Stakeholder Meeting Addresses Shortage of Clinical Training Sites

Last week, I attended a meeting, hosted by the Health Resources and Services Administration’s (HRSA’s) Division of Medicine and Dentistry, to discuss the challenges faced by members of the Primary Care Cluster to obtain and maintain clinical training sites. With data from the 2013-2017 PAEA Program Surveys showing significant concern about clinical sites among PA program directors, and the number of programs paying for clinical rotations steadily rising, this is an issue that becomes more pressing with each passing year.

The goal of the meeting was to follow up on previously identified key priority areas: 1) the need to connect the community to institutions involved in training; and 2) a need for more preceptors and “ideal” clinical training sites. The meeting focused on the challenges, needs, and areas of opportunity to support and advance community-academic partnerships, community preceptors, and community-based clinical training sites.

On behalf of PAEA, I presented data from the 2013–2017 PAEA Program Surveys and the 2013 Recruiting and Maintaining U.S. Clinical Training Sites Joint Report of the Multi-Discipline Clerkship/Clinical Training Site Survey. These surveys reflected significant concern about the adequacy of clinical opportunities for PA programs, revealing that 94.8% of responding program directors were moderately or very concerned about the adequacy of clinical sites, with 91% and 73.3%, respectively, specifically concerned about primary care and specialty preceptors.

New data from PAEA’s 2016 Program Survey indicates that 35.4% of accredited PA programs now pay for clinical sites, representing a 14% increase from 2013. Clinical sites cost programs an average of $232 per week. Equally troubling is the fact that these sites are often distant from the physical location of the program, and, for students who do pay for remote site housing, programs on average estimate the cost per student to be $3,495. PAEA is concerned that increasing costs will become an additional burden borne largely by students, which may impact student diversity.

Representatives from the Society of Teachers of Family Medicine (STFM) and from the American Dental Education Association were also in attendance and expressed similar challenges regarding clinical training in their disciplines. Last August, PAEA was invited to attend an STFM-sponsored summit, which led to the creation of the Primary Care Preceptor Action Plan, and was represented by Constance Goldgar, MS, PA-C, Olivia Ziegler, MS, PA, and Cynthia Booth Lord, MHS, PA-C, who also represented the nccPA Health Foundation. PAEA will continue its participation in this effort with Ziegler, PAEA’s chief assessment officer, selected as a team leader on STFM’s Interprofessional Preceptor Expansion Oversight Committee.

Chief Medical Officer of the National Association of CHCs (NACHC) Ron Yee, MD, commented on the important role that financial realities play in CHC decision-making. Other representatives from NACHC provided an overview of the challenges clinical placements present to CHCs and federally qualified health centers and emphasized that training students is an important pipeline for the CHC workforce. However, the overall financial impact comes down to a “value proposition” where the “numbers need to add up.” They encouraged education programs to work with CHCs to share the administrative burdens of training health professions students.

Having practiced for 25 years in CHCs, I felt the need to underscore this point, explaining to the group that education programs can’t simply join the discussion with lists in hand of preceptorship needs — but must ask how they can help health centers meet their missions.