Shots fired- AAPA to formulate new certification process

[Guest JMPA]

the tremendous waste that occurs in healthcare today is do to administrative bureaucracies such as the nccpa, it is not do to the over testing or over treating. Why do we as a profession have the most strict and time consuming maintenance requirements and at the same time the least autonomy and respect?

[Statko]

At the risk of sounding very corporate, I worry that our profession has no mission statement, road map, long term plan, whatever you wanna call it.

Issues such as what we call ourselves, autonomous practice, certification, lobbying/public awareness, clinical doctorate, explosion of new training programs, reimbursement, scope of practice, etc are all interconnected.

 

Here's a small example: When I started working in academics, I was floored by the level of detail ARC-PA requires educational programs to provide to their students regarding objectives.  There is a whole taxonomy (Bloom's) for breaking down tasks into mastery levels and criteria percentages must be assigned to each item. It doesn't cut the mustard to say to students that they must "Know criteria for diagnosing hypertension." Now it has to read something like "Draw a table outlining the categories of hypertension, including a brief description of each category, and include all systolic and diastolic values associated with each."  Essentially, if students read and know the objectives, they're getting a modified version of the test questions, and will pass the test because they will have achieved "competency" as defined by their program and as required by ARC-PA.  Now let's look at the PANCE/PANRE.  We're generously provided with a "blueprint", which is basically just a laundry list of topics. Such as "hypertension". No idea if you will be asked to define it, pick a drug to treat it, etc. IF (big if) we want recertification, shouldn't the competencies they (whoever "they" are) be published/known so that it mirrors our educational system and gives all PAs a fair shot at passing the test? Oh, and so you can actually learn/study the things you don't know or need to brush up on, rather than trying to cram an abridged version of PA curriculum down your throat in a 3-5 day conference?

 

WTH? This is craziness.

 

The profession needs someone or some organization to step up as a leader, and not just serve as another bureaucracy. We need a unified, bigger vision for PAs where all these pieces of the puzzle -- from PA school to recertification and continuing ed -- make sense and work together toward a common purpose that serves to further and enhance our profession. Right now, the only common denominator I see is a money grab.

[KMD16]

the tremendous waste that occurs in healthcare today is do to administrative bureaucracies such as the nccpa, it is not do to the over testing or over treating. Why do we as a profession have the most strict and time consuming maintenance requirements and at the same time the least autonomy and respect?

.....the least autonomy and respect indeed. 

 

We're been overshadowed by the NP. 

 

We'll soon be supervised by the DNP while our organization fight each other. 

 

All of this are depressing. 

[CAAdmission]

I'm surprised to see so many on here agreeing with the AAPA on this.

 

 to me, the idea of having multiple certifying bodies and less cohesion across the board is NP territory. The administrators and physicians I've worked with have always seemed to have more respect for the process (and the credentials) because they can actually identify one in the first place and it's the same for everyone. I'm not sure anybody understands the situation with NPs -- some seem to take a board exam of sorts, some don't; there are various credentials with nobody being sure what they mean or how one obtains them (and maintains them). I recently saw a CV that had been submitted by an NP to my employer and it featured: "JANE DOE, NP-C" at the top. I thought to myself, "huh?" I'd never seen that one before.

 

I wouldn't knock NP practice. What part do you see as being the problem? In many states they can write their own ticket, in spite of having the worst knowledge base of any prescribing clinician.

 

As for "respect for the process" I have never heard of that earning someone a job. I have heard of dozens of PAs losing positions due to less onerous countersignature requirements.

[MedicinePower]

This is an outrageous move by AAPA. How does it possibly benefit our profession to create multiple certification organizations? Are the NCCPA proposed changes really so substantively bad that we need to make a humiliating public spectacle of our profession by creating a competing certification board? Of course this is most likely a bluff by AAPA but reflects poorly on PAs as a profession.

It's an outrageously good move by the AAPA.

[rev ronin]

I'd like all participants to remain cordial and remember that the PA forum has a unique place as a truly neutral venue:  We are neither beholden to the AAPA nor NCCPA, nor any other entity, for that matter.  This is likely to be the only truly open Internet forum where any PA (not just one who pays dues to AAPA) can comment freely and be heard by all.

