Psychiatry as a Lens: What Doctoral Education for Physician Associates Reveals About Modern Medicine

James C. Somers, DHSc, PA-C, DFAAPA

Author’s Note: This article reflects my personal professional perspective, shaped by more than two decades as a practicing clinician, practice owner, educator, and professional leader within the Physician Associate profession. My decision to pursue doctoral education was not driven by a specific job title, promotion, or external requirement. At the time, I was already well established clinically and professionally. What I was looking for were options that I could not yet fully anticipate, particularly as I began thinking about what the final 10 to 15 years of my career might look like. Education has repeatedly expanded my professional horizons, often in ways I could not have anticipated. I view doctoral education not as a mandate or a marker of professional superiority, but as a pathway to expanding responsibility, adaptability, and stewardship of our profession. The views expressed here are intentionally candid and offered to advance thoughtful dialogue within the profession. They do not represent an official or unified position.

Discussions of doctoral education for Physician Associates (PAs) often begin with comparisons to physicians, to other health professions, or to earlier educational models. While understandable, these comparisons obscure a more consequential question: whether current educational structures prepare PAs for the roles they already perform in contemporary healthcare systems. At this stage of the profession’s evolution, the central issue is no longer one of clinical outcome equivalence with Nurse Practitioners or even Physicians; it is preparedness.

I believe that Psychiatry and mental health offer a particularly useful lens for examining this issue. Not because psychiatry is exceptional, but because it exposes pressures that are now present across all of medicine. Workforce shortages, fragmented systems, cultural complexity, technological disruption, and widening inequities are especially visible in psychiatric care. What psychiatry reveals is not an anomaly. It is an early warning signal. For PAs pursuing or considering post-professional doctoral education, psychiatry clarifies what modern practice increasingly demands across clinical settings.

Viewed through this lens, the question of doctoral education shifts away from credential accumulation and toward structural readiness. Mental health outcomes are deeply system-dependent, shaped by access to care, workforce composition, insurance design, continuity, housing stability, and community resources. They are also culturally mediated, influenced by how distress, illness, and recovery are understood within specific communities.

Contemporary analyses of the mental health crisis consistently identify access failures, workforce shortages, and fragmented delivery models as primary drivers of poor outcomes, rather than deficiencies of any single profession.¹ Psychiatry makes explicit what many areas of medicine still resist acknowledging: clinical outcomes cannot be separated from the environments in which care occurs.

When these broader contexts are ignored, psychiatric care is often reduced to a narrow public health and psychopharmacology lens. Diagnostic precision and pharmacologic intervention matter, but they are rarely sufficient on their own. Effective psychiatric care requires integrative clinical judgment that accounts for human experience, environmental factors, family systems, culture, and the social determinants that shape suffering and recovery. Treating symptoms without addressing context may be efficient, but it is frequently ineffective.

PAs practicing in psychiatry already manage this complexity every day. They provide longitudinal care while coordinating across fragmented systems. They work with patients whose symptoms are inseparable from trauma, loneliness, financial stress, identity, and marginalization. At the same time, persistent workforce shortages have expanded PA roles across outpatient, inpatient, and community-based settings. Psychiatric PAs routinely manage complex panels, participate in collaborative and stepped care models, mentor team members, and serve as continuity anchors for patients navigating unstable systems. These realities do not reflect a failure of master’s-level education. They reflect a profession whose responsibilities have outgrown the structure of its training.

We are now seeing technology further magnifying this gap. Psychiatry has been at the forefront of telehealth expansion, digital therapeutics, and emerging applications of artificial intelligence. These tools are often introduced as solutions to access problems, yet they are often introduced without adequate discussion of equity, bias, data quality, or appropriate clinical use. PAs encounter these technologies in real practice environments, often expected to implement them responsibly without formal preparation to evaluate their limitations or unintended consequences. In practice, technological adoption has outpaced professional readiness in governance, oversight, and ethical accountability.

This is where doctoral education should be understood not as a kind of “professional mimicry”, but as professional maturation. This professional maturity means structured preparation for roles that require integrative judgment, leadership, systems thinking, and translation of emerging science into practice. It is not about becoming something else. It is about taking responsibility for what the profession is already doing.

