Season 1: Episode 9: Shenandoah University - Tony Miller, M.Ed., PA-C

Unknown Speaker  0:08  
Welcome to this episode of the PA path podcast. I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession

Unknown Speaker  0:25  
and, you know, think about the skill sets that we have to bring to bear and the amount of responsibility that we have as a professional and is that commensurate with with the degree that we're offering?

Unknown Speaker  0:41  
Well, hello and thank you for joining us again today. I'm excited to welcome back Stephanie Vander Mulan from Creighton University. As you know, Steph is a partner in this podcast and is going to be interviewing our guests with me together today. Our guest is a distinguished professor and former director of the Division of PA studies at Shenandoah University in Winchester, Virginia. We're talking about Mr. Tony Miller. He has over 42 years experience in VA education. And he has held a variety of educational leadership positions, including Associate Dean for the School of Allied Health and founding chair for the Department of PA studies at the Medical College of Ohio, which is now known as University of Toledo. He's been a division head a program director, a state president for the Ohio Association of VAs and a national president for the Association of PA programs, which is now known as PE A. He is a scholar, a gentleman, and a very insightful leader who we are excited to bring on board today. His resume and his bio is so large, we're going to post it on our website. But we are going to get into some of the areas that he has led over the years. So please join us in welcoming Mr. Miller.

Unknown Speaker  1:55  
Well, Tony, thank you so much for joining Stephen. today. We're so excited to talk about your career and about Shenandoah University and your perspectives on a lot of things in the profession. Let's start by asking you about your path to the PA profession.

Unknown Speaker  2:10  
Well, thanks for having me, both of you. I really appreciate it's an honor to be asked to be along with you on this journey in this podcast. Well, I had just graduated from high school and was working leave it or not as a garbage man for my summer job. And at some point, I got my draft number and out of the lottery, it looked like it was going to be fairly likely that I was going to end up in the rice paddies of Vietnam. And I thought I would like to have an alternative to that. So my dad had been in the Navy. And so we went down together to the Navy recruiter and talked about different options. And long story short, I ended up joining and initially actually became a radar man, because I initially signed up to be a photographer's mate. And they said, Really, I don't know why the recruiter told you that you could be of tigers mate. There's like two in the United States Navy. And you have to wait for one of those guys to die or retire. So I was a radar man, I was attached to a destroyer, the USS Richard II bird, and eventually worked in with the chiefs and shadowed a corpsman chief on our ship and really got interested and petition to get transferred and go to core school. And believe it or not, I got accepted. We were in the Mediterranean at the time I hopped off the ship went back to the states and became I went to the core school at Great Lakes where ultimately got stationed. I did some time in med surge and also at one point got transferred to boot camp to do daily sit call. And it's there where I met a guy I think his name was Chuck curry and Chuck was a PA and he was our medical officer and we got chatting about things. And I really was intrigued by the PA program. There was also some students from the University of Nebraska that were also in the military, that I had a chance to chat with the hand it turns out that there was a PA program that I didn't know about at Cuyahoga Community College that was affiliated with a collision clinic. I applied to that program and got in I was to my surprise, and then I was really nervous of whether they would let me get out early. So I got a two months early out in order to go to PA school and went to that program and believe it or not, you know not that typical that you would get in the first time you tried to a program but I did. And that that was my initial start and Pa education or not a P education but in the PA profession. Right after that I was sort of an interesting time. So I would just say that the we as a class had to advertise for our jobs. I mean, we took out ads and the American Academy of Family Practice journal which by the way, had a disclaimer at the end, saying that just because we put our ads in the classified that didn't mean that they endorsed the PA profession. So it's sort of odd. But I ended up getting a job in a small town in Ohio for a guy named Melton layman. By the way, there's a book about him now because of his work with the Amish. And I worked with him and was a great job. But I got recruited to Cuyahoga Community College and to become a sort of a faculty member at that time, we were called preceptors. Because we couldn't go on a faculty contract. And that was in 1978, that I got my first start and Pa education, worked in multiple jobs. You know, he did clinical coordinator, Academic Coordinator, and then eventually became the program director. And at that time, I became a program director of two PA program well, a PA program in a surgical surgeon's assistant program, because we had both at that time. So I did that for a few years, eventually moved into administrative position would be like a Dean's position at that time was called division head of health careers and natural sciences. And for about five years and really enjoyed that job. I actually oversaw the PA program and the essay program, we got a new president, and she decided to have this what we call competitive repositioning. All the administrators had to apply for new jobs. And well I wasn't selected shortly thereafter, ended up developing a the first master's program in Ohio at the Medical College of Ohio, which now is the University of Toledo and stayed there for a number of years, met this gentleman at an APA conference in Chicago. Right after I gave this talk. I'm as you know, we were at that time, we were doing presentations on the degree issue. And he said I you know, I heard that you might make a good program director and I'm recruiting right now. And I said, Well, I'm not really looking for a job and he goes fine. Just, that's perfect. Come and have lunch with me. Turns out he was the president of the university at Shenandoah University. And I was sort of intrigued because most of time is both of you know, when people are recruiting for program directors, it's usually a dean or biology ad or something like that. But the President came all the way to Chicago to recruit recruiting, so I thought it'd be worthwhile to give them some time. I met him for lunch, and then the next day again for breakfast and long story short, I came out there interviewed, it's a beautiful spot. And some things were happening in my life that made it possible for me to move and in October of 2000, I ended up at Shenandoah University. And we launched the first program or the first cohort in 2001.

