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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????



55 comments:

  1. Thank you for posting this! It is very informative, and as a pre-PA starting a PA program in the Fall, it is good to have some idea of possible "next steps" after graduation!

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  2. Being a Canadian PA would completing a residency or doctoral PA give you access to work in the us?

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    Replies
    1. Sorry I never saw this post. The rules are still the same for working in the US. Graduate from an accredited PA program, pass the PANCE, become licensed by the state in which you want to work in. Completing a residency or getting a doctoral degree in PA studies does not grant you any authority to work in the US.

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  3. I am currently a cytologist and I am interested in switching my career to becoming a PA. I always wanted to become a doctor, however, due to life experiences, things shifted. My questions are: I live in New Jersey, what schools do you recommend to be the best for a PA program? Are GRE's required?

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    Replies
    1. Hi Linda,

      I would check out the PAEA program directory for PA programs: http://directory.paeaonline.org

      There are currently 4 PA programs in New Jersey, but it looks like Rutgers and Seton Hall are accredited and Monmouth has provisional accreditation right now. Kean University is still in development. Rutgers is the only program that does not require the GRE. It really just depends what you are looking for. I have heard great things about Rutgers. I would look more online at each program. Best of luck!

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  4. I did some research, but I wanted to get a better insight of becoming a PA from someone who is already a PA or a student of PA.

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  5. Is the program rewarding? Some people have there pros and cons of any field/ career. What are done for this field?

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    Replies
    1. If you are asking if PA school is rewarding, then yes. Very much so! I'm confused about your second question, sorry.

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  6. Staten Island University Hospital has a program as well
    http://www.statenislandem.com/pa-fellowship/

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  7. Thank you for sharing this valuable resources. PA's are so important and unfortunately, undervalued. The more people involved in programs like the ones mentioned the better.

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    Replies
    1. Thank you! I appreciate your input. The number of PA residencies and fellowships continues to grow with growing interest. I will post an updated version of the current list soon.

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  8. Great article. I believe the EM PA Residency in Cook County is in IL, not IA. I'm looking forward to an updated article if there have been new residencies added or possibly any PA programs in the process of developing a new residency. Keep up the good work.

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    Replies
    1. Thanks! I fixed that.

      I know off the top of my head that UT San Antonio (Emergency Medicine) is developing a program and Community Health Care (Family Medicine) is as well.

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    2. Are the new rankings of PA schools by U.S. News suppose to come out soon? Did they improve on their methodology this time? Also, what made you choose UT Southwestern over Baylor College of Medicine? Thanks Paul.

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    3. Hi Anonymous,

      To my knowledge, they are supposed to be released March 11, 2015. As for the methodology, they released a statement about it not too long ago, you can find using a google search.

      I will release a blog post soon about my decision of UTSW over ANY PA program. Thanks

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    4. Also, this post has just been updated.

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    5. http://doseofpa.blogspot.com/2015/03/why-i-chose-ut-southwesterns-physician.html

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  9. So I'm graduating from High school this year , and I want to be a Neonatology Physician Assistant. I know its a bit early for me to be thinking this far, but I really want to be prepared . I am looking for certain PA schools that are in Florida. If I get into those schools, are they going to let me specialize in Neonatology? I think they would right? Also , I don't know if there are any schools in florida , so based on your knowledge , could you tell me? I did my research , and I'm still confused. And Lastly, I have to do my four years of undergrad, and then also adding the years for becoming a PA , how many years total will I be in college? Thank you !!

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    1. As long as you are a PA-C, i.e. you graduate and become nationally licensed, you can pretty much specialize in whatever you want as long as you find a supervising physician willing to train you.

      The PAEA directory has a list of all PA programs and you can sort it by state. I suggest you google it.

      PA programs are about 2-3 years long, so total school would be 6-7 years.

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    2. 6-7 years as in including college years?

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    3. Yes, if you include undergraduate years. There are some newer PA programs that combined bachelors and masters degrees for 5-6 years.

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  10. Hi I graduated as a PA and I wanted to get in contact with you regarding fellowships/residency programs. I had some questions whats the best way to do that?

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    Replies
    1. Hi Anonymous,

      For personal reasons, I do not post my own e-mail on here. You can imagine the amount of e-mail I would get. There are lots of people who spam my blog daily as well, so it builds up. If you'd like to contact me, leave your contact information here and I will contact you and delete your post. Thanks!

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  11. Yeah I can understand that. I was wondering in order to do a residency program do you need to be board certified? I have struggled with the PANCE and I was looking at some options where maybe I could work to get experience then maybe try and take the PANCE again. Whats your opionin or do you know any good tutors/review courses? How did you study?

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    1. I believe so, yes. Residencies are post-graduate programs and they are intended to advance your knowledge and skills as a practicing, and licensed PA.

      I think your best bet would be to get a good PANCE tutor or study guide from online and take it again before applying for jobs. You might consider working as a phlebotomist, CNA/MA, pharmacy tech, or something in the medical field while you study and retake the PANCE. I have a blog post about the PANCE and PANRE with plenty of resources.

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  12. Im looking for a PANCE tutor do you know of anyone?

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    Replies
    1. Please check out my blog post about the PANCE/PANRE.

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  13. Does anyone know if there are postgraduate PA programs that specialize in neurology? All I see is neurosurgery or psychiatry.

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    Replies
    1. Hi anonymous,

      I've done some extensive research and I have yet to find a neurology residency for PA programs, although that would be very interesting. I think the problem is the cost to set one up (mainly payment of the PA resident) since the funds have to come from the hospital/clinic itself.

