Creating a Sub-specialty Certification

[coloradopa]

Okay, here is the challenge:

I'm at the American Headache Society Scientific meeting in Beverly Hills. Today I became chair again for the PA section. Our group (combined PAs and NPs) gave a challenge to me and my NP chair counterpart to create a sub-specialty certification in headache medicine. The UCNS (United Council for Neurological Subspecialties) has a board exam for neurologists but would never allow NPs or PAs to sit for it. The NPs believe that they could get one of the NP specialty boards to create a certification for NPs in headache medicine but they would never allow PAs to sit for it. I'm doubtful if the NCCPA would ever consider a headache medicine exam because it is such a small group.

Having certification is very important. Can you imagine trying to get credentialed with insurance companies or hospital as a ER PA without ACLS cert? That is what we face. Insurance companies do not want to allow referrals to NPs or PAs for headache unless they are "certified in headache medicine" of which there is no such thing at this time.

So, are you aware of other certification boards that is independent and would consider something like this? We may have to create our own certificating board but that would be complex and expensive.

Creating your own board is not complex or expensive. You would simply need a business registration. You could even register it as a 501 (c)(3) non-profit. In most states this would be fairly inexpensive. You could then develop your own test and administer it. If you did it by mail it would be fairly inexpensive.

The real question is what it would mean. There are essentially three levels of medical certification. The first arises off of a nationally recognized training program. Examples would be the PANCE or board certifications arising off the ACGME residencies. The second arises off of non-recognized GME programs that have become recognized or required by government organizations. For example Hepatology is a CAQ run by the AASLD. Medicare requires a transplant program to have a CAQ qualified hepatologist. The third is everything else. There are hundreds of unrecognized medical "certifications". Some are based on legitimate organizations others not so much. All it takes is a sign and a business license. I would put the NCCPA CAQs in this category. They are not normed and don't undergo the same rigorous development that the PANCE does. From an EBM perspective this is essentially level III evidence.

If you honestly think that "certification" matters then go for it. Realistically it won't matter. Either the insurance company will question the legitimacy of the certification or impose additional requirements such as fellowship training. They don't impose these requirements on the physician, they are simply looking for a reason not to pay you.

From an NCCPA standpoint here is there criteria:
"The NCCPA Board of Directors chose the specialties to include in the initial roll out of the CAQ Program in 2011. The specialties included in the initial launch were selected based on information about the need for specialty credentials that NCCPA received from PAs practicing in these specialty areas and from leaders of the specialty organizations serving those PAs. We also considered a host of other factors, including the number of PAs practicing in the specialty, mobility trends into and out of the specialty, the criticality of the patient population served, and the degree to which the specialty is hospital-based."

Looking at those criteria I think that its unlikely that they will develop a headache CAQ.

[jmj11]

I agree with you steve, more testing leads to more control, less lateral mobility. It is certifications beyond our PA cert that will ultimately destroy this profession by increasing "control" over us. We need less control and more autonomy. Physician Associate is the route to go. Long live the battle from Assistant to Associate. Stay strong my brethen.

I think this conversation just went down a rabbit hole, down which I am not even tempted to go. Ironically this whole thing is about seeking autonomy and the whole point is assuring lateral mobility. If you want to move in any direction you want to go, you can. But the industry wants you to prove that you have the skill set in those far corners. It is limiting and restrictive to PAs to declare to them that they can not move into specialties but must stay in the narrow scope of primary care. The autonomy that I want is owning my own specialty clinic and playing with the big-boys, like all PAs should have the right to do. But the insurance companies say, if you declare yourself to be a specialist, then you need some standard of proof. It is no different than what ACLS does for PAs in acute settings.