Protecting physicians

Advocacy win: Tennessee’s Doctor of Medical Science degree legislation

The AOA and TOMA helped shut down legislation that would have created a pathway for DMS degree holders to operate under limited physician supervision.

In 2017, Tennessee lawmakers introduced first-of-its-kind legislation to create a special licensing pathway to allow physician assistants who complete a newly created Doctor of Medical Science (DMS) degree program to provide primary care services under limited physician supervision.

The legislation was backed by Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tennessee, which offers the only DMS degree program which would meet the criteria established by the bill (the DMS program is not AOA-accredited).

The AOA and the Tennessee Osteopathic Medical Association actively opposed this legislation, and in response to numerous concerns raised by stakeholders, LMU-DCOM released a statement on March 14 indicating that they would no longer pursue the legislation.


    1. David

      Your statement doesn’t reflect reality. Primary care providers are in demand and there are not enough residency slots, nor students wanting to practice primary care.

      A system solution is team-based medicine with 1 or 2 physicians and several non-physician providers all trained at advanced doctoral levels for patient safety and cost control. Another version would be several physicians and 1 or 2 non-physicians specializing in chronic disease management.

      Your statement is as realistic as a paramedic saying now shut down the expansion of EMTs!

  1. DO

    The practice creep among NP/PAs has been astonishing. And physicians have succumbed to outside pressures to allow it. People in education have have cried for “ interprofessional education” as physicians have more burdens to have to accomplish in a typical patient visit – but this (interprofessional education) I believe has translated to “what’s the cheapest way to replace/ avoid hiring – a physician.” Collaboration shouldn’t mean replacing physicians.

    My suspicion is the Tennessee legislation (largely centered around a PA doctoral, “DMS” program) was opposed by nursing and PA groups – as they are fighting for independence even with their current level of training without a doctoral degree – ARNPs and PAs have – with a few rare exceptions- Masters training. In sharp contrast to physician education, many of these ARNP Masters programs are now completed mostly online while these students work full time jobs (I know an ARNP that worked as an LPN and RN in S Carolina while apparently completing her ARNP/ Masters degree from a school in Kentucky) and PA education is extraordinarily brief for the reponsibility and privilege they are given (2.5 years!)

    I actually really like what LECOM has done. They say hey I know you’re a Physician Assistsnt but if you want to be a doctor (namely a DO) let’s get you into medical school. They’ve recognized PA training and give them a year of advanced standing (essentially). So it’s a 3 year DO program for licensed Physician Assistants.

    1. David

      Yes indeed the opposition came strongly from NP and PA lobbyists.

      Going to medical school, forgive me, is a waste of time and money. If you want to be a physician with a physician title, then go to medical school. But in 2018 we are seeing that there are other viable pathways to patient care. LECOM would require 3 years and $150K tuition and additional loss income in residency. This is not affordable. Why not just have LECOM develop a program that takes PAs and train them in their medical curriculum where they are?

      I would rather train as a PA for 2.5 years, practice for 3 to 5 years in primary care, IM or the ED, spend an additional 2 years in medical training by a medical school fulfilling ACGME requirements (all the while not having to leave practice and incur more debt) and finish being able to practice with more primary care privileges. The DMS legislation was not offering autonomy without oversight, it was offering greater privileges with physician oversight and regulation.

      What if a PA trained in school for 2.5 years, practiced for 5 years, completed another 2 years of medical training with board exams and then entered a specialized primary care residency program with the same medical school for lets say 18 months. The focus was primary care, chronic disease managment and lets say behavioral health? Hmm food for thought. Now you have a provider who has trained for 4.5 years post bac, plus 5 years, plus an additional 18 months residency and boarded. Still not a physician, but good enough for society?

  2. Robert G. Kloos, D.O., FACOS

    Shame on Lincoln Memorial University – DeBusk College of Osteopathic Medicine for even creating an “Doctoral” degree of Medical Science. You are an Osteopathic Medical School. You should be training osteopathic physicians. You want to train Nurse Practitioners or Physician Assistants, fine, but don’t obfuscate and confuse the public into thinking their healthcare provider is a doctor. We don’t need our own profession shooting us in the foot.
    Seems everybody wants to be called “doctor,” but they don’t want to go through what it takes to become one. Physical therapists now are granted DPT degree. Pharmacists are granted PharmD, Nurses are being awarded Doctorate of Nursing degrees, yes, Dr. Nurse. And of course, once called “doctor,” the push is on to expand privileges and scope of practice.
    We are undermining our own profession. As it becomes cheaper to make a doctor, we cheapen the care, while increasing the cost. There is a difference when I have a patient referred to me for surgery if their provider is a physician, or a wanna be. The non-physician has usually done many more tests- – -mostly unnecessary, and costly- – – and still have no working diagnosis; they just send the patient for me to figure it out.
    I can only thank God that I plan to work just 6 more years. But I worry who will be there to care for me; it won’t be a non-physician!

    1. Chris Smith

      They will be a doctor but not a physician. There is a difference. Medical and Osteopathic physicians do not own the title “doctor”. Have faith that the population. Can understand that. I do and I’m not in the medical field.

    2. Steven Johnson, PA-C, DMSC

      Physicians do not own the term “doctor.” It is an academic degree and you should applaud the other professions for challenging themselves to be trained at the highest level possible. Show me the peer-reviewed evidence that medical care provided by non-physicians is inferior to that of physicians. The VA has plenty of studies suggesting otherwise.

