Call Me Medical Care Practitioner? How About Doctor
The name change debate for PAs rages on with a new contender rising to the top of the heap: Medical Care Practitioner.
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Results of PA Title Change Investigation
The name change debate is officially dubbed the “Title Change Investigation” by the American Academy of PAs (AAPA). In 2018, the AAPA House of Delegates commissioned a study into the legal and financial ramifications of a professional name change, something those in the profession have been requesting for over a decade. British marketing giant WPP was hired with input from San Francisco-based firm Lander. AAPA’s legal counsel also weighed in.
Medical Care Practitioner–A New Generic Title for an Already Misunderstood Profession
In November 2020, the results of WPPs survey were presented to the House of Delegates, and Medical Care Practitioner was announced as “an opportunity for the profession”. Survey respondents were apparently split between Medical Care Practitioner and Physician Associate. Respondents inside the profession, i.e. PAs and PA students chose Physician Associate while “employers, physicians, and patients” preferred Medical Care Practitioner. WPP suggested the acronym MCP.
Survey respondents were asked to choose between Physician Associate, Medical Care Practitioner, and Praxician, a term made up by WPP. The goal of the new name would be to better reflect what PAs do: diagnose medical conditions, write prescriptions, etc. Who were these people chosen to give their opinion? WPP surveyed 27,000 PAs and students while only 700 others. The latter group included 400 patients, 100 physicians, and 200 employers.
WPP argues that Medical Care Practitioner best fits what PAs do and is more associated with terms like “compassionate” and “holistic”. They also argue that Medical Care Practitioner uses real, easy-to-understand words rather than relying on insider knowledge. This title would be “familiar” and “accessible” they say.
Medical Care Practitioner vs Physician Associate
On the other hand, Physician Associate was too often perceived as subordinate and lacking any additional clarification. Surprisingly, WPP also considered the similarity to the current PA post-nominals as a negative. We believe this to be a strength of the Physician Associate title. It seems irresponsible to throw away 50 years of PR behind the PA moniker.
Praxician did not fare well in the research…Obviously. WPP intended this new term to convey “action” and “experience” but it unsurprisingly lacked any positive word associations. Praxician also connotated “inexperienced”, “unqualified”, and “impersonal.” Expectations of a praxician ranged from diagnosing to scheduling appointments.
The PA title change survey from WPP also included feedback from government agencies such as the Center for Medicare and Medicaid Services (CMS). A senior official admitted that CMS has never experienced a credentialed provider wanting to change their title but that it would be most efficiently done through legislation. This means AAPA would have to spearhead getting a bill through Congress.
When asked about a PA name change, the Department of Veterans Affairs pointed to previous difficulties even substituting “PA” for “physician assistant”. Officials at the Indian Health Services indicated that it would take years to transition to a new name for PAs and that it might be easier to start with individual states.
The Cost of Change
A Physician Assistant name change would not come cheap, either. WPP estimates the total cost over 5 years to be $21 million. That doesn’t even include the cost for AAPA Constituent Organizations, PAEA, NCCPA, ARC-PA, or individual PA programs.
Is Medical Care Practitioner worth $21 million? Is Physician Associate? What are we really trying to accomplish with a title change? To ensure our survival, for one. PAs are rapidly losing ground to nurse practitioners. Though more rigorously trained, PAs are more costly and cumbersome to hire. And while PAs have been clear about their commitment to team-based care, some physicians are actively engaged in a battle against anything that may be seen as encroaching on their turf. The future for PAs is undoubtedly in jeopardy.
The push for a PA name change stems from the difficulty in modernizing legislation. PA advocates are finding that key opinion leaders are unsettled with the idea of advancing legislation to benefit an assistant. Even though the scope of practice need not change in order to reduce administrative burden, the Physician Assistant title has proven to be an impediment. Changing our official title to either Medical Care Practitioner or Physician Associate would first and foremost be done to more accurately reflect what PAs do for millions of patients every day.
But is Medical Care Practitioner any better? WPP thinks so. Here at The PA Doctor, we are not convinced. Any positive name recognition that PAs have earned over 50 years would vanish overnight. We would be starting from ground zero trying to build a reputation for Medical Care Practitioner and MCP.