Unknown Speaker  7:44  
So Tony, tell us a little bit about you've been at Shenandoah for quite a number of years now. So tell us a little bit about Shenandoah, you know, kind of what sets Shenandoah apart? What makes it unique? And you know, what would you say applicants need to know about Shenandoah University PA program?

Unknown Speaker  8:01  
Sure. So I think the thing that intrigued me about Canada was it was the first private school that I worked at I have been at a public community college and I was at a public medical school while the state systems this was the first private and I was intrigued by the fact that Shenandoah has a diversity of offer. So we have a highly rated conservatory. We have an arts and sciences and I was always intrigued by the intersection of arts and medicine. In fact, I've developed one of the first courses called humanities for the PA profession when I was there. So that small field when I first came there was only 2000 students, the and that still remains. We're up to about 4000 students right now, but it still has that small college feel. We're on first name basis with the President. Her name was Jim Davis, who recruited me and laughed and was replaced by Dr. Tracy Fitzsimmons. I know her as Tracy she knows me as Tony, it's all first name basis. We have interactions with the trustees on a first name basis as well and have visited with them and so forth. So it really is a family type of feeling at Shenandoah University. And that also means that we can do a lot of innovation and you know, balance off the arts and medicine so our students can go to a play or a performance free as long as it's because they're students that get in for free and they have that opportunity. And it's a beautiful area. We're in the Shenandoah Valley, only about an hour and a half to two hours away from DC so we you know, you can get the big city if you want to, or you can go hiking if you want to. And then shortly after I moved there maybe about five years after I moved there, you know we got our first olive garden so we made it to big time. We still don't have Trader Joe's or Whole Foods. We're working towards that.

Unknown Speaker  9:58  
How would you say that small school environment and that more family feel that first name basis with the President? How would you say that that translates to the student experience at Shenandoah?

