As my first rotation in surgery draws to a close, I’ve been reflecting not only on anatomy and technique, but on the structure of medicine itself. Surgery teaches hierarchy not as an obstacle but as a rhythm, one that protects patients and preserves excellence. In that rhythm, I found clarity about my role as a PA student: to learn medicine deeply while honoring the lineage of those who have mastered it.

The following reflection captures what this rotation has made me realize about hierarchy, collaboration, and the meaning of a “Master of Medical Science.”

There is an unspoken fear that recognizing a Master of Medical Science within the physician assistant profession somehow threatens the sanctity of the Doctor of Medicine. But that fear arises only when one misunderstands what hierarchy truly means.

Hierarchy, in its truest form, is not domination; it is order. It is the arrangement of knowledge in ascending depth. A Master of Medical Science does not compete with a Doctor of Medicine any more than a river competes with the sea. One flows naturally into the other; each has its function, its boundary, and its beauty.

Competence versus authority

The master’s level represents competence within medicine, the ability to think medically, act medically, and collaborate within the framework of diagnosis and care. The doctoral level represents authority within medicine, the ability to lead the discipline, to integrate all sciences into autonomous decision-making and stewardship of patients’ lives. One prepares; the other consummates.

The problem has never been encroachment but ambiguity. For decades, physician assistants have practiced medicine while holding degrees that avoid the very word medicine. The intent was humility and political caution, but the effect has been conceptual confusion. We became practitioners of medicine whose education was linguistically divorced from it.

Restoring clarity

To call the PA degree what it is, a master’s in medicine, is not rebellion but restoration. It restores honesty to language, alignment to academia, and dignity to collaboration. It allows us to speak of the PA and the physician not as competitors on parallel roads, but as threads within the same design, distinct in form, yet woven toward the same purpose: the healing of human beings.

A Master of Medical Science cannot encroach upon a Doctor of Medicine because medicine itself is a tapestry, each thread distinct, yet essential to the pattern’s strength. To recognize that truth is not to seek equality, but to seek coherence.

And coherence, in medicine as in life, is the highest form of respect.

This rotation reminded me that medicine is sustained not by equality, but by continuity, and that humility, when paired with curiosity, is the purest form of mastery, learned in the quiet rhythm of surgery.

Chidalu Mbonu is a physician assistant student.