The Ethics of Change
An official name change for Physician Assistants would affect every single PA past and present. Yet, how many of them would have a say as to whether or not their professional title is changed? How many could say they had a direct impact on whether or not everything about their professional identity got a makeover? Essentially none.
Anyone who has spent time serving in a professional association knows that membership numbers are less than ideal. Though organizations like AAPA and AMA (American Medical Association) say they represent all of their constituents, the fact is that less than 25% of those whom they claim to represent actually belong to those organizations. 25% may even be an overestimation! And of that 25%, the vast majority aren’t active voting members.
And of those that do favor a name change, how could AAPA justify going against the wishes of the 27,000 surveyed PAs and PA students who cast their ballots for Physician Associate to side with the few hundred outsiders who chose Medical Care Practitioner? No matter how you break it down, it would be wildly immoral to force such a monumental change upon so many unwillingly.
Fast Forward 5 Years
Can you imagine the conversations should PAs change their title to Medical Care Practitioner? Can you imagine the questions every front desk person would have to answer?
“We have a 2:00 appointment with Mr. Jones, our MCP.”
“What’s an MCP? Is that like an NP?”
“No, it stands for Medical Care Practitioner.”
“What is a Medical Care Practitioner?”
“Oh, they used to be called PAs or Physician Assistants.”
“Aren’t they all medical care practitioners?”
“Yes, I suppose they are…”
Or maybe it would go something like this:
“We have a few appointments available today. Whom would you like to see? Dr. Smith, the NP or the Medical Care Practitioner?”
“Well, I have no idea what that last one is, so I would rather just see the doctor.”
We feel that this is ultimately what patients want–to see a doctor. We also feel that adopting an official terminal doctorate degree would not only work to smooth out legislative bumps but would offer a new de facto title for PAs: Doctor.
Let’s Move Forward not Backward
It should go without saying that PA doctors, or Doctors of Medical Science, are not to be confused with Doctors of Medicine (MD). Opponents of such a move would surely cite potential confusion among patients. We don’t believe people are that dense.
Medical doctors don’t own the title doctor. In fact, there really isn’t a doctor profession–it all depends on the context. And just because we’re referring to a clinical setting does not mean that doctor means MD. Consider how many non-MD clinicians are referred to as doctor:
- Psychologists
- Optometrists
- Podiatrists
- Dentists
- Orthodontists
- Naturopaths
- Chiropractors
- Audiologists
We could also add physical therapists, occupational therapists, pharmacists, and nurse practitioners to this list as well.
“But ‘doctor’ is just another word for physician and everyone knows that a physician is an MD or DO.” Really? Because we see the following examples all the time:
- Allopathic Physician
- Osteopathic Physician
- Optometric Physician
- Podiatric Physician
- Naturopathic Physician
- Chiropractic Physician
- Etcetera
Defining More Than a Term
We could also point out, that according to Oxford, the word physician actually means “a person qualified to practice medicine” or “a person who cures moral or spiritual ills; a healer”. So MDs don’t own that one either.
Is it appropriate then that clinicians holding doctoral degrees refer to themselves as doctor in a health-care setting? Yes. Is it appropriate for doctorally-trained clinicians to refer to themselves as a physician? It could be.
All such practitioners should be crystal clear about their training. We can’t emphasize this enough. It would be very concerning and downright unethical for any healthcare provider to frequently refer to themselves as “Dr. So and So” without an equally frequent presentation of their credentials.
For example, credentials should be clearly displayed on all business cards, websites, ID badges, etc: John Smith, DMS, PA-C. Afterward, the honorific “Dr.” may be substituted. Clinical licensure should also be disclosed in new patient encounters: “Hello, I’m Dr. Smith, the PA.” Though we believe the latter will only apply until all PAs become Doctors of Medical Science.
The bottom line is that no clinician with a clinical doctorate should be ashamed of their training nor should they have to tip-toe around MDs.
The Future of PA Education
Being someone’s assistant isn’t the only thing holding PAs back. It’s also the lack of competitive and equivalent credentials, i.e. the lack of a doctorate. PAs are the only major healthcare provider without a terminal doctorate:
- MD … Doctorate
- DO … Doctorate
- NP … Doctorate
- PT … Doctorate
- OT … Doctorate
- PharmD … Doctorate
- AuD … Doctorate
- NMD … Doctorate
- DC … Doctorate
- PsyD/PhD … Doctorate
And then there’s us:
- PA … Master’s
A name change doesn’t remedy this issue. Not by a long shot. We could call ourselves anything we wanted but we’d still be seen as second-tier without a doctorate. Legislators aren’t willingly going to hand over additional rights and responsibilities to a second-tier clinician.
