ADPA President’s Perspective: Historical Overview of PA Degree

Author: James R. Kilgore, DMSc, PhD, PA-C, DFFAPA

ADPA | President’s Perspective

Which degree for PAs?

The arguments for an advanced PA degree are that a standardized degree is needed to reflect the level of academic training PAs receive, keep PAs competitive, prevent PAs from being considered “lower” level providers compared with other professionals (eg, NPs) with standardized more advanced degrees, hold more credibility with the public, employers, and lawmakers, who do not fully understand PA training as “competence-based” education, and to allow for personal and professional growth (eg, Research, administration, academia).

Those opposed to degree advancement (referred to degree creep) are that it will decrease diversity of the profession and that not all programs can adapt to an advanced degree putting some long-standing programs at risk, discourages students from pursuing an advanced degree due to economic, social or education reasons, cause feelings of competitive disadvantage for those with less than the most advanced degree option and possibly cause a split within the profession, inhibit state-to-state mobility if certain states begin to require the more advanced graduate degree, convey that PA programs are a degree-based, not competency-based profession, cause potential loss of applicants and training programs because of increased cost associated with advanced degrees, and cause uncertainty until impact of the decision on the PA profession is known.

Take a really deep breath! This was written in November 2000 and published in PASource Volume 1 / Issue 1. I am not teasing anyone, but this was written in response to the PA profession up to that point did not have a defined degree for the profession. The debate about a Standardized Minimum Degree was intense, hotly debated and had strong opinions on both sides of the argument.

For those who have been in the profession for over 30 years, they clearly remember the intensity of the discussion regarding requiring a minimal terminal degree for the profession. In 1998 there was a resolution in the HOD to have APAP and CAAHEP establish as the standard, the minimum of a baccalaureate degree to be awarded to all PA training programs to their students upon completion of their training. That was referred to the Education Council for review and research. A recommendation was made by the AAPA/APAP joint task force and Education Council for all accredited PA programs to confer a minimum of a bachelor’s degree upon graduation. In 1999 in the HOD in Atlanta, it was rejected. Refer back to the APAP degree task force and AAPA education council to debate further and present their findings to HOD 2000 in Chicago that led to the adoption of four policies. It directed the Speaker of the HOD to inform the ARC-PA of the AAPA desires to make a graduate degree, professional or academic, a requirement in PA program accreditation standards. Prior to 2000, the PA profession did not have an adopted minimal degree for the profession.

The issues were published in the JAAPA in a November 1998 article entitled, “A Standardized Degree: Time to Move the Debate Forward”. Those who supported the transition were eager to award students a credential worthy of this advanced level of educational attainment. The article was written by a well-known colleague, PA Bill Kohlhepp.

Now, 28 years later, we are at the door again, debating the same issues about the value of the advanced terminal degree, and raising the same issues. One would have thought that we would have learned our lessons having been down this road previously.

But wait, you said a baccalaureate degree? The story continues. On April 24, 2000, Mississippi Governor Ronnie Musgrove signed a bill permitting physician assistants to be licensed in the state, making Mississippi the last state to license PAs. A 118-1 vote in the House and a unanimous vote in the Senate passed Bill HB846. The licensure legislation, which went into effect on July 1, marks the end of a 30-year battle by Mississippi PAs to gain legal acceptance of their profession in the state. At that point, all 50 US states, the District of Columbia and Guam also allowed PAs to practice.

But why did it take so long? The fight actually began in the 1970s when PAs practicing without a formal law gained opposition from organized nursing and medical disciplines. Practice Acts were proposed in the 1980s but were defeated within the state. In 1995 the Mississippi Nurses Association (MNA) opposed the bill, fearing that restrictive rules proposed by the Medical Licensing Board would force nurse practitioners out of the healthcare picture. Finally in 1996 progress was made with all 10 of the PAs in the state (yes, 10) and the major medical organizations supporting the legislation but the MNA again opposed the bill for several reasons, primarily because they felt the nurse practitioner could meet the unmet needs of Mississippi. Then in 1997, stay with me here, the MNA and MAPA/AAPA negotiating team were able to agree on four of the five MNA proposed changes to the PA bill. They disagreed on the issue of requiring a master’s degree for the PAs. The MNA thought that the PAs should be held to the same standards as the NPs who were required to have a master’s degree.

Finally, after several more years of fighting back and forth, in 2000 there was a consensus reached. PAs who have been employed and working in Mississippi prior to July 1, 2000, could apply for a licensure between July 1, 2000, and December 31, 2004, but must be a graduate of an accredited PA program, have NCCPA certification, and have a baccalaureate degree to be eligible. On or after December 31, 2004, PAs will be required to hold a master’s degree in a health-related or science field in order to receive licensure.

2020: ARC-PA formally required all accredited PA programs to confer a graduate degree, cementing the master’s as the standard entry-level credential.

Obviously, sometimes it takes a while to make a major change. In 2006, PAs in the Army could earn a Doctor of Science (DScPAS-EM) offered in partnership with Baylor University , after an 18-month residency in emergency medicine.

Our profession has constantly been evolving since its inception. Many of the same arguments for and against advancing degrees essentially remain the same. These debates are helpful and allow for all voices to be heard, but clearly our profession moves forward with innovation and adopts change. Even if it takes a while.