 

Let's not lose that. If they've got any brains at all, both "sides" of this are looking at what we discuss here.

[CAAdmission]

If they've got any brains at all, both "sides" of this are looking at what we discuss here.

 

Based on past experience, that's a big "if"...

 

NCCPA is also not beholden to anyone. They essentially run a monopoly over a profession and make a lot of money doing it.

 

[mmiller3]

It's an outrageously good move by the AAPA.

Agreed, but I hope the AAPA has a plan, and is not just posturing.  I am personally sick of the monopoly the NCCPA has right now.

[Reality Check 2]

I want our profession to move forward and not just have agencies collecting money for membership and certification that really do nothing to HELP us or PROMOTE us or ADVOCATE for the true nature and awesomeness of our profession.

 

We are a great profession that can meet the needs of healthcare if allowed to practice correctly and to the extent of our knowledge - which is great.

 

I don't intend to bash either organization but am disappointed to date with their lack of forethought and, currently, ZERO response to my correspondence with NCCPA. 

 

AAPA needs to take off the kid gloves and cow-towing and start really ADVOCATING for us and AAPA and NCCPA should be collaborative instead of antagonistic. WE ARE WHO THEY SERVE - yet, we aren't being heard or acknowledged.

 

History shows us that revolt is often the only way to get attention................ Sad but true.

 

I want to take the AAFP exam minus OB and be certified under the specialty I practice - family practice. 

 

We move forward or we die out

[ColoradoIMCardsPA]

I'd like all participants to remain cordial and remember that the PA forum has a unique place as a truly neutral venue:  We are neither beholden to the AAPA nor NCCPA, nor any other entity, for that matter.  This is likely to be the only truly open Internet forum where any PA (not just one who pays dues to AAPA) can comment freely and be heard by all.

 

Let's not lose that. If they've got any brains at all, both "sides" of this are looking at what we discuss here.

 

I hope I have not been un-cordial... If I have, I apologize...

 

I seem to have the minority opinion here. My personal take is that the proposed NCCPA changes are not that big a deal and have provoked a surprisingly high level of blow-back.

For the AAPA to use the "nuclear option" and threaten to make a new credentialing board seems like a show of disunity in the PA profession which I fear reflects badly on us as a profession. It doesn't make it look like we have our "stuff" together.

 

The addition of PI-CME/SA-CME or whatever (I have not fully familiarized myself with those because I'm in the last certification year on the 6 year cycle that doesn't need those) seemed to me much more onerous than the proposal to have to take some take-home tests that you can fail and then remediate. Or left-out specialties like geriatrics (see post above) to have to take a general knowledge test, which we already have to do.

 

CME and testing requirements may annoy you, and likely they are overly expensive, but doesn't it make our profession MORE respectable if we are held to a continuing education standard? Lifelong learning is at the core of the practice of medicine, no matter what the bureaucratic requirements may be.

 

Granted, there is a tendency for the boards (including MD boards) to over-emphasize silly and non-practical knowledge.

[PACdan]

This is an outrageous move by AAPA. How does it possibly benefit our profession to create multiple certification organizations? Are the NCCPA proposed changes really so substantively bad that we need to make a humiliating public spectacle of our profession by creating a competing certification board? Of course this is most likely a bluff by AAPA but reflects poorly on PAs as a profession.

 

We could (hopefully) use it to our advantage, much like NPs, and carve out a better standing for our profession. A new certifying body could bring about a name change, set precedence for improved practice for PAs, etc.

 

...My personal take is that the proposed NCCPA changes are not that big a deal and have provoked a surprisingly high level of blow-back.

 

 

And then one day we wake up and they've decided to implement their plan despite all the blowback. The downside to only having a singular certifying body in my mind, is that you have no alternatives. They really can do what they want.

[Reality Check 2]

I copied and pasted this from another thread where I posted it. 

 

MAIN POINT - AAPA membership is optional and doesn't represent us all.

NCCPA certification is required and they don't listen to us at all.

 

I do not think the masses of PAs are being heard. I see this as two CEOs/Boards having a grudge/power match and we are still just in the cheap seats watching.

