Why do a residency?

[andersenpa]

I agree that a residency increases knowledge and skills. PA residents finish with better capabilities than new PA graduates.

 

The better descriptor would be to say that they finish residency with more skill/competence than PAs who have been practicing for a similar amount of time.

 

No arguments there. However, when Andersonpa says "the foundations of PA history- clinical competence", I have to ask, "shouldn't PAs ask for and expect more."

 

And by "more", you mean- demand to be called "Doctor"? Why?

Demand respect from patients? And when they see "Dr. PA" on you coat instead of "MD", will you demand those credentials as well, simply because you completed a residency that is 1/3-1/5 the time commitment of a physician residency, and has none of the graduated responsibility or independent practice that those programs have?

 

If every PA graduate completed a residency and IF every PA graduate could attain the same COMPETENCE as a Medical Doctor at the end of PGY-1 (internship year),

 

That’s a big assumption.

 

PAs would still be regarded as inferior by many patients and Physicians and insurers and credentialing boards. The PA profession should not offer it's time and treasure without a compensatory reward of the enjoyment of being addressed as "Doctor" following residency and enjoyment of independence. Finally, if PA programs are going to 3 years full-time study and mandatory residency, then there is no daylight between medical student education and internship years with regard to training.

 

I was not aware that 3 yr course of study was anywhere near the norm. Some programs are designed this way. The overwhelming majority of programs are still 2 yrs. But that is beside the point. Physician residency and PA residency are two different models, and as close as they may seem they are very different in the type of clinician they are training.

 

Only the rewards differ. PAs would work the same time in school as medical student/resident but receive far fewer rewards. I suggest that we say "No" to residencies as they are being offered today.

 

No, I suggest that the PAs who want what you want use the existing pathway to get there- MD.

 

We as PAs should not be using our established education/training systems to game the system into becoming physicians. We should be acknowledging the outstanding clinicians that PA education creates, and demonstrate how THAT model can become one of the de facto primary care providers in US health care, alongside MDs, DOs, and NPs. Clamoring for titles and respect of institutions that we are not a part of looks mighty weak……

[JohnB]

I've been a PA working in a jail clinic for the past 15 years. When I was a PA student I had introduced myself to a patient as John the PA student. The patient replied 'yes doctor.' The attending physician interjected and identified herself as the attending doctor in charge of the unit. The patient replied 'yes nurse.' After several rounds with both of us trying to correct the patient as to who we were the attending finally rolled her eyes and asked the patient 'why did you come here today?.'

The people who come to clinics/hospitals don't really know or care about the alphabet soups after our names. They have their own perceptions about who we are in our white coats and just want/need help from someone who is competent and compassionate.

 

I am currently considering the Montefiore PA surgical residency and will probably complete the application and send it in this weekend. I want the residency because I want to be competent working in a surgical/ICU setting. My hesitations are: I'm currently working about 60hrs a week. What will the schedule be like? and a J-O-B when the year is up.

[JohnB]

I've been a PA working in a jail clinic for the past 15 years. When I was a PA student I had introduced myself to a patient as John the PA student. The patient replied 'yes doctor.' The attending physician interjected and identified herself as the attending doctor in charge of the unit. The patient replied 'yes nurse.' After several rounds with both of us trying to correct the patient as to who we were the attending finally rolled her eyes and asked the patient 'why did you come here today?.'

The people who come to clinics/hospitals don't really know or care about the alphabet soups after our names. They have their own perceptions about who we are in our white coats and just want/need help from someone who is competent and compassionate.

 

I am currently considering the Montefiore PA surgical residency and will probably complete the application and send it in this weekend. I want the residency because I want to be competent working in a surgical/ICU setting. My hesitations are: I'm currently working about 60hrs a week. What will the schedule be like? and a J-O-B when the year is up.

