The Evolution of the Physician Associate Profession: Embracing Doctoral Education

Abstract

The Physician Associate (PA) profession has reached a defining inflection point. Once created to meet physician shortages through focused clinical training, it now faces a dual challenge: expanding clinical demand amid worsening physician shortfalls and an escalating national deficit in healthcare leadership and administrative capacity. As healthcare systems become increasingly complex, the evolution of the PA role from master’s-level clinician to doctorally trained leader represents both a natural and necessary progression. This paper examines national labor data, the educational trajectory of the PA profession, and the growing emergence of doctoral programs (DMSc, DMS, DScPAS, DPA) as strategic solutions for advancing PAs into leadership, policy, and system innovation.

Introduction

The Physician Associate profession—rooted in the mid-1960s solution to physician shortages—has matured into a vital pillar of American healthcare. PAs now practice across every specialty and region. Yet, their representation in system leadership, administration, and policymaking remains limited. While physicians, nurses, pharmacists, and therapists have transitioned to doctoral-level preparation, PAs remain anchored at the master’s level. This educational ceiling limits competitiveness in an era demanding interdisciplinary leadership and strategic acumen.

The last decade marks a turning point. In 2015, only three to four PA-specific doctoral programs existed nationwide. By October 2025, there are 41 active programs across at least 25 states. This tenfold expansion demonstrates that doctoral preparation is no longer experimental—it is the profession’s natural evolution.

I. The National Context: Physician and Leadership Workforce Shortages

Recent data from the Association of American Medical Colleges (AAMC) and the U.S. Health Resources and Services Administration (HRSA) paint an increasingly dire picture of the physician shortage. The U.S. faces a shortfall of up to 86,000 physicians by 2036, spanning both primary and specialty care. HRSA projects as many as 187,130 full-time equivalent physician vacancies by 2037 across all specialties. Eliminating Health Professional Shortage Area (HPSA) designations would require 13,075 additional primary care physicians immediately. Physician attrition increased from 3.5% to 4.9% between 2013 and 2019, with burnout and early retirement accelerating post-pandemic.

In parallel, the Bureau of Labor Statistics (BLS) reports 616,200 employed 'Medical and Health Services Managers' in 2024, with demand projected to grow 23% from 2024 to 2034—adding roughly 62,100 openings annually. Median annual pay stands at $117,960, underscoring the strategic value of these roles. The nation thus faces a dual crisis: shortages of both clinicians and qualified healthcare leaders.

II. The PA Profession at a Crossroad

PAs stand between two realities: indispensable to care delivery but underrepresented in decision-making. This gap is not rooted in ability but in credentials, institutional hierarchy, and access to leadership training. As other professions redefined their educational standards, PAs risk marginalization if the profession remains static. The crossroads is clear: remain a primarily clinical workforce dependent on delegated authority—or evolve into a distributed leadership force integrated into healthcare governance and innovation.

III. Doctoral Preparation: The Bridge Between Clinical Mastery and System Leadership

Doctoral preparation establishes parity with parallel professions that have already transitioned to terminal credentials—nurse practitioners (DNP), physical therapists (DPT), and pharmacists (PharmD). Such parity strengthens the PA’s standing in interprofessional and policy contexts. Doctoral programs extend PA education beyond clinical care to encompass leadership theory, healthcare finance, and policy development.

Doctoral-trained PAs uniquely combine bedside experience with strategic insight, translating administrative objectives into clinical reality. They represent a cost-effective and scalable solution for developing future healthcare leaders.

IV. The Economic and Workforce Implications

The intersection of physician shortages and leadership vacancies creates an unprecedented opportunity for the PA profession. Doctoral-trained PAs can manage service lines, implement quality initiatives, and assume C-suite positions. They offer continuity, scalability, and pragmatic leadership at a time when healthcare systems need it most.

V. Challenges and Considerations

While the movement toward doctoral preparation is essential, challenges remain. Institutional recognition, equitable access, and professional unity must be addressed to prevent division within the profession. Doctoral education should be viewed as an extension of the PA mission—advancing patient-centered care through leadership and scholarship.

VI. The Path Forward: Embracing Change

As we look to the future, we must embrace the changes that doctoral education brings. The PA profession has the potential to redefine its role within the healthcare system. By advocating for the importance of a terminal PA degree, we can ensure that PAs are not only part of the clinical workforce but also leaders in healthcare innovation.

The question we must ask ourselves is: how can we collectively support this transition? By fostering a culture of continuous learning and professional development, we can empower PAs to take on leadership roles that are critical for the future of healthcare.

Conclusion

The PA profession stands at a decisive crossroad. National labor data reveal two converging shortages: physicians to deliver care and qualified leaders to manage it. Doctoral education provides the bridge between these realities. By equipping PAs with advanced competencies in leadership, systems thinking, and organizational strategy, doctoral programs empower the profession to fill critical healthcare gaps. Doctorally prepared PAs are uniquely positioned to sustain, lead, and innovate within American healthcare. The question is no longer whether the profession should evolve—but whether it can afford not to.

References

• American Academy of PAs (AAPA). Physician Associate Competencies Update. 2023.

• Association of American Medical Colleges (AAMC). The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. 2024.

• Bureau of Labor Statistics (BLS). Medical and Health Services Managers: Occupational Outlook Handbook. U.S. Department of Labor, 2024.

• Cangelosi, J. D., et al. (2022). Developing Leadership Competencies in Advanced Practice Clinicians. Journal of Healthcare Management, 67(4), 205–212.

• Health Resources and Services Administration (HRSA). Physician Workforce Projections, 2023–2037. U.S. Department of Health and Human Services, 2024.

• Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. National Academies Press, 2011.

• Mittman, D. E., & Cawley, J. F. (2020). The Physician Assistant: An Essential Part of the Health Workforce of the Future. JAAPA, 33(7), 36–42.

• Physician Assistant Education Association (PAEA). Doctoral Education for Physician Assistants: Emerging Models and Implications. 2023.

• Yale School of Medicine. Increases in Physician Attrition Rates Could Worsen Shortages. 2023.

• Academy of Doctoral PAs. List of Doctoral Programs, October 2025.