 

I have complained, suggested, advocated and pleaded for board question issues for 25 years to no avail. Not even so much as a thank you, kiss my butt email reply. 

 

Not all 108,000 PAs in the US are represented by AAPA - look at their membership numbers - but all of us are certified through NCCPA. Many PAs have steered away from AAPA over the years due to a perception of little return for $250 or whatever a year in membership. Too national, not local enough, not visible enough, no tangible results that affect my daily life, etc. Some members sign up only for the CME and better program rates. 

 

IF NCCPA put this to a majority rules vote of board certified PAs and not through their wishy washy namby pamby focus groups and "public input" (WTH?) then we might actually get something that reflects what we do.

 

AAPA membership is not required. NCCPA certification IS.

 

In my solo opinion, NCCPA is the one who dropped the ball and might not even know there is a ball in this issue.

 

WE ARE CERTIFIED PAs - WE SHOULD GET FULL SAY IN THIS PROCESS OF CERTIFICATION. Yet, no one listens...................................

 

My old cranky 2 cents.

[BruceBanner]

The AAPA can eat my shorts. They'll never get $1 of my money again until they start kicking down doors and stepping on toes to advance our profession in tangible ways--like expanded scope, autonomy, new TITLE, etc. They're just a figurehead.

 

I personally think the NCCPA had some great ideas with the new recert plan, albeit maybe unrefined in the specialty areas. I love the take-home test idea.

 

And again I'll say the AAPA isnt going to do anything. They are posturing over the NCCPA as a power play. 

[mmiller3]

The AAPA can eat my shorts. They'll never get $1 of my money again until they start kicking down doors and stepping on toes to advance our profession in tangible ways--like expanded scope, autonomy, new TITLE, etc. They're just a figurehead.

 

I personally think the NCCPA had some great ideas with the new recert plan, albeit maybe unrefined in the specialty areas. I love the take-home test idea.

 

And again I'll say the AAPA isnt going to do anything. They are posturing over the NCCPA as a power play. 

 

How is more testing good for us? 

[Reality Check 2]

The old Pathway II method was really quite nice, in my opinion.

 

I learned, I collaborated with colleagues and I had to look up resources to support my findings.

 

My problem with current testing is the format and content of the questions - quite frankly - they are stupid and not in the least realistic. 

 

I read the question - formulate an answer in my mind and then find that choice isn't one of the answers - I am not dumb - and I wasn't wrong. My reality didn't match whatever archaic or unrealistic text or "best practices" BS the current statisticians used to formulate a question.

 

No one has ever listened that the CONTENT of the exams is a core problem for a lot of us. 

 

2/3 of Psych meds are used off label. My worst score on any test was psych because I didn't "read the book". No - I followed my local board certified psychiatrist recommendations and - wait for it - my patients actually got better.......................

 

To me it is like the parole hearings in movies - "yes, I am a changed person. I have no intentions to harm anyone and will be a good citizen". 

WHAT THEY WANT TO HEAR - NOT WHAT REALLY HAPPENS.

 

Change has to happen - the current testing regimen and content is awful. I am tired of "playing the game".

 

I was not a Marine but have adopted the adage - ADAPT, IMPROVISE - OVERCOME................................

[True Anomaly]

My educated guess would be that the AAPA is actually quite serious about moving forward with this process, if the NCCPA doesn't come back to the table to discuss further

[ksmith10]

 

 

I completely support the AAPA with this move and am grateful for their efforts. It's the same movement as the one taking place on behalf of physicians against their board exams (which are only every 10 years and not the proposed every 2 years for us) and MOC requirements. It's healthcare providers starting to stand up and say "enough" so we can take care of patients instead of following the orders of boards made up of non-practicing PAs.

 

 

 

But that's the kind of misinformation being spouted off by AAPA and used to justify their petulant behavior-- which, I agree with ColoradoIMCardsPA, reflects poorly on the profession. There is no proposal to take a board exam every two years. There is simply a proposal to have some sort of take-home activity that would be completed over the course of several months within the 2 year certification period, with the goal of maintaining general medical knowledge. The NCCPA has stated that it would NOT be similar to Pathway II - in other words, would not be designed to require looking things up and seeking out resources to answer the questions. Instead, they would be similar to PANCE questions that are relatively straightforward, but with the ability to look up the answer if necessary. Failing would only result in having to complete remedial CME in "target areas" where you are weak, and would be part of the required CME for the next cycle--not additional hours.