[Gonadometrics]

We may not come to agreement on this one. I only wondering if I am "gaming the system to become of Physician" or "is the system gaming me and my wallet to get Physician equivalent service without the proper pay and credentialing." I don't object to the traditional role of the PA. I reject the pressure to extend PA school to three years and pushing the residency. PAs are being gamed. If the health care community wants PAs to be identical in function to the MD/DOs, then there should be the proper credential, pay and independence. If the credential, pay and independence are not there, PAs should remain as they are and not be gamed by the system.

[Gonadometrics]

We may not come to agreement on this one. I only wondering if I am "gaming the system to become of Physician" or "is the system gaming me and my wallet to get Physician equivalent service without the proper pay and credentialing." I don't object to the traditional role of the PA. I reject the pressure to extend PA school to three years and pushing the residency. PAs are being gamed. If the health care community wants PAs to be identical in function to the MD/DOs, then there should be the proper credential, pay and independence. If the credential, pay and independence are not there, PAs should remain as they are and not be gamed by the system.

[foreveryoung]

Gonadometrics, I have no clue where you are getting 3 year PA programs from. They are few, and the programs I know that were three full-time years actually cut back to 27 months like the average program.

 

With a fellowship, I am looking at three years of graduate plus education. A doctor has 7 plus years. A postgraduate program is only one way to achieve lifelong learning and improve my knowledge, exposure and diagnostic skills. Choosing to do a postgrad program should not be looked at in other way than what it is: another way to be a better provider for my patients. That is what it is about- being a better provider. Considering that medical information grows exponentially, I hope that more residencies continue to come available so that PAs have opportunities to brush up on medical information as they change between specialties, because continued learning and evolving the profession to account for growing medical knowledge is vital to the success of our profession and the best care of our patients.

[foreveryoung]

Gonadometrics, I have no clue where you are getting 3 year PA programs from. They are few, and the programs I know that were three full-time years actually cut back to 27 months like the average program.

 

With a fellowship, I am looking at three years of graduate plus education. A doctor has 7 plus years. A postgraduate program is only one way to achieve lifelong learning and improve my knowledge, exposure and diagnostic skills. Choosing to do a postgrad program should not be looked at in other way than what it is: another way to be a better provider for my patients. That is what it is about- being a better provider. Considering that medical information grows exponentially, I hope that more residencies continue to come available so that PAs have opportunities to brush up on medical information as they change between specialties, because continued learning and evolving the profession to account for growing medical knowledge is vital to the success of our profession and the best care of our patients.

[EMEDPA]

if I were graduating today I would do a residency without question. I applied to the only em residency in the country the yr I graduated just as it lost its funding.

I think long term we probably are looking at all pa programs going to 3 yrs as the prior hce quality of the applicant pool declines.

I think within a decade insurers and hospitals (as well as employers) will be pushing for all pa's to demonstrate added levels of competence in specialties outside of primary care whether that be through completion of a residency or a CAQ exam or both. I know of a new em residency in the making that willrequire its grads to pass the em caq to graduate.

20 yrs from now I think all pa programs will be 3 yrs followed by a mandatory 1 yr residency, still around 1/2 the min time in training that a doc has(4 yrs vs 7).

I think it is likely pa programs will become more homogenous with more similar pre-reqs and coursework. more pa to physician bridge programs will open as well.

when I was a senior pa student a group of us sat around and talked about similar issues. we all believed physician associate would become the chosen term for the profession( and it will) and we thought most pa programs would go to an ms(and they have) and we postulated about pa to physician bridge programs and now they exist. if you had told us then that we would be making > 100k/yr we would have laughed in your face. our class poll said a good starting salary for a pa was 40k at a time when most of us made 30-35k as medics/nurses/rt's.

[EMEDPA]

if I were graduating today I would do a residency without question. I applied to the only em residency in the country the yr I graduated just as it lost its funding.

I think long term we probably are looking at all pa programs going to 3 yrs as the prior hce quality of the applicant pool declines.

I think within a decade insurers and hospitals (as well as employers) will be pushing for all pa's to demonstrate added levels of competence in specialties outside of primary care whether that be through completion of a residency or a CAQ exam or both. I know of a new em residency in the making that willrequire its grads to pass the em caq to graduate.