  3. Richard

    I think that the pathway for a new provider wouild have been great for a PA and DO/MD. It’s terrible cause the nursing lobby is stronger than both the osteopath and physician assistant. What’s wrong with acknowledging that the PA education is superior to the NP and our doctorate would have accounted for more. The nurses go to school once a week for NP and DNP , while our program is a full time 40 to 50 hr a week program. I wish the MD/DO didn’t fight against this legislation. We would be limited to family medicine anyways. This would have given us the same respect if not more than the NP for the effort we put in our career as well as the education

  4. Robert Miller, D.O.

    Did you folks know that Butler University in Indianapolis is starting an online DMS program soon ? Why don’t the PAs go back to med school, if they want to be a DOCTOR ?

      1. Jude Opoku DO

        MDs are allopaths but they are practicing medicine. Should they go back to school of medicine in order to practice? Your point is the weakest one yet

    1. David

      Because its the year 2018 now and there are many advanced technologies that are disruptive and changing the face of education. It’s like a MBA who went to brick and mortar school saying to a DO who gets an MBA online that his/her degree was not legit due to using online technology.

      I have personally attend UTSW 2nd year medical school GI medicine blocks and less than 50% of the class was present because they are at home watching the videos!!!!!

      What if you were a DO with 1 year residency practicing as a GP and all of sudden someone said you weren’t qualified to practice anymore, that you had to go back to brick and mortar school, stop worrying about being a parent and spend another 150K to get a degree that someone thought was better than the one you had? Not fair of course.

      Did you know that even to get into medical school after practicing 13 years of medicine and surgery, I would have to do an entire post bac in basic science just to waste my time taking the MCAT that has no relevance to my medical knolwedge and compete with 21 yo’s just coming out of studying biochem. Only to sit around and learn stuff I already know so that I get into a residency!

      No, we live in a world that strives for efficiency, not redundancy. I believe in disruptive educational models that challenge our current preconceived attitudes and prejudices. Medical training of the future will be very different then it is now. This is already happening with 3 yr medical schools in several states.

      I will go to medical school if you waive the MCAT and allow my record to prove my academic success and let me finish in 2.5 years and only 1 year residency.

    2. Nkechi

      My sister is a DOCTOR of science as she has a PhD in Chemistry. My father is a DOCTOR of computer science (again PhD). My brother is an MD. I plan to get my doctorate soon to advance my career as a PA educator. DOCTOR is not synonymous with physician. I don’t know when or why educated people can’t see to understand that distinction.

  5. Ian Allen

    It’s a win for the DO’s and MD’s but a loss for the patients. With our aging population and the looming 120,000 physician shortage in America we are refusing to address the crisis because the AOA and AMA’s ego’s are “too big to fail.” You can send everyone to medical school all day long but there are not nearly enough residency programs, thus we are right back at square one and the patients have no one to go to and thus no access to healthcare.

    Also NO one is going into family medicine. Primary Care, aka first-line in healthcare, is the most deficient. We are either going to have to start letting new medical grads practice as GP’s or let mid-levels have some sort of primary care independence. PA school is 2.5 years after undergrad, then the DMS program required the PA to have been practicing in EM, IM, or FM for 3 years, then it itself was 2 years from that to “finish off the masters in medical science.” Equaling 7 years of medical training and practice. LMU is doing this because they see the writing on the wall and are addressing the issue head on. I know PA’s and NP’s with doctorates and 100% of them are respectful enough not to address themselves as doctors to the patients, docs, or RNs/MAs. The mid-levels are not asking to practice cardiology or nephrology on their own but only primary care where screening and chronic disease management is the focus. They can always refer to the specialists. Let’s not let our ego’s get in the way.

  6. Janet

    Physician Assistant Programs average 115 graduate hours to obtain a Masters Degree. Nurse Practitioner average 50 for Masters and 80 for Doctorate. The Lincoln Memorial Program would require an additional 45 hours, just in case you can’t do the math, that’s 160 graduate hours for PA to obtain DMS. I’ve seen the remarks that coursework is largely online. However, the majority of NP programs are online quite often no RN experience required. Additionally, I know several medical students or recent MD graduates, who readily admit they are/were not required to attend lectures. Instead they watch online, sometimes at 1.5 speed. Primary Care, in many states, is heading to NP with VERY limited education. It doesn’t appear that those who approve legislation really understand the educational requirements. PLEASE give me a Physician Assistant with Masters or a DMS. Although DMS not same, it is near DO and possibly as good or better than as advertised foreign medical schools, as my Primary Care Provider. I hate the thought of my future Primary Care provider being an NP with less than half the graduate hours of Master level PA with being my provider.

  7. Chris Smith

    Physicians do not own the term doctor. Yes, PAs and NPs can be doctors, but they aren’t physicians. Trust the population to know the difference; I do. I’m not a nurse, PA, or medical provider et al, but I still know the difference.

  8. Pingback: Doctor of Medical Science Legislation "Not Palatable" to Physicians

  9. Sarah

    Tired of MD/DOs fighting against PAs. We took classes alongside the DOs (or MDs depending on the school) and we were required to have higher grades to pass the same classes. We were required to actually attend class 8-5 year round with no summer break. We would study with the second year DO students and some of the PAs were way more knowledgeable then they were. More years of education does not magically make you a better provider. Research backs up the claim the PAs can provide equivalent high quality care to patients. It’s kind of funny now that physician programs (some) have shortened programs and now allowing “assistant physicians” to practice out of school with no residency… so PA school…I don’t see the difference other than title.

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