The Doctor of Medical Science is becoming the go-to degree for PAs. It will very likely become the entry-level degree for PAs. The University of Lynchburg alone has helped create hundreds of DMSc-doctors after only 5 years. And though we have some reservations about the clinical content of some DMSc programs, we point to LMU and Butler as examples of solid clinical training for PAs who already boast thousands of hours of training and possibly tens of thousands of hours more in real-world experience. No, experienced PAs don’t need a doctorate to be fully responsible for the care they provide, yet it isn’t going to happen without one.
Here’s What We Suggest
Option 1
Re-branding PAs only serves to set the stage for greater battles including scope of practice and adoption of a terminal doctorate. Why not get right to it? If full practice authority (FPA), or independence as some might say, is the ultimate goal, let’s spend the millions getting results.
Step #1: Standardize all PA education in awarding the MMS or Master of Medical Science.
Step #2: Advance legislation to create a new doctorally-trained provider type with full-practice authority–the Doctor of Medical Science.
Step #3: Master’s-level PAs can remain PAs and continue to work while collaborating with an MD/DO as their individual circumstance dictates or continue to push for FPA themselves.
Step #4: Master’s-level PAs can receive additional clinical training through a clinical DMS and be granted full FPA, same as any other healthcare provider.
Along with a new degree comes a new identity, one that we get right from the start. No silly title change required.
Option 2
Step #1: Make the Doctor of Medical Science (DMS/DMSc) the new entry-level degree for PAs.
Step #2: Push for legislation that adds Doctor of Medical Science as the new title for PAs.
Step #2: Continue to push for FPA for the profession as a whole and grandfather in experienced PAs where ever possible.
Either of these options would avoid a contentious title change battle that will surely leave half the profession angry and disillusioned. Besides, something as monumental as a name change should be voted on by all PAs or should at the very least, be opt-in rather than “can’t opt-out”. The above suggestions allow each PA to choose their own path.
We’ll pass on Medical Care Practitioner… And Physician Associate
$21 million is a lot of money especially when it won’t change a single thing about PA practice. Those more important battles would likely have to wait years until a name change is complete. There is a better option… Focus on the future. Focus on becoming, and better yet earning, the title of doctor. Spend that $21 million on untethering PAs and PA Doctors from physicians. “Just say MCP?” Naw, just say Doctor.
How do you feel about a name change and terminal doctorates? Please leave a comment below but keep it professional and constructive or it will be automatically deleted.
This is a very good perspective on the name change. Giving the DMS-c more creditability would be a great move in the field. Typically to get the full benefit of the DMS program providers typically should have a few years of experience to express their own clinical views throughout the doctorate program . If Universities require one to two years of clinic experience prior to applying for the program , this would benefit the profession. Encouraging the DMS program could be the standard requirement to push for more autonomy and possible the ability to supervise current colleagues. This will add value to the DMS program and prevent providers from anxiously entering the field unsupervised/autonomous. Hopefully PAs can look at possible ways to improve the growth of our profession that may satisfy all parties.
-Christopher Bradley DMS-c ,MPAS, PA-c
While I agree we should get to a place where we should call ourselves Doctor, but it’s incredibly short sighted to disregard the title. One is an educational title and one is a professional title. Practice laws do not say “doctor,” they specify one as a physician, NP, or PA both in writing and in spoken word when discussing updating practice laws. Saying “just call me Doctor” isn’t going to help, because you need to specify your professional credentials, which would be physician assistant.
You say it’s a lot of money to spend to not change anything, but neither does earning your doctorate. Its about creating potential for change. A doctorate creates opportunities and changing the title will create opportunities for legislators to increase scope of practice and not hung up on “assistant,” plus much more opportunities.
I also find the assertion that referring to oneself as a physician wholly inappropriate. This is a legally protected title and cannot be used with severe repercussions, same as if the medical assistant called themselves a physician assistant. Semantically correct, but very illegal.
