This article explores the differences between traditional philosophy doctorates (PhDs) and professional/vocational doctorate programmes within UK profession-specific health disciplines. These include a Doctorate of Nursing Practice (DNP), Doctorate in Clinical Practice (DClinP), and Doctorate in Pharmacy (DPharm).
Three areas are considered:
The constantly changing environment of academia and the health service has led to changes in the levels of undergraduate nursing teaching, from diplomas to degrees and, more recently, to postgraduate qualifications, including those required for study at doctoral level. The doctoral degree is the highest level of postgraduate study in the world and there is a growing tendency for clinical practitioners in senior roles in the NHS to complete secondary (masters) or tertiary (doctoral degrees). In 2010, medical practitioners formed the second highest occupation for professionals holding a doctorate (11% of the employment share) (Lindley and Machin, 2011), although this information is not broken down into individual health professions, such as nurses or physicians.
Doctoral study, in particular, has traditionally been by research only, with a purely academic focus. This may not be fully relevant for those professionals who want to develop a clinical or corporate-based career, rather than preparing for an academic position. Improving the relevance of research degrees appears to follow logically, and has resulted in a number of alternative taught programmes. These include study units that prepare students for the high level of academic study of the PhD, but may also include relevant applied topics. There is often confusion between the two higher degree programmes, with potential postgraduate practitioners unsure which would best enhance their career potential and professional development.
The PhD, in the form of an advanced dissertation, began in Germany at the University of Berlin in the early part of the 19th century (Simpson, 1983). The first US university to award a PhD was Yale in 1861 (Yale Graduate School of Arts and Sciences, 2018). The first PhD in the UK was introduced in 1917 by the University of Oxford. However, higher doctorates in science and literature (DSc and DLit) were also offered by universities such as London and Edinburgh at this time (Simpson, 1983). The designation of PhD arises from the Greek ‘philo’ (to love) and ‘sophy‘, meaning the love of or pursuit of wisdom, rather than related to philosophical studies. It is noteworthy that Oxford denotes all its doctoral degrees as a Doctor of Philosophy, awarding a DPhil, rather than a PhD.
Most developed countries and some developing countries, including Indonesia, offer PhDs. Globally, the highest number of PhD graduates are from the USA, with Germany second and the UK third. Lowest in the top 15 is South Africa (Organisation for Economic Co-operation and Development (OECD), 2016). Although the basic PhD structure is similar, there are differences in the examination process in different countries. For example, in some Scandinavian countries, eg Sweden and Finland, a thesis can be defended by delivering a lecture, as well as in front of a panel (Kyvik and Tvede, 1998). In Australia and New Zealand, the geographical shortage of external experts for oral examinations has caused problems. Therefore, traditionally, a PhD thesis is considered by two or three independent examiners who write a report and make an outcome recommendation (Kiley et al, 2018). It is noteworthy that more universities in New Zealand are striving to introduce an oral examination, following research emphasising its value (Kiley, 2009; Crossouard, 2011).
All UK universities offer a PhD qualification, but not all offer professional doctorates (PDs). Nonetheless, all four countries in the UK have some universities that offer PD programmes. PDs were designed to meet the needs of the contemporary workplace (Table 1). They originated in North America during the 1930s (Ketefian et al, 2005), and were first offered in the UK in the early 1990s (Bourner, 2010). Initially, some of the subjects offered were in education, clinical psychology and engineering, but the programmes have since expanded into virtually all disciplines. Nonetheless, the largest numbers undertaking PDs are concentrated in four fields: health, education, business, and social care, as reported by the Higher Education Funding Council for England (HEFCE) (Mellors-Bourne et al, 2016).
