Learning How to Practice Medicine—Virtually

Yale is poised to join the list of top-tier universities now offering online master’s programs. Will these initiatives work?

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Updated on March 20, 2015

Physicians assistants are highly paid medical professionals who provide a lot of the same healthcare services that doctors do. They take patient histories and perform physical exams, diagnose illnesses and develop treatment plans, prescribe medications and counsel patients. And in surgical settings, they suture wounds and assist with the procedures.

PAs, as they’re known in the industry, typically earn master’s degrees in medical science before practicing. These programs usually last three academic years and include classroom instruction in topics ranging from anatomy to pharmacology. Students also participate in more than 2,000 hours of clinical rotations. This training entails a lot of rigorous coursework—education that would, in theory, be hard to deliver outside the brick-and-mortar walls of the 175 or so higher-education institutions with accredited PA master’s programs.

Or maybe not. Soon, an aspiring PA might be able to complete nearly all this coursework online—and through an Ivy League to boot: Yale.

Yale announced earlier this month that it’s partnering with 2U, Inc.—a firm that helps selective nonprofit universities develop virtual degree programs—to launch its online PA initiative. The project is still pending approval by the accrediting commission for PA schools and from various state licensing agencies. But if it gets the green light, it would likely be the country’s first fully online PA degree. (Some programs are considered "hybrid" and entail a combination of on-campus and online coursework.) It would also become Yale’s first fully online master’s program and join the university’s existing on-campus PA program, which was launched in the early 1970s. The online program would cost the same as the on-campus one, whose sticker price is $35,654 annually for the first two years, excluding other fees.

Yale’s announcement comes at a time when millions of American students take at least one distance-learning course each semester, seven in 10 U.S. college leaders say online learning is critical to sustaining their institutions, and Massive Open Online Courses are (or at least were) all the rage. So it’s hardly surprising that degree programs are increasingly moving online.

What is perhaps surprising, however, is the diversity of programs that are taking this route—that something as hands-on and complex as medical science can now be taught remotely. Moreover, it’s no longer just the obvious backers—largely for-profit and two-year colleges—that are embracing online education. Indeed, many of the institutions that are going beyond the familiar territory of MOOCs and spearheading these virtual degree programs are as traditional as colleges get. In other words, these sought-after schools are embracing the Internet not only as a platform for spreading free knowledge but also as another means of delivering a highly exclusive—and expensive—education.

Georgetown has an online master’s program in nursing and midwifery: Nursing@Georgetown; George Washington University has one in public health: MPH@GW. There are the University of Southern California’s online graduate programs in education and social work (MSW@USC), as well as that in engineering at UCLA. A slate of top-notch schools also offer online MBA programs, including Temple University, the University of North Carolina—Chapel Hill, and Carnegie Mellon. The list goes on.

In a recent piece for The Atlantic, Michael Roth, the president of Wesleyan University, points out that recent years have seen "a wave of books, articles, op-eds, and films pronouncing the imminent demise of higher ed as the country knows it." These theorists predict that the Internet will "unbundle" and democratize college. Roth was reviewing Kevin Carey’s new book, The End of College, which likewise foresees an "apocalyptic," Silicon Valley-esque "hacking" of higher education in the U.S.—particularly when it comes to the country’s so-called "cathedrals of learning" (e.g., highly exclusive universities such as Yale). Roth, who sees deep flaws with the book’s logic, quotes Carey as writing, "those that cannot change will disappear. The story of higher education’s future is a tale of ancient institutions in their last days of decadence, creating the seeds of a new world to come." According to Roth, there’s no way technology will disrupt the college system to the point of extinction. Ultimately, he argues, students still find value in studying and working face-to-face rather than watching "what happens from a distance on screen."

Yet according to a new report by the research firm Eduventures, there are now 3.4 million students attending college exclusively online, accounting for 15 percent of all higher-education enrollments today. Most of these people are "adult learners"—nontraditional students such as working parents. By 2020, according to Eduventures, the number of students studying exclusively online could grow to as many as 5 million people.

It’s hard to say whether America’s higher-education system is fated for disintegration or disruption or demolition. But, as even Roth acknowledges, the landscape is shifting. Will students get the same quality training online as they get in-person? Will a college education be more accessible to more Americans while retaining its caliber? Will "cathedrals of learning" such as Yale still play the same role two decades from now as they did pre-Internet?

