Tuesday, June 16, 2015

Online Physician Assistant Programs

First Online PA Program
By now you’ve surely heard of the first Physician Assistant, excuse me, Physician Associate program wanting to go “live”. What I mean by this is a fully incorporated didactic online program in medicine resulting in the completion of a master's degree without any prior PA training (no certificate, associate’s or bachelor’s degree in PA studies). Yale first announced this news on March 10th, 2015 and while it has had mixed feelings from across the PA and physician community, technology is changing, education is changing, and the realm of the physician assistant must change too. In this article I will brief you on the background of the program and hopefully provide an unbiased approach to online physician assistant programs.

The introduction of Yale School of Medicine's online Physician Associate program has definitely stirred about much debate. Schools like Yale have an outstanding reputation of graduating highly skilled and well-trained physician associates/assistants, but in April of 2015 ARC-PA did approve their initial proposal, as an increase in class size was necessary. Van Rhee, Yale’s director, claimed ARC-PA policy said that they “will not consider a new request for an increase in class size from a program until 4 years after the program’s most recent submission and approval for a class size increase.” Dean Alpern of Yale claimed that the proposal was denied because ARC-PA believed the program would not be similar enough to Yale’s current PA program to be considered class size expansion. Whatever the cause, Yale has proposed to apply as a new PA program separate from the currently accredited program using the provisional accreditation process. Van Rhee claims that this process will take approximately 1.5 years from April 2015. This is exactly what they propose to do in the near future.

Yale’s program is intended to be a blend of online courses and clinical clerkships, helping to meet the demands of PAs in primary care and underserved areas all over the U.S by matching the size of it’s current program in its first year (12 students beginning at 3 separate times each year). The program plans to expand to approximately 350 students within 5+ years and plans to work with an online education company called 2U. Requirements for admission to the program would be the same as those currently required at Yale’s prestigious PA program. This is contrary to popular belief that students admitted to this program would somehow be less qualified. Clinical sites would be selected by the program faculty with specificity to each student’s location and career goals, maintaining a very student-specific agenda. Tuition costs to each matriculant of the program would be the same as those to the current Yale PA Program, approximately $87,330. This has also stirred about much debate, as Yale may have a financial hidden agenda to starting such a program. Opponents of the program, namely alumni of the PA program, are upset about a lack of transparency and being caught off-guard with how rapidly the school planned to implement such a program. They also claim that it would devalue their own degree, as the program’s would be entirely different.

Other programs, such as the University of Wisconsin, offer ‘distance’ or online (part-time) programs with recorded web-based didactic lectures and clinical rotations in your surrounding community and another program called ‘wisPACT’ that offers live real-time online (full-time) lectures with clinical rotations in or around the school. In both programs, students meet in Madison for the first summer of the program for 2-4 days. The first program is completed in approximately 36 months and the latter, 24 months. Labs must be conducted through UW-Madison PA faculty at partnering hospitals and clinics in Wausau, WI, twice per semester. More information is available on their site, but other online PA programs’ should not go unnoticed or be under any less scrutiny than Yale.

While I do not sanction online physician assistant training, I realize that times are changing, and even our program uses podcasts and online resources as variations in teaching methods. Without them, we would be lost in this advancing digital world. Hell - look at our CME credits! Half or more of that is online nowadays!

Concerns brought about by members of the PA community (i.e. Cons to starting an online PA program): Please realize these are mostly opinions and are summarized here for your own advantage.
  • Damage the credibility of the reputation itself by not being well-accepted publicly
  • Decrease the reputation of upstanding and rigorous PA programs nationwide
  • Create clinical site competition between PA programs around the U.S.
  • Programs will not be able to guarantee clinical sites in your area and students will have to provide costs for travel and lodging in areas where sites are available.
  • The creation of newer, less well-designed online PA programs will ensue (University of Phoenix, Kaplan, etc.)
  • Medical training involves substantial patient interaction that should be developed in concert with coursework, not separately
  • Adequate preparation for clinical rotations will not be met with crash courses on campus, including anatomy, procedure workshops, H&P workshops and patient simulations
  • May compromise patient care quality due to online degrees not having significant foundation
  • Students do not reap benefits of on-campus life that shape medical providers (student clinics, supplemental courses, school organizations, leadership positions, special events, attending grand round lectures, networking or building professional relationships in-person, access to libraries or other on-campus resources
  • Clinical content may be ‘watered down’ and exams may be reused with the potential for more cheating to occur
  • Loss of camaraderie between students
  • The program may or may not be fully interactive, offering real-time access for questions and staff support
  • Medical schools are not following suit
  • An online degree will not be equivalent to other degrees  
  • Yale’s PA program is currently undergoing major curriculum changes and may have financial ties to starting a program of such size, including cheaper cost to educate students and more financial gain