| Doctoral programme | Vocation/profession | Title/post-nominal letters |
|---|---|---|
| Health studies | Health professionals (any, including managers) |
Doctor of Health Studies (DHS) |
| Nursing practice | Nurses | Doctor of Nursing (DNurs)/DNursing) |
| Clinical practice | Health and social care (any) | Doctor of Clinical Practice (DClinP) |
| Pharmacy | Pharmacy | Doctorate in Pharmacy (DPharm) |
| Clinical psychology | Psychology (may have alternative undergraduate degree) | Doctorate in Clinical Psychology (ClinPsyD) |
| Public health | Health/Health Management | Doctor of Public Health (DRPH/DPH) |
| Clinical dentistry | Dentist | Doctorate in Clinical |
Programmes of study
Doctor of Philosophy (PhD/DPhil)
A PhD in medical disciplines traditionally involves 4 years' full-time or 6–7 years' part-time study, and the researcher examines a subject in depth by carrying out empirical research, including data collection, analysis and synthesis. This may be an individual journey, exploring a subject alone, or undertaken as part of a research team. Health professionals and some academics can opt for the part-time pathway, allowing them to continue in their professional role, progress their career and maintain a salary.
The mode of entry may follow directly from an undergraduate or postgraduate degree, or be initiated at a later career stage. The award reflects independent study, concluding with the submission of a thesis that has demonstrated an original contribution to knowledge. This may be a new application of existing knowledge, or the development of innovative ideas or approaches.
In most countries, completion of the study is examined through submission of a thesis and a viva voce (oral) examination. There is normally no taught element in a PhD programme, but some institutions will expect students to demonstrate that they can meet the required research standards and, if necessary, undertake study to ensure this. There may or may not be formal examinations in the relevant subjects, which must be passed in order to achieve the PhD.
Some elements of supported learning in how to be a researcher is becoming the main approach in most universities throughout the world. This allows for students to discuss and negotiate their programmes with their respective institutions. However, there is variation in the level of support and research skills learning. There has also been criticism of the traditional pathway as a dated process, with students ill-prepared for the rigours of a viva-style exam (Gould, 2016). The call for more transferable skills to be integrated into doctoral study goes back to the Bologna Declaration (European Ministers of Higher Education, 1999; European Commission, 2019) recommendations, which have encouraged a shift towards more structured training programmes for PhDs, as reported by the Research Councils UK (2016) and The Wellcome Trust (Coriat, 2018).
The traditional PhD has experienced some diversification, now allowing a PhD award via publication or professional practice routes. A PhD by publication/professional practice requires the submission of a portfolio of work, containing published papers with a collective theme. Previously published articles are used to demonstrate how the individual has advanced new knowledge in a given field. The papers must have been published in high-quality peer-reviewed journals. A summary statement describing the genesis and cohesion of the submitted papers, as well as a critical analysis of them, is required. The statement must also draw out the contribution to the field and demonstrate why this is original work. The statement can be from 5000 to 10 000 words in length, depending on the institution.
Clearly there are some challenges involved, such as ascertaining the level of an individual's contribution to collaborative projects and the level of authorial ownership from multi-authored papers. The other authors are required to sign statements confirming the respective contributions. There is also a route to complete a PhD by concurrent publication, allowing planning of the body of work in advance, bringing cohesion to the themes and strategic targeting of publication placement. Agreeing authorial contributions in advance may help obviate some of the issues for the retrospective route.
Professional doctorates
The professional/vocational doctorate (taught doctorate) comprises 3 or 4 years' full-time or 5 to 7 years' part-time study in a particular discipline. In the health field, this is sometimes called a clinical doctorate. Aside from the doctorate in clinical psychology (DClinPsy), which has a significant placement component, full-time study is unusual in the health professions. Students complete 1 or 2 years of a taught programme of study, where credits are accumulated, before undertaking the research and thesis stage of the programme. Credits are awarded for passing written/oral examinations or for the submission of assignments on designated topics. Group registration on such courses means that there is likely to be a student community, which can provide some teamwork and support. The HEFCE report (Mellors-Bourne et al, 2016) on the provision of PDs in England states that the ‘cohort-based’ nature of studying is reported by PD students as being of particular value.
