Doctor of Medical Science

Discussion in 'Nursing and medical-related degrees' started by Kizmet, Feb 22, 2020.

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  1. Kizmet

    Kizmet Moderator Staff Member

  2. Vonnegut

    Vonnegut Active Member

    It will be interesting to see what the actual utility of that degree becomes, and how widely it is adopted. Certainly will make a life-time of title headaches.
     
  3. LearningAddict

    LearningAddict Well-Known Member

    I don't know what this will do. You will still be frowned at (if not threatened) for calling yourself "Doctor" in a clinical setting. A PA already has the necessary knowledge to be licensed for their job. Would an online medical school be a better option in a situation like this? I'd imagine you could accelerate due to having quite a bit of the medical education under your belt already, clinical hours, and have the luxury of already having an established place to practice out the remaining clinical hours needed? However, the only online medical school I know of that you wouldn't have to actually leave the country for at some point is IUHS (International University of Health Sciences), and that's important because if you are a practicing PA, you can't just up and leave for an extended period and still have your job when you come back.
     
  4. Rich Douglas

    Rich Douglas Well-Known Member

    The field is feeling itself through this.

    Nurse practitioners used to do a long masters. Now we routinely see the DNP.

    40 years ago, the Air Force was sending medical technicians to get bachelor's degrees to become PAs. Now the entry-level credential is a master's. It may soon be first-professional a doctorate. This may conflict with doctorates designed for practicing PAs, just as some master's-qualified NPs decide to get the DNP (despite its redundancy). Some DNP programs are designed for NPs already in practice.

    And so it goes.

    Military story: back in the lat 1970s, the Air Force began training some of its technicians to become PAs. But they remained enlisted, even after graduation. However, they were instantly promoted to master sergeant upon graduation, and quickly shot up to senior master sergeant and, subsequently, to chief master sergeant. Then the Air Force decided it wanted to commission its PAs as officers. Depending on which enlisted grade you were, you instantly became a second lieutenant, first lieutenant, or captain.
     
  5. copper

    copper Member

    As a PA, I really don't see the allure of a DMSc. Most PAs have Masters degrees in PA studies and still quite a few with Bachelors and certificates. The DMSc may offer some utility in an educator track but most PA professors hold a PhD. I think the MBA would give much greater bang for the buck for an administration track. I doubt the DMSc will be the new entry level degree into the profession like the DNP. I know there is a movement to allow PAs more autonomy and perhaps even full autonomy??? If an entry level Doctorate PA is is the future, then consider going to medical school because the whole purpose of becoming a physician extender is defeated by the educators who are trying to capitalize on a "mid level provider" profession by turning it into a 4 year degree program!
     
  6. LearningAddict

    LearningAddict Well-Known Member

    I didn't know you were a PA before. I've often wondered about how much credit someone like you would get toward an MD from one of these online medical schools and what your remaining course track would look like. I hear some are flexible but I'm skeptical about just how flexible they are in reality given how few students they enroll combined with the goal of making a buck.
     
  7. copper

    copper Member

    There is a US DO school that credits one year: https://lecom.edu/academics/the-college-of-medicine/accelerated-physician-assistant-pathway/

    As far as foreign schools and "online medical schools" I think it basically helps with admissions but you still have to do the full program.
     
  8. LearningAddict

    LearningAddict Well-Known Member

    Ah, that's tough. I was under the impression that the basic sciences portion would be wiped out at least. Without that, it's pretty much starting from scratch, but an experienced PA has to be in a much better position from a knowledge standpoint than the average medical student who is coming in fresh.
     
  9. copper

    copper Member

  10. LearningAddict

    LearningAddict Well-Known Member

    I remember seeing the one from Yale some time ago and was surprised. Times have certainly changed.
     
  11. copper

    copper Member

    Are you in healthcare?
     
  12. Kizmet

    Kizmet Moderator Staff Member

    Thanks for the list. If there are others it would be great to make a comprehensive list. Maybe you can drop one in this thread if you ever bump into it.
     
  13. LearningAddict

    LearningAddict Well-Known Member

    Not anymore. I used to do some counseling work in one of my many former lives, lol. I may do it again some day.
     
  14. copper

    copper Member

  15. Neuhaus

    Neuhaus Well-Known Member

    I feel like healthcare is reaching a point where something needs to change and people are starting to realize it.

    Kansas created a license class for medical school graduates who did not land a residency and were otherwise ineligible for licensing as physicians.

    New York (and others) allow Nurse Practitioners to practice without the supervision of a physician.

    There was a proposal just a few years ago to rename "Physician Assistants" as "Physician Associates" because they felt it better captured the collaborative nature of PAs and MDs and better reflected their scope of practice since the profession evolved (for quick reference, in the early 2000s there were at least two colleges in PA that offered license qualifying associates degrees to become a PA and there were at least three PA diploma programs in the state of New York).

    We need more healthcare providers. However, there are potential people sitting around working as ER scribes right now because their medical education was from a non-US country, they passed their exams and they can't get a residency. We are leaving highly trained professionals to languish because we have a system that required artificial barriers to entry (you used to be able to gain admission to medical school without a bachelors degree, for example, as long as you completed pre-med coursework) in order to keep wages up. Lawyers in the US did the same thing.

