Although physician assistant postgraduate residency programs have been around for 35 years,it’s only in the past decade that they’ve really started to catch on. In 1998 there were 17 programs; today there are 35. As they become more popular, this question becomes more urgent: Are postgraduate PA residencies worth the time and effort they demand?
My answer? Probably not. And here’s why.
For one thing,residencies essentially duplicate what PAs find in their typical work environments. While entering a medical specialty through postgraduate residency training may be obvious for physicians,whowill often work autonomously making crucialpatient-care decisions, PAs generally practice with physician supervision. Therefore, a formalized training program of supervised practice seems redundant and unhelpful.
In addition, typical PA postgraduate residency programs pay below-market-value stipends for extremely heavy workloads. Therefore, a newly minted PA not in a residency program wouldlikely be making more money while working fewer hours.
Even more importantly, residencies don’t pay off over the long run. Although residency advocates claim that graduates command higher salaries than new PAs entering the same specialty, this is not a fair comparison, since residencygrads have a year of clinical experiencethat new PA grads don’t. And recent research suggests that after several years in the workforce, residency graduates actually don’t make a penny more than PAs who have not been through residency programs.
My colleagues and I surveyed graduates of three surgery PA residency programs in early 2006, gathering data on how these grads view their training.We also collected data on salaries and on the number of hours PA residents worked each week.We found that the residency-trained PAs worked an average of 15.5% more hours than informally trained surgery PAs and also earned an average 15.1% more. Therefore, the residency-trained PAs only made more money only because they worked longer hours! When that fact was taken into account, salaries in the two groups were equal.
If residency training doesn’t result in higher pay,why would anyone choose to do a residency? One could argue that the value of residency programs isn’t entirely financial, and research does suggest that residency grads are very satisfied with their training. Perhaps, then, residencies offer intangible benefits, such as increased confidence. But is that enough of a benefit to make such programs universally worthwhile?
If specialty certification gains momentum, it could drive the growth of residency programs, which could limit specialty mobility within the profession. This, in turn, could render the profession less responsive to changes in workforce demand and even make it less attractive to people considering a health-care career. One of the most attractive aspects of the PA profession to incomingstudents is the possibility of later mobility.
As our profession looks at specialty certification and as more graduates choose specialties, I think additional research should be done on the factors that affect these choices and on the educational systems that have evolved around them.
The bottom line? Once all the possible benefits and drawbacks are fully considered, we need to know whether PA postgraduate residency programsare going to help us—or hurt us.