This pathway is typically taken by those with significant professional experience and/or qualifications, such as optometrists, nurses, pharmacists and podiatrists. The required level of academic entry varies, but is usually a postgraduate qualification, for example a master's degree (Bourner et al, 2010). The thesis and research element of the professional doctorate will have the depth, but not necessarily the breadth, of a traditional PhD, since part of the study programme is used for the taught element. Nonetheless, students are still expected to submit a thesis and to defend it through a viva voce examination (Table 2).
| Professional/vocational doctorate (PD) | Doctor of philosophy (PhD) | |
|---|---|---|
| Focus | Professional qualification | Academic and/or research |
| Structure | Mandatory taught components | Little/no taught elements |
| Thesis (excluding medicine and dentistry) | Advances professional practice in your field | Advance theory and knowledge in specific area |
| Length of thesis (words) | 40 000–60 000 | 60 000–80 000 |
| Career goals | Desirable for senior clinical roles |
Required for careers in research and teaching |
| Completion rates | Not extricable from general ‘doctorate’ data |
72.9% (2013)† |
| Transferability | Recognised in US, Canada and Australasia | Universal |
The purpose of universities in providing taught programmes is to deliver a qualification that is equal in status and personal challenge to a PhD, but is focused on developing the skills and knowledge appropriate to a professional, clinical or industry-based career, rather than an academic one (Bourner et al, 2010). This more structured approach facilitates the acquisition of specific skills at an advanced level, such as complex aspects of patient care or leadership in healthcare practice.
The research undertaken is expected to have an impact on professional practice or procedures (Mellors-Bourne et al, 2016). There is usually organisational support, with the research elements integrated into the workplace. Such professional development would appear to resonate with establishing senior professional roles, such as for consultant nurses. However, the HEFCE report (Mellors-Bourne et al, 2016) indicates relatively weak employer support in the healthcare sector, attributing this to ongoing budget constraints. Self-funded candidates are a growing trend (Mellors-Bourne et al, 2016).
Differences in application
The development of alternatives to the PhD indicates a growth in demand for professionally based higher degrees. This would imply recognition, by health professionals, of the importance of continuing higher-level learning and development that is applicable to the workplace. It is also a product of the rising emphasis in educational ‘drivers’ such as the need to demonstrate competencies, skills and training, which require validation by qualifications up to the highest level.
Advanced nursing roles, and more consultant-level positions for all clinicians, have fuelled increased demand for advanced education and research skills. However, there are no statistics available on how many of a given profession have a doctorate, including for nurses. There is certainly a range of options, from a PhD by research or publication, to PDs in nursing, clinical or professional practice, leadership, education or management, to name a few.
Clearly, it will be necessary for some health professionals with PhDs to be in academic roles, for supervision of the up-and-coming scholars. Indeed, the Willis report (Willis Commission, 2012) pointed out that nursing scholarship must be encouraged, as nursing assumes an expanding role in contributing to research and evidence-based practice. The report stated that more nursing academics are needed to support the future provision and development of nursing education (Willis Commission, 2012).
In order to undertake research programmes and receive funding, the ethical proposal and grant application paperwork requires a principal investigator (PI), who takes overarching responsibility for the research. In the majority of cases, the criteria for the PI is that of a doctoral-level qualification. Some institutions, such as the Medical Research Council (MRC), state they ‘expect’ this to be someone with a PhD (MRC, 2019). The European Research Council (ERC) will accept a PhD or ‘equivalent’ (ERC, 2017). This may be seen as an additional advantage of a PhD, as successful bids for research grants are a major income stream for universities.
The variety of taught doctorates in health disciplines has diversified to include doctorates in nursing or nursing practice/science, podiatric medicine and pharmacy, with the doctorate in clinical practice and in professional practice available to all health and social care professionals (Table 1). Clearly, however, it is important in the health sector that patients and clinicians alike must be in no doubt whether a clinician holds an academic doctorate ie a PhD, or a professional/vocational doctorate/in his or her own field, such as medicine, pharmacy, podiatry or optometry.
