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Friday, March 14, 2014

Physician Assistant Residencies, Fellowships, and Post-graduate Options

Physician Assistant Residencies
Updated: 03/26/2016
Residencies for PAs are currently not required, although some PAs speculate that within the next few years we might see some recommendations by AAPA or by the PA profession in general to seek residency after graduation. Currently, about 5% of certified PAs pursue post-graduate residency.

  • Allows new PAs to obtain clinical and didactic knowledge that would take years of OTJ training to obtain.
  • Employers are willing to pay more for a PA who completed a residency program.
  • Employers may give preference to residency-trained physician assistants. In fields like emergency medicine or surgery, better job positions may be acquired with more training and certifications. “In an interview conducted in 2011 with a physician who is board certified in internal medicine and emergency medicine, he stated that residency programs should not be mandatory but are highly recommended for the more fast-paced and demanding specialties, such as emergency medicine.”
  • PAs wish to change specialties and extra training is needed.
  • PAs with specialized training may serve in the place of residents, increasing the quality of care and addressing the shortage of staff.  
  • PAs with extra training may receive more autonomy and responsibility.

Employers seem to constantly want more and more experience from PAs after graduation that they simply do not have. One problem that exists in health care is that PAs cannot obtain some certifications for procedures because they simply haven’t performed enough of them. For example, with central lines, intubation, thoracentesis, moderate/deep sedation, ultrasound, or paracentesis, you must be checked off for performing a certain number of them prior to becoming credentialed. The only way to obtain certification would be through residency unless your hospital has a high volume of patients requiring those procedures. In addition, you must maintain those credentials by performing a certain number of them per year.

  • Even though employers are willing to pay more for a trained PA, salary maxes out and becomes equal to those who did not complete a residency program. Additionally, this could eventually make residency/fellowship mandatory for all PAs to become competitive for job positions.
  • Residency requires more education, increasing duration of school and structuring the profession more like the physician route. “According to the world-renowned Johns Hopkins University Residency Program, the resident is only in the classroom for three hours per week with the rest of the time spent in on-the-job training.5 Therefore, it is plausible to state that physician assistant residents experience a work environment similar to what is found in a post-graduate PA’s first clinical year of practice.”  
  • Enrolling in a postgraduate PA program would increase student debt.
  • If a PA participates in a postgraduate PA program, they are less willing to change specialities due to time and money invested in the specialty program. This eliminates the appeal of the flexibility of the profession to change specialties.
  • According to Dehn et. al., “residency trained PAs worked an average of 15.5% more hours than informally trained surgery PAs and also earned 15.1% more.” This amounts to “they made more money only because they worked longer hours.”

PAs who have done residency programs claim that it is some of the best experience you can get and once you’ve put in your time, you’re set! They swear by the practical experience you obtain. Other PAs claim you can get paid twice as much, work half as much, and still learn just as much working a job. Well, I’m not here to convince you one way or another. Instead, I just want to give you the basics about each and let you decide your own path.
  • On a case by case basis, student loans are granted deferment status during residency.
  • Residencies are mainly concerned with your PA school grades, evaluations, and letters of recommendation for admission
  • Most residencies work students anywhere between 40-80 hours per week (up to 6 days) and stipends average about $40,000-$75,000
  • Most residency programs can be completed in 12-14 months, however, some can be as short as 6 months and some can be as long as 18 months
  • If you are an experienced PA, you can use residency to advance your skills and knowledge or to change specialties
  • Anywhere from 10-30 people are interviewed annually for anywhere between 1-26 spots in each residency program, however, this data is not officially reported. Most programs only accept between 1 and 3 students.
  • There are currently only 8 accredited clinical residencies for PAs in the US, listed on ARC-PAs website here. Accreditation is voluntary through ARC-PA and does ensure a certain level of educational standards, but it is not required and offers no current benefit. Part of the reason many programs are not accredited has to do with inconsistencies across residencies on requirements for admission and graduation, in addition to expensive costs to obtain and maintain accreditation.
  • It’s better to choose programs that have been well established with great reputations and bring PAs to the forefront with quality clinical rotations.
  • It is highly advised to do residencies right after PA school rather than wait and decide later to do one.

For a complete list of all residency programs available, visit APPAP.org (Association of Postgraduate PA Programs) or simply perform your own Google search. I have only listed some below as examples, and by no means is this list all-inclusive. If you have any to add, please leave them in the comments section below and I’d be happy to add them! EMEDPA of the physician assistant forum has generously contributed this list of APPAP, non-APPAP, and SEMPA emergency medicine residency programs. A Program Quick Reference Chart can be found here.

The residencies and/or fellowships seen in red are not found on APPAPs website. Programs are not required to be registered with APPAP and certain membership criteria must be met to be eligible. While there are benefits to being registered with APPAP, there are also very expensive membership fees that programs may not wish to spend their money on. Do not be hesitant if the program you find interesting is not on APPAPs website.

Physician Assistant Fellowships
Physician assistant fellowships are designed to focus on a subspecialty area of clinical practice, which is why all PA residencies should be called fellowships. They are typically designed for PA graduates that wish to increase their knowledge of a subspecialty area. They often require some clinical experience in a specialty area with demonstrable clinical skills. Regardless of their name, fellowships and residencies are essentially the same for physician assistants and there should be no distinction between them. Unfortunately, programs and hospitals in the U.S. have their own distinction as there is no official designation between them. I'm not here to criticize how they label them, I'm just here to present them as they are. Below are a few fellowships available to physician assistants. If you have any to add, please leave them in the comments section below.

Sources:
Marquette University/Clement J. Zablocki VA Medical Center Milwaukee, Wisconsin???
Wake Forest/W.G. Hefner VA Medical Center Salisbury, North Carolina????



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