Postgraduate PA School Residency and Fellowship Programs

As a new, or even experienced PA, it is normal to feel uncomfortable with the thought of jumping into a medical specialty.

Often we have had little more than 30 days of training in a particular field, and we are joining a team of specialists who expect us to perform at the level of seasoned doctor.

PA training is generalist in nature with the ability to pick and choose among rotations as a student that may help one gain more experience in a particular field of study prior to graduation.

If you have been practicing in a field for some time and want to change directions, it can be very intimidating.

We want to do right by our patients, providing them with the very best care in all situations. While on the job training is fine and dandy, depending on your practice you may receive a lot or very little hand holding. This can be a setup for occupational success, professional and personal growth or, on the flip side, failure!

To help PAs looking to successfully transition into careers of medical specialty postgraduate PA programs began popping up in the early 1970s. As the profession grows and more and more PAs are entering specialty practice, PA residency programs have adapted to fit our needs.

Over the past four decades the PA postgraduate training movement has slowly expanded, and in 2017 there are more than 84 postgraduate PA programs with 70 of those listed on the Association of Postgraduate PA Programs (APPAP) website.

All of these postgraduate training programs also referred to as residencies or fellowships, provide some form of advanced learning in various medical and surgical specialties.

PA Residency Program Accreditation

Unlike PA schools across the country which must undergo a rigorous accreditation process through the ARC-PA, PA residency programs do not require a formal accreditation to exist. Although I think this will change with time, here are the two accrediting bodies:

ARC-PA: 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. Since 2014 The ARC-PA has placed the accreditation process for clinical postgraduate PA programs in abeyance while it studies a different type of process to recognize program educational quality.

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. Since 2014 The ARC-PA has placed the accreditation process for clinical postgraduate PA programs in abeyance while it studies a different type of process to recognize program educational quality. Association of Postgraduate PA Programs (APPAP): At the American Academy of Physician Assistants Convention in Los Angeles in May 1988 a group of postgraduate PA programs met to formalize a national postgraduate PA program organization. Bylaws were written and approved by the eight founding programs and the Association of Postgraduate Physician Assistant Programs (APPAP) was formed to further specialty education for PAs. 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 APPA's or ARC-PA website. In 2017 this says very little about the quality of the postgraduate program.

The Pros and Cons of Physician Assistant Residency Programs

There are pros and cons to completing a residency program, but it is the decision of each individual PA to choose to participate, which greatly depends on the specialty.

Where was the first postgraduate residency PA program established? If loading fails, click here to try again Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. Question 1 Where was the first postgraduate residency PA program established? A Montefiore Medical Center B Norwalk Hospital/Yale University C Howard University Hospital D Cedars-Sinai Medical Center Question 1 Explanation: Montefiore PA Surgical Residency Program Montefiore's Physician Assistant residency is the oldest postgraduate residency program in the country. It was established in 1971 at the Montefiore Medical Center in the Bronx, NY by Marvin Gliedman, MD, Richard Rosen, MD, and Clara Vanderbilt, R-PA. Montefiore became the first hospital to include PAs as house officers on inpatient surgical services. Those PA's quickly became an integral part of the surgical team at Montefiore and their clinical experience was formalized into a 12-month residency in general surgery and surgical specialties. There is 1 question to complete. Return Shaded items are complete. 1 Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All done Need more practice! Keep trying! Not bad! Good work! Perfect!

PROS of PA Residency Programs

Residency programs allow the physician assistant to gain both clinical and didactic knowledge that would take years of on-the-job training to attain. It provides a faster paced, formalized training program of supervised practice, which allows physician assistants to be utilized much faster than new graduates.

The PA can develop the judgment and technical abilities in a specialized practice area, thus increasing their confidence in their chosen specialties.

Many employers give preference to residency-trained physician assistants.

Residency programs can be a great way to transition to specialty practice for a mid-career PA looking for a new challenge.

It is also recognized that most employers are willing to pay more for a physician assistant who completed a residency program.

