Residency Programs and Physician Assistants

Transcription

1 Residency Programs and Physician Assistants 1

2 2 Abstract: Residency programs are arising all over the nation for physician assistants and are a relatively new concept. A residency program provides a multitude of opportunities for physician assistants, but is not required at the present time, thus leaving the decision at an individual basis. Pros for participating in a residency program is that it allows the physician assistant to gain both clinical and didactic knowledge that would take years of on-the-job training to attain. 1 It is also recognized that most employers are willing to pay more for a physician assistant who completed a residency program. The PA residency program has now developed another purpose which is to not only give the PA specialized training but to aid in resolving the serious healthcare dilemma of shortage of residents due to the shift duration cutback. Despite the selected positive aspects of the residency programs, there are also a variety of cons to engaging in a residency program. 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. In addition, residency requires more education thus increasing duration of school and structuring the profession more like a physician. There are positives and negatives to the selected arguments for or against completing a residency program, but it is the decision of each individual PA to choose to participate, which greatly depends on the specialty.

3 3 Residency programs are arising all over the nation for physician assistants and are a relatively new concept. This idea was originally exclusive to medical school graduates but has now been expanded for physician assistant graduates. The goal for PA residency programs has always been to allow for a more focused education in the desired specialty of the graduate, but they are now also being designed to facilitate quality care and staffing needs. 1 Since residency is not required for physician assistants, the topic is controversial in regards to the pros and cons of electing to do a residency-do the pros outweigh the cons and vice versa? This paper will be discussing selected pros and cons of choosing to participate in a residency program which will be supplemented by statistics, interviews with physician assistants and physicians, and journal articles. A residency program provides a multitude of opportunities for physician assistants. First, it allows the physician assistant to gain both clinical and didactic knowledge that would take years of on-the-job training to attain. 2 Basically, it provides a faster paced, formalized training program of supervised practice, which allows physician assistants to be utilized much faster than new graduates. 3 In an interview conducted in 2011 with a practicing PA, he stated that, I fully support residency programs and wish I had that opportunity when I graduated from PA school in Furthermore, the PA can develop the judgment and technical abilities in a specialized practice area, 2 thus increasing their confidence in their chosen specialties. In PA school, you barely skim the surface of the knowledge base you will need in a specialty, which is why residency programs are highly beneficial, says the practicing PA. He also encourages new graduates to take advantage of any residency opportunities in their specialty of interest because many employers give preference to residency-trained physician assistants. 2

4 4 The PA residency program has now developed another purpose which is to not only give the PA specialized training but to aid in resolving a serious healthcare dilemma. Due to the recent limitation of residents hours, there has become a shortage of health care providers who are qualified to take their place, especially in the surgical pre-op and post-op care. 1,4 According to Heinrich, A PA with special training in surgical case management and operative assisting meets many needs previously provided by surgical residents. 1 Therefore, these PAs essentially serve in the place of the residents when residents shift are complete, thus increasing the quality of care and addressing the shortage of staff. 4. It is also recognized that most employers are willing to pay more for a physician assistant who completed a residency program. 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. His reasoning derives directly from his own experience in which he found it necessary and highly beneficial to train the physician assistants for two years before allowing them full autonomy. It is important to obtain a physician assistant s point of view as well, and it has been found that most PAs who have completed a residency program report that are very satisfied with their training. 3 Therefore, there are a variety of benefits which result from participating in a residency program; however, like any controversial topic, there is also an opposing side to explore as well. Despite the positive aspects of the residency programs, there is also an array of disadvantages to engaging in a residency program. 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

5 5 physician assistant residents experience a work environment similar to what is found in a postgraduate PA s first clinical year of practice. Another consideration is the fact that most new graduates are already in a large amount of debt; enrolling in a residency program will likely cause the student to accumulate even more debt, especially since PA residency programs pay their students an average about $40, One must then ask, can you put a price on this type of education and experience? After completion of a residency program, there is the potential for a higher salary; however, that is only for the first few years. The caveat is that after a few years of clinical experience, physician assistants who did not go through a residency program will have an equivalent salary to the physician assistants who did complete a residency program. This is because the physician assistant s salary maxes out after a few years regardless of residency training or clinical experience. 3 One of the largest appeals of the physician assistant profession is the fact that as a PA you have the mobility and flexibility to change specialties, seeing as physician assistants are trained as generalists. However, if one participates in a residency program, it may make one less willing to change specialties due to the time and money invested in the residency s specialty. There are other items to take into consideration. The increased salaries offered to those who complete physician assistant residencies may have a downside. 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. Also, by adding additional years of training for specialties, the physician assistant s education begins to compare to a MD or DO s education level. If a PA expends many additional years for training, potential PA students may ask themselves, why not attend medical

