Pharmacy and Physician Assistant Dual Degree: An Analysis of Its Value and Implications on the Profession

Abstract

The pharmacy and physician assistant dual degree is one of the newest programs offered and has been predicted to have a high likelihood of growth in the future. With only an additional year of education, the PharmD-PA dual degree holder will have prescriptive authority upon graduation to expand their clinical roles. Additionally, by combining both medical and pharmacotherapeutics education, these mid-level practitioners could potentially improve healthcare shortages and allow for improvements in patient care. While there are established PharmD-PA dual degree programs, there is low enrollment coupled by rigorous curriculums and financial burdens that students must endure. Despite its limitations, this novel dual degree program offers pharmacy students another method to provide clinical care apart from the post-graduate opportunities. Schools of Pharmacy should look into the development of PharmD-PA dual degree programs as a unique marketing opportunity for admissions and as a non-traditional method of career advancement.

Introduction

Dual degree programs allow students to gain advanced knowledge and specialized skills beyond the traditional Doctor of Pharmacy (PharmD) degree for credentials that allow for diversification in many practice settings. A study by Migliore et al ¹ showed that 34% of pharmacy students were interested in pursuing an additional degree after graduation, and 79% were willing to take summer classes to obtain these degrees. While 72.1% of pharmacy programs in the United States offer dual degrees, few confer students with a pharmacy and physician assistant (PharmD-PA) dual degree. ² This commentary highlights the need of the PharmD-PA dual degree in the United States and discusses its ramifications in academia and the profession.

Currently, two pharmacy schools in the United States offer PharmD-PA dual degree programs – University of Rhode Island (URI) and University of Washington (UW) College of Pharmacy.^3,4 Both schools partner with PA programs, the Johnson and Wales University and MEDEX Northwest respectively, to implement its dual curriculum.^3,4 The programs’ concept was to create a licensed pharmacy practitioner with an additional year of schooling. These cross-trained individuals would fulfill the requirement for provider status and prescription authority upon graduation with only one extra year of studies to replace the traditional 1-year pharmacy residency and fellowship route. Pharmacy students are allowed to apply to the PA program in their first professional year of pharmacy school after completing PA pre-requisite courses.^3,4 Additionally, they must take the Graduate Record Examinations (GRE), have direct patient care hours, and interview for program entry. The programs offer a mixture of pharmacy and PA didactic coursework year-round starting in the summer of the third year of pharmacy school.^3,4 Rotations are scheduled for both pharmacy and physician assistant areas in the final 2 years of the program.^3,4 Both PharmD and PA degrees are conferred upon graduation of the program.

Benefits of the PharmD-PA Dual Degree

The American Society of Health System Pharmacists Foundation Pharmacy Forecast 2020 predicted that there was a 57% likelihood that Schools of Pharmacy will offer a PharmD-PA degree. ⁵ This dual degree offers participants many advantages to advance their career in alternative avenues for those not interested in post-graduate training. While both post-graduate opportunities and dual degrees allow students to be more competitive in a declining job market, a major advantage of the PharmD-PA dual degree is that they possess prescription authority upon graduation. Currently, pharmacists have some form of prescriptive authority in 11 states under a statewide protocol. ⁶ Other states recognize a collaborative practice model where pharmacists enter into agreements with physicians to change medications, order labs, and offer referrals issuant to the contract. ⁷ However, this pathway is limited to pharmacists with advanced training and subject to approval from the Board of Pharmacy. The PharmD-PA dual degree program can be an alternative pathway to students interested in provider status as physician assistants are already recognized as mid-level providers in most patient care activities.

From an educational standpoint, the curriculum is condensed with students taking classes during the summer and some PA courses being waived for academic credit if students obtain a minimum satisfactory pharmacy grade. For example, basic sciences (e.g. anatomy and physiology) and math (e.g. statistics) courses are transferred from the pharmacy curriculum to fulfill the PA degree while PA courses satisfy the elective hours required for the PharmD program.^3,4 Additionally, existing programs count general medicine and ambulatory care PA clinical rotations for PharmD rotations. Community and institutional PharmD rotations also count towards 2 PA clinical rotations to shorten academic time.^3,4 Obtaining both a Doctorate in pharmacy and Masters in PA with only one more year of schooling offers individuals a faster route for degree completion than those who pursue these pathways consecutively. There is roughly $50,000 to $75,000 in cost-savings for tuition for the dual degree holder compared to those taking the PharmD and PA programs independently. ⁴ This dual degree is a unique marketing opportunity to benefit both schools where incoming students who are accepted into the pharmacy program are guaranteed to fill PA seats if they meet program requirements. Upon graduation, with a set of diverse skills and credentials, these dual-degree holders are able to obtain jobs in both pharmacy and PA fields. With the projected 3% decline in pharmacy compared to a 31% physician assistant growth over the next 10-years, the combination of credentials can allow pharmacy students to fall into another job market until pharmacy positions become available again.^8,9