Unknown Speaker  10:08  
Well, I think that the students know that we as faculty, and all the way up to the administration are approachable for what they would need if they have suggestions or you know, special requested that we are accessible to them. And that even though our class sizes a little bit approaching the higher side was over our class sizes 60. But we have 42, and our Winchester campus and 18 that are allowed on campus. So it still gives them and with the student faculty ratio that we have a way they still get the sort of the one on one interactions with the faculty, every student has an advisor that they meet with on a regular basis. So we still have that, you know, individual kind of appeal, one on one appeal, or the students have. And we do a lot of small group stuff too, as well. So the students get a lot of attention, if somebody is having trouble we know about it if somebody struggles we know about it. So I think that's sort of the I think that's the appeal. We also, you know, have high tech as well. So we have, but I call it we have high touch. And high tech, all of our students when they come in are issued a Apple MacBook and an iPad. And they use that throughout their curriculum that allowed us for example, to move when the COVID pandemic, you know, online or virtual education very easily, it was a very easy transition plus, because we were delivering educational content to our satellite campus, we were set up for that as well. So I would say that we're very nimble, we have high tech. And then we also have that one on one sort of family kind of environment for

Unknown Speaker  11:47  
students. And, Tony, I know over the years, as I've watched you, your brain is always engaging into something innovative, something new. So you talked about some of the innovative things that you were the flexibility that you receive, because of the the institutional support. Looking back, what are some of the things that you are most proud of that you developed at the school that are still in play today?

Unknown Speaker  12:08  
Well, I think one of them is, is that we've been very successful in achieving federal funding through grants. And that has allowed us the resources to do some of the things that we want it to so one of the things that we have right now is one day a week, our students are in a student faculty run interprofessional clinic that we run at our local free clinic, which is called the Sinclair health clinic, that is grant funded, that helps pay for the infrastructure costs with that, the grant has also allowed us to help students with the costs of being deployed for clinical rotations, that remote areas, which has helped with our primary care mission, our rural focus, so that we can support students when they have to take clinical rotations and be away from their armaments and have to pay for housing, we've been able to use it to buy some equipment in the past that has helped us keep up from a technology standpoint, our humanities course I think is unique, which combines cultural awareness or cultural competence or cultural sensitivity, if you will. We also do our ethics within that course. And then also something we call experiencing medicine to the arts. So when we look at, for example, the issues of death and dying and reactions to illness, we use some movies as a way to stimulate student thought and, and an emotional connection to that through sort of a vicarious experience to the movie, and then allows them to talk about things that they may have trouble talking about, if you're just talking about it. From a theoretical standpoint,

Unknown Speaker  13:44  
one of the things that I remember from our engagement early in my career as an academic, were the faculty development workshops that you did with all your colleagues. I think the first time I came across your training was Phoenix. So one of the things you're famous or infamous for is your contributions to PA education in terms of faculty development. So if you can talk a little bit about your passion for leadership, and maybe why you landed in that realm of faculty and curricular development.

Unknown Speaker  14:15  
Yeah, I'm not sure why I landed there. I've always felt that we needed to help our own to get the skills and knowledge that we have. And it was our sort of like bootstrapping folks along the way. And I was very full. And I think that came out of my experience of serving on the board of the Association of PA programs now PA, back and I was the president in about the mid 1980s. In the late 80s or early 90s. We were able to have we had been working with the federal government we were able to secure a contract for leadership training and that was allowed us to bring aspiring program directors, Associate Directors and so forth. For a full week experience. It's St. Francis universe. So Jim Liberato. And we were able to do that, you know, basically for free for a couple of cohorts, eventually, then we ended had to ask people to pay for it. But I work with Simon and some others, to offer those workshops. And then I think they were amazing. I mean, one of the individuals who was flying back on the flight after we'd finished the workshop was one of our students. And she leaned over to me and said, you know, this seems like a lot of fun for you. And it seems like I really want to get involved in becoming a leader in the profession. And that person was Anita Glick, and who eventually became the director of the Colorado program has done a lot of things for our profession became president, so forth. So. And I just recently saw an article that was written when Don Martin regards his recently was appointed to the CEO of NCCPA. And she credited the LTI, or Leadership Training Institute as one of the pivotal areas of her development as a leader. So I'm really proud. And when you see those kinds of success stories, it just wants you to do more and more and more, the leadership thing then turned into we looked at the basic skills, I think there was a grant that actually initially funded the basic skills workshops, and that continued to grow, people were eager for that kind of Faculty Development. I will say that over the years, people said, well, we should, you know, make this more accessible, making it online, and so forth. And we've always pushed back on that, because while we provide some good content, I think the biggest thing that folks get out of those is the relationships that they've developed with their cohort over the over that time. And I see Stephanie nodding, so it just that's probably one of the biggest factors is that development of long term professional relationships. You can call somebody on the phone and say, Hey, I'm having trouble with this particular standard, or this particular for the aarC or I'm having trouble with, you know, retooling my tests, can you give me a help, and now we have that support

