Postgraduate programs for PAs are proliferating. Here's why they're still controversial

Take a job right out of school or pursue additional specialty training?

That’s one of the hottest questions for physician associates (also known as physician assistants), who aren't required to pursue postgraduate training in order to specialize in a particular area of medicine.

Yet the number of programs has proliferated over the past five years. Supporters point to evidence showing that they boost recruitment and retention, a particular boon for the medical centers offering them.

The benefits for trainees are less clear. On the face of it, the programs don't seem to offer much upside in terms of salary and job placement. And while these programs can offer some intangible benefits — mentorship opportunities, for example — quality can vary widely. 

One of the biggest issues is the lack of standardization, notes Janelle Bludorn , a certified emergency medicine PA who is also a medical educator at Duke University School of Medicine . A fraction of programs (less than 20%) have accreditation from the ARC-PA , but most do not, which means there are variations in program offerings and academic rigor. 

Postgraduate programs (also known as fellowships or residencies) haven’t traditionally been a big draw for physician associates. Only 5.7% of PAs have completed one, according to a report earlier this year from the National Commission on Certification of Physician Assistants (NCCPA) . Of those, 24% pursued a program in emergency medicine, and another quarter chose to do their postgraduate training in either general surgery or a surgical subspecialty. Yet they were largely happy they did so: 76% said they were either “completely” or “mostly” satisfied with their choice.

Interest in specializing is high among PAs, according to the American Academy of Physician Associates ’ 2025 Digital Salary Report. Only 20% of PAs in metropolitan areas — where 90% of PAs work — specialize in primary care. (That’s compared to 43% of PAs in non-metro areas.)

At the AAPA’s annual conference this past week, Bludorn co-presented with Jed Grant, DMSc, PA-C , PA program director at Chamberlain University , on the pros and cons of postgraduate training. (She offered the “con” point of view on stage, though she told me that both she and Grant have a balanced approach to the issue.) 

One of the big trade-offs is financial: while these programs typically offer a stipend in the range of $50,000 to $80,000, participants still earn less than they would if they took a job offer. PAs have been in high demand as the clinician shortage shows no sign of abating. The total median compensation for PAs increased 5.5% over 2023, and now stands at $134,000, according to the AAPA’s report. 

“Usually what I'll advise students is that if you're planning on staying in your area of medicine for the long term, and you want to work in a high-autonomy or super-specialized role, then that one-on-one or closer mentorship would be helpful,” Bludorn told me in an interview before the event. “And if you can tolerate that one-year salary sacrifice, a post-grad program might be for you.”

In our conversation below, we discuss more about who might want to consider postgraduate training, what the tradeoffs are and why the number of programs has been growing rapidly.

And tell me, PAs and nurses: what do you think is the value of postgraduate programs?

The transcript below has been edited for length and clarity.

LinkedIn News: What interested you in this topic?

Bludorn: Where I educate, so many students that have an interest in doing postgraduate programs and it's probably one of my more common drop-in or scheduled advising meeting topics that people want to talk about.

My clinical background is in emergency medicine and I never did a postgraduate program. I was somebody who was very fortunate to be able to have really wonderful structured mentoring and onboarding activities, especially in two of my emergency medicine jobs earlier in my career. With that background, I'm always of the mindset that it is possible to have really robust onboarding and on-the-job training — so is there really a grand utility for these postgraduate programs?

LinkedIn News: Tell me more about what these programs involve.

Bludorn: These programs last anywhere between 12 months to two years; most are a year long. Some of them have a dedicated curriculum with didactics or simulation; some programs are just going to give you a really intense working experience alongside physician residents. 

There is a lack of standardization or minimum standards for some of these postgraduate programs. Don't get me wrong, there are some phenomenal programs out there, but the fact that these programs don't offer a must-do curriculum allows for stratification of quality. And they're completely optional.

LinkedIn News: Why would someone do them then?

Bludorn: I'll always say that more education is rarely a bad thing. And you will see more patients under mentorship, [and] in areas of medicine where there's more focus on procedures, you'll get more repetition and practice. 

Or if somebody foresees themselves working as a PA in a really autonomous position later in their career — perhaps covering a critical access hospital where they might be the only clinician in that emergency department at that hospital — then these programs do increase the exposure to formal training.

LinkedIn News: What are the benefits for the institutions offering them?

There is some early evidence that these programs can help improve PA recruitment and retention. For the PA, the benefit would be getting your foot in the door in an area that may be more difficult to break into or an institution that may be more difficult to break into. And then for the institution, they’re recruiting some of the best PA new grads that exist out there and then retaining them. I think more research is needed in this particular area.

LinkedIn News: How many new PA grads pursue post-graduate training?

Bludorn: It’s not a large number [but] it definitely has been growing. In 2020, there were around 70 of these programs. It's teetering around 100 or more now.

One of the reasons it's hard to know exactly how many programs there are is that — unlike general PA programs, [which] are under stringent accreditation — post-grad programs do not require accreditation. There are only 18 that are accredited by ARC-PA. It's optional. There was a study a while back that showed that 48% of program directors said that one of the major reasons why they didn't pursue accreditation was because of the cost.

LinkedIn News: What other factors would someone consider?

Bludorn: At the end of the day, people don't necessarily get paid more or have a higher salary compared to their counterparts who did not do a postgraduate program. People who do a postgraduate program don't always enter at a higher level of autonomy or job level.

The vast majority of programs, 80% of them, are going to be around 12 months in length. But the annual salary ranges from $50,000 to 80,000 [significantly below the starting salary] for a new grad. 

 Many of these programs do have tracks or opportunities for research or scholarship. These are things that you can't discredit, but it's not uniform across all programs. These programs can also provide more procedural skills, more robust mentorship, maybe they do help with confidence — but that's a cost-benefit trade-off that somebody is going to have to make.