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  14. The University of Missouri has an emergency medicine residency that is not on your list. Just an FYI

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    Replies
    1. Hi anonymous, I listed that residency under "Critical/Acute Care Physician Assistant Residency". If you are talking about a different residency, please let me know via a link so I can add it. Thanks for reading!

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  15. Lots of opportunity for residency applicants. Thank you for sharing this post.

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  16. Residencies are competitive but not nearly as competitive as your opening suggests. Based on the math in the article you linked, a 3% chance would be true if every new PA graduate applied to a residency, which they do not. In my graduate class only about 6 of 70 applied for post graduate education. Great info though. This blog rules and got me through rotations!

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    Replies
    1. Hi anyonymous,

      I always post links with references, so here you go: http://www2.paeaonline.org/index.php?ht=a/GetDocumentAction/i/134634

      It very well may not be the case anymore, but at the time of the last documented evidence, this was the case. There is very little research available on post-graduate PA programs, which is why some things in this article may be outdated.

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  17. Duke has an Orthopedic Surgery residency

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    Replies
    1. I have it. It's just listed under orthopedic, instead of orthopedic surgery. I need to change that. Thanks!

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  18. There is a Surgery PA Residency Program at University of Florida, Gainesville that graduates 4 residents per year.

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    1. http://surgery.med.ufl.edu/education/pa-surgical-residency/program-information/

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  19. Hi, I'm a 2nd year physician assistant student and I would really like to apply to a residency program which many require a letter of recommendation from a faculty member. I feel like I did not get to know any particular faculty member during didactic year that I could ask for a letter of recommendation. Do you have any suggestions on how to go about obtaining one?

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    Replies
    1. Hi anonymous,
      I think by 2nd year you mean you are graduating soon, correct? If so, I would try reaching out to any faculty member or your director. I would also try to gather a list of preceptors you might have had that could speak to them on your behalf and give good recommendations of your work ethic. Academically speaking, your recommender is probably used as a gateway to determining your clinical acumen rather than how well they know you personally. I think you could easily talk to your professors about writing you a solid recommendation letter and schedule a meeting (in person) to talk about your experiences, your goals, and what type of person you are. Giving them examples to use in your recommendation letter will only help you and I always give any recommender a list of adjectives I'd use to describe myself and reasons why. Read my blog post about letters of recommendation - it's used for the CASPA application, but still very much applicable. Good luck!

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  20. The University of California, San Francisco (UCSF) School of Medicine is proud to announce the newest addition to its medical education programs. The UCSF Fresno Emergency Medicine PA Residency is accepting applications for its 2016 class. This 18 month post-graduate program is designed to prepare PAs to practice in a variety of emergency medicine environments. We will be accepting 2 residents in 2016.

    Rotations include:
    - Trauma
    - Critical Care
    - Burn
    - Orthopedics
    - Dermatology
    - Ophthalmology
    - Oral Maxillofacial Surgery
    - Toxicology
    - Radiology
    - Emergency Ultrasound
    - ECG
    - Anesthesia
    - EMS

    Resuscitation courses include: ACLS, ATLS, BLS, PALS

    18-month stipend: $90,000
    Full Benefits
    Paid attendance at SEMPA 360, SEMPA’s annual conference

    Our giant, new, state-of-the-art ED at Community Regional Medical Center serves as the only Level 1 trauma center and Burn center for Central California, and handles an annual ED volume of over 110,000.

    For more information:
    http://www.fresno.ucsf.edu/em/pa/
    em.pa.residency@fresno.ucsf.edu

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  21. Paul,

    I added the above information about the UCSF Fresno EM PA Residency. Do you mind adding it to your master list?

    Thanks,
    Fred

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  22. Thank you for the insight. Am a graduate Pa and am stuck. I will like to pick up a masters program. Apart from PA masters programs, what other health related masters program can i pick up

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    Replies
    1. Hi anonymous, here are some other options for PA career advancement: http://www.doseofpa.blogspot.com/2016/03/career-advancement-for-pas.html

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  23. Hey Paul! I have a couple questions about residency (specifically, neurology) - the doctor I was talking to about this subject today said by obtaining a residency, it would cost a practice lot more to hire a PA with this qualification, and he said he would not hire someone so qualified. Have you found this to be true?

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    1. Hi Abby,
      I think this instance was strictly preference. I do not think that all employers would think this way, as there are many employers who would prefer a PA with more experience (and residency provides the means to achieve this). I would continue to look for other employers who value the residency and see it as a benefit. Good luck!

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    2. I would also suggest you contact folks at the "Duke Neurology Advanced Practice Provider Fellowship - NC" to see what their opinions on the matter are.

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  24. Hi Paul,

    I have a few questions about PA residencies. I am a 2nd year university student. Do you mind emailing me? My personal email is: petkova.ev@gmail.com

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    Replies
    1. Hi, if you haven't received an answer already, contact appap@appap.org

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  25. Hey Paul,

    What are the factors residency programs consider when they are selecting candidates? I've been told that GPA doesn't matter in PA school. Exactly how much does GPA matter when it comes to obtaining a residency? Thanks

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    1. WOW. That's a good question. I think this is something that is currently being studied as we speak. I don't believe I can appropriately answer that. If I was you, I'd contact appap@appap.org and see if they might have an answer for you.

      I'd love to know the answer if you find out.

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