PA survey results

[bsady]

I officially closed out the PA awareness study. Ran for 6 weeks. Got 374 responses from 20 different states. Lets start a dialogue about the results. Here is the link to the results...says a lot about how PAs feel....many were AAPA members.
Brian
http://www.surveymonkey.com/Report.asp?U=365095561649

[nodakpa]

I'm a fellow member of NAPA, for about an hour now, member #56. I think the survey results are what I would have expected, but I still don't understand the general dislike of the concept of specialization. If a PA wants to be a generalist, why can't they just specialize in family medicine? I for one am hopeful for specialization to take hold, with field specific training. We already have professional groups for every specialty under the sun, but for some reason there is significant resistance to the concept. As a new PA, I'm genuinely curious about this.

[bsady]

I think the worry for all of us is the lack of flexability this route may take the profession. We all worry that eventually the system won't be voluntary, but will be required like it is for physicians. One of the great things about being a PA is the ability to work in diferent areas of medicine at the same time. Take that away and make specialty certification or training a must...then why be a PA?

[chatcat]

I, on the other hand ,don't understand the need for specialty certification. Part of the beauty of our profession is the ability to move from one area of medicine to another throughout a career without hindrance of exams. We already take a certification/recertification examination that assures competency of general knowledge that includes many areas of medicine. Most of us do not specialize in post PA residencies,rather, enter the work force once certified and learn on the job.
I see the specialty certification as creating needless rules and regulations for our utilization. For example~let's supose you are working in Internal Medicine and want to pick up some extra work in EM. Do you have to take exams to practice in both??? What about legal ramifications...in a lawsuit will we all be told that to practice in our fields we have to take an addition exam to be current with the standards of care even if we have been practicing in good standing for years? Let's not forget that noone but the agencies that will gain monetarily from administrative cost of maintaining certification will benefit from this added burden...don't expect anyone in the current healthcare system to offer a higher salary for yet another piece of paper saying we passed an exam. I just don't understand where the data is that suggests adding hoops to jump through via specialization will benefit the role/utilization/outcomes we currently have in the healthcare system?

[LESH]

Dear Colleagues:

Aren't we overlooking the need for specialty certification? It is in the patient's best interest, and won't a few more letters on the name badge and a degree or two gain the profession more respect in the medical community?Or how can we overlook the pressing need to standardize PA specialty education and training (of course the best way to do this is thru residency programs established in academic health centers affliated with medical schools, we all know that).

Last, but not least and my personal favorite...how are we gonna keep up with our NP colleagues? Won't this eventually hurt PAs in the health care work force? After all, the NPs have all sorts of specialty certifications right? We gotta keep up with the NPs. It's like our national defense policy during the cold war instead of Mutually Assured Destruction, PAs need Mutually Assured Degrees(or certification/specialization, the D in Degree just worked better).

Sorry, I can't help myself at times. Yes, I am being sarcastic. Folks better fight this tooth and nail, before you wake up and find out you got to start taking another test to validate your credentials. Stranger things have happened, think "Brave New PA world/1984". i.e. you Cert PAs, your professional organization endorses having a Masters. Who has your back? Competency based education doesn't mean what it used to mean..lol Why should the specialty PAs be any different? Wait I think hear the train leaving the station...

Let me review the ARC-PA Postgrad PA standards again, maybe there's a market ...hummm. Sorry, just felt the need to rant. Thanks for letting an old guy out in the sticks vent.

Good luck in your future PA endeavors, you all better fight this...

Lesh

[Contrarian]

What starts as voluntary... often becomes a REQUIREMENT...