 

If people are concerned about a push to require specializing and the loss of lateral mobility, it seems like this should be something you support.

 

 

- the certification process was just changed recently (the new 10 year cycle, the different kinds of CME, CAQH testing, etc)

 

But people have been complaining quite a lot about the PANRE and its difficulty, lack of relevance to their area of practice, etc. The NCCPA appears to be trying to address this. The different kinds of CME seem to be something they are willing to cede.

 

Look, I genuinely understand the points being made here by those who are further along in their careers and no longer see the utility in any of this. I understand why you all would just view these things as barriers that put us at a disadvantage compared to NPs. But for those of us who are new to the profession and don't yet have the experience, network, or expertise that you all do, the process by which we become credentialed and maintain certification holds more weight. None of these proposed changes will change state laws, and many of us will still be practicing in states where it is significantly less cumbersome and more desirable for practices to hire NPs. I believe one of the few things we have on our side, regardless of how inconsequential some may believe it to be, is a familiar, standardized and rigorous certification process that reflects the time-consuming effort required to remain up-to-date in our profession.

 

 

Until these two organizations agree to sit down and work  together for the good of our profession, the AAPA's threat may be all they have for ammunition.

 

But that's what the NCCPA has been trying to do....

[Reality Check 2]

KSmith

 

Until you have actually taken the PANRE multiple times (yep, I have) AND done Pathway II (yep, I have) and until you have been in practice for more than 15 years - I am on 25....

 

You really don't get to say you understand the problems with PANRE or NCCPA or CME.

 

This whole PI CME is a giant clusterFUC& and hard to find, hard to get and not uniformly accepted by AAPA/NCCPA.

 

The content of PANRE is INANE and so fraught with problems, in my opinion, that is does NOTHING of any use to my daily clinical practice and actually dumbs me down from doing what is best for my patients. 

 

I go through my daily work life doing right by patients and fighting with insurance idiots and doing a generally good and heartfelt job and then I have become a robotic idiot to study for PANRE and unlearn what I do everyday to answer a question based on someone's "book evidence" of the "right thing to do" and hope it is good enough to pass a test that keeps me credentialed with insurance companies (that I hate) and state boards and hospitals. 

 

So, it doesn't reflect that I am a good primary care provider or that my patients get good advice and get better - it means I figured out once again how to pass an inane test.

 

If I am going to go through all of this and pay this much money - I would like it to reflect reality and what I do - not what I know to say.

 

Big difference in that in my opinion. I have 20 more years to go doing this - so I find it pretty important.

 

My very old 2 cents.....................................

[mmiller3]

But that's the kind of misinformation being spouted off by AAPA and used to justify their petulant behaviror-- which, I agree with ColoradoIMCardsPA, reflects poorly on the profession. There is no proposal to take a board exam every two years. There is simply a proposal to have some sort of take-home activity that would be completed over the course of several months within the 2 year certification period, with the goal of maintaining general medical knowledge. The NCCPA has stated that it would NOT be similar to Pathway II - in other words, would not be designed to require looking things up and seeking out resources to answer the questions. Instead, they would be similar to PANCE questions that are relatively straightforward, but with the ability to look up the answer if necessary. Failing would only result in having to complete remedial CME in "target areas" where you are weak, and would be part of the required CME for the next cycle--not additional hours.

 

If people are concerned about a push to require specializing and the loss of lateral mobility, it seems like this should be something you support.

 

 

But people have been complaining quite a lot about the PANRE and its difficulty, lack of relevance to their area of practice, etc. The NCCPA appears to be trying to address this. The different kinds of CME seem to be something they are willing to cede.

