CAQ standard has already started

[LT_Oneal_PAC]

“PAs at this medical center even teach new physicians procedures, like spinal taps, that we have done frequently,” he adds. “So it is obviously important to keep skills sharp.” 

Parker was one of the first PAs in New York to earn the Certificate of Added Qualification (CAQ) in Emergency Medicine from the NCCPA. The CAQ credential recognizes experience, education and qualifications in emergency medicine, and requires recipients to pass a national exam in the specialty. 

Dr. Dowidowicz points out that Adirondack Medical Center has now set the CAQ “as a standard for PAs in emergency medicine as a measure to prove their high-level of competence.” 

 

 

https://www.amccares.org/press/Physician-Assistants-play-critical-role-in-patient-care-at-Adirondack-Health-443

[EMEDPA]

one of my per diem jobs requires that I have the CAQ for full procedural sedation privileges. They will hire folks without the CAQ but those folks have a restricted scope of practice.

the em pa community, moreso than any other group of PAs, has embraced the CAQ. with only 3 sittings for the test to this point 1 in 20 em pas have it with more signing up each time the test is offered. it won't be long before jobs ads say "preference to em caq holders". a few years later it will list it as an absolute requirement. for the em pas I know it is actually a pretty good filter. the folks willing to go out and get acls/atls/pals/difficult airway course and have a doc sign off on a procedures list are among the most skilled and autonomous pas I know. if you only want to work fast track for your entire career you really don't need the caq. but if you want to take care of folks who are very sick in the main dept or solo facilities it is a good idea. em trained and boarded docs designed this test, including a recent president of acep. they respect the test and the process of becoming eligible and will go out of their way to hire folks who have hopped through this hoop. I think it was money well spent as it has already gotten me new and better jobs with essentially an unlimited scope of practice.at my most recent new job I was offered credentialing for thoracotomy and bronchoscopy, both of which I refused.

[LT_Oneal_PAC]

I'm all for it.

[EMEDPA]

I'm all for it as well(bet you couldn't tell). I also think residencies are a good idea. This will unfortunately become a slippery slope I think:

1.need caq to get top jobs (starting already)

2.need residency to be eligible for caq( several em residencies now require caq passage already)

3. not enough residency positions (already true,mirrors situation with docs)

4. lots of PAs working at mediocre jobs

5. fewer HCE qualified applicants applying to PA school

[robidf]

I'm all for it as well(bet you couldn't tell). I also think residencies are a good idea. This will unfortunately become a slippery slope I think:

1.need caq to get top jobs (starting already)

2.need residency to be eligible for caq( several em residencies now require caq passage already)

3. not enough residency positions (already true,mirrors situation with docs)

4. lots of PAs working at mediocre jobs

5. fewer HCE qualified applicants applying to PA school

Exactly why I think these CAQs need to be hard...unfortunately, admission committees are no longer filtering out the low HCE applicants.  In fact these applicants are the majority.  The profession is changing and I don't feel its for the better..

[EMEDPA]

I can only speak to the em caq. I took the first offering of this test( I understand it changed a bit since then) and felt it was very in depth and covered a lot of stuff outside the realm of typical em like inpt critical care management. I passed and only missed a few. I think a newer pa or one from outside of em would have failed this test. the pass rate for the em caq is something like 95% but I think the prereqs dissuade a lot of marginal folks from considering the test so it self selects for providers who will pass it.

[jwells78]

E-  I agree that it is a slippery slope.  I definitely see an inverse relationship with need for residency/internship for (especially EM) jobs and experience level of recent PA students.  As it stands right now, the relatively large California based EM group I work for has 2 sites with an EM residency for PAs, and I have been (informally) tasked with investigating those residencies to see how we can streamline incoming PA/NPs and bring base knowledge up across the board here in the North state.

 

I see EM CAQ/ATLS/Difficult airway/US as par for the course within 5-10 years;  should add FCCS. 

 

Unfortunately, most of the students we have had through our site recently have had little more than 1-2 years or NO HCE, and I think it is that inexperience that is largely driving this trend (here anyway).  Perhaps there will be no other way than above to get into EM/ICU/trauma once HCE for PA school is officially gone the way of the buffalo...

 

Anyway, I took the CAQ last month and am ... ahem... *patiently* awaiting the results... 

[True Anomaly]

I really think the EM CAQ was pretty fair when I took it last month- it must've changed from when you took it, E, because there wasn't much inpatient critical care on my exam (unless there are different versions).  

 

I'll be embarrassed if I didn't pass it- not because I think it was exceedingly easy, but I really feel my training and experience should've prepared me enough to pass this exam with ease.  

[EMEDPA]

TA- I have heard they looked at the feedback from the first group of test takers and revised the test to make it more em centric. the first version focused almost entirely on pts requiring admission and there was very little "bread and butter" em on it. I"m glad that has changed.

I'm sure you and JWells both passed it with flying colors. I got my results around Christmas.