Leadership scholarship supports this framing. Research has shown that doctoral-level education is associated with stronger critical thinking, ethical reasoning, strategic insight, transformational leadership behaviors, and emotional intelligence.² These competencies are no longer optional for applied healthcare leadership roles. Many PAs already serve in leadership capacities without formal preparation, clear authority, or protected time. Doctoral education offers a mechanism to close that gap deliberately rather than by attrition.

Professional maturation occurs across several domains. Cognitive maturation supports movement beyond checklist-driven care toward nuanced decision-making in complex clinical contexts. Role maturation prepares PAs for responsibilities in education, quality improvement, population health, informatics, and program development, roles that are increasingly common yet inconsistently supported. Ethical maturity equips clinicians to engage inequity, technology governance, and organizational decision-making as core professional responsibilities rather than peripheral concerns that can be deferred to others.

For patients, the impact of this maturation is reflected not in titles but in improved access and better health outcomes. We can see continuity improve, technology integrated more thoughtfully, and advocacy within complex systems becomes clearer and more consistent. Care begins to reflect social and cultural realities rather than treating symptoms in isolation. When doctoral preparation is designed with these outcomes in mind, it strengthens the dimensions of care that patients most often report are deficient.

This model of doctoral education is neither physician training nor a traditional research doctorate. It aligns with the longstanding professional consensus that post-professional doctoral pathways should serve leadership, educational, and systems-facing roles without redefining entry-level preparation for PAs.^3,4 Clear boundaries matter. Doctoral training does not confer equivalence to independent physician practice. It is not required for all PAs, and, importantly, it is not simply an extension of biomedical content.

Skepticism toward advanced degrees in the PA profession is understandable, particularly given the profession's emphasis on core clinical competencies and efficiency. However, skepticism should not be confused with evidence. Actively avoiding engagement with doctoral education, I believe, poses a greater professional risk than deliberately shaping it. The PA profession has always evolved in response to patient and system needs, and those needs no longer resemble those of the healthcare environment in 1967, when the first PA class graduated. Healthcare delivery, complexity, and accountability have changed substantially. Meeting the needs of patients and health systems today cannot be accomplished by remaining structurally static. If PAs do not define how advanced education supports leadership, systems redesign, and accountability, others have and will continue to do so on our behalf. Avoiding conversation does not preserve the profession’s identity. It relinquishes stewardship of its future.

A broader professional responsibility is at stake. If the PA profession does not define the purpose, boundaries, and standards of doctoral education, others will. Prior analyses have warned of the risks of allowing market forces and institutional incentives to shape doctoral pathways in the absence of profession-led standards and governance.³ Workforce analyses similarly emphasize that addressing inequities will require not only more clinicians, but clinicians prepared to engage in system redesign and interdisciplinary leadership.⁵

Psychiatry, with this view in mind, can then be viewed as a lens rather than an exception, offering a preview of where medicine is headed. Doctoral PA education, understood as professional maturation, represents continuity rather than departure. It extends longstanding PA commitments to team-based care, patient-centeredness, and pragmatic problem-solving. It offers a path forward that prioritizes readiness over rhetoric and responsibility over reassurance, while remaining grounded in the values that have defined the profession from its beginning.

References

1. Kilgore JR, Somers JC, Rolfs J, et al. Roadmap to better mental health care. Lynchburg Journal of Medical Science. 2025;1(1):Article 2. doi:10.63932/3067-7106.1002

2. Kilgore JR. Leading with a doctorate: the impact of advanced scholarship on leadership effectiveness. Lynchburg Journal of Medical Science. 2025;1(3):Article 2. doi:10.63932/3067-7106.1047

3. Kibe LW, Kayingo G, Cawley JF. Postprofessional PA doctorates: a new era. JAAPA. 2018;31(11):46-51. doi:10.1097/01.JAA.0000545078.39838.78

4. McKenna RE, Hooker RS. The PA postprofessional doctorate. JAAPA. 2025;38(5):35-41. doi:10.1097/01.JAA.0000000000000201

5. Belz FF, Vega Potler NJ, Johnson INS, Wolthusen RPF. Lessons from low- and middle-income countries: alleviating the behavioral health workforce shortage in the United States. Psychiatr Serv. 2024;75(7):699-702. doi:10.1176/appi.ps.20230348