 

Look, I genuinely understand the points being made here by those who are further along in their careers and no longer see the utility in any of this. I understand why you all would just view these things as barriers that put us at a disadvantage compared to NPs. But for those of us who are new to the profession and don't yet have the experience, network, or expertise that you all do, the process by which we become credentialed and maintain certification holds more weight. None of these proposed changes will change state laws, and many of us will still be practicing in states where it is significantly less cumbersome and more desirable for practices to hire NPs. I believe one of the few things we have on our side, regardless of how inconsequential some may believe it to be, is a familiar, standardized and rigorous certification process that reflects the time-consuming effort required to remain up-to-date in our profession.

 

 

But that's what the NCCPA has been trying to do....

 

How does adding in more work in between cycles benefit us? We already have enough to do to maintain certification IMO (especially compared to NPs); adding further requirements is ridiculous.

 

I am one of the (apparently few) in favor or scrapping a re-cert test altogether in exchange for increased CME.

[CorpsmanUP]

But that's the kind of misinformation being spouted off by AAPA and used to justify their petulant behaviror-- which, I agree with ColoradoIMCardsPA, reflects poorly on the profession. There is no proposal to take a board exam every two years. There is simply a proposal to have some sort of take-home activity that would be completed over the course of several months within the 2 year certification period, with the goal of maintaining general medical knowledge. The NCCPA has stated that it would NOT be similar to Pathway II - in other words, would not be designed to require looking things up and seeking out resources to answer the questions. Instead, they would be similar to PANCE questions that are relatively straightforward, but with the ability to look up the answer if necessary. Failing would only result in having to complete remedial CME in "target areas" where you are weak, and would be part of the required CME for the next cycle--not additional hours.

 

If people are concerned about a push to require specializing and the loss of lateral mobility, it seems like this should be something you support

 

 

But that's what the NCCPA has been trying to do....

Ksmith 10

 

In an effort for transparency, are you currently on the BOD of the NCCPA? Do you have first hand information concerning the efforts of communication between the two boards?

[8404PA]

KSmith

 

Until you have actually taken the PANRE multiple times (yep, I have) AND done Pathway II (yep, I have) and until you have been in practice for more than 15 years - I am on 25....

 

You really don't get to say you understand the problems with PANRE or NCCPA or CME.

 

This whole PI CME is a giant clusterFUC& and hard to find, hard to get and not uniformly accepted by AAPA/NCCPA.

 

The content of PANRE is INANE and so fraught with problems, in my opinion, that is does NOTHING of any use to my daily clinical practice and actually dumbs me down from doing what is best for my patients. 

 

I go through my daily work life doing right by patients and fighting with insurance idiots and doing a generally good and heartfelt job and then I have become a robotic idiot to study for PANRE and unlearn what I do everyday to answer a question based on someone's "book evidence" of the "right thing to do" and hope it is good enough to pass a test that keeps me credentialed with insurance companies (that I hate) and state boards and hospitals. 

 

So, it doesn't reflect that I am a good primary care provider or that my patients get good advice and get better - it means I figured out once again how to pass an inane test.

 

If I am going to go through all of this and pay this much money - I would like it to reflect reality and what I do - not what I know to say.

 

Big difference in that in my opinion. I have 20 more years to go doing this - so I find it pretty important.

 

My very old 2 cents.....................................

 

 

I wish I could "like" this post more than once!

[ventana]

Does anyone allot some of their CME money to pay for a subscription to UpToDate? I have $1500/yr for CME but it's not a lump sum payment, I have to submit requests for funds if I want to pay for something. I'm just about to start the position (my first PA job) so I'm not entirely sure how all of this works and am wondering if this would be approved.

 

 

I am currently reviewing a letter of employment for the first PA position I have been offered and wanted to know if this is something that other people have run across. The terms mention a 90 day probationary period followed by an initial performance review at 6 months and again at 12 months, then annually thereafter. Is this standard?

 

 

But that's the kind of misinformation being spouted off by AAPA and used to justify their petulant behaviror-- which, I agree with ColoradoIMCardsPA, reflects poorly on the profession. There is no proposal to take a board exam every two years. There is simply a proposal to have some sort of take-home activity that would be completed over the course of several months within the 2 year certification period, with the goal of maintaining general medical knowledge. The NCCPA has stated that it would NOT be similar to Pathway II - in other words, would not be designed to require looking things up and seeking out resources to answer the questions. Instead, they would be similar to PANCE questions that are relatively straightforward, but with the ability to look up the answer if necessary. Failing would only result in having to complete remedial CME in "target areas" where you are weak, and would be part of the required CME for the next cycle--not additional hours.

