Physician Assistant Residency
The journey to becoming a physician assistant is long and at times, arduous; requiring a four year undergraduate degree, followed by a 2-3 year PA program. As physician assistant students and clinicians, we are probably having the same thought right now, didn’t you choose this career path to AVOID a lengthy physician assistant residency, among many other reasons?
Today, we will discuss PA residencies and look at some pros and cons that may influence your decision to start working immediately after graduation, or pursue extra training in a specific sub-specialty.
With the length of many physician assistant programs, it can be difficult for students who would like to specialize to feel comfortable moving into a career in a specific specialty. For example, in my program, we had one course in psychiatry which spanned a single semester, meeting once per week for an hour or two.
In this setting, it does present some challenges to specializing initially right out of school. Depending on the specific job setting, the amount of supervision and guidance initially may be extensive, or minimal. This can create difficulties with new graduate confidence in pharmacotherapy, procedures, and overall patient care.
Although PA residencies have been available for decades, only recently has the average graduating PA student been given so many possible decisions. With the number of physician assistant residency programs increasing each year across many different specialties, it can present many other challenges regarding choosing the right residency, versus choosing one at all.
Like we said, graduating from a PA program is in itself difficult and expensive. This means that a physician assistant fellowship (fellowships and residencies are often used interchangeably in the physician assistant world) is out of the question for many.
For example, in my own personal experience, graduating with a B.S. in biology, it took two other careers, one in pre-hospital medicine and one in chemistry, to finally find the physician assistant path.
Many of your journeys may be longer than mine, with pauses to start families, do research, or explore careers very distant from medicine. Once we decide that our goal is to become a physician assistant, we sacrifice countless hours to shadow, volunteer, and gain health care experience.
When interviews roll around, our profession is unique in that we are not only asked “Why do you want to be a PA?”, but also “Why do you not want to be a physician or nurse practitioner?”
After the long arduous interview process, we finally settle into a rigorous physician assistant program, not realizing that in modern medicine, our interview process is only just beginning…
A Residency is not Required to Practice
I just want to make it perfectly clear that attending a physician assistant fellowship isn’t a requirement to practice medicine. As we said, this isn’t always practical for everyone.
So, if you aren’t considering a residency, I want to give you some advice when looking for your first job.
During my clinical rotations, I took each rotation as a five week long job interview. My goal was to impress each preceptor, clinical manager, or hospital administrator in order to keep future doors open. My thought was that each opportunity was a chance to impress, and maybe be offered a job come graduation.
For those entering rotational year, I urge you to do the same. By graduation, I had the blessing to be juggling three different job offers, all with similar salaries and benefits packages, but in two different specialties. Despite the joy of knowing I had a job, choosing became very difficult. Although I would be paid instead of paying to attend, it still seemed very similar to comparing PA school admissions offers.
So, the take away here is treat every rotation as an interview. Don’t make the mistakes that so many students make, and wait until after you’ve graduated to start looking for job opportunities.
Choosing a Residency Program
You can imagine my stress level when a physician assistant from the emergency department I rotated in approached me and suggested I apply to the new emergency department PA residency that was being created. Now, my decision was not only between job offers, but whether I wanted to specialize and undergo even more specific training in emergency medicine.
As previously discussed, many specific sub-specialties may only be briefly touched upon during the busy curriculum of a PA program. A PA residency is a unique opportunity for a student interested in a specialty to receive additional, protected didactic and supervised education, most times at an academic medical center. Similar to a residency of a physician, there are specific times for lecture, procedural/simulation lab practice, case presentations, and you guessed it, more exams.
In addition to the training one receives from physician assistant school, a residency is an additional training program that may last 12 to 24 months, focused on a specific specialty. Areas include emergency medicine, cardiothoracic surgery, orthopedics, OBGYN, psychiatry, and many more. The application process is similar to what we are used to, with writing samples, test scores, letters of recommendation, and grades from respective PA program. Very competitive residency programs may only enroll 1 to 2 students per year.
Although some programs are accredited through the ARC-PA or the Association of PostGraduate PA programs (APPAP), this is not universally required. Many programs offer certificates of completion and the goal is to train students to become more independent in their sub-specialty. Potentially end results include increased provider confidence, increased provider autonomy, higher salary, increased rate of hire, and increased scope of practice for the clinician.
Many programs’ websites are extremely helpful in terms of exploring the scope, content, and schedule for the residency. For example, many emergency department residencies offer rotations in specialties throughout the hospital to help improve comprehensiveness of the material covered.
Similar to the difficulty of choosing one PA program over another, it can be very challenging for a PA student or applicant to decide whether to take a job right out of school, or pursue more directed education in a specific sub specialty. Now, we will explore both the positives and negatives to help you make an informed decision.
Physician Assistant Residency Positives
Some of the main sources of discussion in relation to residencies include the increased scope of education. In a short period of time, the resident may undergo an intense amount of training that otherwise, may have taken years to experience. Higher levels of education may result in increased opportunities to perform procedures, increased autonomy and higher scope of practice for the clinician.
As a result of the increased didactic training and protected time for procedures, the clinician may have increased confidence in the specialty. As a result, this provides job security for the future, as resident will have more experience over a new graduate without a residency. With the increasing competitive nature of medicine, some specialty jobs for PAs may even require a residency.
Not only will this improve the PAs influence in terms of job scope of practice, it may open up doors otherwise for teaching opportunities and increased leadership due to the extra training. Additionally, a 2000 study by Asprey and Helms found that PA residencies were associated with increased residency confidence and higher job satisfaction.
Now, let’s talk physician assistant residency salary. Although the initial investment in a PA residency usually requires a salary “stipend” that is lower than most high paying PA positions, many argue that obtaining a PA residency is an investment that may prove financial dividends. Future job offers allow the physician assistant more room to negotiate higher future salary given the extra training. Lastly, student loans can also be deferred during a residency.
Physician Assistant Residency Negatives
The main concern for those applying to physician assistant residencies is financial. In the modern world of costly tuition, many students graduate from PA school with significant debts. Thus, it can be very hard to justify another year or more in school, deferring student loans, increasing interest, and a lack of full salary.
From my research, many physician assistant residencies offer stipends of $50,000 per year to $75,000 per year. For a student with significant debt, it can be hard to pass up a full paying job elsewhere and quicker time to paying off existing student loans.
Additionally, by the time a PA student has completed PA school, a great deal of educational time has been invested. Many argue that adding more schooling can be emotionally exhausting. Many students and professionals look forward to having the “9 to 5” job, as opposed to residencies which may require up to 80 hours of education, clinic time per week.
Conclusions on Residencies
The decision to pursue or not pursue a physician assistant residency is complex and multi-factorial. There is no one correct or incorrect answer and I think that the decision is individualized. For me, my interest was more in primary care, thus the solution became simple.
There are a great deal of benefits for those who are interested in specializing out of school, but care should be taken to reviewing the specific residency, its’ scope, and the potential for employment after completion.
For those interested in specializing, I think it is an excellent, intelligent investment from an academic, professional, and clinical scope of practice standpoint. Despite this, I can see why financial costs such as paying off loans, initial reduction in pay, may sway those away from a residency.
If you are considering a residency or chose a residency, comment and let us know why or why not!