As physician associate (PA) programs continue to develop across the country in response to growing workforce demand, higher education leaders are navigating a new set of operational pressures.
While curriculum design and enrollment strategy are important components of planning conversations, clinical education infrastructure increasingly defines whether PA programs can successfully launch.
This article begins an ongoing exploration of the operational realities shaping PA education today, starting with what many leaders acknowledge as the most significant constraint: clinical site and preceptor procurement.
Why Clinical Site and Preceptor Procurement Is the Biggest Lift in PA Program Development
Clinical education is foundational to PA training, but the work required to support it is both extensive and often underestimated. Accreditation standards alone introduce significant complexity.
"For the initial provisional application, programs must demonstrate they have sufficient preceptors and sites for all learners," said Jennifer Feirstein, academic officer at Evidence In Motion. "For a cohort of 60 students completing eight rotations each, that's a minimum of 480 placements, secured years before a student ever enters the clinical phase."
That long runway creates uncertainty. Clinical sites often are hesitant to commit so far in advance, while programs must simultaneously ensure each placement meets rigorous standards related to learning outcomes, patient exposure, safety and preceptor qualifications.
PA programs are drawing from the same limited pool of clinical sites and preceptors, many of which are already facing heavy patient demands. With less time available for teaching, fewer clinicians are able to serve as preceptors.
"Over 65% of PA programs are now paying for some or all rotations," Feirstein said. "That adds financial strain, but it also adds administrative complexity that many programs are not adequately resourced to absorb."
Why PA Programs Struggle to Sustain Clinical Placement Staffing Internally
Despite the scale of clinical education demands, many PA programs lack the appropriate staffing or budget to support them internally. Clinical placement administration extends far beyond recruitment and includes credentialing, onboarding, evaluation tracking, patient logs, site assessments and ongoing compliance monitoring.
"For every single rotation, there are dozens of administrative steps that must be completed," Feirstein said. "And at any point, an unexpected issue can arise that requires immediate intervention to protect the student's progression."
In many programs, this work falls to a small team or a single faculty or staff member who also is responsible for teaching, advising, remediation, service and scholarship. Over time, that model becomes difficult to sustain.
"There's a mismatch between the expectations placed on clinical faculty and the capacity they're given to meet them," Feirstein said. "That tension only grows as programs scale or diversify geographically."
How Dedicated Clinical Support Changes the Role of PA Faculty and Leadership
When clinical site and preceptor procurement is supported by dedicated staff, the impact extends well beyond administrative efficiency. It fundamentally reshapes how faculty and leaders allocate their time.
"Faculty still need to be involved in vetting sites and making final determinations about learning quality," Feirstein said. "But much of the work of identifying sites, collecting documentation and managing placements can be handled by specialized staff."
That shift allows faculty to focus on areas where their expertise is most valuable: student advising, remediation, curriculum development and preceptor mentorship.
"It creates space for faculty to be educators again," Feirstein said. "And it reduces the risk that comes from critical clinical education processes depending on a single individual's bandwidth."
For institutional leaders, that resilience becomes increasingly important as programs grow, faculty turnover occurs or student populations become more geographically distributed.
How National Clinical Networks Support Enrollment and Access
Clinical education infrastructure also plays a critical role in enrollment strategy. Students value proximity to home as they consider PA programs and increasingly seek programs that minimize the need for relocation.
However, the highly competitive nature of PA admissions can challenge their value alignment of professional goals with residence preferences and needs.
"Many students simply cannot move for PA school due to cost or family obligations," Feirstein said. "Hybrid education removes barriers during the didactic phase, but without a national clinical network, those barriers can resurface during rotations."
Programs that can support students in their home communities are better positioned to recruit nationally, expand access and contribute to a more diverse PA workforce.
"When students don't have to choose between education and their existing responsibilities, the profession benefits," Feirstein said.
What Higher Education Leaders Should Look for in Clinical Education Partnerships
As PA programs scale, leaders must evaluate clinical education partnerships with long-term sustainability in mind. Strong partners value teaching and are willing to adjust workflows, such as scheduling or patient flow, so students can participate in care without reducing patient access.
"For clinical sites to adjust workflows, they have to see the value of teaching," Feirstein said. "That means academic institutions must be able to articulate a clear value proposition."
She added that sustainable partnerships also depend on shared investment in innovation, from new care delivery models to emerging technologies that will shape future practice.
"Clinical education partnerships work best when both sides are committed to learning, improvement and long-term collaboration," Feirstein said.
Designing PA Programs for the Long Term
Clinical education is not a peripheral function of PA programs. It is the infrastructure that determines whether growth is sustainable, equitable and aligned with workforce needs.
As higher education leaders navigate expansion, accreditation and competition, rethinking how clinical education is supported and by whom is becoming a strategic imperative.