Unknown Speaker  17:04  
system? That's quite a legacy. When you think about the cohorts that go through, you often see them ultimately teaching those workshops together. So you you continue that legacy, just from the investment that you made? That's That's great. Thanks.

Unknown Speaker  17:19  
I think that's something that's very unique to PA education and Pa educators is that that collaborative spirit, and that there's a thing that I was like, and that is the rising tide floats all boats? And I think that's, you know, that's I think that's something that the PA educators do well, it's, we share knowledge, we share best practices, and, and it's something that I think all programs and all educators benefit from. So Tony, the PA curriculum is densely packed, it always has been and with the growing body of medical knowledge and the advancement of medical technologies, it gets more and more challenging to condense the the appropriate amount of information into a curriculum into a shortened period of time. So what do you see are some of the toughest challenges that your PA students face throughout the process of their education? And what advice do you give those students to help them navigate pa education?

Unknown Speaker  18:12  
Yeah, I think there's a lot of challenges. And I think that the challenges are often unique to each individual, depending on whether they're a traditional student or a non traditional student, whether they have family, or they don't have family and so many different factors. So I'd say the first thing would be is getting to know the student and really having some type of advising mentoring relationship with them, to really feel out what their unique situation is, and to help them individually. But if you wanted to look at sort of a group, make some generalizations. I would say one of the things that are happening right now is the cost of education continues to rise. And I think in the last a PA salary report, we saw that there really wasn't much of an increase in salary. So will that rising tuition continue? Will those I guess will this, the graduates be able to amortize their debt effectively with the salaries that they're getting in the future? And the opportunities and I think that's another thing we need to watch as a profession are the are the opportunities for our graduates continuing to be there? I think last year, in the last couple years, things may have slowed down. It might be possible to say that that was related to COVID. But it Time will tell whether or not the job market for PCs will continue to grow. But Stephanie, you're you're absolutely right. I think the expectations for our graduates continues to grow. When you and I Kevin got out, I think there was some patience on the part of our initial job supervisors whether that was our supervising physician or or team to allow us some time to sort of grow into that job and so forth. I feel like my doc that I worked My first job was very patient. I don't see that as much. I think that our our graduates are expected to hit the ground running. And when I worked at the medical school, I could tell you in the halls I always hear well, don't worry about that they'll get that in residency, don't worry about that, they'll get that a residency. Well, we don't have residency per se. I mean, you know, it's optional. So we don't have a required residency. So our students have to hit the ground running. And not only are they expected to do patient care and provide high quality patient care, but they need to know a lot about the healthcare system. How did how people get reimbursed? What about insurance, how to code things, quality assurance, all kinds of, you know, patient safety, there's a lot of things that, that we have to continue to squeeze in our curriculum. And and that continues to be a challenge. So you asked about advice, I'd say general advice, continued to balance your work, and school and your life. Always make sure I always tell my students I said, You got to give yourself some time off during the week. Take take on that even if it's just an afternoon that this is not a study time this is for this is me time. Well, we also have to recognize that we are a helping profession. And that our focus always needs to be on what we need to do to eventually provide high quality, compassionate care for patients. And so there needs to be some self sacrifice to get to the point where we are competent providers, and also continue to be providers and that were that we're always taking the patient's interest above our

