and accessibility, and influence on patient care quality and outcomes.
The future of PA doctoral education will likely continue evolving as current programs mature and adapt, new PPDs emerge, the PA profession expands its role in healthcare delivery, and healthcare systems become increasingly complex. Success will require maintaining flexibility while ensuring educational quality, meeting workforce needs, and advancing the profession’s capabilities to serve patient and healthcare system demands. This evolution presents both challenges and opportunities for the PA profession to shape its educational framework in ways that enhance patient care and professional development while preserving the essential characteristics that have made PAs valuable contributors to the healthcare system.
Needs for future research
Due to the relatively recent advent of PA specific PPDs and the limited number of graduates who have completed the program the authors recommend additional research be conducted on this phenomenon. Studies on the evolving demographics of the enrollees will identify if shifts have occurred in such areas as age, gender, or racial composition of the student body. Research on the market demand and utility of the degree will assist the PPD programs in responding to trends in enrollment and employment. Also of interest would be any efforts to enact a discipline specific accreditation process or standardization of curricula of the PA specific PPD programs.
Conclusion
The emergence and rapid growth of DMSc programs represents a significant evolution in PA education and professional development. These programs, including but not limited to exemplars like the one at ATSU, demonstrate the profession’s commitment to advancing healthcare leadership, education, and clinical practice. Through customizable and comprehensive curricula delivered in flexible formats, these programs enable practicing PAs to obtain doctoral-level education while maintaining their professional obligations.
The success of PA-specific PPDs reflects both the growing sophistication of the PA profession and its vital role in addressing contemporary healthcare challenges. Graduates from these programs are advancing into diverse leadership positions across healthcare settings, contributing to educational excellence as PA faculty, engaging in healthcare policy development, and promoting evidence-based practice improvements. This diversification of career paths strengthens the profession’s ability to influence healthcare delivery at multiple levels.
The continued evolution of these doctoral programs, supported by early research showing positive outcomes in career advancement and professional satisfaction, suggests a promising future for PA doctoral education. As the healthcare landscape becomes increasingly complex, these programs provide PAs with the advanced knowledge and skills needed to navigate challenges, advocate for optimal patient care, and contribute to healthcare innovation. The collaborative efforts of PA doctoral programs, through initiatives like the Consortium of DMSc/DMS Programs, further demonstrate the profession’s commitment to maintaining high educational standards while fostering innovation in curriculum design and delivery.
For PAs seeking to expand their influence within the medical community, doctoral education offers a pathway to enhanced expertise and leadership capabilities. Whether pursuing roles in clinical practice, education, administration, or research, graduates of these programs are positioned to make meaningful contributions to the future of healthcare in America. As the profession continues to mature, the ongoing development and refinement of doctoral education will play a crucial role in preparing PAs to meet the evolving needs of patients, healthcare systems, and the broader medical community.
References
- American Academy of PAs. History of AAPA & the PA Profession. Accessed November 13, 2024. https://www.aapa.org/about/history/
- Physician Assistant Education Association. PAEA: 50th History Highlights. January 2022. Accessed November 13, 2024. https://paeaonline.org/wp-content/uploads/2022/01/PAEA-History-Highlights-Graphic-4.pdf
- Carnegie Project on the Education Doctorate. Founding literature. Accessed November 13, 2024. http://www.cpedinitiative.org/
- Costley C, Lester S. Work-based doctorates: professional extension at the highest levels. Stud High Educ. 2012;37(3):257-269.
- Bernard KS, Derr JN, McMoon M, et al. The contribution of postprofessional doctorates to the career development of healthcare workers: a scoping review. J Allied Health. 2024;53(3):e191-e200.
- 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 Pac J Coop Educ. 2004;5(1):60-69.
- Lee A, Green B, Brennan M. Organizational 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. Routledge; 2000.
- Maxwell T. From first to second generation professional doctorate. Stud High Educ. 2003;28(3):279-291.
- Kilgore R, Colletti T, Rolfs J, et al. Characteristics and career effect on PA graduates of a doctor of medical science program. JAAPA. 2025;38(1). doi:10.1097/01.JAA.0000000000000170
- A.T. Still University. Doctor of Medical Science. Accessed November 13, 2024. www.atsu.edu/dmsc
- Danielsen R. The Professional Doctorate: What are we waiting for? Clinician Reviews. 2017;27(6):79.
- Gillette C, et al. What Physician Assistants prefer in a post professional doctorate program: a cross-sectional rating and rankings study. J Physician Assist Educ. 2023. doi:10.1097/JPA.0000000000000502
- American Academy of PAs. About AAPA. Accessed November 19, 2024. https://www.aapa.org/about/
- Kulo V, Cawley JF, Kayingo G. The implementation of the clinical doctorate degree in physician assistant education and its potential effect on the Master’s degree as PA entry-level education. BMC Med Educ. 2021;21:274. doi:10.1186/s12909-021-02725-5