Proponents of online PA programs (i.e. Pros to starting an online PA program): Please realize these are mostly opinions and are summarized here for your own advantage.
  • The number of available seats or space at PA programs has always been a limiting factor - online PA programs may alleviate this issue
  • Online programs bring a more self-directed learning approach to the profession, something we already implement in every PA program across the nation
  • PA students do not need a brick and mortar classroom to learn, they need quality lectures and expert opinion
  • Students will not be required to move away from their support systems and save money on living expenses

Common misconceptions about online PA programs: Please realize these are mostly opinions and are summarized here for your own advantage.
  • Programs like Yale will have contracts with clinical rotation sites, offering stipends for those who allow students time, expertise, and experience, rather than just shadowing. Yale will not and does not pay any clinical preceptors for their time. This policy will not change.
  • It degrades the profession. We must realize that this is an opinion, not a fact. Others in our profession argue that even if you complete the online program, you must pass the PANCe and employers won’t care where you got your degree because a PA-C is a PA-C.
  • Online PA programs will enroll less qualified applicants - Yale has made this abundantly clear that all applicants to either program will be judged according to prior standards, including appropriate didactic training and prior clinical training.
  • Online PA students will create clinical site competition between other PA programs near their hometowns. This is a false belief, as we can look at the numerous postgraduate online PA programs below and understand that many of these also have similar curriculum’s. If ‘x’ number of postgraduate physician assistants call fill spots in clinical sites to complete their master’s degree, then why couldn’t 350 students across the U.S.?
  • Adequate preparation for clinical rotations will not be met with crash courses on campus, including anatomy, procedure workshops, H&P workshops and patient simulations - Yale has provided on campus sessions where students will learn these skills in New Haven, CT. The current plan involves students performing a session at the beginning and end of didactic training, the end of the clinical years,  and an opportunity for students to elect for rotations at Yale, if desired.
  • The increase in online PA students will saturate the market. This is an obvious misconception. If you are worried that 350 students from an online PA program are going to ‘saturate’ your job market, you should be more concerned about the 80+ PA programs that are non-web based with provisional accreditation. In the next few years, more PA programs plan to open up and with them, more PA students. Even so, the job market is only expected to grow.
  • If medical schools are not following suit, why should PA programs? The vast class size of 350+ students is daunting to someone who went to programs much smaller. There are PA programs upward in the 90’s and higher out there, but nothing of this magnitude. Keep in mind that most medical students are not required to even attend lecture and programs admit 200 or more students into each class. These students ‘stream’ their lectures from home or elsewhere without ever stepping foot into a classroom, unless for exams.
  • Class size of 350 is too high. Yale has stated that it will begin with 12 students that start at 3 separate times throughout the year. This doesn’t mean they’re going to go from 0 to 60 in 60 seconds. The approach of the number 350 may be 15-20 years away from when the program begins. This is all unanswered and biased information based on what ‘officials’ from the School of Medicine have stated. Ultimately, ARC-PA will regulate their numbers, so we really should allow them to do their job.  
  • How would students afford programs that cost $87,330 for tuition? This doesn’t seem cheap, but comparatively, students pay this and much more to go to out-of-state PA programs and programs in the northeast in general. There are many programs with similar tuition costs that does not even include the cost of living in an urban area. While I do not agree with keeping costs the same for an online program, this would nearly be unfair if traditional students were charged more for the ‘same’ education (from a material standpoint).  
  • Exams will not be proctored, making knowledge checking avoidable. This is probably not the case, because many online programs in other fields have students attend a local university or testing site for proctoring.

While I must say, this is a dynamic shift in the non-traditional educational model, maybe we shouldn’t be so quick to judge. No one can truly foresee the impact or the quality of the program until it has begun and please realize that everyone in our PA community sees online education differently. Look at CAQ exams and PA residencies, which some PAs also opposed, yet they are still not the standard and are not as common as some might think. Some individuals are more opinionated than others about this issue, but our generation experiences an interactive multimedia education nearly everyday, with podcasts, powerpoints, recorded lectures, phone applications, e-mail, electronic health records, etc. This could very well be more effective than a powerpoint or blackboard lecture, anyday, despite what people who went to PA school 10-20 years ago say. Did they even have the Internet then? Just kidding. As another PA member put this - if done correctly, this program could have very positive outcomes, but until it proves itself, it will be under tons of scrutiny.