Thanks for your thoughts, David.
Doctor of Medical Science will be the professional title one day, just as Doctor of Medicine or Doctor of Osteopathy are professional titles.
We agree that using “physician” is considerably more dangerous but something is only legally protected until it’s not.
Thanks for reading.
I cannot agree with you more! Thank you for expressing your thoughts and suggestions here. History is bound to repeat itself as the programs that once issued certificates/associates were forced to start issuing bachelor’s and Master’s otherwise loss their accreditation. It will not be a hard sell the the programs to not only get to charge more than the Masters only program but also force previous graduates to go back to school pay tuition and get the “New” Degree/Title. I hope that when the terminal degree becomes the DMS/DMSc we just drop the S/Sc. Can you imagine DO’s keeping the “M” Doctor of Osteopathic Medicine and be initialed as “DOM” seems ridiculous. Dr. “Blank” our DM fits incredibly well within the abbreviation family see: MD/DO/DM and would be a very easy to understand transition maybe even easier to explain than DNP? Whait your a Doctor or a Nurse …or the redundancy of Doctor Physician Assistant/Associate.
-PA Dave & working towards the DM(S/Sc)
We’ve never considered dropping the S/Sc–interesting! Thanks for reading.
It seems silly to consider the aforementioned doctorates equally. The training is vastly different between an MD and an NP, for instance.
Tyrel, we don’t consider all doctorates equal and recognize differences in training. This discussion is about titles. A psychologist is no less a doctor than a psychiatrist–dissimilarity in training doesn’t detract from earned titles.
Thanks for reading.
Should PAs should be given the same professional and educational titles as physicians without the requirement of obtaining an equivalent level of medical education? Is rebranding the PA as a doctor or physician being “crystal clear about their training”? You raise the point of other healthcare professionals with doctoral degrees maintaining their educational titles despite not being physicians, but never have I heard an audiologist or physical therapist be referred to as “doctor” in a clinical environment involving MDs/DOs. It’s also very clear that their roles in patient care are entirely different. Patients don’t have to wonder whether their primary care doctor is a physician or physical therapist. Similarly, a patient does not need to question whether they should see Dr. Chiropractor, Dr. Podiatrist, or Dr. Dentist when seeking primary care or other services traditionally provided by the MD/DO because these professions are entirely separate in practice. That’s not the case for many MDs/DOs and their mid-level counterparts.
This push for intentionally ambiguous titles and complete autonomy and scope of practice on par with that of MDs/DOs only serves to blur the line between MD/DO providers and mid-level providers. Blurring the differences between two professions with some overlap, and but stark differences in levels of training and expertise can’t be appropriate if we are truly putting the needs of patients first. If put in a situation where they are given the choice to see an MD/DO or NP or PA, patients deserve to know what they are choosing between. Granting similar titles to these professions does not help them in that regard.
It can’t be appropriate to ask for the same titles and occupations as medical doctors without acquiring the same level of education and ultimate responsibility that they have. If mid-level organizations expand their training programs so that they are on par with that of MDs and DOs, then by all means let’s call everyone doctor or physician. But then we should ask: why do we need 4 different terminal degrees with the same training that fill the same jobs? The fact that there are MD physicians and DO physicians that essentially train and operate in the exact same way already makes no sense and only causes confusion and prejudice both within and outside of the medical community. Adding NPs and PAs to the ranks will only make matters worse. Why not just go to medical school?
Mid-level providers have a distinct role in providing necessary care that physicians are well overqualified to provide which is why the educational requirements are not as exhaustive. And according to a lot of outcomes data, they are great at it. They are absolutely necessary and help make our healthcare system much more efficient than it would be otherwise. If we push all of the mid-levels to being essentially another type of physician, we lose that efficiency in patient care, we lose the decrease in healthcare costs that they provide, and we lose a competitive occupation that boasts meaningful work and relatively high earnings without having to spend 11-16 years as a “trainee”.
Thank you for a thoughtful response.
We support PAs with clinical doctorates referring to themselves as “doctor” in the clinical setting.
Credentials should be clearly displayed: John Smith, DMS, PA-C.
Clinical licensure should also be disclosed: “Hello, I’m Dr. Smith, the PA.”
