PA Residency and Fellowship Programs: Are They Worth It?

APPAP defines a PA resident as any graduate PA enrolled in a certificate- or degree-granting postgraduate PA program that is one year in length or longer. Most residency programs take 12 months to complete, though some take longer.

Unlike an entry-level PA program, a postgraduate residency or fellowship focuses on a single medical or surgical specialty. If you are still preparing for entry-level admission, see our guides to PA school requirements, the CASPA application, and PA school acceptance rates.

Formal postgraduate training is voluntary. ARC-PA states that specialty education through a formal postgraduate PA program or residency is not mandatory for physician-PA teams to deliver specialty medical or surgical care. Many PAs train on the job with an employer instead.

Practice your residency interview with an AI interviewer that gives feedback. Start your free week.

Whether a postgraduate year makes sense depends on where you are in your career and how you want to learn a specialty. According to APPAP, postgraduate residency and fellowship programs provide intense, organized educational programming that gives you a wide variety of clinical experiences in a short period of time.

For new graduates and practicing PAs, APPAP outlines four practical advantages over learning strictly on the job:

• Faster confidence and clinical depth. You build experience in 12 months that APPAP notes would otherwise take years to attain on the job.
• Hiring and starting position. Completing an organized program makes you a more attractive candidate to employers and can help you start with a higher level of responsibility and salary.
• Specialty changes for practicing PAs. If you are already practicing, a fellowship gives you a structured path to switch specialty areas or advance your skills and knowledge in your current job.
• Guaranteed didactic and clinical structure. Programs that are members of APPAP must provide both classroom instruction and supervised clinical training, rather than leaving your learning to daily clinic volume.

Two national bodies show up when you evaluate postgraduate PA programs: APPAP (the professional association formed in 1988, alongside its nurse practitioner counterpart APGAP formed in 2014) and ARC-PA (the accrediting commission). Neither is required for a hospital to run a fellowship, and they do different jobs.

APPAP represents 162 established program members and 4 provisional program members. Those programs come from 9 institutional members (which account for 80 programs), 82 active program members, and 4 provisional program members, alongside 51 individual memberships. A majority of APPAP members report enrolling 2 to 4 fellows per year. By our calculation from APPAP's membership figures, the 9 institutional members sponsor 49.4% of the 162 established program members (80 of 162).

ARC-PA clinical postgraduate accreditation is a voluntary external validation process. ARC-PA voted in September 2017 to take clinical postgraduate PA accreditation out of abeyance and approved the Clinical Postgraduate Accreditation Standards, 3rd edition, in September 2019 (effective January 2020). Substantial changes to the standards happen every ten years, and clarifications can be made at any of the four annual ARC-PA meetings.

Under the ARC-PA process, an institution submits a Postgraduate Applicant Information Form and an official application to the Postgraduate Accreditation Sub-Commission for Provisional Accreditation. After receiving Provisional status, the program completes an additional application, a self-study report, and a site visit to be considered for Continued Accreditation. Institutions with multiple clinical postgraduate programs must go through a separate ARC-PA accreditation process for each program.

ARC-PA also accredits post-professional doctoral programs, such as Doctor of Medical Science (DMSc or DMS) degrees, through a separate process from clinical postgraduate residency programs.

Across APPAP materials, published postgraduate literature on APPAP's research page, and the ARC-PA directory, postgraduate PA training spans Emergency Medicine, Orthopedic Surgery, Critical Care, General and Community Surgery, Cardiothoracic and Heart and Vascular care, Oncology, Family Medicine, Hospital Medicine, Neonatology, Neurology, Primary Care, and Dermatology.

While APPAP represents 162 established and 4 provisional programs, ARC-PA lists its currently accredited clinical postgraduate programs alphabetically by state (CA, CT, GA, IA, MD, MN, NC, NH, PA, TX, VA, WI), with programs holding Continued status, Provisional status, or Voluntary Inactive Status across Surgery, Orthopedic Surgery, Emergency Medicine, Critical Care, Family Medicine, Cardiothoracic and Heart and Vascular care, and Oncology.

APPAP encourages prospective applicants to contact member programs directly and ask questions before deciding. We wrote this six-step checklist using APPAP's membership criteria and ARC-PA's accreditation standards so you can compare any fellowship against a direct-hire specialty job.

• 1. Verify accreditation and membership status. Check whether the program is on ARC-PA's list of accredited clinical postgraduate programs (and note its next review date) or in APPAP's directory of 162 established and 4 provisional member programs.
• 2. Confirm the written stipend, costs, and credential. Under APPAP fair practice criteria, the program must publish the exact stipend or salary, any tuition or fees, and the certificate or academic credit awarded.
• 3. Ask who supervises you on rotation. Confirm that attending physicians and experienced PAs precept you directly, and verify that the program does not rely solely on resident physicians for clinical teaching.
• 4. Check how call and service work are handled. Ask about call schedules, on-call sleeping and food facilities, and how the program ensures PA residents do not replace regular clinical or support staff.
• 5. Review the didactic and evaluation plan. Ask to see the learning objectives, classroom schedule, and how often faculty evaluate your progress toward graduation competencies.
• 6. Ask for graduate outcomes. APPAP criteria require programs to routinely collect information on graduates to evaluate outcomes against program competencies. Ask where recent fellows were hired after finishing.

With a majority of APPAP member programs enrolling 2 to 4 fellows a year, selection committees are hiring a small clinical colleague group as much as they are admitting trainees. Whether you are a new graduate or an experienced PA changing specialties, your interview answers need to explain why you want 12 months of structured didactic and clinical training instead of a standard entry-level specialty job.

Use our PA school interview questions guide and our PA mock interview hub to practice behavioral, ethical, and clinical teamwork questions. Below is a residency-specific practice question with an example answer written by our team.

Want to rehearse your answers out loud before your program interviews? Confetto gives you live follow-up questions and rubric-based feedback on every response. Start your free week.

Why are you applying for a 12-month postgraduate PA residency instead of taking a full-time specialty job right away?

• APPAP: Advantages of Postgraduate Residency and Fellowship Programs
• APPAP: Who Does APPAP Represent?
• APPAP: Criteria for Membership
• APPAP: Research and Statistical Profile
• ARC-PA: Clinical Postgraduate PA Program Accreditation
• ARC-PA: Postgraduate Accreditation Process
• ARC-PA: Currently Accredited Postgraduate Programs
• ARC-PA: Postgraduate Accreditation FAQs