[caldje]

well. here is how i look at it (if it matters). Currently, it can't be EASY to move from specialty to specialty anyways. I am sure there is quite a learning curve. If, somehow, all that was required was some sort of documentation of competency made by the supervising physician and PA it really wouldn't be any different than what happens now. It would just be documented. I think as long as 1 year residencies arent required for specialty recognition we are fine. The only thing that will change is a little bit of documentation and a little certificate. The only other problem would be the cost of the tests but I am sure employers would foot that bill.

chris

[chatcat]

The only thing that will change is a little bit of documentation and a little certificate. The only other problem would be the cost of the tests but I am sure employers would foot that bill.

chris

It will interesting to see how you feel about this once out in practice working. That little certificate called recertification that we have to take every 6 years is more than a little certificate~it is our passport to remaining employed.( Every time I recertify I have to concentrate on pediatric topics as I have never taken care of children as a PA and it requires times to prep.for this.) Add another layer of specialty examinations and it really is over the top for validation of competencies. Oh, and lets not forget the ongoing requirement of CME every 2 years. My point is that we have competencies in place that work...requiring more is insane!

[chatcat]

I'm on a roll about this specialty topic and would very much like to know how we can voice our opinions to "the powers that be" about this topic and concerns? Suggestions?
Interesting that this specialty topic places the brunt of passing upon the postgrad PA. Are there plans underway for PA programs to support PA students who will be able to graduate and pass a specialty exam & PANCE?
I would really appreciate someone who supports this specialty exam idea to step up and shed some light on how this is going to improve our profession??

[caldje]

It will interesting to see how you feel about this once out in practice working. That little certificate called recertification that we have to take every 6 years is more than a little certificate~it is our passport to remaining employed.( Every time I recertify I have to concentrate on pediatric topics as I have never taken care of children as a PA and it requires times to prep.for this.) Add another layer of specialty examinations and it really is over the top for validation of competencies. Oh, and lets not forget the ongoing requirement of CME every 2 years. My point is that we have competencies in place that work...requiring more is insane!

I hear ya. It would be a pain. I am just not sure it would really limit our mobility unless it required a residency. Do you think it would?

chris

[Contrarian]

Things to consider if/when specialty recognition launches:

1. "Recognition" creeps into "certification" as it always does... i.e. ... "All PAs we hire at this practice/hospital must be recognized in [insert specialty] before we hire them."
2. Logically speaking... if a test exists to objectively determine competency it should be used. The state has to justify why they allow all PAs in their state to perform certain procedures, while reconciling the fact that all of them aren't specialty recognized. The end result is usually requiring everyone that wants to perform the procedure to get the recognition.
3. Although the FNPs are now having problems getting jobs IN a hospital practicing Internal/Adult medicine. The Nursing lobby will be all over this new "requirement" to help them restrict PA practice.

As it now stands...

Plaintiff Lawyer asks: "What gives you the right, knowledge, and training to practice in {insert specialty here}... and perform {insert procedure here}???

PA-C: "According to state law... The procedure I performed can be performed by PAs. I trained with my current and previous SPs to perform the procedure and have documented 600 successful performances of said procedure as was required by the hospital credentialing committee." "I performed, documented and followed up the procedure according to the current "gold standard" of care.

Plaintiff Lawyer: [slinks away and re-directs the questioning to supervisory issues]

After specialty "recognition" (defacto requirement)...

Plaintiff Lawyer asks: "Did you take and pass the {insert specialty here} recognition test"...???

PA-C: No sir I didn't take it.

Plaintiff lawyer: "What gives you the right, knowledge, and training to practice in {insert specialty here}... and perform {insert procedure here}???

PA-C: "According to state law... The procedure I performed can be performed by PAs. I trained with my current and previous SPs to perform the procedure and have documented 600 successful performances of said procedure as was required by the hospital credentialing committee."

Plaintiff Lawyer: " So you are NOT recognized by YOUR own practice association to practice {insert specialty here}"...!!!???

PA-C: "Yes sir... you are correct... I am NOT "recognized" to practice {insert specialty here}... but PA-Cs have always been able to work in all specialties"...


It all goes downhill from here....

At the suggestion of the nursing lobby... the plaintiff's attorney sues the state and hospital for allowing un "recognized" PA-Cs to perform in specialties they haven't been "recognized" in...