Unknown Speaker  21:38  
own. Tony, you brought up a really good point about the expectations for starting, I wonder, you know, when I started as a PA 1996, my first salary was $55,000. And at that time, I was 12. And I think at that time, the new interns that we hired probably made 140 or 150. And now I would you know, our grads, at least in LA coming into primary care are starting between 110 and 125. And the interns are probably starting between 225 to 275. I would imagine. So I don't know if that's a matter of the salary expectations. And you know, when you make a six figure salary, you generally are expected to be productive? Or is it related to the increasing NBA leadership of health systems that are you know, all these practices are being bought up. And Doc's are less and less responsible for the employment of a PA and more and more are just involved in collaboration or supervision. Do you think that which one? Do you think it is? Or is it both?

Unknown Speaker  22:48  
I think both, I think that there will always be an examination of the ratio between pA and physician salaries and whether that stabilizes or continues to narrow and gap. If it continues to narrowing gap, then people will continue to ask the question is, you know, do what why should I hire a physician assistant or a Physician Associate? When just for a couple more $1,000 I can get a sort of quote unquote, reel to reel doc, if you will. So I think that that ratio needs to be continued to be monitored. And, and again, it's a struggle because as tuition goes up, the expectation for salary is going to continue to grow. As our quote unquote autonomy goes up, you know, as we as the academy continues to push for OTP, as we continue to look for better recognition as a professional, then are the expectations for us goes up. And then of course our salary should go up commensurately. So it's that kind of struggle. But I think you're right about the EMBA kind of approach. I served until recently on the board of directors for Valley physician enterprise, which is the the organization that manages all of the not all of but some of the groups in in my area that came under this umbrella. And you know, we sit around our board meetings and talk about there's all kinds of metrics is this patient satisfaction metric? What is the metric of dealing with how many patients people see and how fast they get appointments? And how long do they have to wait for an appointment and how long they wait in the waiting around? So up in the boardroom? It's all about metrics. And probably the last thing to talk about is, you know, how many people are at, you know, mortality and morbidity, but I mean, that's part of the discussion, let me say, but most of the discussion is about the metrics. And like I just mentioned, the bottom line. Sure. Yeah, yeah. And money. How much are we losing? How much are we making?

Unknown Speaker  24:55  
Sure, sure. One of the things that I was hoping we could chat about was is your perspective on the doctoral degree, I think you've been a vocal proponent for the doctoral degree. And I'd love for you to share your reasons why, and certainly maybe update us on that, because I know it's an evolving thought process.

Unknown Speaker  25:12  
Yeah. And I want to start off by saying that I was not always favorable us moving to a doctoral degree. And I still have some scars for when I served as the chair of the degree Taskforce. So regarding that took us to the master's degree. We voted on that as an organization in October of 2000. And when that passed, with a lot of dissent, and so forth, and discussion at our business meeting, people put on black armband for the rest of the meeting. It was a pretty dicey time. And honestly, I went in there thinking that we were going to endorse a baccalaureate degree at that time, because we had certificate Baccalaureate master's degrees and associate degrees at that time. And when we sat down and examined it, we came to the conclusion that we really shouldn't be moving towards a master's degree. And we didn't there was no teeth in it, of course, you know, at that time until the aarC decided to make that a requirement, actually, just fairly recently. So the doctoral degree. As you know, there are

