Do Physician Assistants Need a Residency?

Physician assistant residencies have been around for roughly five decades now and continue to be a hot topic. They average from one to two years in length and span from surgical to non-surgical specialties. Most studies have focused on similar parameters of these residency programs such as short and long-term salary, career advancement, and employability when compared to non-residency-trained physician assistants (PAs). Some residency programs are highly structured with didactic-like portions of the program. Others are more of a pure practice model. And although there are Certificates of Added Qualifications (CAQ) there are only 8, ARC-PA accredited, residency programs, with no official “post-residency” board exam.

Residency Accreditation

The ARC-PA accreditation is voluntary for residency programs. The Association of Postgraduate Physician Assistant Programs (APPAP) did develop bylaws but residency programs are not mandated to register with them. These accreditation issues result in the decreased authority of the program. Additionally, if PAs are required to complete residencies in order to work in specialties, this could create a vortex in the employability of all physician assistants, but I digress.

Salary After a Physician Assistant Residency

Interestingly the studies tend to remain quite consistent. When it comes to short to long-term salary there seems to be a slight edge for the residency-trained trained physician assistant, at least within the first few years of practice. There also seems to be a slight increase in early-career salary for the residency-trained PA. However, after a few years, the salaries essentially become equivalent. When taken into consideration that the physician assistant residency itself took a couple years and paid significantly less than the normal PA salary, the mild boost in early salary benefits become nearly mute.

Competitive Edge

The same is true for competitive employability. When compared to recent PA graduates the residency-trained PAs have the edge on employability. However, once the PA reaches three or more years of experience the employability essentially becomes comparable between the two groups. This may be because hiring physicians and hospitals hold experience in the same light as a PA residency. After all, a residency truly is, for all intents and purposes, the carefully monitored practice of medicine, which is somewhat analogous to the role of the physician assistant. Another possible explanation is that employers do not put much stock in physician assistant residencies. This is unfortunate because extra training and education are never a bad thing.

In an interesting bout of consistency, career advancement is also not significantly improved but again fails to be beneficial in the long term. When a residency-trained PA is being considered for employment alongside a non-residency-trained PA that has recently graduated then yes, the residency-trained PA has an employability advantage, but not career advancement. Career advancement and future career choices, again, begin to become equivocal with PAs with the same timeframe of experience.

Growing Pains

The real, unspoken issue is recent graduate fear. Recent graduate fear is the fear of unpreparedness for clinical practice. Due to PA school’s relatively short timeframe, and the lack of a residency, many PA students feel immense pressure at the thought of launching their practice of medicine. As they enter their final clinical rotation or pass their PANCE the onus of the care of people’s healthcare weighs on their spirit and the fear of failure sets in. For many, this anxiety results in the contemplation of a physician assistant residency. Granted there is always an exception to every rule, some PAs truly just want to learn more and get more experience, however, many initiate this pursuit out of fear. This fear is truly unwarranted.

For PAs who have this fear, a possible strategy to combat it is to begin their careers in a field more general to the one they eventually wish to be in. For example, if one wants to go into cardiothoracic surgery but feels ill-prepared then perhaps a few years of learning in general surgery would be a great gateway to learning the milieu of surgical life. In this way, the individual grows in knowledge and skill, still earns a great salary, and simultaneously achieves the much-needed experience; gaining confidence, which does not have a price tag. Another example could be, instead of jumping right into a critical care position or an internal medicine subspecialty, begin your career in emergency medicine or internal medicine, respectively. Again, one can gain the much-needed experience yet still work as a full-time and fully salaried physician assistant.

What’s the verdict on physician assistant residencies?

In conclusion, there are a very select few who would benefit from a physician assistant residency. For most, it is an unnecessary detour and delay in the growth of their PA career. It is honorable to know your limitations, as a matter of fact, knowing your limitations may save your patient’s life one day, but fear is a handicap. Fear is a powerful force and if acted upon can result in negative outcomes.

If you have truly done your research and have dutifully decided that a PA residency is the best option for you then God speed, but for the rest I would say, do not give in to fear. Trust in your training, hit the books even after you graduate, always learn more, and perhaps begin your career in a broader area of medicine or surgery before diving into that subspecialty. At the end of the day, contemplate your career decisions deliberately and dutifully, but most important of all, do not live in fear.

2 Comments

  1. Joshua C. Bailey

    I have been a PA for a little over 5 years and I am at the end of a 18 month EM Fellowship at the Mayo Clinic. When I look back at some of my experiences in medicine I cringe at what I may have missed, now that I have been through this training.

    I agree that some may fall into a supportive supervisor employment situation, and that a residency/fellowship isn’t warranted. Also some are smart enough to learn all they need to know to practice at a high level. My first acute care position was not like that. I worked in a busy urgent care where I had no MD coverage, and was too green to know what I had gotten myself into. I do think there is nothing that can replace the experience of defending and expanding your knowledge base in a structured validated learning environment.

    As the scope of our profession expands, fellowships/residency programs are a way for us to prevent negative outcomes for patient’s, especially in some predatory organizations, which may take advantage of a new grad PA that isn’t aware of their limitations.

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