Center for the Future of Health Professions Dec. 2023 digest
Posted: December 12, 2023
We are excited to introduce the December 2023 op-ed column for the Center for the Future of the Health Professions Digest! Our goal is to provide accurate and reliable information and research on the healthcare workforce to help policymakers and health system stakeholders effectively plan for a sustainable future. This month’s column covers the evolution and future of postgraduate physician associate/assistant (PA) training programs. These programs have become a vital component in PA postprofessional education and training. We explore where we currently stand and where we might be heading.
We are excited to feature Dr. Melissa Ricker. Dr. Ricker holds a bachelor of science in human biology from North Carolina State University, a master’s in PA studies from East Carolina University, and a doctor of medical science from A.T. Sill University. She also completed the WakeMed Health and Hospital Surgical Trauma Critical Care PA Fellowship Program.
Currently, Dr. Ricker practices clinically in pulmonary critical care and serves as the PA fellowship director for the enterprise-wide Atrium Health Advanced Practice Provider (APP) fellowship, overseeing tracks in Charlotte, North Carolina, Winston-Salem, North Carolina, and Macon, Georgia. Since taking on the role of PA fellowship director in 2018, she has collaborated closely with co-director Anne Vail, DNP, to maintain the national reputation of being the largest and most clinically diverse APP fellowship in the country.
To ensure these PA fellows are equipped to provide compassionate care to all, recent program enhancements have included a diversity, equity, and inclusion curriculum, a formal leadership program, local and international service opportunities, and education/research collaborations with other allied health residents at Atrium Health.
We invite you to share your thoughts on this month’s digest with us.
Randy Danielsen, PhD, PA-C Emeritus, DFAAPA
Professor and Director
The Center for the Future of the Health Professions
A.T. Still University
The evolution and future of postgraduate PA training programs: A vital component in PA education and training
With just over 50 years of the physician assistant (PA) profession in the rearview mirror, it is humbling to think how far the profession has come in such a relatively short period. Certainly innovative for its time, the PA curriculum was designed to run over just two years from its inception, intended to build upon an educational and life experience foundation to fulfill a post-war workforce shortage. Initially a primary care focus recognizing the value of the PA profession, didactic and clinical training were eventually broadened, per accreditation standards, to include a minimum of family medicine, emergency medicine, internal medicine, surgery, pediatrics, women’s health, and behavioral health.1 These professionals are prepared to practice clinically after completing a standardized national certification exam. This is the story we, as PAs, all know and tell.
Unknown to many, in a blind spot on that same rearview mirror lies the fact that PA postgraduate education has co-existed for nearly the same duration. Just six years after the PA profession was founded, Montefiore became the first hospital to include PAs as house officers on inpatient surgical services, and their clinical experience was formalized into [the first] 12-month residency in general surgery and surgical specialties.2 Healthcare professionals and institutions saw value in postgraduate education for these PAs decades ago, enhancing specialty education and training while intensively cultivating other professional skills not traditionally taught within this PA education and continuing to invest in them today. In 2023, more than 160 programs across the United States offer advanced specialty training in nearly every specialty of medicine and surgery.3
This raises the question, do postgraduate PA training programs continue to have a place in the future of PA education and training?
For new graduate PAs entering the workforce, the job market can be challenging. According to the Physician Assistant Education Association’s June 2023 End of Program PA Student Survey, only 35.0% of graduating PA students reported accepting or receiving at least one job offer.4 Landing that job took an impressive number of applications, an average of 9.9. However, even more impressive, those reporting no job or offer reported submitting an average of 13.3 job applications.4 For those for whom clinical work experience or specialty training is an employment barrier, seeking an optional PA fellowship may be a solution to secure long-term employment. A certificate of completion is often awarded following the successful completion of a PA fellowship program and is used to demonstrate increased competence and confidence. In a 2020 national survey of postgraduate physician assistant fellowship and residency programs, 96% of the respondents were employed within two months and 78% reported the demand was “high” for their employment, often presented with “multiple offers”.5 Following the hiring trends of new PA graduates and institutional tendency to hire a PA without experience will be vital to potential increased adoption and growth of the postgraduate training of PA new graduates.
Adding to the marketability of a PA completing a fellowship, PA fellowships seek collaboration with Doctor of Medical Science (DMSc) programs to add to their value, combining the efforts of academic clinical coursework and the structured clinical fellowship experiences. PA fellows enroll in a clinical fellowship and time de-escalated academic doctorate program to apply academic concepts, research methods, and educational and leadership learnings deeply. Graduates receive both a fellowship certificate of completion and a doctorate. While no published work exists on the impact on their employability, one can hypothesize that the increased academic skill only boosts their marketability and value to any hiring institution.
That said, these programs are not solely beneficial for the PA fellow, they are often very beneficial for the sponsoring organization. After all, with the affordability of healthcare becoming more at the forefront of our training and clinical decision-making, hospital operational leaders are choosing to invest in PA fellowship programs because of the financial and nonfinancial return on investment. The opportunity to select highly motivated PA candidates, enroll them into a year-long program at a reduced stipend, invest in their clinical and leadership growth, introduce them to key system leaders, and promote engagement in scholarly work all collectively facilitate this introduction into a multifaceted and fulfilling career as a PA. In the same 2020 postgraduate survey previously mentioned, 83% of participating programs endorsed a local retention strategy to retain trained talent, with 55% intentionally cultivating graduates to serve in local [leadership] roles post-training.5 Additional retrospective added value was the interprofessional collaboration these programs fostered (93%). And, 76% reported they felt their fellowship programs helped improve the overall system autonomy of their APPs.5 As financial value becomes more transparent to the public, this will likely influence further institutional investment into PA fellowship programs.
Lastly, without a doubt the pandemic challenged the medical community, and PAs were not immune to the hardships. Our professional flexibility afforded many PA transitions into new or virtual roles, often with limited mentorship or training. APP fellowship curriculum remains dynamic as healthcare delivery evolves and institutional changes occur. PA fellowship programs can more readily and intentionally provide training for PAs entering these specialties. Mentorship is also a pivotal root of the program (lasting often after fellowship) that can influence future career trajectories, development, and advancement. Examples include training those in behavioral health and specialty medical tracks telehealth, preparing new leaders as their institutions develop their APP leadership structures, and opening/closing fellowship tracks that may align with future institutional growth or consolidation.
When we look in this rearview mirror in another 50 years we envision a future where postgraduate training for PAs is readily visible, highly esteemed within the field, and characterized by rigorous academic and clinical standards. This training will foster intentional collaboration across disciplines and serve as a valuable optional pathway for PAs to enhance their expertise and confidence in both academic and clinical settings.
References