Let’s stop degree creep in health care

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist.  And for the nurse, unless they have RN, BSN or RN, MSN after their name they can’t be the floor nurse or work in a clinic.  And for the physician its becoming commonplace for them to have MPH, PhD, or ScD after their name if they want to do academic research.

Let’s not forget the audiologist who nows has to have a AuD to practice as well as the physical therapist profession who is now upping their degree requirements for graduating students to being a DPT degree.  There’s also the NP profession which is going to require a DNP degree by 2015.

What’s with all of the degree creep in the health sciences all about?  Does everyone really need a doctorate degree after their name to prove their worth?  Or are we showing our insecurity?  Do we believe that by having a higher degree it will then make us qualified to practice in our chosen health career?

Is there really a difference between a RPh degree and a PharmD degree?  Does this really make a better pharmacist who’s out there practicing?  Is there a difference in how a NP practices who has a MSN degree vs. a DNP degree?  How about the physical therapist?  Do you see a difference between a master’s degree credentialed PT vs the DPT credentialed when taking care of the patient’s therapy demands?

What “bug” has bitten all of us?  It seems that all of the health career fields are no longer content with their previous education degree.  Do they now believe they have to acquire a higher degree?  For what?  To prove what?  Or is it possible that the higher degrees are just padding the academic institutions pocket in regards to higher tuitions?  Or are the higher degrees actually training and teaching the students material they need to know?

I’ve talked to many people in health care and in my conversations with them I’ve come away with knowing that they all agree that in their various fields (I have friends who are pharmacists, NPs, RNs, PTs, PAs) and they all agree that the higher degrees being required by their professions is not creating a better enabled clinician upon graduating.  Yes, they have some additional requirements in doing research, or writing a few more papers, but when it comes down to taking care of patients, the additional higher degree didn’t make any difference.

So let’s stop this train, it’s has gotten out of control.  Let’s stop this degree creep.  We are all capable health care providers, no matter our degree, or credentials.  And we definitely don’t need ‘doctorate’ after our name to prove it.

Sharon Bahrych is a physician assistant who blogs at A PA View on Medicine.

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  • Anonymous

    another way to consider what you’re suggesting is, “what we should do is step back and consider what a person REALLY needs to know how to do, to “do” health care.

    can of worms, meet Sharon Bahrych, PA-C, MPH

    I agree with that assertion, by the way.

    • Anonymous

      please explain your ‘can of worms’ civisisus.

  • http://www.facebook.com/paul.c.weiss Paul Weiss

    I graduated in 1990 with my bachelor’s degree in physical therapy. The amount of new information that has developed in my field since that time is staggering. I greatly enjoy keeping up with it. To stay abreast, I regularly present at district and state meetings of my professional association.

    I can not see how people could enter my field these days without having an advanced degree.

    I share the authors concern regarding rising tuition costs.

  • http://drrjv.wordpress.com/ drrjv

    Great post! Basically, everybody wants to be a doctor – pharmacists, nurses, physical therapists, audiologists, lawyers, chiropractors. Next thing, electricians and plumbers!

    Brings to mine a favorite clip: http://www.youtube.com/watch?v=xVdUsgYA_D4

  • http://www.facebook.com/people/Patricia-Kelly/56303697 Patricia Kelly

    what we could actually do is follow the United Kingdom on this issue.  All professions get professional Bachelors degrees of 3-6 years in length.  Physicians get Bachelors of Medicine and Surgery….6 years.  Nurses get Bachelors in Nursing (3-4 years).  PTs, OTs, get 4 year bachelors degrees, as do pharmacists, vets, podiatrists.  Dentists get 5 or 6 year bachelors degrees.   There is no MD in the UK as an entry level degree; it is a research post professional degree, much like a PhD, instead.   In order to make up for time lost, years spent at university are entirely on the professional subject studied (nursing, medicine, dentistry, physical therapy, etc.)  All pre-reqs and general studies are done at the secondary level and proven by “A” level examinations written at age 18 or so.   There is no degree creep and there is now an emphasis on making sure that the professions can be as inclusive (rather than out of reach) as possible.  

    • Dana Sayre-Stanhope

      True – but guess who’s the only one who gets called “doctor”

      • http://pulse.yahoo.com/_UDJTUH45CFUC6LKCBLB6FGRDKU Diane

        Oh, I was watching one of the medical type shows filmed in one of those European countries on Discovery Health recently and I noticed the doctors were called Mr. I believe this show was a special and involved a surgeon even so I was quite suprised to see that.

  • Megan Rose

    Hey Sharon, PA-C, MPH…In the haste of your jealousy you must not have noticed that you are contradicting yourself. You also follow your licensed credential with an academic credential. 

    I applaud those of us that have not become aged and bitter and actually enjoy our profession enough to care about providing others with the best healthcare experience. These are the people pursuing additional educational opportunities. What is the harm in wanting to know as much as possible? Jealous much?