The popularity of the professional doctoral degree arises from its ability to confer professional and academic recognition, while meeting specific professional needs. This seems attractive on many levels, benefiting both individuals and healthcare institutions and facilitating promotions. For example, an aspiring consultant podiatrist may be expected to have completed, or be studying for, such a postgraduate degree. In clinical psychology, the doctoral degree is the prerequisite qualification for entry.
The UK healthcare vision is that doctoral training via a PD would address the learning needs of health professionals, arguably more than a PhD. The application of doctoral-level study to ‘real world’ problems is congruent with improving health and system outcomes, especially, perhaps, in enabling the development of sound critical analysis. There can also be significant commercial advantages to such applied research, for example in piloting new equipment and techniques. Nonetheless, outside of the UK, the PD has not achieved the recognition or status of the PhD in the majority of countries (see Table 2).
It is noteworthy that, despite proliferation of the PD into multiple disciplines, there has been a recent decline in PD enrolments in England (Mellors-Bourne et al, 2016). This was particularly evident in the health sector (Mellors-Bourne et al, 2016) and may relate to the impact of budget constraints affecting the NHS. The number of PhD graduates in science and health in the UK grew exponentially between 2008 and 2013, but a drop after 2013 was seen both in Europe and in the UK. This trend was not seen in the USA (OECD 2016). Completion rates appear lower for the PDs, which may reflect the later career stage in which they are undertaken, but the statistics for both are estimated (Table 2) and analysis of attrition is difficult.
Recognition and status
Such relatively rapid changes to traditional doctoral education have inevitably prompted debate in the academic community. There have been reports criticising the increased volume of candidates achieving doctorates of all types, a situation viewed synonymously with a decline in standards (The Economist, 2010; Larson et al, 2014). Furthermore, there have long been issues with ensuring transparent and consistent assessment of the PhD, which relies solely on the opinion of the small number of examiners who read the thesis and conduct the viva voce (Jackson and Tinkler, 2001). Clearly, this applies to all doctoral programmes, with regard to the thesis examination. However, the taught/vocational doctorate also includes credits for assignments, arguably giving a more balanced assessment.
The perceived dilution of status, which is inevitable when a degree becomes more accessible to many people, is pertinent to all doctorates. Reports in the media have equated the increase in doctoral studies with falling standards, which they ascribe to a shorter study period and to more funded students (Attwood, 2008). However, the larger number of students may be attributed to a more structured approach of a taught doctorate, which enables students to undertake rigorous study at this level while continuing to pursue a clinical or industry-based career.
Some pedagogical criticisms have been made regarding the ability of a practice-based thesis to fulfil the requirements of PhD-level research, since there may be a tendency to ‘evaluate’ existing practice, rather than to create new knowledge (Winter et al, 2000). It is noteworthy that to achieve university validation for the programme, all doctoral programmes must meet the grade descriptors for doctoral study (Table 3), as stated by the Quality Assurance Agency (QAA) (2015). Doctoral study has been placed at level 8 on the HEFCE QAA benchmark, but this does not differentiate between the two forms of doctoral award (QAA, 2015). The QAA continues to respond to reform of doctoral education by UK (Harris, 1996; Metcalfe et al, 2002; QAA, 2015), and European agencies (European University Association, 2010).
