This study characterizes three leadership positions (PD, AD, and CD) in PA academic programs by doctoral degree credentials, gender, and underrepresented minority status. Program directors were more likely to have an advanced degree and tended to have been in PA education longer than other leadership cadres and faculty. Gender and URIM status were equally represented in all leadership roles within the PA professoriate. To our knowledge, this is the first study reporting on the role of doctoral education, gender, and minority status within academic leadership among PA-trained faculty.
Leadership and Doctoral Degree
Our study highlights the limited supply (19%) of doctoral-trained PA faculty overall, and the disproportionate distribution of advanced academic credentials among faculty. Having a doctorate degree increased the odds of being in a program director position two-fold. The direction of this relationship is unclear, i.e., does obtaining a doctoral degree create opportunities for PD roles; or do those already in the PD role prospectively obtain the doctoral degree? A combination of both pathways is likely. A recent study reported an employer preference for doctoral-trained faculty, particularly for program director positions10. This trend may compel those interested in advancing their professorate career to obtain a doctoral degree to be competitive on the job market. The recent growth of doctoral programs earmarked for PAs11 has provided these opportunities. For those already holding leadership positions, there are multiple factors that drive them to obtain doctoral degrees. In most academic institutions, tenure, promotion, and seniority are largely dependent on academic credentials. Indeed, PDs were more likely to have published, received grants and have tenure compared to ADs and CDs. Additionally, interaction with doctoral-trained academic leaders from other similar programs may influence the desire to pursue doctoral education. Regardless of the direction of this relationship, it remains to be established whether doctoral degree training improves PA program director leadership competencies or enhances program wide outcomes12.
The disparity in doctoral credentials between PDs and other leaders may be explained by the accompanying finding of ADs and CDs having the least longevity in PA education (2.5 years) and therefore may be still in a status of rapid adjustment and equilibrium, and by the similar patterns in reported salary. Additionally, a doctoral degree requires an investment of time, financial and personal sacrifices without a guarantee for a positive return on investment10 therefore limiting the motivation/incentive for this cadre of leaders to further their education to the doctoral level. Moreover, the skillsets for AD and CD roles are largely focused on PA curriculum and pedagogical acumen, student performance and success, and internal and external relationship building. Whist similar across programs, these skillsets are customized and mastered within each academic program. Moreover, most doctoral degrees obtained by PAs do not provide specialized training13 in PA education and therefore may not be regarded as valuable to their current roles. Instead, the PAEA offers focused and relevant trainings for ADs and CDs. Therefore, those in these positions may not be motivated to pursue formal academic doctoral degrees. Among NLs, preclusion from leadership burden, and therefore more time to pursue further education may explain the proportion of NLs with doctoral degrees. Perhaps for the same reason, non-leaders reported more academic scholarship than leaders. Paradoxically, however, non-leaders also reported higher levels of burnout than leaders. Being managed by others versus being largely self-managed as a leader may be a contributing factor. This finding warrants further study.
Leadership and gender
Previous studies have reported significant differences between the numbers of females and males in senior leadership positions in academic medicine within the US14,15. After controlling for several variable, there were no gender differences in the odds of having any leadership role in this study. Notably however, more male faculty have doctoral degrees compared to female faculty.
Leadership and URIM
Our findings highlight the scarcity of faculty from backgrounds underrepresented in medicine. In our sample of over 900 PA faculty, only 38 (4.0%) were African American, only 36 (3.8%) were of Hispanic origin, and only 8 (0.8%) were AIAN/NHPI. This trend is consistent with the national PA census and matriculation statistics. In 2020, among certified PAs, 3.3% identified as African American, 6.7% as Hispanic, and 0.7% AIAN/NHPI16. Because applicant matriculation provides the pipeline for future PAs in practice, and in faculty roles, disparities in matriculation directly impact disparity in faculty diversity. This is evident in the composition of matriculating students in 2017-18 (graduation ~ 2020). Only 3.8% of all matriculants were African American and 0. 5% AIAN/NHPI (compared to 80% White); and 8.8% were Hispanic 17. While there are many factors associated with these disparities, there is a critical need for strategies to increase minority student enrollment18,19.
Because of these disparities, our URIM sample was small (n = 82). However, despite the URIM faculty being only a small fraction of the total sample, they were overrepresented among those with doctoral degrees. Reasons for this finding are unclear. It is plausible that the few URIM faculty are more likely to have predictors of leadership competencies, a self-selection and self-drive for leadership affinity20. This observation could be driven by the long-lasting racial imbalances that have existed in the US, leading to URIM faculty to feel the need to overachieve to succeed in academic leadership. This “working twice as hard” phenomenon has been reported in a higher education leadership qualitative study21. In this study that examined women of color in faculty governance, participants reported having to go the extra mile to be seen as credible and capable. For example, they felt the need to take on more roles beyond their non-URIM counterparts. For similar reasons, URIM faculty may feel the pressure to obtain doctoral degrees in order to be considered for leadership positions, while non-URIM faculty may not have a similar perception. Future qualitative studies will shed more light on this observation.
In summary, the likelihood of being a PA academic leader differs by terminal degree, but not by gender and URIM status. This study identifies three main differences among the PA professorate. First, ADs and CDs, although members of the PA academic leadership team, do not have advanced academic credentials as do PDs. Second, of all leaders, PDs have more longevity in academia. And third, URIM faculty are grossly underrepresented in the PA professorate, but the few URIM faculty have received advanced academic credentials.
Our study has several strengths. First, our analyses included only faculty who identified as PAs and principal faculty at > 50%FTE. Second, the dataset represented participants from 97.9% of PA all PA programs in the country. Third, our analyses and study design looked at the differences within the PA leadership team by roles.
Because of the cross-sectional design of this study, the direction of the relationships we found cannot be inferred and data on other non-academic leadership training was not available to be considered. Additionally, self-reported survey data is subject to individual bias and misreporting and some respondents did not answer all survey questions. Finally, these data were collected in Spring 2019, just before the COVID-19 pandemic. Radical changes in PA education may limit the generalizability of these findings post-pandemic.