 

If people are concerned about a push to require specializing and the loss of lateral mobility, it seems like this should be something you support.

 

 

But people have been complaining quite a lot about the PANRE and its difficulty, lack of relevance to their area of practice, etc. The NCCPA appears to be trying to address this. The different kinds of CME seem to be something they are willing to cede.

 

Look, I genuinely understand the points being made here by those who are further along in their careers and no longer see the utility in any of this. I understand why you all would just view these things as barriers that put us at a disadvantage compared to NPs. But for those of us who are new to the profession and don't yet have the experience, network, or expertise that you all do, the process by which we become credentialed and maintain certification holds more weight. None of these proposed changes will change state laws, and many of us will still be practicing in states where it is significantly less cumbersome and more desirable for practices to hire NPs. I believe one of the few things we have on our side, regardless of how inconsequential some may believe it to be, is a familiar, standardized and rigorous certification process that reflects the time-consuming effort required to remain up-to-date in our profession.

 

 

But that's what the NCCPA has been trying to do....

 

 

 

So to point out the obvious

PA for a whole 17 months and now giving out advice on a recertification process you have never done....

Nuff said....

[db_pavnp]

I wish you were half as interested in discussing the post as you are dismissing it based on some fallacy of authority.

[TWR]

MMiller3 I do not think you are"one of the few" but rather in the majority about scrapping the PANRE. I think the misconception is that scrapping the written test would negate the "C". I believe the argument is more along the lines of having maintenance of 100 hours of CME be sufficient to maintain the "C". So those PAs practicing in one of the 20 states that require it to practice don't have to move or change professions.

[Poetsiren]

Ksmith10,

 

I feel like I am hearing alot of things from you that I have heard from the NCCPA. It would be in your best interest to realize that the "take home" testing and remediation that the NCCPA is proposing is being added, and that there will STILL be proctored exams that you will be expected to take. It will NOT be just one or two take-home exams throughout the 10 year period, but several (currently "unspecified" amount),  WITH proctored exams at set periods, and ADD that to more CME requirements AND try to take care of your patients..... Sure! If all you see is "we're going to have PAs do take-home exams to recertify" it sounds like a GREAT thing.....

 

Not to mention the fact that the addition of specialized exams, regardless of the claim NCCPA has made that there will still be a generalist focus and a generalist provider exam, is cause for concern. If you were an employer who saw someone coming into a specialty from another area of medicine, would you want that person to have passed that specialist exam that you KNOW exists?! What if that PA wanted to work in several specialties? So you see, despite the NCCPA claiming it would "increase flexibility" of PAs, it would create a "trapping" effect and make the PA profession more like NPs in that it would require certification in each specialty, regardless of the generalist exam, and this is completely antagonistic to the PA profession and its original mission in the medical arena. Even though NCCPA says "No employer will know what exam the PA takes" when it comes to specialty exams..... it will become a jumping point for employers, and even other medical professionals who may think less of their PA peers, to question the PA qualifications. We will have lost the ability to be as flexible as we are. Don't get me wrong, I can understand taking an exam when the content isn't what you practice day to day (speaking of specialist medicine). That bites.....I don't have an alternative option, sorry. But PAs start out as certified generalists.

 

AND you have to pay for all the services that the NCCPA will be supplying to ALL PAs, and you KNOW how much PANCE costs.....So no, the NCCPA is being VERY vague on purpose. And so far the AAPA is having none of it. I mean, I agree with "db_pavnp" with what was said on the bottom of the first page of this thread: "It strikes me as a **beyond monumental task** to attempt to manage 12 specialty exams in one organization.  Some of these exams will be pure garbage."

I ask the same thing: how can NCCPA even regulate that number of exams on such a scale?! 

 

It's my honest and personal opinion that the NCCPA got greedy in that it has a monopoly on an expanding obviously successful profession and it knows it.

And no, I haven't had to recertify yet, either. But I friggin' HATE tests and am a PA-C, too, and I even dislike the NCCPA proposal.