What Effect Will a Doctorate Have on a PA’s Career and Quest for Financial Independence?Jun 23, 2022
Guest Post by Russell Singleton, DMSc, PA-C, with The PA Doctor
Doctoral degrees for PAs are not new, but they’ve never been as popular as they are right now. Many believe that the future of the profession depends on adopting a terminal doctorate while others bemoan neverending degree-creep. Besides defining your professional trajectory, deciding on a doctoral degree could have serious implications on your plans to be financially independent. Let’s break it down.
Doctoral Degree Options for PAs
When I was a new PA, getting a doctorate meant earning a PhD or possibly a DHSc (Doctor of Health Science). There were no PA-specific doctorates. That was 10 years ago. Today, the Doctor of Medical Science is the terminal degree “by PAs, for PAs”. The DMS/DMSc is not standardized at this point and available offerings differ quite a bit.
The Clinical DMS
The first Doctor of Medical Science program was Lincoln Memorial University’s DMS. It’s no secret that I’m partial to that program and am now an alum. It began as a 2 year endeavor but stands at 17 months. It’s the only program to be both exclusively clinical and taught by physicians.
Butler’s self-paced DMS is the next best clinical program, in my opinion. There certainly is an advantage to a self-paced experience but you pay for that convenience. It’s the second most expensive option (second only to High Point’s new DMS) and will set you back $35,000 if you apply the discount for precepting Butler PA students.
Rocky Mountain University of Health Professions offers a Doctor of Medical Science degree in Psychiatry, but there still seems to be a fair amount of non-clinical or quasi-clinical courses in the syllabus.
In the early days of the DMS/DMSc, you could identify a clinical program by it’s credentials: DMS,while the schools offering a DMSc were more likely to be focused on global health, health policy, or disaster preparedness. Rocky Mountain University of Health Professions started to break that mold with their DMSc Psychiatry track, and now High Point has destroyed it entirely with their DMS that only offers Administration and Education tracks.
The Academic DMSc
Lynchburg College was the second school to offer the Doctor of Medical Science and changed their name to Lynchburg University shortly after. Lynchburg offers a DMSc with tracks in Education, Global Health, and Advanced Practice. It appears that the clinical portion of their Advanced Practice track is self-determined and relies on work credit. It’s a significantly shorter program than most at 12 months and is among the cheapest at $25,000.
Of the five other schools awarding the Doctor of Medical Science degree for PAs, Education is the most common emphasis with several offering specialities in Leadership or some variation of Advanced Practice which I refer to as a “professional” track to differentiate it from an unquestionably clinical curriculum.
Am I being too hard on all of the non-LMU schools? Perhaps. But it’s only because I feel so strongly about the need for the DMS to remain a bonafide clinical degree. The nursing industry made the mistake of watering down the DNP (Doctor of Nursing Practice)–no offense to my nursing colleagues. I’m aware of only 1 DNP offering that is even remotely clinical. As a result, I don’t see the DNP getting much respect from physician colleagues. I don’t want the same thing to happen to the DMS.
Non-DMS Doctorates for PAs
In a completely mind-boggling move, several schools offer a Doctor of Physician Assistant Studies. Ironically, one of the PA-specific doctorates, the Doctor of Science in Physician Assistant Studies at Baylor for members of the military, is an amazingly robust clinical program that essentially takes the shape of an 18 month residency in Emergency Medicine, Clinical Orthopedics, or Surgical/Intensive Care.
Massachusetts College of Pharmacy and Health Science also offers a Doctor of Science in Physician Assistant Studies (DScPAS) but it’s nothing like Baylor’s program. Touro and the University of Pittsburgh offer a Doctor of Physician Assistant Studies (DPA/DPAS). Why they possibly thought including “Physician Assistant Studies” in the name was a good idea is a mystery, especially now that the AAPA House of Delegates has voted to transition to Physician Associate.
One Degree To Rule Them All
In the future, I hope to see the Doctor of Medical Science become standardized or at least adopt similar credentials. Until recently, I was proud of my D.M.S. credentials (sans the lowercase “c”). But I’ve since decided that I’m not going to join another superior minority (as in PA vs NP. Again, no offense intended). So now, I proudly display my credentials and advanced clinical education as “DMSc, PA-C” in the hope that it will be more readily recognized.
I would also argue that DMS was already in use in medicine: Diagnostic Medical Sonographer. Try Googling both “DMS” and “DMSc” and see what you get. This is what our patients are going to see. With the clinical distinction of the DMS a thing of the past, I’m not going up against Google and practically every other DMSc program to die on that hill. I’m sorry LMU, I still love you.
Plus the MMSc for PAs (Master of Medical Science) has been around for awhile and it just makes sense to have a MMSc that precedes a DMSc.