| QAA level 8 descriptor number | Doctoral degree descriptors |
|---|---|
| 4.181 | The creation and interpretation, construction and/or exposition of knowledge which extends the forefront of a discipline, usually through original research |
| 4.182 | Able to conceptualise, design and implement projects for the generation of significant new knowledge and/or understanding Holders of doctoral degrees have the qualities needed for employment that require both the ability to make informed judgements on complex issues in specialist fields and an innovative approach to tackling and solving problems |
| 4.183 | A substantial taught element in addition to the research component (for example, professional doctorates), lead usually to awards which include the name of the discipline in their title (for example, EdD for Doctor of Education or DClinPsy for Doctor of Clinical Psychology) Professional doctorates aim to develop an individual's professional practice and to support them in producing a contribution to (professional) knowledge |
| 4.184 | The titles PhD and DPhil are commonly used for doctoral degrees awarded on the basis of original research |
| 4.185 | Achievement of outcomes consistent with the qualification descriptor for the doctoral degree normally requires study equivalent to 3 full-time calendar years |
| 4.186 | Higher doctorates may be awarded in recognition of a substantial body of original research undertaken over the course of many years |
As part of the freedom of movement enshrined within the EU Charter of Fundamental Rights, the Bologna Declaration aimed to provide a framework for universally recognised and transferable higher education qualifications between European nations (European Ministers of Higher Education, 1999). This may encourage the future convergence of some doctoral pathways. Aside from improved harmonisation, the reinvention of the traditional PhD could invigorate standards. It has already been suggested that the postnominal initials associated with the degrees should be more consistent, to avoid confusion between the many different designations currently used (Dearing, 1997).
The future
There are already numerous varieties of doctoral degree and more pathways may still emerge. Currently, the PhD remains the gold standard for higher research degree training (Kirkman et al, 2007), while professional doctorates aim to forge a closer relationship between knowledge production and utilisation (Rolfe and Davies, 2009; Burgess et al, 2013). The UK is a knowledge and wealth-based economy, and continued diversification of routes to doctoral study should support these economic drivers. The number of doctoral graduates is generally increasing and, if fit for purpose, should offer graduates the highest level career opportunities.
There remains an important position for each pathway in the healthcare setting. Indeed, Rolfe and Davies (2009) stated that, although the PhD remains the doctorate of choice for traditional academic roles in health sciences and other disciplines, an alternative, but no less academically sound, education should be offered. This will add value to those preparing for a full and active role at the theory–practice interface in health care. The Willis report recommended greater partnership between the NHS and the universities, for the optimal blend of applied and worthwhile research (Willis Commission, 2012).
There has been a trend towards convergence of the pathways, whereby some PhDs have become more structured, providing more taught support (Research Councils UK, 2016). More attention to the taught content and the support structures underpinning this difficult journey should also help attrition. Some of the barriers to studying at this level while maintaining careers and family commitments are recognised challenges (Anonymous Academic, 2017). The experiences of nurses in the USA are that of poor mentoring, financial concerns, social isolation and the ‘institutional culture’, all of which are cited as barriers to completion of doctoral degrees (Lee, 2009). It may be that diversification of the routes to a doctorate will ultimately reinvigorate the traditional route and introduce the best elements of postgraduate study. If due care is paid to student support, more entrants and less attrition would be expected to follow.
The move to an all-graduate nursing profession (Willis Commission, 2012) is a strategic move to support the complex healthcare needs of the future. This is likely to impact positively on careers in higher education and encourage postgraduate education and research. In health care, it is noteworthy that holding a dual doctorate is becoming increasingly popular in the medical and dental professions. This allows the clinician/scientist to have an in-depth knowledge of both clinical and scientific rigour, thus allowing research to go from in vitro to in vivo and incorporating a sound understanding of both disciplines. This is another example of ‘upskilling’ in response to the demand for increasing levels of specialism, which is part of the delivery of modern health care.
Clearly, commitment to attaining the highest standards in academic fields necessitates career pathways reflecting scope and proper remuneration. Although this has been an area of weakness, for example in nursing, where there has not been a dedicated academic career trajectory (Willis Commission, 2012), Health Education England has started to address this in the Shape of Caring Review (Willis, 2015). Recommendations are made concerning research and innovation, as well as emerging academic careers' support.
Conclusion
Both types of postgraduate doctorate—PhD and PD—are highly prestigious academic degrees, and confer the title ‘doctor’, irrespective of the working environment. All forms of doctoral study continue to evolve and a student considering embarking on a research degree programme should seek advice from an academic institution about which programme will best suit their future career. Harnessing postgraduate talent, developing advanced clinical skills and facilitating quality research output, will be central to the future of healthcare service provision.