A couple of years back, CASPA (the Central Application Service for Physician Assistants) modified how some common pre-PA roles were categorized.
The changes resulted in a few roles being downgraded from direct patient care experience (PCE) to health care experience (HCE), and, consequently, there was an outcry among prospective PA students. In a few short weeks, the decision was pretty much reversed.
So why the objection?
By definition, a PCE position means that a future PA has direct responsibility in caring for patients, while HCE positions expose students to a medical environment but don't carry much patient responsibility.
To most PA programs, because of the increased level of responsibility, the hours gained through PCE roles are generally more valuable than those accumulated through HCE. Many PA programs also have a minimum requirement for PCE hours for applicants to be considered.
HCE is still quite relevant for an application, and there are plenty of great pre-PA experiences that comes from roles that are classified as healthcare experience rather than patient care experience.
But when CASPA made the swap, applicants were disqualified or at least made less competitive for many PA programs. Hence, the collective future-PA meltdown that led to the about-face by CASPA.
However, even with the reversal, where the HCE/PCE divide exists isn't so black and white. And it can get even murkier when it comes time to add your experiences to your PA school applications.
So, here, I'm going to lay out the significant differences in categorization of PCE and HCE and how these can (and should) play a role in your approach to your PA school application.
Defining PCE vs. HCE
According to the CASPA, patient care experience is defined as having direct responsibility for a patient's care, while healthcare experience is both paid and unpaid work in a health or health-related field where you are not directly responsible for a patient's care but may still have patient interaction.
So the difference is, essentially, level of responsibility, not just whether you have contact with patients, which is where some folks get confused. You can interact with patients in a role without carrying a real responsibility in a patient's direct care, as you might as a patient transporter or pharmacy technician.
Common entry-level roles that usually qualify as direct patient care (PCE) include EMT, CNA, MA, phlebotomist, dental assistant, patient care technician, and physical therapy aide. Higher-level roles, like a nurse, paramedic, physical therapist, and dental hygienist, definitely qualify.
Healthcare experience (HCE) is essentially anything else in the medical realm that doesn't qualify as PCE. These kinds of positions may involve activities like clerical work, hospital volunteering, filling prescriptions or passing medications, delivering patient meals, stocking supplies, record keeping, or working as a scribe.
One common source of confusion for applicants is that CASPA lists some positions with the same title as examples for both PCE and HCE categories, as with CNA and MA positions. This double listing of some roles is the result of the controversy a few years ago.
The intention is for applicants not to attribute administrative work to PCE hours, even when done as part of a role traditionally considered to be PCE. So, there are a few job titles that ended up on both lists.
If you work in a role that has a PCE-like title but you're doing only administrative work or in a PCE role that has a sizable administrative component, you're expected to account for this in your application.
Let's say you work full-time as a medical assistant and three days a week, you spend your time rooming and assessing patients, taking vitals, giving vaccines, and providing education. These hours should be counted as PCE.
If on the other two days, you answer phone calls, schedule appointments, and complete other administrative tasks, these hours should be classified as HCE.
On your application, you'd include two entries for your MA position, one PCE entry with the hours spent in direct patient care, and one HCE entry for your administrative hours.
If you have two entries for the same position, you should separate your total hours and allocate the appropriate portion of time to each entry so that you aren't double-dipping. From our above example of being an MA with split duties, a total of 1000 hours with 3/5 spent in direct patient care would mean that we’d allocate 600 hours to the PCE entry and the HCE entry would get 400.
To eliminate confusion and to highlight the skills built in each aspect of the role, you should also craft unique "experience details" descriptions for each entry.
Now that we've sorted out the CASPA difference between PCE and HCE, it's time to re-enter the gray area.
Ultimately, whether a role is considered PCE or HCE is not up to CASPA — each PA program determines what they consider to be direct patient care experience.
Programs have fairly uniform opinions with the most common pre-PA roles involved in direct patient care, like MA, CNA, patient care tech, and EMT.