This may also be the bridge between those lectures you couldn’t stand, those that forced you to read the textbook, or worse, Up-to-Date. Thinking on my own didactic education and how many lectures I have listened to via podcast, it may not be such a bad idea if the lecturers were high quality and of expert opinion. Imagine if every lecture you had was perfect, just like the lectures you when told yourself “I wish there were more people who taught like them.” This could also be the bridge between increasing our own numbers as a profession, which we are so apt to do, as evidenced by the massive influx of accreditation-seeking PA programs. Economically, this type of education makes sense for those who may not want or simply cannot afford education in urban areas (due to living expenses) or wish to do their rotations in rural areas. There is a lot of unmet need, and PA education, in addition to physician and nursing educational models, must change with the times. Again, I am not an ambassador, nor do I endorse online PA programs, but my intention is for all to see both sides of the spectrum.

Looking at the percentage of newly graduated PAs of traditional programs that do not pass the PANCE, we can analyze that this newer non-traditional method of learning is being scrutinized from the ground up even though they have yet to put it into practice. Has anyone considered why our traditional model isn’t perfect and why PA students aren’t passing the PANCE at programs right now? The fact is that the ineffectiveness of our current system is going unnoticed and we are putting all of our attention on this shiny new object that no one wishes to welcome, yet no one stops to think about how traditional programs could be improved. Let’s be honest with ourselves - online PA education would not remove students from practicing and being tested over clinical skills or learning what heart or lung sounds-sound like. That can be studied from Bates or from YouTube videos, as we all have done at one time or another. As another put it, being successful as a PA lies with the individual and programs have the responsibility to foster and encourage this process, but it is not the model of learning that makes the PA. It is the desire, the ambition, and the will to become a better clinician, to learn medicine and become the best physician assistant you can to improve patient care quality.
The real challenge facing us is not online PA programs, however. Degree creep (the clinical doctoral PA degree), postgraduate education (residencies and fellowships), and advanced certification (Certificates of Added Qualification) are the true beasts. It is my belief that these ‘options’ will become more of ‘requirements’ in the near future, as employers will continue to expect more and more from new graduates and even seasoned PAs.

Postgraduate Online PA programs
Have your bachelor’s, associate’s or certificate in physician assistant studies? Need to obtain a master’s degree before 2020? Other PA programs, including A.T. Still University and Pace University, offer advanced physician assistant postgraduate programs to enhance, rather than replace the education already offered. For example, A.T. Still University offers physician assistants who have graduated prior to the new 2020 requirements of a master’s degree to pursue a Master of Science in Advanced PA Studies with a concentration in either Clinical Medicine or Education and Leadership.

Pace’s program is all online and can be completed in 4 semesters (1 year part-time study). The program is “highly competitive” and seeks students with prior clinical experience and appropriate didactic training. All courses and exams are completed online. The application is completed online.

Other similar online postgraduate PA programs include Drexel University, The University of Wisconsin-Madison, Touro College, and the University of Nebraska.



  1. Bad idea for the profession. Bad idea for the public. Bad idea for Yale graduates.

    Good idea for filling Yale's coffers.
    Don't do it at our profession's expense.

    There is too much education and training required in PA school.

    When is the last time you saw an accredited "online" MD program?
    Yeah. . . I thought so....

    PAs should protect the public by protecting the profession - just like other professional do.

    1. I'm a Registered Respiratory Therapist with an MSRT and 34 years of clinical experience. I agree that PAs should protect their profession. However, look at the RNP online programs. I can't believe an RN can get a BSN online and then with another 11 months online Get their NP degree and open a clinic totally independent. I personally know that the PAs are much better qualified to treat patients in just about any area of medicine. RNPs are taking over and if quality online PAs programs can help remedy this RN take over, then more power to the online PA programs.

    2. The statement that PA's are "much better qualified to treat patients" is pure ignorance.

      I employ both and it all depends on the individual. I know mid levels who are better providers than MD's.

  2. this is awesome online!!! Get with the times, u don't need to be onsite to attend a lecture.

    1. I agree, especially when your an older adult who has to pay bills and fend for family. Let the subjects be online live our education needs to fit everyone not just the old.

  3. For those of us who live HUNDREDS of miles from the nearest PA program this is a welcomed option. Uprooting yourself isn't always an option.

  4. Thanks everyone for your opinions. We may not all agree on this subject and I appreciate the discussion!

  5. I currently work in the IT field, but my Bachelor's is in Molecular and Cellular Biology. It is my passion. However, I have dependents and cannot stop working. I love that I can learn at home online. I hope this is well received because some of us in our 30's desire a change in career...like I so desperately want.