    • Anonymous

      Okay, Megan, first off I’m not jealous.  Yes, I did follow my professional degree with an academic credential, that happened 17 yrs ago.  At that point in time I wanted to get the master’s because I wanted to address my lack of research skills, which my MPH taught me as well as epidemiology.  And I have used my MPH skills/knowledge ever since, seeing that I do a lot of medical research.  I don’t have a problem with those of us in the health care field who acquire additional post professional degrees if they are wanting to broaden their educational/scientific to do research or go into academia. 
      The point of my post was that I’m seeing a lot of health care programs that are requiring a masters or doctoral degree when they used to require only a bachelor’s or masters (such as what I listed above).  Unless you are going into academia to teach, do those clinicians really need those advanced degrees?  My fellow colleagues tell me ‘no.’

  • http://pulse.yahoo.com/_CXFHAQB33DHMT4OAARKIKABBBE Surrendered

    The real problem is in the medical setting where everyone is called “doctor”. It does a disservice to the patient, family and everyone involved.  For further confirmation what potential problem this is – watch this hilarious Youtube video http://youtu.be/Tmj6WtkJg8A

  • Anonymous

    “We are all capable health care providers, no matter our degree, or credentials.  And we definitely don’t need ‘doctorate’ after our name to prove it.”

    I seriously disagree. My wife is a BSN, and the difference in abilities between her and a nurses’ assistant, MA, or LVN is quite staggering. Additionally, the difference between a PA and an MD/DO is incomparable. I have worked with several PA’s, and have been referred consults by several more in the same specialty. The lack of knowledge by these so-called “specialized” PA’s is immense. But that’s expected, considering the lack of intensive training in medical school and an appropriate residency. PA’s serve the purpose of providing access to healthcare at a cheaper cost to society, as well as to maximize some private practice physicians’ revenues.

    To be honest, I would have respected your position more if you were an MD/DO. But, given your credentials, it seems like you are actually showing your insecurity with this article. Everyone has a place in healthcare, and they need to know the limits of their abilities…period.

  • http://www.facebook.com/people/Patricia-Kelly/56303697 Patricia Kelly

    To MuddyWaterz,

    I’m pretty sure she meant “capable providers” within their own scope of practice.   And, I think you need to judge providers at the professional level on their own individual merits, training, specialization and abilities because we are all unique.    We all have experience with conferring or referring to specialists who know far more than we do about certain areas.  Within our own areas,  though, which may be narrow or broad, our competence should be assured and we should know what we don’t know, restricting our practice to that with which we are comfortable and referring as appropriate.   

  • http://www.facebook.com/ed.mathes Ed Mathes

     
    I, personally, have an Associates Degree.  Obtained at a time when most PA programs were awarding Certificates, back in the 70′s.  SInce that time I have completed a BS degree…. in general sciences.  Has it helped?  Knowledge is a good thing.  Has it affected my ability to gain employment?  No. I have published a dozen or so articles and wrote a book chapter in a respected textbook.  Would having a Master’s or a Doctorate made a difference? No. 

     I don’t even list my degree on my resume any more. Do I need an advanced degree?  30 years after entering my profession I’m not sure I would learn anything that would help me clinically.  CLINICALLY.  You read, do CME, keep up with the literature, you should be good.

    I do see a benefit if you are doing academia and/or research.  I, with my A.S. ans B.S. degrees, have 2 major projects going right now, in collaboration with a couple of PhDs.  I am the PI.  I designed and run the research projects.  My co-investigators are a microbiologist and an engineer.  Plus a couple students for data entry and general scut work.  Admittedly,  I have struggled with some facets of the research.  Designing the trial, obtaining the grants, crunching the numbers, have proven somewhat difficult.  But I learn as I go, or seek help from one of the many experts at my hospital.So maybe here an M.S. or Doctorate would help.  Certainly the PhDs run circles around me when it comes to Theory and Crunching numbers.  I contribute the clinical applications/endpoints.
     
    And I have no desire to complete an advanced degree.  I am old enough and been around long enough to let my track record speak for itself.  That being said, when asked about the “type” of PA programs someone should attend, I encourage nothing less than a Master’s program.  We, as a profession, have to be able to “compete”.  

    I understand what Sharon is saying.  Is an advanced degree required to function effectively in a clinical setting? Does everyone need a Doctoral title after thier name to prove their worth?  If I can be held up as an example, no. 

    Ed

  • http://www.facebook.com/people/Yale-Lewis/100001648132529 Yale Lewis

    Noctors are always trying to feather their nests, and use a lot of alphabet soup.

  • http://www.facebook.com/people/Karl-Hafner/100001398635141 Karl Hafner

    It is to the point that if you don’t have specialty boards in medicine you most likely will be very limited in what you can do or more importantly what you will get paid for.  Some advance degrees do help.  My MPH is very helpful in my medical practice.  In general we are going to far.  I don’t need to or want to spend my life learning and get to work for just a few years. 