2U is a cloud-based software platform focused on higher education, with roughly a dozen university partners, including UC Berkeley, Syracuse, Northwestern, and many of the aforementioned institutions. It was 2U that first approached Yale proposing that it develop some sort of online degree program. James Van Rhee, the PA-program director, heard that the company was on campus, and after hearing about the possibilities he quickly latched onto the idea.

The reason Van Rhee is seeking to expand the PA program to the web is simple: Though PAs are in extremely high demand and command high salaries, many students are discouraged from pursuing the career because they don’t want to move to a new campus to get their credentials, he said. According to the Bureau of Labor Statistics, job opportunities for PAs are expected to grow by 38 percent between 2012 and 2022. That increase works out to roughly 33,300 new positions, in large part because of the aging population and the increased prevalence of chronic disease, among other factors. Glassdoor, a popular online career resource, ranked PAs as No. 1 in its 2015 list of the "25 Best Jobs in America." And the mid-career median pay for PAs, according to Forbes, is $97,000.

Providing the same quality of training as Yale’s on-campus program, the online coursework would reduce the financial burden and stress of relocating to New Haven, Van Rhee said: "They won’t be away from their support systems. They’ll be by their families, spouses, grandparents, siblings … For us not to move them away from that, it makes becoming a PA more enjoyable." It would also encourage PAs to learn and work in their local communities—often rural, underserved settings that are in greater need of these resources. "There are more than enough people who need healthcare around the country that don’t have it," he said. "These students could fill that niche."

But a key question remains: Are students who attend class remotely receiving good-enough training? Or put another way, would the students who do the coursework online get more out of Yale if they were instead enrolled in the on-campus program? A growing percentage of college officials believe that students need more discipline to succeed in an online course than they do in a face-to-face setting, according to a new report by the Babson Survey Research Group, which surveyed more than 2,800 higher-education institutions in the U.S. In 2005, 56 percent of high-level college administrators said they believed the online courses require greater discipline; by 2014, that figure had grown to 69 percent of respondents. Student retention also appears to be a growing concern, with 45 percent of administrators responding in 2014 that online courses have a harder time retaining students than on-campus ones do, up from 27 percent in 2004.

Van Rhee insists that the online program will be interactive and encourage active rather than passive learning. Even during pre-filmed lectures, students can engage in intimate discussions with each other and their professors. And online classes, like those on campus, are capped at 12 students. Acknowledging that "not everything can be taught online," Van Rhee stressed that virtual students will visit the campus on occasion for "intense immersions" to learn skills such as, say, suturing wounds. Online students would visit the campus during the first week or two of the program as well as at the end of their first year to learn clinical skills—training that for on-campus students happens over the course of the year. The online students would also visit the campus at the end of the clinical year to do testing and have the option of doing a rotation at the Yale New Haven Hospital, according to Van Rhee.

Still, using the Internet as a delivery platform will inevitably reshape any degree program, including the nature of its on-campus version. As the Stanford professor Caroline Hoxby wrote in a 2014 paper on the economics of online higher education, "the experience of news organizations suggests that giving away content on the Internet sets a precedent in which consumers become unwilling to pay for it." And while she was referring to MOOCs, which unlike Yale’s online PA program are typically free, she raises an important concern about the viability of a virtual degree that costs just as much as its on-campus counterpart. "Although online education may be an infant industry, research and original content creation is a mature industry in which [highly selective] institutions already have efficient scale and some natural market power," Hoxby writes. "If anything, [highly selective] institutions weaken rather than strengthen their market power ... when they increase their exposure on the Internet."

Hands-on sciences are difficult to replicate via a computer. And after just a few years of existence, many MOOC initiatives are getting flack for failing to provide what they had promised. Even Sebastian Thrun, the computer scientist who created the for-profit virtual education platform Udacity, admitted that his experiment piloting online courses at California’s San Jose State University hardly fulfilled what he had hoped: "We were on the front pages of newspapers and magazines," he told Fast Company in 2013, "and at the same time, I was realizing, we don't educate people as others wished, or as I wished. We have a lousy product."