20 yrs from now I think all pa programs will be 3 yrs followed by a mandatory 1 yr residency, still around 1/2 the min time in training that a doc has(4 yrs vs 7).

I think it is likely pa programs will become more homogenous with more similar pre-reqs and coursework. more pa to physician bridge programs will open as well.

when I was a senior pa student a group of us sat around and talked about similar issues. we all believed physician associate would become the chosen term for the profession( and it will) and we thought most pa programs would go to an ms(and they have) and we postulated about pa to physician bridge programs and now they exist. if you had told us then that we would be making > 100k/yr we would have laughed in your face. our class poll said a good starting salary for a pa was 40k at a time when most of us made 30-35k as medics/nurses/rt's.

[KMD16]

We may not come to agreement on this one. I only wondering if I am "gaming the system to become of Physician" or "is the system gaming me and my wallet to get Physician equivalent service without the proper pay and credentialing." I don't object to the traditional role of the PA. I reject the pressure to extend PA school to three years and pushing the residency. PAs are being gamed. If the health care community wants PAs to be identical in function to the MD/DOs, then there should be the proper credential, pay and independence. If the credential, pay and independence are not there, PAs should remain as they are and not be gamed by the system.

 

I agree with you on your analysis. Highly trained/skills/experience doesn't equate pay. Hospitals/supervising physician primary goal is to increase their bottom line (wallet) at our expense/loss.

[KMD16]

We may not come to agreement on this one. I only wondering if I am "gaming the system to become of Physician" or "is the system gaming me and my wallet to get Physician equivalent service without the proper pay and credentialing." I don't object to the traditional role of the PA. I reject the pressure to extend PA school to three years and pushing the residency. PAs are being gamed. If the health care community wants PAs to be identical in function to the MD/DOs, then there should be the proper credential, pay and independence. If the credential, pay and independence are not there, PAs should remain as they are and not be gamed by the system.

 

I agree with you on your analysis. Highly trained/skills/experience doesn't equate pay. Hospitals/supervising physician primary goal is to increase their bottom line (wallet) at our expense/loss.

[Febrifuge]

My first job out of school, they promised me in the interviewing and negotiating process that I'd get lots of support and teaching time, not quite like a residency, but with a mind toward respecting my "newness" as a fresh grad. That didn't happen. I was frustrated and worried I was not up to snuff on the specialist aspects, because they had no incentive to follow through on their promises; by the time my credentialing went through, the practice was so busy it was all about moving patients as quickly as possible. If I'd been in a residency, that probably wouldn't have happened.

 

Of course, if I'd been in a residency, they also wouldn't have given me a five-figure check when we agreed I'd leave under amicable terms, either. (The one-year NDA was up a lot more than a year ago, but I'm still being vague on purpose.)

 

In other words, if you know you want to work in an area where residencies exist, and you can handle the lousy hours and lousy pay for a period of time, it seems like they are probably worth it. And more importantly it's a structured way to get through that awkward phase of being an utter n00b -- and very probably shorten it, too.

[Febrifuge]

My first job out of school, they promised me in the interviewing and negotiating process that I'd get lots of support and teaching time, not quite like a residency, but with a mind toward respecting my "newness" as a fresh grad. That didn't happen. I was frustrated and worried I was not up to snuff on the specialist aspects, because they had no incentive to follow through on their promises; by the time my credentialing went through, the practice was so busy it was all about moving patients as quickly as possible. If I'd been in a residency, that probably wouldn't have happened.

 

Of course, if I'd been in a residency, they also wouldn't have given me a five-figure check when we agreed I'd leave under amicable terms, either. (The one-year NDA was up a lot more than a year ago, but I'm still being vague on purpose.)

 

In other words, if you know you want to work in an area where residencies exist, and you can handle the lousy hours and lousy pay for a period of time, it seems like they are probably worth it. And more importantly it's a structured way to get through that awkward phase of being an utter n00b -- and very probably shorten it, too.

[navyflyPAC]

I just wanted to say thank you to everyone. It's nice to see the diverse opinions and levels of experience here. Thanks!