Unknown Speaker  26:17  
lots of programs that have started an add on doctoral degree. And for the most part, they're pretty successful and recruiting people. So there's a demand. And in at least one I've talked with directors, in some cases, there's waiting lists, they're not having much trouble filling that. A couple years ago on the Virginia Academy, a PA is asked me to give a talk. And it was because somebody else cancelled and they needed a last minute person and I don't talk much about clinical subjects. So I said, I'll talk about the doctoral degree because Betty Coplin and I had just written an article about that, you know, the doctoral degree a ticket to autonomy. And as I was given the presentation, which I thought was fair and balanced, I was saying, here's here's the tuition, here's the, you know, here are the sort of benefits. And here's the downside. Pa, in the back room stood up and asked me a question you said, you know, so basically, you're saying that the average PA program has about 107 credits, I said that that's true. And the average cost of PA program is somewhere in you know, 85 $95,000 range. Yeah, that's true. And it takes about 27 months or so. Yeah, all that's true. You go. So if I was to get an MBA or an MPH, I would, if I was doing an MBA, I'd take 45 credits, if I was doing an MPH, it'd be about 60 credits, and they'd probably be about half the cost. So you're saying that you guys are going to do us a favor, by offering a doctoral degree, after we graduate, have us come back and do 30, some more credits or whatever, and charge us another $30,000 While we're trying to work, and then have a family. And you think that you're going to pat yourself on the back about this. And that was a eureka moment. For me. I'm like, Sure, this guy's got a great point. Like, we're already there in credit hours. We're all already there in cost. Why do we need to, you know, do this, and I thought, there's an aspect of doing an add on doctoral degree that that, you know, that sort of struggles that I struggle with, from a moral standpoint, a moral and ethical standpoint, are we really, I mean, we're helping people. And, you know, it's not gonna make anybody a better clinician, necessarily. I mean, there are some programs like, I think Butler's that focuses on on more clinical things, but most of them are public policy, you know, leadership and so forth, or education. And so I think that we have an obligation to look at that issue. And see if we could do it more cost effectively and quickly for our graduates to give them a leg up not from a clinical standpoint, by by any stretch of the imagination, but by other things, other opportunities that they could create. And I'm really an advocate of an optional doctoral program programs that want to do it or, you know, create that track within their curriculum. And I'm talking entry level doctorate, let them be able to do that and offer that for the people that want it. Some people will not. And I would just add one other thing. Part of my motivation is, you know, you guys know Carl faster, and he's been a sort of a beacon for me and my growth as a PA educator. And he was the first person that I know that actually began to look at that and actually had proposed it internally before he retired at Baylor. And one of the things he said is, you know, really, it's not the clinical stuff that's really expanded as much although I think there was three antihypertensive drugs that I think I studied in PA school, and now there's like 300. But it's that quality assurance, the health care systems, all the other non clinical stuff that's really continued to grow, and has pushed the boundaries on our curriculum. You know, this whole argument about keeping up with the Joneses. Maybe we shouldn't, but, you know, pharmacies at the doctoral level PTS at the doctoral level, occupational therapy is an optional doctoral level, they almost went to a mandatory doctorate, but now they backed off on athletic training is now masters required. And you know, think about the skillsets that we have to bring to bear and the amount of responsibility that we have as a professional. And is that commensurate with the with the degree that we're offering?

Unknown Speaker  30:49  
Yeah, I don't know where stuff is on us. But you planted a seed a couple years ago. And I was actually very much against the concept because I was concerned about the impact on diversity. And since that time, I've been watching with curiosity on a wide variety of areas, Twitter and other social media avenues. And the truth is students of color around the country take great pride in being accepted into a doctoral program in a wide variety of barriers, it is palpable to see the excitement for a family, when one of the kids gets accepted, or one of the young adults gets accepted into a Ph. D. program, Edd, MD, etc. And so I, I'm not sure we're effectively capturing that concept of diversity yet, because certainly those doctoral programs had a significant expense to them as well. But you know, they have a great, well, not all of them had a great outcome financially afterwards, but most do. So I I'm, I'm open to it. And honestly, as a leader, I'm also considering starting a post doctorate program, because I think the writing's on the wall, and I think we're going to need to go there, and I'd like to be able to set something up so we can shift to it fairly quickly,

