I did not pursue this Doctor of Medical Science degree for the sole purpose of leadership or going into the academic world. When I look at the courses in this DMSc degree plan, I see courses that will help me as a PA. Courses like medical writing, community health, organizational leadership, and the other courses that I will take will definitely help me in my practice. I have already started to integrate some of the things that I have learned in my first year into my practice. It has not given me more autonomy or a higher pay, but it has allowed me to be a better communicator with my patients and with those that I work with. It has allowed me to look at practice issues from a different viewpoint and has helped me come up with solutions. I consider that a payoff for me.

When you look at the courses that we will take, honestly, they deal with the side of medicine that PA school has never taught you. If they did cover one of the topics, then it was most likely a 50-minute lecture they gave you. I would make the argument that these courses that we are taking should be taught in PA school and should be stand-alone courses. This will increase the timeline to completion, but it will have a payoff in a PA who is well-rounded and able to address the complex situations that we face in our daily practices. As a colleague describes it, seeing a patient during a visit is the easy part. It is all the "noise of medicine" (i.e. indirect stuff) that is the hard part. Schools do not prepare us for that.

I do not think that [courses] have to be "pointless credits." These can be courses that set up PAs for lifelong success. As the program director of a postgraduate fellowship for NPs and PAs, I see on a regular basis that our NP and PA schools are failing to prepare these graduates for the realities of medicine. They are great in the book aspect of medicine but poor in knowledge in dealing with the realities of medicine. Things like developing a quality improvement plan or communicating in your writing are so important. Leadership classes. Dealing with the business side of medicine. These are all things that we are covering in this doctoral program. You give these skills to students and, then they will continue to remain relevant as a PA in their organization. When you remain relevant, then there is a good chance for promotion at best and, at worst, not being laid off by your organization if times are tough.

In our program, our Fellows have to plan and execute a QI project. We as a program teach them how to do that. Quality Improvement metrics are the way that medicine is going. Eventually reimbursement will be based on that. Meet a metric, and you will receive full reimbursement. Fail to meet those metrics, then you do not get paid. Right now, we are in the phase of if you meet or exceed a measure then your organization gets bonus money from the health plan. For example, one of our Fellows tackled the low screening rates for diabetic retinopathy in our clinic. Through her project and working with the staff, she was able to raise the rates significantly. The rates rose so significantly that our clinic received over $1 million because we met a metric set by our Medicaid management organization. That NP became very relevant to our organization because she raised the quality of care in our organization but then also brought in over $1 million that was used to enhance some of our patient care programs.

All of this is to say that I do not think, as a profession, we should shy away from a doctoral degree. This is not a path just for those that want to go into academics, leadership, or research. This is a path that can teach you so many different skills that you can use in your personal practice and to help your organization to raise the bar for patient care, which we should all strive to do. PA curriculum currently does not give us enough tools to do that. This will help us to remain relevant in our personal practices but also on the national level. If we continue to bury our heads in the sand, then we will not have a seat at the table on the state and national level. Others will make the rules for us.

I could go on a long time about this topic, but I will close for now. In the end, once I complete the Doctor of Medical Science degree, the title of doctor will not matter at all if I do not use what I learn. I will be judged based on how I utilized the tools that I have been given. These tools that I am gaining through a doctoral program will continue to help me to stay relevant in my field.

-Robert Gamboe, PA-C, DMSc Class of 2026 Program Director NP/PA Fellowship Shasta Community Health Center