[navyflyPAC]

I just wanted to say thank you to everyone. It's nice to see the diverse opinions and levels of experience here. Thanks!

[navyflyPAC]

Just out of curiosity, Febrifuge touched on it a bit, but what is it like to be a newbie PA and how do you get "broken in"? It does seem like it would be a stressful time. Can you all tell me what the process is like and the expectations that go along with? I know this will vary by practice and specialty, but any advice would really help.

[navyflyPAC]

Just out of curiosity, Febrifuge touched on it a bit, but what is it like to be a newbie PA and how do you get "broken in"? It does seem like it would be a stressful time. Can you all tell me what the process is like and the expectations that go along with? I know this will vary by practice and specialty, but any advice would really help.

[foley08]

As a new grad who just finished his first month in the ED I personally wish we had mandatory 1 year residencies. That being said, much like PA programs developed a curriculum and way of doing things based on med school/the medical model. I feel that residencies need to be tweaked and made our own as well.

 

With less time I feel like there really needs to be concentrated experience in one's chosen specialty and not a carbon copy of an intern year with off service rotations. Also I think pay should be 70-75 thousand without slave hours.

[foley08]

As a new grad who just finished his first month in the ED I personally wish we had mandatory 1 year residencies. That being said, much like PA programs developed a curriculum and way of doing things based on med school/the medical model. I feel that residencies need to be tweaked and made our own as well.

 

With less time I feel like there really needs to be concentrated experience in one's chosen specialty and not a carbon copy of an intern year with off service rotations. Also I think pay should be 70-75 thousand without slave hours.

[jdtpac]

navyfly73,

Let me try to answer your question from a different perspective than some of the previous responders. I have been in practice for over 35 years and have served in many positions where I was responsible for recruiting and evaluating new PA's. Prior to the development of residency programs we were all on the job trainee's in all subspecialties and our supervising physicians were committed to training us to provide the services they believed were necessary to care for their patients. The key to our success as new graduates was to be willing to take on the responsibilities which were once the purview of physicians in training. I think you will agree that prior to the creation of postgraduate residency programs we proved to be quite capable of providing those services with a high level of quality and professionalism. Otherwise, we would have not been providing those services today.

 

I will say that when comparing a new graduate starting out in a new job to someone who has completed postgraduate PA training program residency, the residency trained PA has an advantage. However in my experience within 2-3 years on the job both individuals are generally equally qualified. The problem with postgraduate residency programs is there is simply just not enough to go around for every individual graduating from their entry level program. Just do yourself a favor and research postgraduate programs and you will find that they are not as accessible as you might believe they would be. Many of them do not provide a large salary which seems to be a concern for you. It also depends on yourself and how comfortable you feel about your own skills and knowledge. I think you should also try to get the following position paper from the AAPA: Flexibility as a Hallmark of the PA Profession:The Case Against Specialty Certification.

 

Good luck in your training, if you would like to discuss this one-on-one, please send me a message and we will try to contact each other.

[jdtpac]

navyfly73,

Let me try to answer your question from a different perspective than some of the previous responders. I have been in practice for over 35 years and have served in many positions where I was responsible for recruiting and evaluating new PA's. Prior to the development of residency programs we were all on the job trainee's in all subspecialties and our supervising physicians were committed to training us to provide the services they believed were necessary to care for their patients. The key to our success as new graduates was to be willing to take on the responsibilities which were once the purview of physicians in training. I think you will agree that prior to the creation of postgraduate residency programs we proved to be quite capable of providing those services with a high level of quality and professionalism. Otherwise, we would have not been providing those services today.

 

I will say that when comparing a new graduate starting out in a new job to someone who has completed postgraduate PA training program residency, the residency trained PA has an advantage. However in my experience within 2-3 years on the job both individuals are generally equally qualified. The problem with postgraduate residency programs is there is simply just not enough to go around for every individual graduating from their entry level program. Just do yourself a favor and research postgraduate programs and you will find that they are not as accessible as you might believe they would be. Many of them do not provide a large salary which seems to be a concern for you. It also depends on yourself and how comfortable you feel about your own skills and knowledge. I think you should also try to get the following position paper from the AAPA: Flexibility as a Hallmark of the PA Profession:The Case Against Specialty Certification.

