Considerations for PA education and training

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Fifty years ago, in a rapidly changing medical landscape, Eugene Stead, MD, proposed a unique solution to deliver high-quality healthcare to patients.1 Advances in technology and treatments were moving physicians out of clinics toward specialty practice. Academic centers were facing the challenge of training future physicians in these specialties while addressing the growing needs of populations who were accessing care for the first time. More patients necessitated the need for more manpower. Thus, the PA was born. Dr. Stead pioneered a model that has endured for 50 years. For the profession to continue to advance, current and future generations of PAs must grapple with the challenges of 21st century medical practice.
Then, like today, questions emerged about this new profession. How would PAs be selected? How would they be trained and by whom? What education would they receive? Who would supervise their care? Upon whose territory would they tread? What exactly would they do? The AAPA Joint Task Force for Full Practice Authority and Responsibility (FPAR) has revived these questions and, in the June article, proposed a new definition for optimal team practice. Implementation of this proposal may encourage more flexibility in the job market, but what will it mean for PA programs, students, and educators? These questions must be answered before moving forward.
We must all consider the changes proposed by the task force. Those involved in PA education have a unique perspective to offer on the issues as both clinicians and educators. This commentary focuses on the implications for students, PA programs, and PAs entering the workforce.
If we are to continue to provide quality, competent care to our patients, we must be able to prepare graduates to practice in multiple settings, between specialties, and with varying levels of responsibility. Our on-the-job training, facilitated by the codified relationship with our physician colleagues, gives new graduates the opportunity to grow and develop clinical experience in a supported environment. This must be preserved because matriculating students have varying amounts of previous healthcare experience. We must guard against placing new PAs in situations where their education and experience are outpaced by the expectations and responsibilities of that practice. For the experienced PA, this supported environment also is crucial to protect the lateral mobility between specialties that is part of the value proposition of PAs. As PAs, the value of our professional flexibility and variability has proven paramount in our profession's development and growth. We must protect this.
The potential resulting demands for PA education programs are important to consider. Our long-held focus on a generalist education is a cornerstone of our professional identity and lets graduates meet the current and changing needs of the healthcare environment. If we are to continue to evaluate who we are as PAs, as Dr. Stead likely would have encouraged, we must analyze our competitive advantage in a dynamic healthcare environment, both for practicing PAs as well as for current and future students. One response to greater practice responsibility may be to increase the length of training either in graduate or postgraduate programs. Lengthening education programs may hurt our ability to attract top talent, who often consider other careers before selecting the PA profession. In addition, graduating PAs would likely be saddled with even greater debt without a definite return on that investment.
A movement toward revised admissions standards and greater previous healthcare experience requirements would change our applicant pool and potentially challenge holistic admissions efforts as programs attempt to select students most capable of practicing without required supervision.
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