Do PAs Exist to Optimize Salary or to Provide Quality Care?

?Jim Anderson, MPAS, PA-C, DFAAPA | Clinical Advisor

A January 2025 piece in the Journal of the American Academy of Physician Associates

?(JAAPA) reveals some compelling questions about why physician associates (PAs) exist.

The informative piece looks at the impact of the Doctoral of Medical Science credential on PA practice. The survey article claims to examine the characteristics and effect of a Doctor of Medical Science (DMSc) on the careers of PA graduates and concludes that the doctoral degree “was considered a positive career benefit by graduates.”

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I found several things about the piece puzzling and worthy of further examination. Surveys are often self-serving, and this piece was no exception. A few things jumped out at me as I reviewed the JAAPA article. First, the authors caught my attention with all 7 PA of them citing either DMSc or DHSc credentials. Secondly, the article chose to focus only on the perceived benefits of the doctoral degree, without any discussion about whether there is any evidence that the quality of care provided by doctoral degree PAs is any different than that provided by PAs without such a degree.

?“The article chose to focus only on the perceived benefits of the doctoral degree, without any discussion about whether there is any evidence that the quality of care provided by doctoral degree PAs is any different than that provided by PAs without such a degree.”

?I’ve always been disturbed when such discussions fail to consider the quality of care, instead focusing on “positive career benefits” such as compensation, promotions, leadership opportunities, and career advancement. These are of course important factors in our work as PAs, but I am struck by the lack of discussion about how such factors relate to our core responsibility to provide the highest quality of care to our patients.

?The article raised these important questions for me:

?1. Why do we become health care providers? Is it to elevate “career development’

?(translate salaries, leadership opportunities, etc.) or is it to provide the highest quality

?of care for our patients, particularly ones who are underserved?

?2. Is there data showing that advanced degrees as discussed in this article result in

?improved care over that provided by PAs without advanced degrees or only with a

?Bachelor’s or Master’s degree? I have a Master’s Degree, but to be honest, the reason

?I got it was to placate employers. I don’t think it added anything to the quality of care

?I provided, and it seemed to me to be more a reflection of “degree inflation.” I have

?not come across any data showing that PAs with doctorate degrees provide better

?care than those without.

?3. Regarding degree inflation, where are we headed? I often hear PAs complain about

?how we have to keep up with NPs and their advanced degree status, but I still don’t

?really understand why, particularly with the aforementioned lack of data about any

?relationship between that and quality of care metrics. So, what’s next? A Double

?Doctorate? Or a Double Super Doctorate? It all seems based on a model of

?competitiveness, vs a model invested in quality of care.

4. Advanced degree programs for NPs and PAs are expensive. Some PA programs offer

?doctorate programs that cost $12,000-$14,000. In the words of a famous Wendy’s

?commercial, “where’s the beef?”, there needs to be substance behind that kind of

?investment. Again, where is the evidence of benefit for our patients, particularly the

?chronically underserved?

?5. Don’t get me wrong. I believe in the value of professional development, but how did

?that get defined as adding ridiculously expensive initials to our credential list? As a PA

?who practiced for about 24 years, I found opportunities for professional development

?that I believe added value to my patients, without the obsession with initials or the

?outlay of thousands of dollars.

In the end, I think that our fascination with advanced degrees reflects capitalist values that guide our troubled medical system. As we continue to move toward expensive advanced degrees, based on some vague belief that we must keep up with professions that we wrongly identify as our competitors, it takes us “out of our game” and moves us away from where we should be focused, which is on our commitment to provide high-quality care for the patient.

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