B3.01a Part Two

I’m glad to have you join me once more. In our previous post, we looked at Standard B3.01a, and the evidence programs need to demonstrate sufficient clinical capacity. The basic requirement is straightforward: programs need enough appropriate clinical sites and qualified preceptors to support their students, and they need the documentation to prove it.

Knowing what you need is one thing. Finding it is another.

I recently had the opportunity to discuss this challenge with Starr Newman, PA-C, Clinical Advisor at AMOpportunities, during our webinar, Clinical Capacity, Evidence, and the Alternative. Starr has more than 20 years of clinical experience and previously served as a founding Director of Clinical Education, so she understands this problem from both the program and clinical development sides.

Watch Clinical Capacity, Evidence, and the Alternative

One thing became clear during our conversation: clinical education has changed considerably. Some of the strategies that worked perfectly well years ago simply don't work as reliably today.

Remember When You Could Just Call Someone?

I've been involved in PA education since 1991. At that time, there were approximately 52 PA programs in the country. Today, there are roughly 330.

That means far more programs are competing for access to many of the same hospitals, healthcare systems, clinical sites, and qualified preceptors. In some areas of the country, regional saturation has become a very real problem.

Years ago, developing a clinical site could be relatively straightforward. You identified a potential preceptor, made contact, developed the relationship, completed the necessary paperwork, and moved forward. Today, you may not even be permitted to contact that preceptor directly.

Large healthcare systems increasingly manage clinical education through centralized offices. Affiliation agreements may require extensive institutional review. Some healthcare systems already have relationships with medical schools and multiple PA programs. Others may have exclusivity arrangements that make additional partnerships difficult or impossible. And even when the door is open, developing a group of clinical placements can take months, or longer.

The old system hasn't disappeared completely. But in many markets, relying upon it exclusively is becoming increasingly difficult.

Sometimes the Problem Isn't Your Program

This is an important point. A program can have an excellent clinical team doing everything it knows how to do and still encounter a market where there simply isn't enough accessible capacity nearby.

• Maybe the hospital system next door is already committed to several other educational programs.

• Maybe your region has become saturated.

• Maybe you have plenty of excellent rotations but can't find sufficient capacity in women's health or pediatrics.

• Maybe you have an affiliation agreement with a large health system but can't navigate from the senior administration to the individual departments and preceptors who actually need to commit to taking on students.

These are problems Starr and I are seeing programs encounter regularly. At some point, doing more of what you've always done may not solve the problem. You may need to look somewhere else, or approach clinical development differently.

What If the Clinical Year Doesn't Have to Revolve Around Campus?

One of the ideas Starr discussed during our webinar was the development of a clinical hub.

Most programs understandably want to keep students reasonably close to campus. Travel and temporary housing can lead to high costs and inconvenience for students. But what if your local market simply doesn't have the capacity you need?

Instead of sending students from one distant rotation to another throughout the clinical year, Starr suggested looking for another geographic area where a collection of high-quality clinical experiences can be developed. An anchor hospital might provide inpatient experiences, while surrounding practices provide family medicine, internal medicine, pediatrics, women's health, and other required rotations.

Students could then spend much or even all of their clinical year within that ecosystem rather than relocating repeatedly. It's a different way of thinking about clinical capacity: Don't necessarily bring every clinical experience to the program. Sometimes you may need to bring the students to the clinical experiences.

Of course, programs must consider student travel and housing costs and appropriately disclose those expectations. But in a saturated clinical market, expanding the geographic boundaries of the clinical year may open opportunities that simply don't exist close to campus.

Another Alternative: Don't Build Everything Alone

The other idea Starr and I discussed was partnering with an outside organization to help develop clinical capacity. I'll admit that I find this model interesting.

Organizations such as AMOpportunities already have relationships with healthcare systems and preceptors. They can help identify potential placements, facilitate introductions, assist with contracting and documentation, coordinate site visits, and take some of the administrative burden off the program's clinical team. Starr described the relationship as working alongside the program rather than simply filling individual slots.

That doesn't change anything we discussed last week: The program still owns the rotations.

The program must vet the clinical sites and preceptors, ensure they are appropriate for its curriculum and learning outcomes, and maintain the documentation necessary to demonstrate compliance. An outside partner can help develop the infrastructure, but accreditation responsibility remains with the PA program.

There is another kind of capacity worth considering here, too: your own. Every hour your clinical team spends cold-calling potential preceptors, navigating hospital systems, pursuing agreements, gathering documents, and trying to penetrate a saturated market is an hour they cannot devote to their many other responsibilities.

For some programs, handling all of that internally may continue to make perfect sense. For others, outside assistance may be worth considering.

The Model Has to Evolve With the Environment

I'm not suggesting that every PA program needs to build a distant clinical hub or partner with a third-party organization. However, I do feel that programs should be willing to reconsider assumptions that may no longer fit the environment in which we operate.

Clinical capacity isn't becoming easier. The number of PA programs has grown dramatically. Healthcare systems have changed. Competition for qualified preceptors is real. And, as we discussed last week, ARC-PA still expects programs to demonstrate that they have sufficient, appropriate, vetted, and documented clinical experiences for their students.

When the environment changes, sometimes our strategies need to change with it. That's why I enjoyed my conversation with Starr. She wasn't suggesting that programs abandon their responsibility for clinical education. She was offering another way to think about fulfilling it. Right now, I think PA education can benefit from exactly that kind of creative thinking.

Thanks for joining me for this discussion. As PA education continues to evolve, we'll keep looking for practical ways to respond to the challenges facing programs, faculty, staff, and students across the country. I hope you'll join me again next week as we continue the conversation about the issues that matter most in PA education. See you then!