Thank you for this article Where did you get this information: “WPP estimates the total cost over 5 years to be $21 million.” I’ve been looking for the reference that states this and have been unsuccessful. Thank you!
Kati, it was in a document released by the AAPA.
Optometric “physicians,” chiropractic “physicians,” and the other examples you listed are inaccurate not to mention illegal. The term “physician” is a legally protected term reserved for those who hold MD or DO degrees, and reflects the rigor, training, and years spent becoming an expert in their respective specialty. Chiropractors are not physicians, naturopaths are not physicians, and optometrists are not physicians. Words have meaning, otherwise let’s just throw out the dictionary! PAs should have pride in our profession, who we are, and the education we receive as generalists who can move between specialties. This push to blur the lines between PAs and physicians as if to draw equivalence between the professions defeats the whole purpose of how and why PAs exist in the first place. PAs are PAs, and physicians are physicians.
Laws vary by state.
And it’s surprising you aren’t more familiar with how often these phrases are used. Look through your Sunday paper—I guarantee you’ll find examples.
“Doctor” and “physician” are general terms not professional designations.
The only truly specific identification, and thus proper identification, are your professional credentials: MD, PA, DPM, etc.
What is the difference between an Ophthalmologist and an optometrist? They both understand that DEGREE does not equal LICENSE. I have no idea why some people believe that obtaining a terminal degree in a medical science is like taking a walk in the park. PhD’s not only teach the foundations of medicine to 1st and 2nd year medical students but we are also taught to investigate, postulate and contribute to the field of knowledge for which one has earned their PhD. This is why in the British Health Care system you must have a PhD to be called Doctor and the MD’s are addressed as “sir” or “Madam”.
Todays problem with healthcare nomenclature and an outdated training model of education started with “The Flexner Report of 1905”. The year is now 2021, however. If completing the MD training model and becoming board certified makes one such an infallible clinician I have no idea then why Medical Boards not only exist in every state? These boards also discipline and revoke MD licenses on a daily/regular basis. Or why medical error is the 3rd leading cause of death in the U.S? Or why Allopaths (MD) and Osteopaths (DO) introduce themselves as “Doctor” without telling patients which “Doctor” knows how to perform OMT and Lymphatic drainage? Or even why most clinicians let “Up to date” or “Epocrates” tell them how to practice medicine?
Go for the Doctoral degree and the Doctoral title. You cannot think like a guppy fish when swimming and trying to survive in a pool of sharks. At the end of the day it is years of practice, attending CME’s, consulting with colleagues and reading charts/hospital reports that eventually makes one a seasoned clinician except for the surgical specialties/sub-specialties. A residency training model for budding surgeons makes sense, but I do not see the sense in training as a hospitalist for 3 years in hospital only to practice outpatient primary care medicine exclusively outside of a hospital?
My point is this, tune out the people who do not walk in your professional shoes then ADVANCE your profession without asking for permission to do so. If you pay the right politicians about 5 million of that 21 million your change can happen while spending less money. The optometrist, Psychologist and DO’s set their bars high and all went through the fight years ago to level the playing field. If the PA profession would have stopped this foolish debate about 20 years ago and just moved on and forward today would have been about discussing the history of a past war and not the beginning of it.
I say let those who want to stay masters trained or stay with the PA nomenclature,( whether assistant/associate), leave them behind. When The Osteopathic Schools started changing their “NAMES” from “Arizona College of Osteopathic Medicine” to “A.T Still University” I wonder if the AAPA and NCCPA took note of why all the Osteopathic Colleges of medicine changed their “NAMES” to be known by the term “UNIVERSITY”? Maybe AAPA should read what the book “first aide for the boards” continues to say about the COMLEX exam.
If you have a PhD in Neurology, DMS degree or Doctorate in Public Health and a PA “License” Then you are Doctor whatever, Neurologist, Medical Scientist or Public Health Specialist. Hence nomenclature for the License should change. “Physician and Surgeon” per 1892 terminology no longer exists because Doctors no longer make housecalls with a Gladstone bag that contained a bottle of whiskey and a knife to remove your appendix if needed when they arrived at your home.
So go for the GOLD medal instead of providing GOLD medal patient care and accepting the 3rd place bronze medal in terms of what your are called.