The benefit of the PharmD-PA dual degree on patient care outcomes could be immense. Most physician assistant programs offer students 2-3 courses in pharmacology in their training before graduation. With a specialized pharmacy background, these concurrent degree holders will philosophically be better equipped to prescribe pharmacological interventions for their patients, ultimately optimizing patient care. With healthcare provider shortages especially in medically underserved areas, this pipeline of PharmD-PA degree holders could be an innovative method to create more mid-level practitioners for a growing population.

Limitations of the PharmD-PA Dual Degree

A limitation to this dual degree is that physicians still maintain authority over the direction of medical care for a supervised physician assistant or a pharmacist practicing under a collaborative practice agreement. ¹⁰ We hypothesize that PharmD-PA dual degree holders will work either as a pharmacist with expanded roles under a collaborative practice setting, or as a physician assistant with advanced pharmaceutical knowledge in a clinical setting where in both scenarios, physicians ultimately control the care of the patient. The combined skillset would be best suited in outpatient clinics, urgent care centers, inpatient settings, or in academia. This may be translated to community pharmacy where the graduate may practice the traditional roles associated with dispensing and broaden their differential diagnosis capability by triaging self-care consultations. Additionally, with the similar annual salaries for a pharmacist of $128,710 and PA at $115,390, this dual degree is unlikely to provide substantial payoff for graduates.^8,9

Currently, the existing programs offering PharmD-PA dual degree have few applicants. This economic variance is compounded by many Schools of Pharmacy offering a variety of other dual degree programs (e.g. PharmD/MBA, PharmD/MPH) that have higher popularity among applicants. Additionally, schools will need to provide either full-time equivalents (FTEs) or workload redistribution for a dual degree program administrator that oversees students in the track. Both schools will need to ensure that the program complies with the accreditation standards from both Accreditation Council for Pharmacy Education (ACPE) and Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). While there would be increased collaboration between programs to improve collegiality and interprofessional education initiatives, faculty will have to monitor the progression of students in tandem. Another limitation is the exponential growth of PA schools themselves that could lead to new graduates saturating the growth market in a similar fashion to pharmacy. There have been 112 new ARC-PA accredited PA programs since 2015, representing a 67.8% increase in new educational programs, which could affect supply and demand of graduates in the future. ¹¹

Students entering the dual degree program will need to maintain the minimum grade point average needed to advance in each program as failure of a course will delay and complicate their pathway. While students benefit from having some academic credit waived, this is offset by having less time off in a condensed program as classes are year-round. Students will also have to pass both disciplines’ board exams in order to obtain licensure as well as comply with State requirements in both fields for continuing education. This could be burdensome on students who are licensed in more than one state or pursue advanced certification or specialties. Finally, there are financial burdens for students to consider as their schooling will be longer compared to those who do not pursue dual degree programs.

Implications of the PharmD-PA Dual Degree on the Profession

The PharmD-PA dual degree could have important ramifications for the profession in its ability to change education tracks, healthcare practitioner roles and shortages, job satisfaction, and financial outlook. This is a strong offering to employers as individuals have the option to work as a physician assistant, pharmacist, or combine their skillset in a unique niche. A well differentiated graduate will have greater marketability and sustainability to meet the demands of the healthcare environment. While better job satisfaction and competition could be beneficial factors, the ultimate benefit would allow these dual degree holders to have full prescribing power, an asset that distinguishes them from other post-graduate education routes. This could ultimately reverse physician shortages especially in medically underserved areas. However, the popularity of the program in existing Schools of Pharmacy remains low and it is unknown if students will select this avenue for career placement compared to other dual degree programs or postgraduate training. It is also unclear how other healthcare professionals will react to the PharmD-PA dual degree holder and the financial incentives of this position. Despite these uncertainties, Schools of Pharmacy should look into the development of PharmD-PA dual degree programs as a unique marketing venture and create opportunities for students to pursue the dual degree as a non-traditional method of career advancement.