6 6 school? By creating higher paid positions for specialties and by encouraging residencies, one seems to be contradicting the principal function of the physician assistant which is be utilized as mid-level practitioners for general care. It seems as though the PA profession is becoming more like the physician profession, but, in all reality, PAs are not physicians and chose PA school for an assortment of reasons. There is a very limited amount of information available to compare the difference between physician assistants who went through additional training in a residency program compared to those who did not attend an additional program. This is due to the residency programs being relatively new and the subsequent lack of statistics from PAs who completed the programs. The United States Department of Labor reported the 2011 statistics for physician assistant salaries, reporting a mean annual salary of $81,230; this is over double the amount of the aforementioned average salary of a PA resident. 6,7 Statistics show that while physician assistants practice in over sixty different specialty fields, 17, 947 PA respondents reported that their primary specialty was one of the primary care fields: family/general medicine (24.8%), general internal medicine (6.4%), general pediatrics (2.2%), and obstetrics/gynecology (2.3%). Other prevalent specialties for PAs include general surgery/surgical subspecialties (2.7%/7.3%), emergency medicine (10.3%), the subspecialties of internal medicine (7.6%), and dermatology (3.8%). 8 Physician assistants earn different salaries based on clinical experience, and the following statistics demonstrate this. The top ten percent of physician assistants in 2009 earned a mean annual wage of $115,080, and the bottom ten percent earned $55, In specialty hospitals, PAs earned a mean wage around $90,940, in outpatient care centers they earned $87,060, and, in general medical and surgical hospitals, physician assistants earned $86, According to Dehn, residency-trained PAs work[ed] an average of 15.5% more hours than

7 7 informally trained surgery PAs and also earned an average of 15.1% more. Therefore, the residency-trained physician assistants made more money only because they worked longer hours! When this fact is taken into account, salaries in the two groups were equal. 3 According to the Association of Postgraduate Physician Assistant Programs (APPAP), there are fifty-one accredited physician assistant residency programs. 6 Fifty percent are associated with a surgical residency, 19% percent are associated with emergency medicine, and the rest include dermatology, psychiatry, critical care, hospitalists, OBGYN, urology, oncology, neonatology, and otolaryngology. 6 Acceptance to a residency program is competitive, taking into account that there are anywhere from one to five seats per class. Due to the competitive nature; it is highly unlikely for the majority of PA graduates to be offered a seat in a residency program. There are nearly 160 accredited physician assistant programs with a class size ranging anywhere from twenty to eighty students. 10 With only about fifty-four physician assistant residency programs in the United States, each with a limited number of seats, the odds of a PA graduate being accepted into a residency program are minimal at best. For example, if one estimates that there is an average of forty seats per physician assistant program and that there is an average of three seats per residency program, then there is approximately a 3% chance of a PA graduate gaining a seat in a residency program. Residency programs are a benefit to those physician assistants who wish to vastly expand their knowledge of the specialty in which they seek to practice, more specifically a fast-paced specialty. The motive for a postgraduate PA enrolling in a residency program should not be to complete their residency in hopes of a greater salary. This is because, after time, those physician assistants who did not complete a residency program will, after a few years of experience, match those salaries of PAs who did attend a residency program. For instance, the tuition for a

8 8 Physician Assistant Program is around $78,000 for tuition for didactic months and the clinical year. (citation blinded) 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. Understandably so, as soon as graduates are certified through the PANCE, many would like to start working and earning money to pay off loans, especially when they may be trained and gain skills by working clinically instead of by attending a residency and thus possibly owing more money due to more loans and minimal pay. The beauty of the physician assistant profession is the ability to change specialties as desired. Physician assistants are trained as generalists who are autonomous in their work; to pick one particular specialty after a residency program no longer matches the traditional nature of the profession. Also, encouraging residencies may result in requiring additional training for the PA s changing between different specialties. In addition, 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. In conclusion, there are advantages and disadvantages to completing a PA residency, and the individual PA can make an informed decision as to whether to participate in a residency program based on understanding the issues involved. With residencies offered primarily for surgical specialties and the fast-paced specialties, such as emergency medicine, those who wish

9 9 to practice in these fields are more pressed to decide whether a residency is right for them. 3 It will certainly be interesting to see how the availability, acceptance, and parameters of PA residencies evolve over time.

10 10 References 1. Heinrich JJ, Fichandler BC, Beinfield M, Frazier W, Krizek TJ, Baue AE. The physician's assistant as resident on surgical service. An example of creative problem solving in surgical manpower. Arch Surg Mar;115(3): doi: /archsurg PubMed PMID: American Association of Surgical Physician Assistants (AASPA). PA residency programs [Internet]. Sebastian, FL; Available from: 3. Dehn R. PA - Is PA residency training worth it? [Internet]. New York: Clinical Advisor; Available from: 4. McGill F, Kleiner GJ, Vanderbilt C, Nieves J, Keith D, Greston WM. Postgraduate internship in gynecology and obstetrics for physician assistants: a 4-year experience. Obstet Gynecol Dec;76(6): doi: / (91)90204-i. PubMed PMID: Rotellini-Coltvet LA. (2011). What I wish I had known: one postgraduate residency's experience with the accreditation process. Baltimore, MD: Johns Hopkins Hospital. Available from: 6. Association of Postgraduate PA Programs (APPAP). Available PA programs. Alexandria, VA: APPAP; c Available from: 7. United States Department of Labor, U.S. Bureau of Labor Statistics, Office of Occupational Statistics and Employment Projections. Occupational outlook handbook, edition: physician assistants [Internet]. Washington: Office of Occupational Statistics and Employment Projections; Available from:

11 11 8. American Academy of Physician Assistants (AAPA). National physician assistant census: research and technology services: results from AAPA s 2009 census [Internet]. Available from: 9. Fields, R. Compensation: 8 statistics about physician assistant compensation [Internet]. Chicago, IL: ASC Communications; Becker's Hosp Rev. Available from: Physician Assistant Education Association (PAEA). Physician assistant programs [Internet]. Alexandra, VA: PAEA; Available from: Blinded

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