Unknown Speaker  32:03  
I was gonna say, it probably isn't a secret that Shenandoah University is has looked at different options to increase our diversity. And one of the things that we started to look at is, could we start a part time option or weekend, not a Weekend College, but you know, part time options, and in a way to to attract individuals who have economic or family situations that prevent them from doing the traditional type of program, we sort of took a, you know, 180, and went to the side to go, we're going to do with an optional doctorate program, we recognize that we would be bringing in additional revenue to the university and as part of that package, which by the way, is on hold right now, because the accreditation issues to talk to our administration of taking some of that revenue, and putting that into full rights for disadvantaged students. So I think that you can do both, if you have the will, if you have the will, you can take away obstacles at the same time we're taking away the GRE is a requirement at our school, it it's no longer a requirement, as of this admission cycle. We looked at that as an obstacle for diversity. So if you have the will, you can examine what are the barriers and then try to overcome those barriers?

Unknown Speaker  33:15  
Steph, how about you? Where are you at in the dark for Alicia?

Unknown Speaker  33:20  
Yeah, you know, I think I think we're, we're in a bit of a unique situation, when you when you compare ourselves to physical therapy, occupational therapy, you know, some of the other professions that have moved to a doctoral degree because they don't, they don't also have another entity that is doing the same thing that that we are so you know, there there is already a path to a doctoral degree in the practice of medicine, and it's, you know, MD do. And so if we're arguing that a doctoral degree in PA education doesn't change our scope of practice, it doesn't, you know, change our patient care, unless you consider the programs that Tony was speaking of. If you argue that then I just have a little bit of a difficult time, it creates a cloudy picture creates a cloudy picture in the clinical setting where we say, Pa education, trains, individuals to practice medicine, medical education, trains, individuals to practice medicine, they're not the same education, but they both ultimately end in a doctoral degree. I'm not opposed to it, but I just I think it creates a it creates a an odd dichotomy. That I don't know how we reconcile that with, you know, for patients, I don't know how we reconcile it for you know, our physician colleagues, I don't know how we reconcile it for payers, you know, insurance companies, health systems, I think it has the potential to create a lot of problems. And I and sometimes I wonder if that outweighs the perceived benefits of it. So again, um, you know, I, I certainly have explored the arguments pros cons, you know, the different types of doctoral degrees and you know, whether that's a terminal degree or an additive degree, I see probably sit firmly on the fence on that situation at the moment, I have to say I just but but what I do believe is that we can't not explore it, we can't not come together as a profession in a unified manner. And and pursue this because I think if it if it happens organically, it pops up in one way here and in one way there, and it pops up in all these different places in different centers. And we don't as a as a profession, approach it with unity. I think it has the potential to fracture our profession. And I think that is a problem.

Unknown Speaker  35:33  
Yeah, there was a lot. I mean, it was not clean in the nurse practitioner profession when they went to DNP. And, and actually, in all the professions that that eventually went to that. So I agree with you, it doesn't need to be studied. And and I don't know that there's ever going to be a clean, clean answer for it. But we sort of have to weigh the pros and the cons and then see what what's gonna be best for. I mean, some people will say, Well, what's best for the patient. And that is my driving mantra for almost all the things that we do at our PA school at Shenandoah. But we also have to consider, you know, what's best for our graduates as well. So, because ultimately, they'll be serving the patients.

Unknown Speaker  36:14  
Tony, is there anything else that you hope to share with us today that we haven't touched on or we haven't discussed?

