The PA profession is currently in the midst of booming expansion. Some in PA education have predicted that as many as 40 new programs will be developed in this decade; thus the total number of programs in the United States may reach 200. Much like the big PA program expansion of 10 to 15 years ago, this phenomenon is not without controversy. Opinions on whether this expansion is good or bad for the profession divide into predictable groups: one group fears that lots of new PAs will lower salaries and/or the quality of PA graduates. The other group worries that without more PAs, we will be unable to address predicted medical workforce shortages. Some also fear that if the profession does not grow as other medical professions obviously are doing, PAs will become a smaller and less influential slice of the medical workforce. As anyone who was watching the profession in the late 1990s can attest, these are familiar arguments, but they are only peripherally related to the serious challenges created by the rapid expansion of the profession.

First of all, it is important to understand that serious medical workforce shortages are predicted in future decades as far as the eye can see. Add to that the fact that in the United States, higher education is not centrally planned; thus decisions to open new programs or expand existing ones are really made at the local institutional level. Sure, there are constraining forces, such as meeting accreditation standards, but basically the forces that determine the magnitude of PA program enrollment reside in individual institutions of higher education. So when workforce projections demand more health care workers and the applicant pool for prospective PAs is as strong as it currently is, many educational institutions will view this as a great opportunity to start a PA program. The answer to the question “How many PAs are enough?” isn't the big factor here. PA program enrollment increases will happen anyway because the factors driving these decisions are dispersed across many different independent institutions.

Regardless about how we feel about the profession's rapid expansion, it is happening right now. Similar to the last expansion, one of the biggest challenges is finding enough qualified PA educators to provide quality instruction at these new programs. Dozens of new programs require dozens of new program directors and many more faculty. Adding to the difficulty is the retirement of the baby boomer generation of experienced PA educators. In addition, rapidly increasing clinical salaries are enticing PA faculty back into clinical practice or keeping those interested away from becoming faculty. If qualified faculty aren't available to teach the increasing number of PA students, the quality of new graduates will likely decrease.

However, since the last big expansion, a more serious challenge has emerged – the shortage of clinical site capacity to provide increasing numbers of PA students with a solid, hands-on, patient-based experience. Several factors have contributed to this shortage, including managed care systems determining that precepting students reduces clinical productivity, the growth of the number of students from other health professions competing for the same clinical sites, and preceptors moving from salaried to productivity-based compensation that penalizes them for the time spent teaching.

So here's where the rest of the profession fits in – this is where each PA individually can make a difference. Are you precepting PA students, and if not, why not? Of course, there can be many barriers to becoming a preceptor, but often those can be overcome with some initiative and persistence. If you want to make an impact on the quality of PA graduates, and therefore the future of the profession, this is the one important contribution that will indeed make a difference.

If the PA profession is to successfully transition into one with a much larger training capacity, an increase in the clinical training capacity will be essential. We all have a vested interest in the profession graduating well-trained new PAs. It is time for all clinically active PAs to contribute by becoming a clinical preceptor.

Rick Dehn is a professor in the College of Health and Human Services and chair of the PA program at Northern Arizona University, Phoenix. This blog post expresses his personal views and does not express or represent the views or policies of AAPA.