In the absence of physician mentorship, who will train the next generation of primary care clinicians?

The erosion of physician mentorship is not just a quiet tragedy; it is an accelerating crisis with rippling effects across the health care system. While much has been written about physician burnout and workforce shortages, far less attention has been paid to the vacuum this leaves in clinical mentorship, particularly in primary care. The implications for physician associates/assistants (PAs) are especially profound.

PAs were historically trained in the postgraduate space under a model of close, hands-on mentorship by physicians, often family physicians or internists, who guided them through real-world challenges in patient care. That apprenticeship model helped shape both competence and confidence. Today, with an aging physician workforce and an exodus of primary care doctors from clinical practice, that system is fraying, if not entirely, in many places.

I’ve seen this firsthand. As a PA educator and program director, I regularly hear from students and early-career PAs who are hungry for guidance in medical decision-making and navigating the ethical, emotional, and systemic pressures of clinical practice. Many are placed in roles with minimal supervision and high productivity expectations and struggle in silence. The result? A vulnerable workforce is at higher risk of burnout, disengagement, and clinical error.

This is not a call to return to the old system: It is too late. Instead, we must create new structures of support and advanced clinical training that reflect the current reality. The postgraduate PA fellowship or residency is one of the most promising yet underutilized tools.

These programs offer structured training in high-need specialties, including primary care, psychiatry, and rural health. Unfortunately, they remain few and far between, expensive to run, difficult to scale, and often lacking a sustainable financial model. Many health systems still see them as “nice to have” rather than mission-critical.

Here’s where innovation in education comes in. Doctor of Medical Science (DMSc) programs, especially those designed for practicing PAs, can serve as academic homes for these fellowships, embedding them within broader leadership and systems-based curricula. They offer a platform to expand clinical competence and cultivate the next generation of clinical mentors.

Our team is actively exploring how to build this connection, linking clinical fellowship training with doctoral-level education that focuses on value-based care, resilience, health care economics, and team-based leadership. It’s not just about adding more letters after someone’s name. It’s about creating a new pipeline of primary care leaders trained to practice, teach, advocate, and innovate in a broken system.

Of course, no educational program can fully replace the presence of an experienced physician mentor at the bedside. But we must be realistic. That workforce is shrinking, and no nostalgia will bring it back. Instead, we need scalable, interprofessional models that train advanced practice providers to safely, ethically, and thoughtfully fill some of these mentorship and leadership gaps.

If we fail to do this, the consequences will compound. New PAs will continue to be thrown into roles they are not ready for, and patients, especially in underserved areas, will suffer. But if we act boldly now, we have a chance to redesign a system that supports both learners and patients alike.

The loss of physician mentorship is not just a physician issue—it is a system issue. Until we treat it as such, we will remain caught in a cycle of shortages, burnout, and declining primary care access. It is time to think differently and collaborate.

Kenneth Botelho is the founding program director of the doctor of medical science (DMSc) program at the College of St. Scholastica in Minnesota. A primary care clinician, educator, and national advocate for postgraduate PA training, he leads initiatives focused on strengthening early-career mentorship, improving workforce stability, and addressing the growing gap in clinical apprenticeship models across U.S. health care.

He is the founder of Paving Practices, a workforce innovation initiative dedicated to developing scalable training pathways that support retention, system readiness, and leadership development for PAs and NPs.

Dr. Botelho serves as president-elect of the Society of PAs in Family Medicine and collaborates with health systems nationwide to integrate structured postgraduate training with doctoral-level academic progression. His work centers on building sustainable models that reduce burnout, enhance clinical preparedness, and better align education with the realities of modern health care.