Affordability and Total Burden: Making the Cost of Accreditation Sustainable

Rigorous accreditation requires a meaningful investment of resources, from ensuring the expertise of qualified reviewers and the development of sound standards and processes to the systems needed to evaluate whether programs are preparing graduates for practice. These investments are essential to credible quality assurance. At the same time, an effective accreditation system should recognize the resources required of programs and institutions and provide the oversight necessary to protect educational quality and the public without imposing excessive financial or administrative burdens.

Accreditation Fees

Accreditation fees are the most visible cost programs face, and are used to support the people, processes, and infrastructure accreditors need to carry out their responsibilities. Looking across health professions provides useful context for understanding those costs.

The purpose of these comparisons is not to suggest that PA education and other health professions are identical or that their accreditation systems should be. Rather, examining how established health profession accreditors structure and finance programmatic accreditation can help illuminate different approaches to a responsibility they share: assuring educational quality and protecting the public.

Cost comparisons also require care because accreditors structure their fees differently, include different services, and operate on different review cycles. Even with those qualifications, the differences in published recurring fees are notable.

• ARC-PA: For the period July 2026 through June 2027, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) annual accreditation maintenance fee is $28,000. The published fee rises to $31,000 for July 2027 through June 2028.
• ACOTE: The Accreditation Council for Occupational Therapy Education (ACOTE) annual accreditation fee is $5,400 for 2026 to 2027, and $5,560 for 2027 to 2028.
• CAPTE: The Commission on Accreditation in Physical Therapy Education (CAPTE) annual fee is $5,085 for 2026 and 2027.
• CCNE: The Commission on Collegiate Nursing Education (CCNE) annual fee is $2,948 for a program offering one degree in fiscal year 2026, and $3,007 for a program offering one degree in fiscal year 2027.
• CAAHEP: The Commission on Accreditation of Allied Health Education Programs (CAAHEP) uses a different model, with a base annual program fee of $660 for a one-program campus for 2026 through 2028, supplemented by program fees established by its discipline-specific committees on accreditation. Annual program fees charged by discipline-specific committees tend to range from $500 to $2,750.

These figures are not directly comparable. ACOTE’s annual fee, for example, includes the regular on-site evaluation associated with reaccreditation, while CCNE charges separately for evaluation teams. CAAHEP’s base fee represents only one component of what an accredited program may pay. CAPTE’s annual fee covers one cohort, with an additional charge for additional cohorts. Differences in review cycles, program configurations, and services included in published fees further complicate the comparison.

However, even after accounting for those differences, the ARC-PA’s $28,000 annual accreditation maintenance fee stands out among the selected health professions examined. This comparison does not attempt to establish what PA accreditation should cost, but the magnitude of the difference warrants closer examination of how accreditation costs are structured across health professions and what may account for those differences.

Initial Accreditation and Additional Fees

Initial accreditation costs are more difficult to compare because accreditors organize and finance the process in substantially different ways. The ARC-PA lists a $65,000 provisional accreditation application fee in addition to a $2,000 provisional application eligibility fee to check eligibility to enter the accreditation process. The ARC-PA also has a $10,000 interval assessment fee for provisional monitoring and final provisional review, and programs begin paying a prorated annual maintenance fee once provisional accreditation is awarded.

CAPTE structures initial accreditation across several stages, with published fees totaling $20,500 for its letter of intent, candidacy review, pre-accreditation, and initial accreditation. ACOTE also assesses fees at several stages, including a $2,000 letter of intent deposit, a $3,840 candidacy application fee balance, a $5,840 pre-accreditation review fee, and a $5,840 initial on-site fee for United States programs in 2026 to 2027, totaling $17,520. CCNE lists a $2,500 new applicant fee for a program offering one degree, with evaluation costs assessed separately.

These figures illustrate the considerable variation in how much obtaining initial accreditation costs, but they are not direct equivalents. Among the models PAEA has examined, recurring annual fees provide a clearer basis for comparison because programs bear them year after year as part of maintaining accreditation.

Fees associated with reconsideration and appeals provide another point of comparison. The ARC-PA lists a $10,000 reconsideration fee and a $40,000 appeal fee, plus expenses. CAPTE lists reconsideration and appeal fees of $4,280 and $7,500, respectively. ACOTE lists a $5,000 appeal fee, and CCNE lists a $15,000 appeal fee.

