I agree that specialization seems to be the going trend among PA practice, but I'm not convinced it will be good for the profession at all. If that becomes the prevailing condition along with doctorates as ticket to entry, it will hasten its end significantly. I'm on the fence about where the PA profession is headed as it is, but if specialization is hard wired into it, then kiss it goodbye because it won’t be around in 20 years, let alone in a decade.
Specialization and doctorates don't play well to the strengths of PA's. Having excellent generalist education, and stepping away from that ability to move within the profession among specialties offers much less flexibility. Why would you want to give that up? Its ok for physicians, because they are at the top of the game. Even among those folks, having to relocate for any reason can be a huge setback. I'd never welcome giving up that freedom if I were a PA. The cardinal rule of "pick two of three ideals you want in your job (location, salary, and specialty) and you will get it" will be upended even worse than it is today. When you are locked into specialty, you won't even get a good shot of picking any other ideal, because you will be typecast. You choose a specialty, and location and salary will be largely decided for you. Not a plus. Throw that in with a residency AND a doctorate? Nobody will want to do that job. The barrier for entry will be too steep, and a two year degree will become a four year degree paying less than the two year degree did before it was monkeyed with beyond recognition.
If anyone things that the DNP is a cash grab, then a doctorate for PA's is exponentially more blatant. DNP works for nurses because nurses obtain it over the course of 3-5 years while they work in a decent paying industry with lots of employment, tons of flexibility with hours and job locations to choose from, and majority (or occasionally exclusively) online delivery. And that's if you opt for the DNP vs the more lucrative Masters NP, which can be obtained in 2 years. My peers and I are working 3 days a week, making $80k to $100k per year, while going to school, networking with potential employers, and having a decent amount of time for family and other interests. Another plus is that the DNP is by no means the ticket to ride. The master’s degree is as common to obtain at this point, and I feel like there will always be schools that will see the financial value in keeping that option open. There will always be a market for folks like myself who have no desire to get a DNP, but will shell out cash to anyone offering a masters NP. Folks like me and my friends also are more likely to come back in a few years to crank out a post masters certificate in another specialty like FNP to broaden horizons. But your typical PA candidate is no longer an experienced health care professional who has the luxury of time to sit and rack up a doctorate while they ride in the back of an ambulance or work as a CNA while they plug away at school to get a doctorate (not to mention a year-long residency!). Then, to step out into a market in four years where you are forced to go where the jobs are and get paid the wage that prevails in those locales? Then, when the going gets tough and you want to pick up work in another specialty... you can't, because either you don't meet criteria, or else another specialist PA looks better on paper. You end up getting screwed by your own.
And as far as specialty goes for NP's, most of the areas where their specialties are separated into are strategically delineated... psyche, women's health, FNP, adult gerontology/acute care. The NP world is also consolidating many of those that can be combined...for instance, psyche is transitioning to one specialty from where it was previously two... pediatric and adult. Those specialties are formed around natural landscape features.
All of those things that are nudging PA's into specialization are indeed happening (residencies, CAQ's, creeping specialization and lack of lateral movement), but its more organic than regulated. And one state changing the practice arrangement means the profession is still 23 states behind NP's, who have taken decades to get where they are. If I understand it correctly, its far more nuanced than simply being independent, like NP's have become. There will be no jumping to the head of the line based on merit, although I've said before that I feel like PA's are qualified to join NP's in that regard.