    The thing is that these artificial barriers end up hurting the industries rather than helping them. Let's take lawyers for example. I've spoken previously about my mother and how she went from paralegal to attorney. I've also mentioned how, at the time of her legal education, she was in a very tight spot. There were fully ABA accredited JD programs that were part-time and did not qualify one to sit for the NY bar. My mother could have, with far less interruption to her life, earned her JD at Brooklyn Law through their weekend JD program (not bar qualifying for NY) had she been willing to practice in NJ or CT or anywhere else where the ABA stamp was all that was necessary. It was a ridiculous barrier. As is the no online learning barrier that keeps graduates of Syracuse's new hybrid JD from sitting for the NY bar.

    So what did the market do? It found other ways. You've always been able to represent yourself. You've always been able to go to the clerk's office to pick up forms. Now, though, the court website in New York has form wizards that walk you through filling them out. We have LegalZoom. We have simplified forms for forming corporations with easy to use templates. When my company needs to form an LLC (which is often) the task is delegated to the most junior paralegal in our legal office so that the attorneys and the senior paralegals can focus on much more complex work.

    Lawyers wanted to keep their numbers small so that demand would always remain high. The market responded by making many of the more basic functions that lawyers used to cling to available for the masses. That, coupled with a surge in JDs from struggling law schools eager to crank out graduates and collect tuition caused a bubble to burst.

    I haven't seen my doctor in three years. I've seen a highly trained nurse practitioner in the same office instead. Said nurse practitioner manages my prescriptions, does my physical, reviews my labwork and does all of the things I used to rely on my MD to do.

    And what's happening now is people are scratching their heads and saying "Wait a minute, do we really need more MDs?"

    I think that these professional doctorates are nipping at the heels of a licensing scheme that doesn't make much sense. In the Scranton/Wilkes-Barre area, there were two solid masters programs for PAs. One was a combined BS/MPAS program. Five years. You showed up as a Freshman and you left as a PA with a Masters degree. Want to be a doctor? Well, first you spend four years earning a bachelors degree. Then you had to leave town and go to a medical school for four years. Then you had to go wherever your residency took you. That could be clear across the country. Meanwhile, so much of the same work could be done by this locally educated PA. Nursing? Even better. You earned that BSN fresh out of high school. Maybe you earned an MSN online. Now you're setting up a practice and may very well be stealing patients away from that MD down the street.

    DOs used to be second class providers. They fell in line and adopted much of the same structure to either qualify for the same medical licenses as their MD counterparts (in states like New York) or to get equivalent license classes. Now we have two professions that are coming and charging full speed ahead toward MDs demonstrating every day how they might very well deserve a seat at the same table even though they took a different entrance in.

    I'm not saying we don't need MDs, mind you. But the conventional wisdom that only a physician can do X. Y and Z has been shown to be false. In my humble and unqualified opinion, the last great tower the MDs have is the title. Once NPs and PAs start adopting the title of "Doctor" in larger numbers than what we see today, we may find a future where MDs are first among equals rather than top of the food chain.
     
  16. copper

    copper Member

    The Doctor title for NP, PA, OT, PT, etc. is meaningless in clinical practice! It may help in administration, research or academia but these doctorally prepared professions are not "Physicians or Surgeons" like MD or DO. The fact is, today, independent practice has become virtually obsolete because it is too cost prohibitive! Just go to any clinic today and you'll see a multi-specialty, multi-collaborative, multi-titled clinic. Healthcare providers now need to pool resources such as utilizing the same building, office, medical assistants, imaging facilities, labs, medical office assistants, nurses, etc. Even if a PA or NP were to have full autonomous practice, the overhead costs would be so cost prohibitive! MD's and DO's primarily hire mid level and allied healthcare providers in their multi-specialty clinic. True, there are a very few midlevels that have found a niche and can make a living as an independent provider but they are few and far between. Simply put, the cost of doing business has become too high!
     
  17. Neuhaus

    Neuhaus Well-Known Member

    Sure, it is now. My point is that may not always be the case. The lobbying power of NPs has proven itself worthy of taking on the medical establishment. It was fought tooth and nail, and is still being fought, in some states to allow NPs to practice without a supervising MD. The title, I believe, is just the next fight they're teeing up for.
     
    SteveFoerster likes this.
  18. copper

    copper Member

    The NP may have a broad scope of practice that extends into medicine but unlike the MD or DO, it has nothing to do with holding the doctoral degree! You are correct in saying lobbying state legislatures is the key to expanded scope of practice which I hope will never permit surgery which MDs and DOs now hold. There are however, many "procedures" which may also include "minor surgery"now being accomplished by both PAs and NPs and of course, the first assisting role. I'm not convinced the "fight" for title use is worth a damn! Scope is where the money is made! Titles just lead to more liability, lawsuits and increased malpractice insurance premiums. NPs or PAs wasting their energy fighting for the right to be called Doctor in clinical practice is a foolish undertaking!
     
  19. Rich Douglas

    Rich Douglas Well-Known Member

    NPs are expected to do much of what general practitioner MDs used to do--as Neuhaus described above. But behind the scenes? They're still treated like nurses. Pay, autonomy, respect, support, none of it is there in requisite amounts. You put that on top of a previous career as an RN and you get sick of it pretty quickly. The field is hemorrhaging NPs who are burned out, who found that being an NP didn't really improve things over being an RN (which they still must be, BTW). There are a lot of NP grads who went back to RN duties for that reason. Most of the pay, more respect, more protections, less scapegoating. The battles between MDs and NPs have just begun, and it is the patient who will pay for it.
     
  20. Vonnegut

    Vonnegut Active Member

    I'm not sure where you are, but I have been seeing a number of very successful practices that have been opening up with only NPs. They all seem to be avoiding the medicare/insurance route, and are transitioning to either the cash or subscription model.
     

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