[Gaijyn]

For EM at least I saw this coming, or something like it when I was starting PA school.  First it was the progression of req'd residencies for solid credentialing and then when the CAQ was brought to my attention it seemed as if that would likely be the first stepping stone in the process of requiring residencies.  I am on the fence about mandatory residencies personally.  Residency opportunities are limited currently and they tend to start at times not entirely conducive to when a person graduates.  So it is a tougher time table to make sometimes right out of the gate.  I like the idea of a CAQ cert and think it is a beneficial thing in areas like EM and other procedure heavy high acuity care areas.  I am looking at taking it when I meet the required criteria and feel comfortable enough to do so.  

 

Regarding recommended course for the CAQ (and EM in general), what would your personal recommendations be?  I know ACLS/PALS/ATLS/Difficult Airway Course, but what about US courses for FB removal, vascular access, etc? Any other courses?  Also, for the CAQ, do they have review books ala PANCE, Step 1/2/3, etc? Or is it basically just going through Tintinalli's and Current with exp?

[EMEDPA]

sempa has a caq review course at their annual conference.

I liked apls in addition to pals and also(ob), fccs(critical care), and abls(burns). all very helpful high yield courses.

[AREID]

Emedpa...if you don't mind me asking, why did you refuse certification for those procedures?

 

 

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[GreatChecko]

2.need residency to be eligible for caq( several em residencies now require caq passage already)

 

 

Which might those be? I'm definitely applying when the time comes and it would be nice to know which require CAQ passage.

[ventana]

as a 10+ yr PA who has worked in (urgent care, IM, Occ health, physiatry, EM, chronic pain, and per diem in ortho) I can say I am strongly in support of  both CAQ and fellowships.

 

Times have changed, we are no longer (thankfully) the possession of the doc, we are not likely to be mentored by one doc, instead we are hired as a ___________ (fill in the blank) PA and expected to perform at a fairly high level from day one - akin to the Doc's.  OJT is hard to get as $$$ is tight in the medical world and productivity rules......

 

What this creates is a year or two of unsupervised learning as a PA is new in a field - I have seen how this can be a horrible thing for patient care - ie dilaudid for renal colic with NO nsaid given, repeated CT of abd pain in drug seakers (never looking back in chart), learning to do a procedure with inadaquate supervision, basically "flying by the seat of your pants" or "fake it till you make it" type  attitude in some PA's. 

 

 

It is especially interesting to reflect on my own career and it is funny/odd that I have not truly understood what REALLY understand and getting a comfort zone was til about 7-8 years out of school..... it took broad based exposure and a lot of training and ojt to get there and I honestly see very few newer PA's getting even close to this.  Sure I benefited from the mobilty of the old system with out CAQ or fellowships, but I was lucky to not kill anyone.....    it is the old saying you don't know what you don't know...

 

I have worked with a few new doc's (their first jobs out of residency - fully boarded) and it is amazig that even with their HUGE amount of knowledge they too struggle for 1-2 years to get their feet solidly on the ground....   it is pure insanity to think a 28 month PA school allows for this in a narrower scope.

 

 

 

 

 

Part of gaining a higher standing, more pay, more respect, more reliance for the WHOLE profession is raising the minimum bar for a PA - how do we do this?  CAQ and Fellowships (they go hand in hand - as the Fellowships give you the procedures and training to then get the CAQ)

 

 

 

 

So count me in the YEA column for both Fellowships and CAQ - and ideally linked....  just like a doc today has to complete a residency before sitting for boards in their speciality....   

 

 

 

 

I  have also witnessed (what may well be a local issue) with some attendings going back to do different fellowships to cross train to a different area......   more so recently - so it does not have to the only specialty for the rest of your career..

[Guest Paula]

^^^^^^^  Agree with Ventana.  After 9 years out of my program I am still and always will be learning medicine.  I agree in fellowship/residency training and would gladly apply for one IF there was one available nearby and it paid a salary I could live on AND if my job would still be there when I was done.  I am in FP and there is SO MUCH TO LEARN and to be aware of with the complicated patients I see every day.  Two years of PA school really doesn't adequately train us in FP......we need to know more than the specialty PAs...the saying of you must know something about everything gets overwhelming.   I find myself saying to patients more often "I don't know.  I will check and get back to you."  It takes a seasoned provider to know when to say I DON'T KNOW, and to be humble and forget about how you might look to the patient.  I see plenty of patients who would be considered Internal Med and a fellowship in that area is of interest, or a greatly expanded Family Practice one. 

 

These are not available in my rural area.  Not willing to move.  Willing to study on my own and talk with others and the doc I collaborate with. 

[EMEDPA]

Emedpa...if you don't mind me asking, why did you refuse certification for those procedures?

 

 

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I have never done bronchoscopy. I have assisted thoracotomy on my trauma elective but never done one solo. for any chance of survival after thoracotomy you need a surgical icu and ct surgeon quiickly. this is a rural facility > 30 min by air from nearest academic medical ctr. 

if I am not credentialed for these procedures no one can say i "should " have done them.

[EMEDPA]

Which might those be? I'm definitely applying when the time comes and it would be nice to know which require CAQ passage.

 

I know the one in syracuse NY does(downstate medical ctr) as well as several programs in development. you would have to look through each to get a full list.