  6. While I understand that it does not feel correct to those who had to make all the sacrifices to attend brick and mortar schools, I believe that it NPs and APNs can do it why not the PA-C profession. With the same prior HCE hours requirements,and as long as the programs are accredited,I see it as a viable solution. At the end of the day isn't increasing access to healthcare and cut unnecessary costs the true goal of medicine?

    1. I think the argument against yours is that some people feel that there is not a good way to gauge the level of understanding or the bedside manner of the person "on the other side of the computer/device". It's not a question about whether PA students could complete programs like this- there is no doubt most would succeed, as with any PA program. The real question is are we sacrificing quality for quantity? and I don't think you can make a proper assessment without trialing it first.

  7. To be honest, everyone has a valid opinion. Personally, I am 25 years of age with no family, live on my own since I was 19 and began working as an anesthesia technologist. After that certification I worked towards being the anesthesia coordinator at my current hospital and am almost done with my BA and pursuing online PA school. Online education has been my only saving grace to pay my bills and work 60hours a week in a clinical setting. Some may think online learning belittled a profession but I think it does the opposite. It gives people like me a chance to use their clinical knowledge while pursuing a life changing step in education. Demands of people are changing financially and personally so I think the education system should change with it. Not everyone has the option to cease working and commit only to a classroom for years at a time. If it works and produces quality Healthcare professionals, I'm all for it.

    1. I agree, it works for certain people. I also think that if you've been a coordinator and have pupils working under you or around you, you know there are both motivated and unmotivated individuals. There are both individuals you'd trust your life with and others you wouldn't. I think there-in lies the difference. While, yes, a great tool/resource for students who'd like to continue their jobs while they pursue their career as a PA - the biggest challenge is deciding who will complete PA school with an added 60 hours vs. who will not? If you have 5,000+ people apply (which is probably less than anticipated), who is to say one candidate is more qualified than another? What about international medical graduates? Should they be guaranteed the same opportunities as you, if they've been practicing medicine as a physician abroad for 10-20-30 years?

    2. Online students like myself are not given recognition we deserve. Not everyone has the opportunity to go college and have that college experience. We are not lazy and we do not want an easier path to become a Physician Assistant. I may have an online undergraduate but I worked hard to complete my undergraduate with a full time job and a part time job. I now have 5 years (10,000 + hrs) of healthcare direct patient care experience. We work as hard or even harder than on campus students, no offense. This is exactly why we have more Nurse Practitioners, they are given the opportunity to advance as a professional with online degrees while the are actually learning on the job. I don't think is fair that an international student is given preference over an american citizen who working multiple jobs to become a better citizen and also pays taxes. Why are we called the land of opportunity if we don't even give opportunity to our own citizens?

    3. Hi Anonymous,

      Thanks for reading and reaching out. I appreciate your feedback, but I have to disagree with you on some aspects of your post. First off, I don't think anyone thinks online-students are lazy or that they do not have to work as hard. I think there is a lot of stigma out there about people taking online courses, but in reality, the type of clinician you become is totally dependent on your drive and how much effort you put into being a student. I think the barrier between brick and mortar students vs online students rests in the inability to understand one another's paths to the same goal. The brick and mortar student finds fault in the online student for being able to take their coursework at their own leisure, though it may not be as such. In some regards, you could understand how a person being forced to go to class for 8-9 hours every day, 5 days per week, taking 2+ exams every 1-2 weeks and unable to work on top of this would be frustrated that an online student could take class at their own pace, whenever they'd like. In my own personal opinion, if I would have taken my PA program and made it into an online version I don't think it would have been as rigorous.

      I also don't think that the reason there are "more NPs" is because they are given the opportunity to advance their careers while working and "learning on the job." Nurses have totally different roles in the healthcare system than PAs or NPs. The nurses I work with both on an inpatient and outpatient basis do not have the time to learn from me the things that I do all day everyday. They are extremely busy 90-95% of the time, so I disagree with that. I think the reason there are so many NPs is because the nursing profession has been widely accepted as a whole and other healthcare professionals were familiar with them from the get-go. Their role came out earlier than that of the PA and they were accepted into society well and continue to be. Their degree system advanced to an online method faster than the PA profession and that only increased their numbers further. I think it's a little premeditated to say that this is solely the reason why there are so many NPs.

      I applaud you for working while obtaining healthcare experience, but keep in mind there are students just like yourself who obtained HCE while working 2-3 jobs and were in brick and mortar schools. It doesn't mean that you are any less than they are.

      The statement that an international student is given preference over you (an American citizen) is entirely 100% false. Anyone who has been in a PA program or worked for one knows that international students are definitely the minority and have a much more difficult pathway to acceptance simply because of their international status.


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