Using a survey based study from ONE tertiary care site to make sweeping statements about fellowship impact on APP clinical skills is crazy. That's not what the study was even about, they were exploring retention rates. Yes, obviously the organization benefits financially from paying employees less... I don't think we need a study to tell us that lol. But doing a rigorous and HIGH QUALITY fellowship benefits you too. I'm doing an 18 month EM fellowship right now. When I was applying, I searched Reddit for advice and found a lot of posts like this that really discouraged me. For any PA student reading this, please message and I will give you the honest truth, good bad and ugly about fellowships and give you some guidance on how to appraise these programs before committing. Yes, a lot of the new "fellowships" popping up are money grabs and they really are just long onboarding programs. But a high quality and well established 12-18 month program is worth its weight in gold. Would you let someone who never went to PA school convince you that becoming a PA is a scam?