The PA profession was born out of wartime necessity. Over the last 50 years, however, PAs have evolved into an integral part of modern medicine. PAs are the primary care providers for millions of Americans while similarly trained clinicians treat millions more across the world. Captain Larry Aguirre of the California Army National Guard, is a PA and Doctor of Medical Science who continues the tradition of service to the country and patients alike.
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The Making of a Hero
Dr. Aguirre graduated from the University of Redlands with a degree in Sociology and Anthropology before attending the Master’s PA program at Western University of Health Sciences in Pomona, California.
After completing his primary medical training, PA Aguirre attended a 12-month fellowship in psychiatry at the UC Davis School of Medicine. Regarding the experience, he says “For me, it was a way to meet the need of my community which is heavily underserved in psychiatry. The program I went through set you up with a faculty mentor for case conferencing. The didactic was a mixture of distance education, onsite CME activities, and readings. It was a great experience and I would love to see similar programs developed for other specialties.” Further validating his training and experience, Dr. Aguirre also holds a Certificate of Added Qualifications (CAQ) in Psychiatry from the National Commission on Certification of Physician Assistants (NCCPA).
After 8 years of practice as a psych PA, Aguirre decided to pursue a clinical doctorate. When asked why he chose to do so as a mid-career professional, he simply states “it is the standard for healthcare professionals. Patients prefer someone who is trained at the doctorate level.”
Dr. Aguirre completed the Doctor of Medical Science (DMSc) program at the University of Lynchburg with an emphasis in Clinical Medicine and Psychiatry.
What is a DMSc?
The Doctor of Medical Science is a relatively new post-professional doctorate for PAs (physician assistant/associate) now available at several major universities across the country with more set to join the ranks.
“I decided on Lynchburg’s program based on perceived value: cost, content, time. You can elect different tracts, such as leadership and education. The focus is on clinical concerns and research such as evidenced-based medicine, best practices, running practice analysis or Plan-Do-Study-Act projects” says Aguirre.
Is a DMSc a physician?
While a bona fide doctor, he readily acknowledges that he is not a physician. Dr. Aguirre currently chooses not to use the term “doctor” in a clinical setting though he would be open to it in the future. “I am still on the fence with how to move forward on using this term. I think we all need to be on the same page and not have some PAs use the term but not others–it will probably be used in the future.”
Dr. Aguirre is also quick to recognize, however, that it doesn’t take an advanced degree to be a competent clinician. “I think it is unfortunate that there is increasing pressure for PAs to have a doctorate as there are PAs that have provided amazing care with no more than a certificate. Despite this, I think it would be wise and necessary for PAs to keep pace with other healthcare professionals. I think most of us would agree that it is not the degree that motivates us to give the best care we can and to make our organizations work better. But there are too many individuals that can’t properly assess a person, let alone a profession, without that doctorate degree to help reflect the highly competent individuals that we are.”
Clinical Doctorates for PAs
Clinical doctorates for physician assistants help these highly competent individuals gain recognition for an increased depth of knowledge acquired through clinical practice and advanced training in medicine, leadership, and scholarship. Doctoral degrees are also the preferred level of education in academia and in government work. Doctoral PAs also become experts in patient care, research, and administration in addition to opening up new career pathways.
The value of PAs in medicine has been well established. But for better or worse, the public views those with doctoral degrees as more qualified and better prepared than those with a “lesser” degree. “I would prefer students to have a year of clinical practice or be in their first year of clinical practice before taking up doctoral training. Having a year before eligibility for a DMSc gives it more credibility and students would get more out of it if they are actually practicing. I strongly support the idea of adding an additional clinical year to our training to set us above other advanced practice clinicians. This training should be less expensive and primarily distance-based and should augment the first licensed clinical year,” states Aguirre who self-financed his doctoral program in addition to using loans.
Optimal Team Practice and the Future of PAs
One of the most pressing questions facing the PA profession today is related to autonomy and scope of practice. But one question that has yet to gain momentum is whether or not doctoral PAs should operate under the same rules and regulations as PAs with less formal education. “I am in favor of Optimal Team Practice (OTP) and Full Practice Authority (FPA); probably graduated over a few years,” states Aguirre.
He continues, “For a long time, we used the model of dependent practitioners, but it seems like we are moving away from this as health care changes. We are no longer employed by physicians. They don’t really want to assume the responsibility of mentorship or legal liability as there is no financial incentive. Ultimately, physicians probably would prefer to have us practice under our own license.”
PAs and NPs are sometimes preferred over physicians by practice managers as they generate similar levels of revenue but cost significantly less to employ. This is not only threatening to residency-trained physicians but demeaning as well. No PA wants to replace a physician. On the contrary, even when advocating for modernizing outdated legislation, PAs have continued to support team-based practice with their physician colleagues.