The PA profession is projected to grow by 30% between 2014 and 2024, one of the fastest rates for all U.S. jobs. This growth is in response to the increased demand for health care providers. However, one of the major limitations to the ease of this growth is the availability of clinical training sites.
Current PA students have felt the impact of the clinical site shortage, traveling further and spending more money to fulfill their required clinical rotations compared to their predecessors.
In the Joint Report of the 2013 Multi-Discipline Clerkship/Clinical Training Site Survey (Recruiting and Maintaining U.S. Clinical Training Sites), 95% of PA program directors responded that they were moderately or very concerned about the adequacy of clinical opportunities for students.
What causes a clinical site shortage?
Dr. William Kohlhepp, president of PAEA, recently gave testimony to the Health & Human Services Subcommittee of Congress on the topic of clinical site shortages.
He explained that a critical shortage in providers has resulted in the rapid expansion of existing PA programs and development of new PA programs. This, in turn, increases pressure on clinical sites to take on PA students. Separately, practicing clinicians face demands to increase productivity and implement government-mandated measures like electronic medical records, which decreases their availability to precept PA students.
The increased demand has not been matched by an equal increase in clinical sites or preceptors.
How does a clinical site shortage affect PA programs?
The ability to provide PA students with appropriate, supervised clinical practice experiences across the required settings (outpatient, inpatient, emergency, surgery) and in particular disciplines (family medicine, internal medicine, general surgery, pediatrics, ob/gyn, mental health) is required of PA programs as a condition of accreditation.
Programs that are not able to meet these requirements risk losing accreditation. (Remember, as long as a program is accredited at the time of matriculation, you are golden.)
The number of PA programs paying for clinical sites is increasing, which increases program expenses. Personnel costs can also increase as it may take more clinical coordinators to put in the time and effort needed to find and place students in clinical sites.
Programs that are more established are likely to have stronger relationships with clinical sites; however, with increasing class sizes, even established programs may face similar issues as new programs.
How does a clinical site shortage affect PA students?
The clinical site shortage can affect PA students across geographic locations. Areas with a concentration of teaching hospitals that would seem to be good training grounds for PA students may be saturated with trainees (read about a recent grad who experienced this with her Boston-based PA Program in this prior post).
The number of trainees from medical schools, NP programs, and other PA programs along with the number of medical facilities in the region can affect clinical training site availability.
As a result of the clinical site shortage, PA students may travel further to their “local” rotations. Clinical rotations are also more likely to include a distant location, which would require students to pay for remote site housing, also often arranged by the student.
The average estimated cost per student for remote housing is $3,495. All of this means more time, effort, and cost for a PA student.
What's the fix?
There is no single solution that would fix the problem of clinical sites shortages. However, Dr. Kohlhepp proposed a few ideas during his testimony that could help to alleviate the strain.
First, a very small percentage of PA programs receive any federal funding. If federal funding was increased, programs would have more resources to hire additional clinical coordinators and pay for clinical sites.
Secondly, federal incentives for precepting PA students could lower the barrier for clinicians to participate in clinical education. Precepting students could count towards some federally mandated change in practice, easing the burden on clinicians to hit other benchmarks and creating more time for them to participate in education.
What does a pre-PA student need to do?
The most important step for a pre-PA student is to consider access to and cost of clinical sites in their overall PA school plan. If you are accepted to a PA program, there is no real risk of not being able to complete your require rotations due to a clinical site shortage. The situation is not dire. You will be able to complete the clinical rotations that are required.
However, limited availability of clinical rotations may increase your required time, effort, and cost during the clinical year.
Clinical rotation availability is one of the 7 characteristics you should be evaluating in PA programs to help make your best choice. If you have not downloaded your free worksheet to help you evaluate PA programs that are right for you, be sure to sign up for yours.
Accreditation Standards for Physician Assistant Education, Fourth Edition. ARC-PA, Inc. March 2010. http://www.arc-pa.org/wp-content/uploads/2016/10/Standards-4th-Ed-March-2016.pdf
Recruiting and Maintaining U.S.Clinical Training Sites. Joint Report of the 2013 Multi-Discipline Clerkship/Clinical Training Site Survey. https://members.aamc.org/eweb/upload/13-225 WC Report 2 update.pdf
Public Witnesses Day, Wednesday, March 8, 2017. Labor, Health and Human Services, Education, and Related Agencies. http://appropriations.house.gov/calendar/eventsingle.aspx?EventID=394714
Keahey D. Stakeholder Meeting Addresses Shortage of Clinical Training Sites. March 1, 2017. http://paeaonline.org/stakeholder-meeting-addresses-shortage-of-clinical-training-sites/
Physician Assistant Education Association, By the Numbers: Program Report 31, Washington, DC: PAEA, 2016. doi: 10.17538/PS31.2016. http://paeaonline.org/wp-content/uploads/2017/02/Program-Survey-31_V3_Updated-Jan2017.pdf