Physician Assistant Recertification Testing

AAPA and NCCPA at odds about retesting physician assistants

For more than 40 years, the American Academy of Physician Assistants (AAPA) and the National Commission on Certification of Physician Assistants (NCCPA) have worked side-by-side to establish physician assistants (PA) as essential healthcare providers.

AAPA is the primary national professional society for PAs, promoting and advocating for the PA profession and serving as a collective voice for PAs. NCCPA is the national certifying body for PAs and has been since the organization’s inception in 1974.

But after proposed changes in PA recertification were announced, the two organizations have taken opposite sides on what is right for PAs and their patients.

NCCPA’s Proposal

The NCCPA has proposed a specialty-based, closed-book proctored exam along with two take-home exams for every 10-year recertification cycle.

“Like all certifying organizations, we have an obligation to examine what the profession is doing,” said NCCPA’s president and CEO Dawn Morton-Rias, EdD, PA-C. She said the NCCPA has a responsibility to be knowledgeable on what is relevant within the profession. Knowing what PAs are up to enables NCCPA to keep PA testing current and effective.

This is why the organization proposed changes to the physician assistant national recertifying exam (PANRE). “As the certifying board,” Morton-Rias explained, “our job is to develop certification and recertification strategies that reflect best practices, capitalize on technology and are relevant practice.”

The model, which the NCCPA Board is still discussing, has been designed to preserve the flexibility of the PA profession, reduce stress over generalist exams for those in specialties, and to serve the public trust by testing PAs in areas they practice daily, according to Morton-Rias.

The organization’s decision to consider changes to the PANRE stemmed from an observation NCCPA made: After compiling data research, it found that nearly 75% of PAs were already practicing in specialty areas outside of primary care. As early as April 2015, the NCCPA was working to find what it believed was the best retesting solution.

In November 2015, NCCPA opened a public comment period for the proposed new model, inviting discussion from PAs and PA organizations. In January 2016, the NCCPA and AAPA boards talked via conference call, and after a request from AAPA, the NCCPA extended the public comment period.

AAPA’s Reaction

The AAPA House of Delegates met in May 2016 to discuss NCCPA’s proposal, enabling the NCCPA board chair to address the more than 275 AAPA delegates. During this meeting, the AAPA delegates voiced their opposition to the proposed recertification testing, voting to support “evidence-based alternatives to testing for maintenance of certification,” and opposing “any requirement that PAs take a closed-book, proctored exam in a specialty area for maintenance of certification” as well as “any requirement that PAs take multiple examinations during a 10-year recertification cycle.”

According to AAPA’s website, the House of Delegates urged NCCPA to maintain its current PANRE policy until representatives from both AAPA and NCCPA could agree on the best course of action.

One of AAPA’s biggest concerns is with specialty testing. A unique ability of the PA profession is flexibility; PAs are trained as generalists during their PA education. The organization believes testing in this way would force PAs to choose a specialty, undermining a PA’s “unique ability to fill care gaps in hospitals, health systems and communities.”

“The changes to the recertification process proposed by the NCCPA would have such a significant detrimental impact on PA practice and patient access to care,” said AAPA president and board chair Josanne Pagel, MPAS, PA-C, Karuna RMT, DFAAPA. “These new requirements are cumbersome and unnecessary. Additional testing would take valuable time away [from] patients and could even discourage PAs from staying in a profession that is in high demand.”

During AAPA’s Board of Directors meeting in July 2016, the board members voted to look into the necessary process of establishing a new certifying body for PAs. To start, AAPA is investigating the accreditation and business requirements a new certifying organization would need to proceed.

“The decision to investigate what would be required to establish a new certifying body came only after careful deliberation and in response to the concerns of thousands of professionals that AAPA represents,” said Pagel. “The decision was not made lightly, and it reflects the priority of PAs to put patient care ahead of unnecessary testing.”

Coming to a Head

Morton-Rias told ADVANCE she found it “striking for [AAPA] to reach such a decision so soon after the House of Delegates met in May.” The NCCPA board met for the first time since the close of the public comment period in early August 2016.

In many press releases published by AAPA and NCCPA, both organizations have spoken out against the actions of its counterpart. Included in their lists of concern was the lack of communication on both ends.

“Immediately following the House of Delegates meeting,” Pagel said, “the AAPA Board chair sent a letter to all members of the NCCPA Board, requesting the opportunity to discuss the issues. We have not received a response to that request.”

NCCPA wrote: “NCCPA has repeatedly invited meaningful dialogue and substantive discourse with AAPA, hoping for a collegial and constructive discussion about how to improve the relevance of the PA recertification exam process. . We have been disappointed by the actions taken by AAPA over this past year and their unwillingness to engage in dialogue around this important issue.”

A detailed report on AAPA’s website enables users to review a play-by-play of the actions taken, learn the details of the NCCPA’s proposal and participate in commenting on the issue. The NCCPA has incorporated a timeline on its website, documenting each step of the proposal process, and a detailed webpage dedicated to explaining the proposed updates to PANRE.

Physician Assistant Response

Both the AAPA and the NCCPA report widespread support from the PA community:

“Our members voice their views on internal members-only discussion boards, as well as through emails and letters,” said Pagel. “Their voices have been overwhelmingly in opposition to the NCCPA proposed changes.”

Morton-Rias said, “Feedback has been strong and vibrant. We surveyed 103,000 certified PAs and over 30,400 responded. The majority [62%] indicated a preference for the proposed model, with 11% expressing no preference between today’s PANRE and this proposal.” AAPA has expressed concern over the validity of NCCPA’s survey questions and reported results.

Members from the PA community have been speaking up. Robert Baye, MPAS, PA-C, FAAPA, an allergy/immunology and asthma specialist in Shreveport, La., said he has always viewed the NCCPA as being right alongside AAPA.

“Nothing else has existed,” he said. In his 21 years of PA practice and three recertification exams, Baye said he’s never seen any other system of certification for PAs. “I have grave concerns about divorcing ourselves.”

Baye also said he thinks recertification testing is essential “to maintaining career flexibility to move among various specialties,” believing in what the NCCPA stands for. “It’s an organization that is represented not only by members of our profession but as well as other professional medical organizations and the public. . I feel it is the only organization that should be in the business of certifying PAs.”

Laurie Lane, PA-C, MPAS, who provides emergency and psychiatric inpatient care in Salt Lake City, Utah, views the situation differently. “The NCCPA is initiating specialty certification, which clearly shows no regard for the concept of a PA being generally trained,” Lane said. “We were never to be pigeonholed into a specialty.”

Lane is supportive of AAPA, stating that the organization is “standing up for all physician assistants to make certification mean something positive, measurable and worthy of our time, effort and dollars.”

“I get it,” Morton-Rias said. “I’m a PA too. I’m as much invested in this as other PAs. No one enjoys taking a test, but it lets patients see the PAs caring for them are qualified.”

Next Steps

Both organizations are prepared to discuss the recertification process. Though AAPA and NCCPA have taken opposite sides of the recertification debate, one thing is clear: No permanent action has been made.

“AAPA is just beginning to investigate what will be required to establish a new certifying body,” Pagel noted. “The decision about whether to establish a new certifying body has not been made.”

Morton-Rias stressed that the recertification proposal is still going through review and is not the final model. The organization’s board is looking to what stakeholders, PAs, medical boards and the public have to say.

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