The name change debate for PAs rages on with a new contender rising to the top of the heap: Medical Care Practitioner.
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 Centers for Medicare and Medicaid Services (CMS). A senior official admitted that CMS has never experienced a credentialled provider wanted to change their title but that it would be most efficiently done through legislation. This means AAPA would have to spear-head 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 difficulty 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:
We could also add physical therapists, occupational therapists, pharmacists, and nurse practitioners on 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
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
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.
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? Tell us in the comments below or submit a rebuttal to firstname.lastname@example.org