Why not just go to medical school?
I’ve heard this question a lot, both as a pre-PA and a pre-doctoral PA. And here’s the short answer: I wish I would have just gone to medical school. There, I said it. Go ahead and break out the rotten fruit and let ‘em fly. For the majority of my career, I defended my decision to go to PA school by explaining that it was a more cost effective and timely way to have a good job and enjoy a decent lifestyle. I would also parrot the tired idea of “lateral mobility” (which isn’t as easy, convenient, or appropriate as I was led to believe). While those statements are still partially true, I’m done feigning allegiance to the PA brand.
Why? Because there shouldn’t be any allegiance to the PA brand, that’s why. Our allegiance should be to evidence-based practice and excellent patient care. Can I do that as a PA? Yes. Am I better at it now that I’m also a Doctor of Medical Science? I believe so. But I can’t help but think it wouldn’t have been simpler to just be an MD. I’m sure it will rub some folks the wrong way, but that’s how I feel. Maybe being a PA is a perfect fit for your life and personality – good for you.
So why not just go to medical school now? Because it would be a colossal waste of time, money, and talent. The opportunity cost would be over 1 million dollars. Not to mention that I would have to uproot my family (again) and move across the country. It wouldn’t do my FIRE plans any favors, either.
Here’s another inconvenient truth: MDs don’t have a corner on high-quality patient care and they aren’t the only individuals worthy of respect. But there is some freedom and peace recognizing that, if I had the chance, I would have done things differently. So I’m trying to do the best with what I have and you still won’t find a bigger advocate for PA advancement than me.
Financial Implications of a PA Doctorate
PA doctorates range from a low of $18,000 (AT Still) to a high of $43,000 (High Point University), so they aren’t exactly cheap. And with PA school debt now commonly surpassing $100,000, it’s not hard to make the case that things are getting out of hand. You could easily go to some PA schools and spend as much or more than a public medical school (I’m looking at you Duquesne University). Add a doctorate to that and you’ll be paying down those loans for a looong time.
On the other hand, I borrowed only $60,000 for an in-state PA program and was debt free after a few years thanks to the National Health Service Corps. I paid for LMU’s $35,000 tuition as I went, though I had looked at various ways to finance it including government and private loans, and credit cards. There aren’t any significant scholarships that I’m aware of.
Has becoming a Doctor of Medical Science made me any more money? Yes and no – time will tell. But I am a more competent clinician, however, and that’s ultimately what matters.
Professional Opportunities with a PA Doctorate
I’m not yet decided on where to go from here. I am blessed to practice medicine with a good physician colleague who values my contributions so I don’t have any immediate plans to move. Many PA Doctors are moving into pharmaceuticals and medical devices as MSLs (Medical Science Liaisons). It’s a good gig if you can snag an interview but it typically involves a lot of travel.
I’ve also taught at a private university and would consider taking it up again. I feel that I’m definitely more qualified for a faculty position as a doctor with a terminal degree.
DMS on FIRE
Thankfully, I was turned on to the idea of financial independence early in my adult life. And since that time, I feel like I’ve done a decent job living on less than I earn and investing the rest. I do dream of the day when I’ll have a high enough net worth to do whatever I want – work or not, be a PA or something else.
Besides a frugal lifestyle and paying down debt, investing wisely has been a passion of mine. I am a fan of indexed ETFs for the basis of most anyone’s portfolio. I’ve also dabbled in currencies, peer-to-peer lending, cryptocurrency, and real estate. My current hobby project is a Buffet-esque focus portfolio of 15-20 individual stocks. I keep all of these pet projects to no more than 5-10% of my total portfolio.
Before I had a 401(k) that I maxed out, I had both a Roth and Traditional IRA. I started with the Roth given the tax-free growth but then I added a Traditional IRA (for my wife) to take advantage of a tax deduction right now. Now that I’m contributing to my 401(k), and paying off the DMS, it’s been a while since I’ve contributed to either of the IRAs or my brokerage accounts.
Currently, I’m working towards paying off a vehicle and a loan to upgrade our home HVAC system. I’ll then concentrate on building a savings account with 6 months of expenses. I track my networth with a free account at Personal Capital and I have a Google spreadsheet I created for projecting an annual budget. I’ve programmed the spreadsheet to calculate the time it will take me to be financially independent depending on my current net worth and market conditions. Currently, it stands at around 10 years at which time I’ll be about 45 years old. Not bad.
It’s still too early to say whether or not my doctorate will help or hinder my efforts to become financially independent, but I do feel certain that it has advanced my career as a PA. It was a tough program that I put a lot of time and effort into, and I’m proud of the accomplishment, but it’s not for everyone.
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