Unknown Speaker  36:19  
Sure, I think that we have an obligation to look to the future. And I think we need to look what's happening in the in the environment in which our programs reside locally, regionally, statewide, and as well as nationally and see, what are the trends? And I think that one of the things that I'm concerned about right now, probably not, the best thing to say on a podcast for students is that, you know, there is this potential that some things are going to all sort of coalesce. One is the people of my generation, the baby boomers are eventually going to die out. And that blip in terms of population is going to go away. So there's going to be less people with chronic care conditions and so forth that need health care. And if there's less people in that population needs health care, then we don't need as many providers, number of PA programs continues to expand. our applicant pool was sort of flat. And you know, we don't know what's happening in the job market right now, right now, pap A's are a great thing. And we've survived a lot of things. So I don't want to be totally pessimistic. But I want to say that we do need to watch what's happening in the environment. We just can't, you know, be in our ivory towers of academia and just sort of do our day to day thing we need we have a responsibility as a profession to monitor what's happening and to respond. Now, to paint an optimistic picture many, many years ago, there was a report that came out called the German EC report says we're, you know, we have too many doctors, are we going to have too many doctors and, you know, I live through that time in our applicant pool went way down, where we are almost on a one to one ratio. Shortly thereafter, a couple things happen that I think we're good things, they cut back a little bit on residency programs. And when they cut back on residency programs to respond to that report, because they weren't going to cut back on medical schools, because medical schools drive their tuition, they get reimbursed from the state on a capitation basis, and so forth. So what what happened is residency programs cut back Well, who's going to do some of the work of those residents that, you know, the workups, the pre op physicals and things like that, Oh, what about these PhDs that are out in the primary care world. And so we ended up getting, you know, saved by that Medicare reimbursement happened around the same time. And then shortly thereafter, that a couple you know, several years after that, they cut back on residency hours, and fill some of that with PDAs. So I think there's going to be potential opportunities for a PS, I'm not sure what those are, might be, some of it be non clinical roles. But there certainly are opportunities for PA as well, we do need to monitor that. And when I do consultations with PA programs around the area of accreditation, I say, I'm not going to just do a deal with you on accreditation issues. I want to talk about quality indicators, and how to make your university distinctive because if we get into this competition for students down the road as the applicant pool sort of narrows, it's the distinctive schools that are going to survive. It's the ones that have value add in a good reputation. And not just the US News and World Report. You know, Canada was up there in the top 20, the youngest one, by the way, you know, we have to do something that is going to serve our students, you know, if you have low intuition, lower tuition that might help, but if you have a quality program that will help.

Unknown Speaker  39:55  
Yeah, I mean, I think your role as chief policy health officer, or I'm sorry, chief policy and Research Officer for Pa was quite a good decision in the sense that maybe as a profession, we started to invest in policy and research at that moment in time. And now, of course, decades in that role, too. And, and so I think we're in a better position as a profession to be able to articulate our necessity to the healthcare workforce than we were maybe 20 years ago.

Unknown Speaker  40:23  
Yeah. Well, I'll tell you, when I was there with the proudest things of, you know, there were several proud moments for me that happened. And with my team, with my team, not just me, but you know, we launched a big research fellowship program, we expanded the data collection, to curriculum and many other issues within our annual you know, our annual reports so that people would have the data they need to make decisions. We introduced the first ever pa education bill in the Congress. And I would encourage everybody to take a look at that pa education Modernization Act. It's a shame that hasn't really moved anywhere. But you know, that's Congress, they have other priorities. But there are some good things in there like getting more federal loan money for our students that they should have gotten a long, long time ago. We also launched the Student Health fellowship program during my tenure there too. So I enjoyed that experience. And I really feel like we were a we had an opportunity to be very impactful, and then those things are still continuing.

Unknown Speaker  41:26  
Well, we want to thank Tony Miller for joining us today. We had a great conversation learning about Shenandoah University, Tony's perspective on the doctoral degree for the PA profession, and some of the challenges our profession may face in the coming year. Tune in next week as we speak to Dr. Michael DeRosa from Samuel Merritt University, Dr. DeRosa is going to provide some insights into his PA program and into his mission work to the remote mountains of Panama. And we'll discuss his unique path to the PA profession from his PhD in neuroscience from UCLA to becoming a primary care focused PA. Until next time, I wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or policy of the University of Southern California.