The states... in the name of "public safety"... changes the practice acts to require "recognition" for specialty specific procedures...

The hospitals begins only credentialing "recognized" PA-Cs to avoid lawsuits...

The insurance companies begin only re-imbursing for procedures performed by "recognized" PA-Cs...

The nursing lobby just sit's back and smiles...

The slope IS slippery...

[LESH]

Things to consider if/when specialty recognition launches:The slope IS slippery...

Contrarian is sooooo right on target IMHO. If I were part of the loyal opposition I would put major resources into doing what he has described, but they do have bigger fish to fry so maybe it's not as big a deal right now.


Lesh

[Contrarian]

It's only "nice to have" when it's Not required...
As soon as some bureaucrat gets wind of it... it WILL BE REQUIRED...!!!

[LESH]

I'm on a roll about this specialty topic and would very much like to know how we can voice our opinions to "the powers that be" about this topic and concerns? Suggestions?

Hi Cat, here ya go: http://www.aapa.org/aapa/board.html you are just a few keystrokes away... and how many forum members are there again?

Interesting that this specialty topic places the brunt of passing upon the postgrad PA. Are there plans underway for PA programs to support PA students who will be able to graduate and pass a specialty exam & PANCE?

The ARC-PA and the Post grad folks have developed Standards for Post grad training programs. I am not aware of any change in the entry level programs to deal with a specialty exam & PANCE. http://www.arc-pa.org/Post_Grad/post_grad.html

I would really appreciate someone who supports this specialty exam idea to step up and shed some light on how this is going to improve our profession??

Would be nice...huh?

Lesh

[coloradopa]

I'm on a roll about this specialty topic and would very much like to know how we can voice our opinions to "the powers that be" about this topic and concerns? Suggestions?

The way to stay informed is to be a member of your specialty organization and state chapter. Keep them informed that you are concerned about this. Information flows both ways.

Interesting that this specialty topic places the brunt of passing upon the postgrad PA. Are there plans underway for PA programs to support PA students who will be able to graduate and pass a specialty exam & PANCE?

There is no specialty exam. It would be a little premature for anyone to demand support for passing this. In the end it will be the responsibility of the individual PA as it has always been to ensure competence to practice. Your PA program should provide general training that covers the ARC-PA competencies. Specialty training is a collaborative effort between the SP and the PA (or rarely in a formal post grad program.

I would really appreciate someone who supports this specialty exam idea to step up and shed some light on how this is going to improve our profession??

The current term is recognition. No one is talking about specialty certification right now. While Contrarian may disagree, there are light years of difference between recognition and certification.

Like or not recognition is here and here to stay. It is not about improving our profession necessarily. It is almost completely driven by the specialty physician organizations. The two that are present currently have different models. The Derm is self paced modules, but recognition is tied to working for a BC/BE dermatologist. If you go to work for an FP, then you lose recognition. This is solely a defensive measure similar to what we saw in Florida.

The CV training is online didactic training meant to compliment what is learned on the job. This grew out of the desire by the CV surgeons to have a more structured learning process than the ad hoc process that has existed in many community hospitals. Part of it is a desire to not reinvent the wheel and part of this is a realization that some hospitals don't have the resources to develop this. Right now recognition is based on cases logged and time served or post grad program. In the future my understanding is that there is an online course that you can take.

The NCCPA stated they are committed to helping specialty organizations develop the resources for recognition if they choose but at least my read is they have no real interest in administering or monitoring recognition.

The bottom line is that if you want a voice in this you need to join. This is all happening through the process where AAPA sets policy. This means if you don't belong to AAPA, your state chapter and your specialty organization you are not going to have a voice. One of the better things that the HOD did this year was to make policy to have the board discuss recognition with the NCCPA and PAEA as well as the specialty organizations. Previous policy prohibited these discussions.

David Carpenter, PA-C