All physician assistant (PA) education programs stress primary care as a fundamental core of knowledge and only graduates of accredited PA programs are eligible to sit for the PA National Certification Examination (PANCE). The PANCE and the recertification examination have more of a primary care focus and specialty examinations are not available. Accordingly, the rheumatology PA needs to be skilled in primary care to recertify.

The vast majority of PAs working in clinical specialties have learned their skills through on-the-job experience and not through a PA postgraduate program. Physician assistants remain fully capable of entering specialty practices based on previous experiences and training. Maintaining this clinical flexibility is a valued cornerstone of the profession, one that continues to attract talented individuals into the field.

However, an issue in PA education that surfaces in policy debates is the importance of accreditation of postgraduate educational programs and the certification of its graduates. Physician assistant postgraduate programs have been part of the profession since 1972. The prototypical PA postgraduate program, also referred to as a PA residency, is a one-year, hospital-based clinical training experience in a specialty field. As postgraduate programs have grown in number and popularity over the years, the development of some form of accreditation system for these programs has emerged.



In 2006, the Accreditation Review Commission for the Physician Assistant (ARC-PA) announced it will institute a voluntary process to accredit PA postgraduate programs. What are the potential implications for the PA profession?

By providing an accreditation process, the ARC-PA will establish professionally developed standards for such programs. This is important as the focus and quality of postgraduate programs has been uneven. Under this new process, accreditation status will offer important information to the prospective PA seeking advanced training. In other words, the program will have a defined educational focus and not one that is strictly service-driven in its orientation.

One argument is that accreditation will confer legitimacy on PA postgraduate programs, allowing those that provide quality clinical education to become more firmly established and better recognized. Others believe it is in society’s best interest to have a legitimate body overseeing the quality of PA postgraduate education. However, this action has troubled many PA constituents who feel that the primary care roots of the profession will be devalued.

While rheumatology has been a specialty for PAs since 1978, there has only been a formal rheumatology postgraduate PA program since 2003. Like all other postgraduate programs for PAs, the postgraduate PA program in rheumatology sponsored by the University of Texas is not accredited nor does it produce a standardized certificate of accomplishment.

The American Academy of Physician Assistants (AAPA) has expressed its concern regarding the accreditation of PA postgraduate programs. There is a fear that recognizing programs in this fashion may narrow the entry of PAs into various clinical fields unless they possess postgraduate training.

To date, there is no evidence that residency training is becoming a qualification for either employment in a particular clinical specialty or for entry into practice. There is also no evidence that this education has much of an impact. The number of graduates of the 30 or so postgraduate programs is less than 80 a year, less than 1 percent of the total number of annual graduates of all postgraduate programs in the U.S. (almost 5,000 in 2005).

For example, if one looks at cardiothoracic PAs, there is no formal evidence or even anecdotal reports that fellowship trained PAs do better in their specialty in terms of salary or scope of function than PAs who are trained on the job. Even if the numbers of postgraduate PAs would quadruple over the next five years, the impact is likely to be negligible on employer demand or in improving the supply of formally trained PAs in cardiovascular surgery or rheumatology.

In the end, accreditation is underway and the standards for programs will be set by the ARC-PA in a voluntary format. Since the training of PAs in a fellowship setting is expensive, programs may not proliferate to the degree that some expect in the next decade. In the meantime, there are opportunities to examine how these programs function and whether there is more value for those who obtain the advanced training.