Emory University Critical Care Residency

PA Surgical Residency Personal Account I attended the Norwalk/Yale Surgery residency 2 years ago. I thought the training was invaluable. The pay was less and the work was exhausting but I’m absolutely positive I am a much better surgical PA because of it. I went into CT surgery after and feel like I’ve always had a huge advantage in my field because of my training. I think most of the negative attitude towards residency comes from PAs that didn’t complete one or had very little exposure to any. Most of the people I know that attended residencies were happy they did. I know there’s a fear that residency training limits you to one specialty but I think it does the opposite. If you end up switching specialties it shows employers that you have a passion to learn and were willing to put in a little harder work for better training. It doesn’t hurt your lateral mobility at all. If two candidates want to switch from CT surgery to Derm, who is the stronger candidate, the one with 3 years of CT experience, or the one with 2 years CT and 12 months of intensive surgical training? Sure, you can get a job that does an excellent job of training you up and allowing you to become a well-rounded, knowledgeable PA but some jobs just need you to crank out patients and know the right answer, not necessarily understanding why that’s the right answer. Residency training just concentrates everything you have the potential to learn in your first 2-3 years into 12 long months. I personally believe if more people did residencies it would strengthen our entire career field. We pride ourselves in being trained in the medical model and residencies are what really separate Physicians from APPs, so why not.

PA Cardiology Residency Personal Account I am currently in a cardiology post-graduate residency/fellowship at The Ohio State University. However, it is not accredited/not listed on the APPAP website. I decided to pursue this after graduation because I wanted more exposure in the different subspecialties of cardiology, something I don’t think I could’ve received if I got a general cardiology position. Here are some +/- of my experience so far (~4 months in) (+) -Exposure to many different sub-specialties: ep, hf, CT, vascular, transplant, adult congenital etc. Also get to spend time with palliative (mostly pts with hf), stress/echo lab, consults etc. -Decent pay (70k). I know I could get paid more but this amount was a good trade-off. -Lots of learning opportunities. I can and am encouraged to attend grand rounds, conferences etc that are set up for MD residents/fellows. We don’t work excessive hours – unlike medical residents. My hours average from 36-40ish a week m-f. Throw in study time and obviously, it goes up. -Good mix of inpatient/outpatient exposure. More so inpatient. -Program is very open to feedback/suggestions and are accommodating. For example, I wanted to spend some time in the stress lab to see vo2/stress/etc test and it was set up very soon after. I imagine the program to get better every year. (-) -Taking a hit on salary. -Moving to a new st 2500 miles from home is/was an adjustment. -The cardiology fellowship for mid-levels is a new thing at Ohio St – so there are obviously things that can be improved such as some teams allowing us to just shadow, or some preceptors not knowing what the fellowship really entails. Each team I am part of is different from the next in terms of learning opportunity, etc. For the most part, many of the teams I am on I feel like I am part of a team and have preceptors who are genuinely interested in my education. Other times (which is rare) I feel like I’m just there to shadow. In conclusion, the program here at OSU could use some more structure but overall I’m glad I applied and was accepted. After just four months in, I am confident I will have more experience/knowledge than if I just took a job. With that said, after one year I obviously have much to learn and will be that way for the rest of my career.

CONS of PA Residency Programs

PAs who jump into specialty without residencies claim you can get paid 2-3 x as much, work less, and learn just as much while getting your training on the job.

Even though employers are willing to pay more for a PA who completed a residency, the salary maxes out and becomes equal to those who did not do a residency program.

Residency requires more education thus increasing the duration of school and structuring the profession more like a physician. Tuition for a Physician Assistant Program is around $78,000 for didactic months and the clinical year. If a student has to take out a loan for $36,000 for two semesters, and, with seven total semesters, our total debt at the end of our physician assistant program is around $126,000. This does not include any interested accumulated. Adding on more expenses and loans for residency programs may put the PA graduate in more debt and leave one with more accumulated interest that is more difficult to pay off in a timely fashion.

A negative aspect of employers’ rewarding those who complete residency programs with a larger salary is that it could become mandatory for physician assistants to complete specialty residency training in order to compete for the positions since more applicants may apply for higher paying jobs than lower paying ones.

Residencies require more education, therefore delaying those practitioners from entering the clinical setting on a full-time basis. This delay limits the number and availability of physician assistants as mid-level practitioners, exacerbating the lack of health care providers to meet the increasing demands of the population for health care.

As you can see, this can turn into a contentious debate! What do you think, are fellowship programs here to stay?