  • http://pulse.yahoo.com/_UDJTUH45CFUC6LKCBLB6FGRDKU Diane

    I graduated with a PharmD 20 years ago – it was the only degree offered at the school I happened to go to. At the time, it was a best deal for me, since I wasn’t interested in working 9-9 in a retail store (even though the pay was 2-3 times as much at the time!)  Now that’s the only degree offered and there is so much competition you need a entry level degree just to get in school. In my current life, I have to keep up just as much as everyone else so the only time it matters is when my alma mater calls and addresses me by Dr. X and I have to blink and wonder who they are talking about! We send clinical letters to doctors many times a day at my job and I address them by my first name, since that’s how I answer the phone and that’s how they know us. My boss graduated before I was born and he is quite an intellegent and well read man with his RPh degree!

    But I have often considered that if I moved on to a more challenging job, I would need more knowledge and perhaps a little umph behind my name. There is so much competition with new graduates and those like me who feel the need to wander a bit that even experience doesn’t always count the same when other people have “proven” their knowledge with those titles/tests. So just as life gets more complicated and stressful with technology and whatnot, I believe learning is just another added feature. In today’s job market, if that requires a “title” to move on or move ahead, unfortunately, that’s part of life.

  • http://twitter.com/reedmonseur Raed Mansour

    Perhaps the “degree creep” is being pushed to make up for physician shortages and the medically underserved in health care.  In that case, I wouldn’t mind more allied health care providers getting professional doctorates to fill the void.  It may also be a way to circumvent MD/DO required referrals, something I believe that each profession may be pushing so that there are less gatekeepers and more access to health care.  I do agree with you that these health professionals probably aren’t any better clinically with more advanced degrees.  However, if I were a physician, I would consider more advanced degrees ahead of practing medicine if I plan on doing research, teach, or take governmental/leadership positions later in my career.

  • Anonymous

    Even my Primary Care Physician (PCP) admits that over 85 percent of the people he sees on a daily basis could easily be treated by an RN. The more serious cases could be referred as is regularly done today. He always says to me, as much as his fellow primary care peers try to embellish the seriousness of the profession, most primary care is not rocket science. He always says, “It’s pretty routine stuff.” He insists that, rather than having many private practices in a neighborhood, a neighborhood clinic with a staff of RNs and a Physician’s Assistant in charge could easily do the job while lowering health care costs for many consumers and as a result become more inclusive to the many uninsured and underinsured in that neighborhood. Do they need a PCP to oversee the clinic? Yes! But that same PCP could oversee several clinics and be on call. My doc says the neighborhood clinic model would lower costs dramatically and get care for many more people who go without care today!

  • Anonymous

    In days gone by, there were turf wars over different fee for service procedures among various medical specialists. Then one was required to subspecialize and become board certified to do different things one was supposedly appropriately trained to do in the first place. Consider cardiology. A noninvasive cardiologist to be optimally marketable today needs board certifications in echocardiography, nuclear medicine, cardiology, certified in CT. I myself am triple boarded in internal medicine, cardiology, and cardiac electrophysiology. We as physicians brought this on ourselves. Now nurses, PAs and others are using this to fight ‘turf wars’ meaning reimbursement increases. It is sad thatreimbursement certifications are motivated by money in the name of quality. Let’s call it what it is and stop the madness. I spent over $6K between board preps and exams in the past 2 years. The board awarding bodies are in this for the money also. Let’s all get real and focus the money on where it’s most effective: paying off our legislators to fix our broken healthcare system

    • Anonymous

      That’s a darn shame! Meanwhile over 50 million Americans have no hope of ever affording such designer specialties. Meanwhile, another estimated 25 million Americans don’t really know what their policy covers until they need it and find out they are underinsured. Meanwhile, our health care system uses up 18 percent of GDP, the most expensive health care in the world, and yet America ranks 37th worldwide in comprehensive health care rankings. Don’t even ask me about infant mortality rates! Best health care in the world? Yeah, for a select few! Geez Doc, just patch me up and throw me back into the game! 

      • Anonymous

        Dave,
        I totally agree with you. I was not complaining to complain. I was illustrating the absurdity of the medical system and to give non-physicians an idea of some reason why things are the way they are. I left medical practice this years because i feel I can help patients in more effective ways outside the practice of medicine, This healthcare system is embarrassing to me as a physician. It afforded me at the end a whole 15 minutes in the office with someone with life-threatening problems. It made me argue with high school graduates why i wanted to order a test or give a certain medication to a patient. So I am with you and all the others with substandard care and the countless others without insurance. My comments were to only illustrate some of the issues inside of medicine that have escalated and take the focus off of the real issue which is the patient.