There are currently 44 residency programs which are a part of the association of post graduate physician assistant programs. Of those 44, there are currently only 8 which are accredited by ARC-PA. Post graduate programs were formalized in 1988 for those who wished to specialize, but accreditation by ARC-PA was only recently instituted in 2008. Accreditation for post graduate programs are currently optional, because the attendance for any post graduate program is also optional. As you can see from these dates, the concept for post graduate education for physician assistants is still relatively new. So, if it is optional, should you attend one of these programs? It depends.
The vast majority of programs train students to come out as generalists. There are few programs, such as Cornell, which place a special emphasis on specialty education, but these are the minority. We are trained to work in the primary care setting. Sure, we are introduced to certain concepts that we would see in the emergency room, such as intubation, but how many of us would feel comfortable coming straight out of school with the expectation to intubate? Not very many, unless you have a background as a paramedic, but that is beside the point. This is why there isn’t any residency program tailored to those going into primary care medicine; we are already trained with this concept in mind. If you plan on joining a specialty practice that is office based, I feel you can learn plenty with the right supervising physician. It is crucial that you find someone willing to mentor you and show you the ins and outs during that first job. It is unfortunate, however, that these supervising physicians are relatively scarce now a day. Times are changing, and many simply do not have the time or patience to teach. Less and less on the job training is being given, with more and more of an expectation to perform autonomously.
The majority of residencies currently available cater to surgery and emergency medicine. Surgery is also to include cardiothoracic surgery, neurosurgery, and orthopedic surgery. I strongly believe that if you want to pursue these options you consider attending a formal residency program. The question you’re probably asking yourself is, why? A formal residency will allow you to see and do more in one year, than many will do in years of practice. Not only will you learn more quickly, but you will ultimately be more proficient at performing procedures. As I stated earlier, the days of on the job training are slowly being phased out. Hospitals will usually only allow the physician assistant to perform procedures, after they have proven proficiency. If you are a new graduate, how are you supposed to demonstrate proficiency if they do not allow you to perform them in the first place? A residency program is the answer.
What about the money? Well, you will not make more money if you attend a residency. I know, if you have more experience, you should be paid a higher salary, right? Well, yes and no. Initially you may or may not get paid a higher salary, but over time, there won’t be a difference. There is a ceiling as to how much a hospital is willing to offer you. After a certain salary, it would make more sense to hire a physician, as reimbursement would also be higher. You also have to take into consideration, that the average salary for a resident is $40,000 per year. The average salary for a new graduate is twice that amount. So, although you may make more after one year of residency training compared to the physician assistant with one year of the on job training, you must also realize you will lose about $40,000 that first year as a resident. Student debt and accruing interest is all too real. A salary of $40,000 a year is just not enough to live and concurrently pay off debt.
Another concern physician assistants have is the possibility of losing lateral mobility. Truth is, that will go away, whether we want it to or not. Just because you did an emergency medicine residency, does not mean you will not be hired as a hospitalist, or vice versa. But, there may be a reluctance to change specialties, as you will have invested both time and money learning your practice. This also holds true for physician assistants practicing for 10 years in dermatology, wanting to make a switch into emergency medicine. On a similar note, is it really wise for a dermatology PA to attempt their hand at emergency medicine? How much do they know about the subject? Will they know how to properly manage their patients? Probably not. They will have the same learning curve that a new graduate will have. What busy physician will want to spend their time and money teaching a physician assistant how to perform – not very many. How many hospitals would want to hire someone with 10 years of dermatologic experience to care for a crashing patient – not very many. Another thing to take into consideration in regards to lateral mobility are the specialty certifications. These specialty certifications are not required by employers, but I have a feeling they will be in the future.
Bottom line: Residencies are worthwhile for those going into surgical or emergency medicine specialties. All others which are not procedure heavy, will do just fine without, granted they have a supervising physician willing to teach.