Cast Your Vote: Are PA Residency Programs a Good Idea? Yes No Vote

PA program residency quick facts:

What about my loans? You can defer student loans during your residency and some programs offer loan repayment.

You can defer student loans during your residency and some programs offer loan repayment. Do I get paid during my residency? Most residencies provide stipends of 40 - 75 k and require 40-80 hours per week up to 6 days per week.

Most residencies provide stipends of 40 - 75 k and require 40-80 hours per week up to 6 days per week. How many hours will I be required to work? The average program length is 12 months but some programs are up to 24 months long.

The average program length is 12 months but some programs are up to 24 months long. How competitive is the process? 10-30 people interview at each program annually and accept on average 1-4 residents.

PA Residency Program offerings

Below, is an exhaustive list of US PA postgraduate residency and fellowship programs as of January 2019.

By far the most comprehensive PA residency program is hosted by the Carolinas Healthcare system which offers eight PA fellowships in Acute Care, Critical Care/Trauma, Family Medicine, Hospitalist, Internal Medicine, Pediatrics, Urgent Care and Urology!

in Acute Care, Critical Care/Trauma, Family Medicine, Hospitalist, Internal Medicine, Pediatrics, Urgent Care and Urology! The Mayo Clinic also offers a deep network of PA residency programs in Critical care/Trauma, Hospitalist, Hematology, and Oncology, Internal Medicine, Otolaryngology and ENT.

I have added a brand new section for Postgraduate PA residency programs as part of the PA School finder website. You can now search by program and specialty via a geographical search console or use the new interactive perfect match tool.

PA Postgraduate Residency and Fellowship Programs by Specialty (Updated March 2019)

Use the search box to search by specialty or location. Click the header column to sort based on that criteria. Click on the web link to visit the postgraduate residency program website.

wdt_ID Program Specialty Location Months Size web Program Specialty Location Months Size web

By the Numbers - What do the studies say?

According to this PAEA study:

PA postgraduate residency education provides an important educational vehicle for training graduate PAs in specialty care. A substantial proportion of residents proceed directly from entry-level to postgraduate training. Residents report satisfaction with their programs generally and specifically in terms of knowledge and skills acquired. More information comparing the differences between academic and internship models of residency education is needed as is consideration of greater standardization in program record-keeping and support for research into the longitudinal outcomes associated with postgraduate education.

According to this PAEA study:

Although most students (89.3%) were aware of residency training programs, results indicated that few (7%) had definite plans to attend. Two-thirds of students stated that they received no information on residency training programs at school (journal ads were the most popular information source). Student perceptions of residency training programs were mixed. Their opinions varied according to their program level (p<0.03) and intended region of future practice (p<0.007). Additional significant variables related to student perceptions included student graduation date, age, and gender. However, these factors were not as significant as the geographic region of intended practice and degree level.

Discussion: Although only one-third of students reported receiving material or information related to residency training programs from their faculty, two-thirds of faculty respondents stated that they provide students with residency information. Of those providing information, only 32.5% of faculty stated that they actually encourage their students to attend postgraduate training. Like their students, faculty members had mixed positive and negative perceptions of residency training programs

Final Thoughts

Personally, I have mixed feelings about residency programs for PAs.

I see the benefits for PAs, supervising physicians and patients. But, I fear that residency programs may become a requirement rather than an option.

This will lead to increase cost and time in school which is one of the key differentiators of the PA and MD profession.

An alternative model would be very short, inexpensive, 2-3 month programs that would allow PAs to gain valuable experience prior to entering specialty. I would love a quick ER or orthopedic "refresher" if I were to change specialty at this point in my career. I think programs like this would be very popular. Especially as there seems to be less and less preceptorship to new PAs entering specialty.

Like PA schools, long, expensive programs are probably not the solution. I am curious to see how this all plays out.

Do you have an opinion? I would love to hear in the comments section!

Additional resources and links

If you haven't already don't forget to check out my Postgraduate PA Residency Section of the PA SCHOOL FINDER website and the new PA School Match Tool that allows you to narrow down your program search in real time!

Residency programs can be competitive and often only have 1-2 available seats per application cycle. We are more than happy to help you with postgraduate application materials/essays through our personal statement collaborative.

Do you know of additional residency programs not listed in this table? Let me know in the comments section and I will add them ASAP!

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