For three months, I searched for a preceptor. I reached out to clinics, private practices, and community providers. I emailed offices, followed up, and posted in professional forums and Facebook groups. I approached the process with persistence and respect for the clinicians whose time I was requesting. Most of the time, I received no response. When I did, the answer was typically the same: not accepting students, already at capacity, not affiliated with your college, or unable to accommodate. I initially believed that with enough persistence and legwork, I would be able to secure a placement on my own. However, I quickly realized I was not alone; many of my classmates were facing the same challenges and ultimately felt forced to turn to paid placement agencies.
In many programs (something that might come as a surprise), students are expected to find their own clinical placements. At first glance, this may seem manageable, even fair. In reality, it often becomes a process where success depends less on persistence and more on connections, availability, and increasingly, the ability to pay. After exhausting available options, students are often left with one remaining path: third-party placement agencies. These services promise to match students with preceptors quickly, and they do. Placements that seemed impossible to secure independently suddenly become available within days. But at a cost. Students are routinely asked to pay $4,000-$5,000 for a single semester placement, typically covering around 250 hours of required clinical training. These hours are unpaid, mandatory, and essential for graduation.
The contrast is difficult to ignore. When students search independently, opportunities are limited. Yet when payment is introduced, placements suddenly become available. This raises important questions about how clinical education is structured, and whether it is quietly shifting toward a pay-to-access model. For many students, this is not an easy expense to absorb. Nurse practitioner students are often working professionals balancing full-time employment, academic demands, and personal responsibilities. Adding thousands of dollars per semester, on top of tuition and unpaid clinical hours, creates significant financial strain. This is especially concerning in psychiatric-mental health, where the demand for providers continues to grow. Barriers to training do not just affect students; they directly impact the future workforce and the patients who rely on it.
There are solutions, and it is my hope that bringing attention to this issue will contribute to meaningful change. Academic institutions can take a more active role in developing and maintaining clinical partnerships. Structured placement support, incentives for preceptors, and clearer systems of accountability could help ensure that students are not left navigating this process alone. Transparency is also critical. If paid placements are becoming part of the educational landscape, this should be openly acknowledged and addressed in a way that is ethical, regulated, and equitable. A system that places access behind a financial barrier risks limiting not only who becomes a provider, but who receives care.
Ksenia Kiseleva is a nurse.