With positions that are less common among prospective PA students that should count as PCE, like ophthalmology tech, physical therapy aide, or autism therapist, programs will usually follow the CASPA guidelines.
But, it's never a bad idea to double check in advance whether your target programs consider an experience to be direct patient care.
Most programs follow the general CASPA guidelines when it comes to using responsibility in the role to determine the difference between HCE and PCE.
But, some programs may elevate roles that would classically be considered HCE, like working as a medical scribe, to PCE status or allow some portion of the total hours gained in a role to count as direct patient care experience.
Classifying PCE vs. HCE on the CASPA Application
Given that the final designation of activity as healthcare or patient care experience is up to individual PA programs, properly categorizing them on your CASPA application can get a bit complicated.
One approach I've seen touted is to list any experience that might qualify as direct patient care experience as PCE on your application. This method is a bad one for a few reasons.
First of all, trying to pass off experience that's not PCE as PCE will not get past PA programs. They get thousands of applications each cycle and are well acquainted with what they consider to be direct patient care experience.
You won't be getting one over on them by categorizing experience that genuinely qualifies as health care experience as patient care experience. And, perhaps more importantly, you don't want to come across as someone who's trying to get one over on them.
Some applicants with less nefarious intentions categorize experiences as PCE simply because they're not careful or because they feel it's easier to leave the decision up to someone else.
When you do this, programs may not think you're acting intentionally deceptive, but they may wonder if you didn't read the directions carefully. And you don't want to come across as someone who didn't prioritize understanding the details of your application.
There's no advantage to be gained by listing non-PCE roles as PCE.
But, what about when one program considers a role to be direct patient care and another program doesn't?
Because it's a centralized service, the information you add to your CASPA application, aside from GRE scores and supplemental applications, is sent to each PA program you apply to.
So, if the schools where you're applying have differing opinions on what counts as direct patient care, there's no possibility of defining a role PCE for one program and HCE for another.
There are a few roles that might fall into this gray area, and the most prevalent one out there is working as a medical scribe.
Using the CASPA definition, a scribe position would be classified as HCE. Though many programs find working as a scribe to be quite valuable for future PAs, the PA schools that count scribing as PCE are the exceptions.
Because the vast majority of programs consider it to be healthcare experience, it makes sense, in most cases, to classify work as a scribe (or another "gray area" experience) as HCE on your CASPA application.
Let's say you're applying to eight programs and three of them view scribing as PCE and the rest consider it to be HCE. It looks a heck of a lot better for you when those three programs promote your experience to PCE than for the other five schools to demote your hours to HCE.
Now, you might be thinking, "Well, what about the programs that consider scribing to be PCE? I don't want to look like I'm not following directions for those programs."
But schools that consider a position that's classically categorized as healthcare experience to be direct patient care experience know they are the exceptions. They're looking at your application with this in mind, weeding through and watching for the "gray area" experiences that they're willing to promote to PCE.
Allowing this process to happen, which is anticipated by the programs with exceptions, is much better than forcing other programs to dig into the details of your entries and flag your application for inaccuracies, leaving room for them to assume that you're either trying to pass off experience as PCE or not reading directions carefully.
The one exemption to this approach is if every school that you're applying to considers a role commonly recognized as healthcare experience to be direct patient care experience.
So, if you're applying to four schools and they all consider subscribing to be PCE, then go ahead and list it as such your application. In this scenario, you wouldn't have any program demoting your experience.
But use this exception sparingly as these are very uncommon situations. Most future PAs are applying to a mix of schools. If you're applying to some that consider a role to be healthcare experience, play it safe and list the position as HCE.
The less unexpected work you create for those reviewing your application, the better impression you will leave.
All experiences that add value to your pre-PA journey are worthwhile if they help to build your foundation to become a PA. But how your target PA program categorizes these can help you make wise decisions on how you spend your time leading up PA school.
Having an application strategy in mind and approaching the classification of each experience with intention can help your potential future PA programs see you as a strong candidate in the most favorable light.