Taken together, these published fees do not tell us what accreditation ultimately costs a program in each profession, nor do they establish what any particular accreditation process should cost. However, they do show meaningful differences in the direct costs programs face across accreditation models and provide a basis for examining affordability more closely in PA education.

Understanding the Full Resource Demands of Accreditation

Direct fees tell only part of the story. Programs also invest substantial institutional resources in maintaining accreditation, including by reallocating faculty and staff time, having an administrative infrastructure, data systems, training, travel, and, in some cases, consultants or other outside expertise.

Much of that investment is necessary for meaningful accreditation. Across the health professions PAEA has examined, accreditation relies on many of the same fundamental elements, which include a self-study or comparable documentation; peer review and site evaluation; standards addressing institutional capacity, faculty, curriculum, student protections and outcomes; and reporting and monitoring between comprehensive reviews. The question is therefore not whether accreditation should require significant work and investment from programs, but whether the cumulative financial and administrative demands are proportionate to what is necessary to assure quality and protect the public.

PAEA’s listening sessions with members and the qualitative feedback they have provided help explain why a broader view of cost matters. Participants have described accreditation as a continuing operating responsibility involving dedicated staffing, reassigned faculty effort, ongoing evidence maintenance, and opportunity costs. Some have also described uncertainty about accreditation expectations as contributing to the need for additional preparation, documentation, and reliance on consultants or peer networks. PAEA’s findings do not establish how prevalent these additional indirect costs are across all PA programs, but they identify questions worth measuring more systematically.

When the Same Cost Creates a Different Burden

Affordability also has an institutional context. The same accreditation fee or administrative requirement may affect programs differently depending on a program’s size, staffing, financial resources, and institutional support. A recurring expense may account for a much larger share of available resources for a smaller program or an institution operating with narrower margins than for a large academic health center. The same may be true of indirect costs. Research in health professions education has identified specialized accreditation as a source of administrative burden on faculty and staff, particularly when institutions must respond to multiple sets of requirements and reporting systems.

This question is not unique to PA education. The Accreditation Council for Graduate Medical Education (ACGME), for example, has undertaken specific work to identify accreditation barriers affecting programs and sponsoring institutions in rural and underserved areas. Such work recognizes that accreditation requirements may affect programs differently depending on their circumstances and institutional context. Whether similar differences exist across PA programs is a question that warrants further study.  

The same proportionality question also extends to procedural costs. A $40,000 appeal fee is the same for every program in nominal terms, but its relative burden may differ depending on institutional resources. A rigorous system should therefore consider not only whether procedures are formally available, but whether the costs associated with them are reasonable and manageable for programs across a range of institutional settings.

A Broader View of Affordability

PAEA’s Guiding Principles on PA Programmatic Accreditation call for an accreditation system that can sustain rigorous oversight without imposing an undue financial or administrative burden on programs. Viewed through that lens, affordability is not simply a question of whether a particular fee is too high.

The goal is not the least expensive accreditation system. It is ensuring a rigorous, credible, and sustainable system that protects educational quality and the public without imposing an undue financial or administrative burden on programs. Published fees show that health professions have made different choices about how to finance and organize this work. Considering those fees alongside the broader institutional resources programs devote to maintaining accreditation can provide a more complete understanding of the total resources accreditation requires and how those demands may vary across PA programs.

Better data can help move the discussion beyond anecdotes and fee comparisons, allowing PAEA to identify where the greatest resource demands occur, understand how they differ across program settings, and consider those findings as part of the continuing conversation about a rigorous and sustainable accreditation system.

Continuing the Conversation

As PAEA continues this work, we want to hear from our members. What does the accreditation process require from your program beyond the fees you pay? Where are the greatest investments of faculty and staff time, institutional resources, or outside support? Do those demands affect your program differently because of the program’s size, resources, institutional setting, or mission? Which aspects of the accreditation process are most important to assuring educational quality, and are there areas where administrative or documentation requirements could be streamlined without compromising quality or public protection?

Your perspectives will help PAEA develop a fuller picture of what accreditation costs programs and inform the Board’s continuing work. Please share your thoughts with the Board of Directors by emailing president@PAEAonline.org.