 

Good luck in your training, if you would like to discuss this one-on-one, please send me a message and we will try to contact each other.

[EMEDPA]

I disagree that a new grad catches up with a residency grad in 3 yrs.there

are many procedures done routinely by em pa residents(intubation and central line placement to name 2) that many facilities will not allow pa's to do unless they have a prior procedure log showing they have done them. it's a catch 22, you need procedures to do procedures. in the setting of a busy er the emphasis is not on teaching, it's on seeing pts and "moving the meat". the rare physician out there will actually take the time to work with a new grad to get them up to speed on procedures in em. most just want pa's to see minor pts and keep the rack empty.

I did not do a residency(although I wanted to) and had to use many of my paramedic procedure logs to get credentialed for adv. procedures. there are procedures done by many of my em pa resident friends routinely that I may never do because I don't have the #s to do them. I have never done a thoracentesis. at my main job I can't do bedside u/s because the threshold is 800 precepted studies. at my rural job it's 25, no problem. we have 1 pa in a group of 15 allowed to do bedside u/s and only because he was/is an u/s tech as well as a pa. I am one of 5 pa's in the dept allowed to do lp's and only because I did them at a prior job. there is no mechanism to train the other pa's to do them.

opinions vary on residencies obviously but as someone who hires pa's I will take the residency grad over the new grad almost 100% of the time. there is no comparison in skill and judgement level. as an em pa resident you are for all intents and purposes a pgy-1 em md trainee and allowed all the experiences that entails. you will see thousands of high acuity patients and receive specific feedback on each one. as someone with over 25 yrs of em experience and >125 thousand em pt encounters I am very comfortable with low to moderate acuity patients and crashing/emergent patients but there is a subset of patients I see rarely which are routinely seen by em pa residents, the obviously very sick but not dying right now icu bound patients. these usually get whisked away by the physicians and worked up for hours. sure, I do this occasionally but could use more critical care experience and may still go back to a residency to obtain it.

people talk about the lateral mobility in the pa profession. the fact is this is likely going to get more and more difficult over time due to hospital and joint commission requirements. documented training for specialization of pa's outside of primary care is what is coming. just watch. soon CAQ's will be prefered then they will be required. then residency and caq will be required.

pa school trains you very well to do primary care and I don't think we will need post grad training to do that but for almost all specialties it is coming, and likely within the next 20 yrs which will encompass the careers of many on this board.

there are 12 em pa residencies now(14 if you are military) with more staring every year. I know of 5-6 in the works due to open in the next 2 years. the physicians want and are pushing for this and they will get it. acep( american college of em docs) wants pa's to have postgrad training and documentation of skills via exam. a former president of acep wrote many of the em caq exam questions. they believe pa's working outside of fast track(in main) need to have documented skills. just watch and wait, it's coming. it used to be that fp docs could get er jobs anywhere. that time is gone. so soon will be the opportunities for pa's to transfer specialties without additional training.

2007 ACEP policy on pa's/np's in the ED:

PAs and NPs working in EDs should have or acquire specific experience or specialty training in emergency care, should participate in a supervised orientation program, and should receive appropriate training and continuing education in providing emergency care.

also from the future of emergency medicine project:

Currently there are very few options for comprehensive physician assistant postgraduate emergency care specific training. Programs for the postgraduate physician assistant transitioning into emergency medicine are under current development. There are currently no emergency medicine–specific standards, competency measurements, or continuing education requirements. Development of emergency care specific continuing education and standards is under development by the National Commission for the Certification of Physician Assistants. These will be needed to help ensure quality patient care.

(sounds like an official endorsement of postgrad training and CAQ's to me.....)

