In fairness, I do think there are multifactorial barriers facing today’s preceptors. Discussion of this issue with colleagues produced the following reasons for the changes we’ve seen:
Preceptor skill level. As educators, we may have failed in our efforts to teach our preceptors how to mentor or precept. Some may not be confident enough in their own skills to be able to precept—or perhaps they are just indifferent.
Time and resources. Time and reimbursement are factors in almost every aspect of health care nowadays. It’s just not possible to say “yes” as often as we used to; the pressure to see patients and maintain or bolster the bottom line is immense. It may be that younger generations of clinicians would be willing to precept, if not for the difficulties associated with reimbursement and lack of time.
Income is now often based on production: the more you see, the more you are paid. With the complexities of ICD-10, the documentation process is much more complex. And then there’s the need to document everything thoroughly in the hopes of allaying litigation somewhere down the road. And so on … What it comes down to is that if the preceptor is unable to see the required number of patients because of time spent precepting a student, many administrators will not support the concept of “giving back.”
Financial compensation for precepting. Paying preceptors is now the norm rather than the exception. The time and effort spent is certainly worth compensation, but with decreasing education dollars, the overall quality of PA and NP education could suffer. Tuition is already high and, whether we like it or not, the cost of paying preceptors will eventually roll over into increased fees and/or tuition to the student.
There is also the issue of who gets the compensation—the institution or the preceptor—which causes some angst among preceptors. Some clinical departments or institutions are paid a lump sum to allow for released time for the provider; others allow the provider to be compensated directly.3 One group I am aware of decided to split the compensation evenly, as they felt this would be the most equitable solution.
Lastly, the amount of compensation varies. This can create a competitive atmosphere as programs “bid” against one another to secure precepting services.
Student preparation. Taking on students is a sacrifice, and the preceptor rightfully should expect them to be ready and willing to learn. At times, there is lack of preparation on the part of the student to be ready to dive in and see patients and not take all day!
But a bigger issue, I think, is that we don’t seem to instill in the new generations of professionals the responsibility to give back to our professions. So many barriers to our professions have been mitigated—we have recognition, reimbursement, and prescriptive authority, as well as the respect of our colleagues—that today’s students don’t have the “fights to fight” that we did. I think that contributes to the decreased dedication (beyond that to the patients, that is). Maybe too, we viewed our choice of profession as a calling—a vocation in which you have to give back to those who come after you—whereas many people today see it as just a job.
Practice is too specialized. More and more PAs and NPs practice in specialties (and some in subspecialties). This means they may not be equipped to offer the generalist or basic specialty clinical education required by the program.
So, yes, the decline of altruism may be a sign of our changing times. But nonetheless, we need to prepare our NP and PA students to step into real-world roles and provide quality patient care. We must identify solutions to this problem, because we cannot simply “drop” precepting or clinical rotations. So what can we do?
Many PA and NP programs have worked hard to develop relationships with preceptors and institutions that support the process. Here are some ways to foster those relationships and bring back the altruism needed to precept in today’s society:
• Seek nonfinancial incentives for preceptors, such as Category 1 CE/CME credit, discounts for conference attendance, opportunities for academic advancement (eg, adjunct clinical professor status), and access to resources via the university library.
• Advocate for a state Preceptor Tax Incentive Program (such as the one in the state of Georgia).
• Reduce the (often copious) amount of paperwork that educational institutions require of preceptors.
We also need to ensure that our students are adequately prepared. In the past decade, students enter our programs with high expectations of what they will get out of a clinical rotation and a preceptor. Some may lack a touch of humility or a servant’s mind, both of which are important to their success.
An NP colleague recently decided to take a “student vacation” for six months, as her opinion was that many of the students she had precepted were not well prepared, either academically or in work/life experience. Her assessment of increasing class sizes was that some students are there “just to fill the program up” and make it profitable. To my colleague’s way of thinking, there is a disservice being done to students who are on rotations and not ready for them. We need to make sure our students are prepared to face the challenges of clinical rotations.
We also need to encourage a renewed sense of altruism in our students, so that they feel compelled to precept when they are alumni. So how do we enhance our preparation of future clinicians through precepting? I would love to hear from you about barriers you have encountered—and preferably, some viable solutions! You can reach me at PAEditor@frontlinemedcom.com.
References
1. Altruism: ethics. Encyclopaedia Britannica. www.britannica.com/topic/altruism-ethics. Accessed March 10, 2016.
2. Morrow KL. Preceptorships in Nursing Staff Development. Rockville, MD: Aspen Systems Corp; 1984.
3. Physician Assistant Education Association. Payment of clinical sites and preceptors in PA education [issue brief]. http://paeaonline.org/wp-content/uploads/2015/09/PaymentClinicalSites-PreceptorsPAEducation.pdf. Accessed March 10, 2016.