I'm not saying on the job training is a bad thing but in 2012 it is the rare pa position in which a physician will take the extra time to teach a pa any new skill. most docs want folks who can do the work, not folks who can be trained to do the work. clinical medicine in 2012 is regulated like no previous time in history. it used to be that "see one, do one, teach one" was an acceptable way to gain new skills. now it's "see 20, do 20+ with someone watching, take a written and skills test, apply for hospital privileges to do so, have it signed off by the chief of staff of the hospital and reviewed by the joint commission for appropriateness, then get credentialed to do them but have to do 20/yr to maintain the right to do so".

[EMEDPA]

I disagree that a new grad catches up with a residency grad in 3 yrs.there

are many procedures done routinely by em pa residents(intubation and central line placement to name 2) that many facilities will not allow pa's to do unless they have a prior procedure log showing they have done them. it's a catch 22, you need procedures to do procedures. in the setting of a busy er the emphasis is not on teaching, it's on seeing pts and "moving the meat". the rare physician out there will actually take the time to work with a new grad to get them up to speed on procedures in em. most just want pa's to see minor pts and keep the rack empty.

I did not do a residency(although I wanted to) and had to use many of my paramedic procedure logs to get credentialed for adv. procedures. there are procedures done by many of my em pa resident friends routinely that I may never do because I don't have the #s to do them. I have never done a thoracentesis. at my main job I can't do bedside u/s because the threshold is 800 precepted studies. at my rural job it's 25, no problem. we have 1 pa in a group of 15 allowed to do bedside u/s and only because he was/is an u/s tech as well as a pa. I am one of 5 pa's in the dept allowed to do lp's and only because I did them at a prior job. there is no mechanism to train the other pa's to do them.

opinions vary on residencies obviously but as someone who hires pa's I will take the residency grad over the new grad almost 100% of the time. there is no comparison in skill and judgement level. as an em pa resident you are for all intents and purposes a pgy-1 em md trainee and allowed all the experiences that entails. you will see thousands of high acuity patients and receive specific feedback on each one. as someone with over 25 yrs of em experience and >125 thousand em pt encounters I am very comfortable with low to moderate acuity patients and crashing/emergent patients but there is a subset of patients I see rarely which are routinely seen by em pa residents, the obviously very sick but not dying right now icu bound patients. these usually get whisked away by the physicians and worked up for hours. sure, I do this occasionally but could use more critical care experience and may still go back to a residency to obtain it.

people talk about the lateral mobility in the pa profession. the fact is this is likely going to get more and more difficult over time due to hospital and joint commission requirements. documented training for specialization of pa's outside of primary care is what is coming. just watch. soon CAQ's will be prefered then they will be required. then residency and caq will be required.

pa school trains you very well to do primary care and I don't think we will need post grad training to do that but for almost all specialties it is coming, and likely within the next 20 yrs which will encompass the careers of many on this board.

there are 12 em pa residencies now(14 if you are military) with more staring every year. I know of 5-6 in the works due to open in the next 2 years. the physicians want and are pushing for this and they will get it. acep( american college of em docs) wants pa's to have postgrad training and documentation of skills via exam. a former president of acep wrote many of the em caq exam questions. they believe pa's working outside of fast track(in main) need to have documented skills. just watch and wait, it's coming. it used to be that fp docs could get er jobs anywhere. that time is gone. so soon will be the opportunities for pa's to transfer specialties without additional training.

2007 ACEP policy on pa's/np's in the ED:

PAs and NPs working in EDs should have or acquire specific experience or specialty training in emergency care, should participate in a supervised orientation program, and should receive appropriate training and continuing education in providing emergency care.

also from the future of emergency medicine project:

Currently there are very few options for comprehensive physician assistant postgraduate emergency care specific training. Programs for the postgraduate physician assistant transitioning into emergency medicine are under current development. There are currently no emergency medicine–specific standards, competency measurements, or continuing education requirements. Development of emergency care specific continuing education and standards is under development by the National Commission for the Certification of Physician Assistants. These will be needed to help ensure quality patient care.

(sounds like an official endorsement of postgrad training and CAQ's to me.....)

I'm not saying on the job training is a bad thing but in 2012 it is the rare pa position in which a physician will take the extra time to teach a pa any new skill. most docs want folks who can do the work, not folks who can be trained to do the work. clinical medicine in 2012 is regulated like no previous time in history. it used to be that "see one, do one, teach one" was an acceptable way to gain new skills. now it's "see 20, do 20+ with someone watching, take a written and skills test, apply for hospital privileges to do so, have it signed off by the chief of staff of the hospital and reviewed by the joint commission for appropriateness, then get credentialed to do them but have to do 20/yr to maintain the right to do so".

[Gonadometrics]

Jdtpac writes "The problem with postgraduate residency programs is there is simply just not enough to go around for every individual graduating from their entry level program. Just do yourself a favor and research postgraduate programs and you will find that they are not as accessible as you might believe they would be."

 

So, I did research it. He or she is right. I count around 145 programs. I don't know the exact number of graduates in each. Would you be willing to accept that PA schools graduate 4000 new PAs per year? If so, then I looked at the residencies. I added up the total number of slots available; approximately 120. So, 4000/120 means 33 PA graduates for every residency slot available. But wait you say. The venerable EMED says that there are new residencies opening every year. I agree. But remember, EMED has oft complained as well of the many new PA schools opening every year. So, let's just play with some numbers. Assume three new PA schools opened making 90 new graduates. Sounds reasonable. Let's also say that three new residency slots opened up. Now, 4090/123 means (VOILA) 33 PA graduates for every residency slot available. No change! So, although I object to residencies for many other reasons, the logistics simply don't support this as well. As long as PA school creation (money printing factories) continues at a paces that exceeds the number of new residency slots available (roughly 33:1), the problem worsens. Even if school creation slowed and residency growth increased, it could take 20 years for each graduate to have a residency opportunity. Remember too, I'm ignoring the desires of 60,000 plus practicing PAs who might want residencies but graduated more than one year ago. That is too much to think about. Oh, let's do it. 64400/120. 537 PAs for each residency slot available. To put this is perspective, some medical schools have a 20:1 chance of acceptance and every graduate gets a residency.

 

I am certain my pen and napkin analysis is not precise. Perhaps EMED has these numbers at his fingertips. I admit that I always genuflect when I read EMED's posts.

[Gonadometrics]

Jdtpac writes "The problem with postgraduate residency programs is there is simply just not enough to go around for every individual graduating from their entry level program. Just do yourself a favor and research postgraduate programs and you will find that they are not as accessible as you might believe they would be."

 

So, I did research it. He or she is right. I count around 145 programs. I don't know the exact number of graduates in each. Would you be willing to accept that PA schools graduate 4000 new PAs per year? If so, then I looked at the residencies. I added up the total number of slots available; approximately 120. So, 4000/120 means 33 PA graduates for every residency slot available. But wait you say. The venerable EMED says that there are new residencies opening every year. I agree. But remember, EMED has oft complained as well of the many new PA schools opening every year. So, let's just play with some numbers. Assume three new PA schools opened making 90 new graduates. Sounds reasonable. Let's also say that three new residency slots opened up. Now, 4090/123 means (VOILA) 33 PA graduates for every residency slot available. No change! So, although I object to residencies for many other reasons, the logistics simply don't support this as well. As long as PA school creation (money printing factories) continues at a paces that exceeds the number of new residency slots available (roughly 33:1), the problem worsens. Even if school creation slowed and residency growth increased, it could take 20 years for each graduate to have a residency opportunity. Remember too, I'm ignoring the desires of 60,000 plus practicing PAs who might want residencies but graduated more than one year ago. That is too much to think about. Oh, let's do it. 64400/120. 537 PAs for each residency slot available. To put this is perspective, some medical schools have a 20:1 chance of acceptance and every graduate gets a residency.

 

I am certain my pen and napkin analysis is not precise. Perhaps EMED has these numbers at his fingertips. I admit that I always genuflect when I read EMED's posts.