CAQ's from a PA-S viewpoint

[EMEDPA]

Yeah, my wife already keeps pushing me towards med school- she doesn't need any more ammunition, thank you very much :)

you are young and smart. you should seriously consider it.

[G. Davenport]

Hi friends. I helped evaluate the ER CAQ test but haven't taken it and most likely won't. I think the CAQ was a bad idea but there is no turning back.

 

the ER residency led to only ER board certified docs in urban ERs, given time, the CAQ will lead to only PAs with an ER CAQ working in the urban ER. the FP DO or MD were pushed to rural high exposure ERs. The same future awaits the young non CAQ PA. It's either that or a residency after graduating (showing competency by passing the NCCPA PANCE exam won't be enough to get your foot in the door).

 

I could ramble on this and I have lots to add. But to be honest, there is no turning back. So buckle up and prepare to go that extra mile -- to work in anything but primary care. The days of past are gone.

 

EMEDPA knows as we worked in ERs that WOULD NOT hire an FP Doc (yet the director was an FP grandfathered into the ER specialty).

[True Anomaly]

you are young and smart. you should seriously consider it.

 

I have considered it, but I think I told you before that I was likely gonna go for a JD before an MD, to help carve out a non-clinical niche once I got older. 

 

And thanks :)

[EMEDPA]

I have considered it, but I think I told you before that I was likely gonna go for a JD before an MD, to help carve out a non-clinical niche once I got older. 

 

And thanks :)

if you do JD do a quality program. there are lots of online poorly accredited JD programs out there that turn out tons of lawyers who either can't pass the bar or once they do they can't find jobs because they went to a less than reputable program.

[EMEDPA]

. The days of past are gone. EMEDPA knows as we worked in ERs that WOULD NOT hire an FP Doc (yet the director was an FP grandfathered into the ER specialty).

yup. and what ends up happening is that these FP docs end up working rural and getting really good at em because they have less support than their EM colleagues at urban and academic centers and do everything that normally is done by specialists and teams in the big city by themselves. some of the best ER docs I know are rural fp docs working in the e.d. These guys can throw in a blind central line, chest tube, etc in less than a minute. Most of the urban EM docs I work with do maybe 1-2 central lines with u/s guidance per year and no chest tubes because the trauma team always jumps on those.

The funny thing is that working rural em is much more challenging than working urban em and yet as Dr Davenport points out above it will be the urban places that want the CAQ first when it really should be the rural places. 2 of the rural places I work at now are preferentially hiring folks with the em caq, although it is not yet a requirement.

[gbrothers98]

Hi friends. I helped evaluate the ER CAQ test but haven't taken it and most likely won't. I think the CAQ was a bad idea but there is no turning back. the ER residency led to only ER board certified docs in urban ERs, given time, the CAQ will lead to only PAs with an ER CAQ working in the urban ER. the FP DO or MD were pushed to rural high exposure ERs. The same future awaits the young non CAQ PA. It's either that or a residency after graduating (showing competency by passing the NCCPA PANCE exam won't be enough to get your foot in the door). I could ramble on this and I have lots to add. But to be honest, there is no turning back. So buckle up and prepare to go that extra mile -- to work in anything but primary care. The days of past are gone. EMEDPA knows as we worked in ERs that WOULD NOT hire an FP Doc (yet the director was an FP grandfathered into the ER specialty).

 

PAs straight out of a program will still get job offers for a variety of reasons, some are cannon fodder, some have prior HCE that will put them above the rest. Regardless, to obtain the CAQ, one has to get the ED hours requirement satisfied. That usually means a full time gig. Same goes for procedures. 

 

yup. and what ends up happening is that these FP docs end up working rural and getting really good at em because they have less support than their EM colleagues at urban and academic centers and do everything that normally is done by specialists and teams in the big city by themselves. some of the best ER docs I know are rural fp docs working in the e.d. These guys can throw in a blind central line, chest tube, etc in less than a minute. Most of the urban EM docs I work with do maybe 1-2 central lines with u/s guidance per year and no chest tubes because the trauma team always jumps on those.

The funny thing is that working rural em is much more challenging than working urban em and yet as Dr Davenport points out above it will be the urban places that want the CAQ first when it really should be the rural places. 2 of the rural places I work at now are preferentially hiring folks with the em caq, although it is not yet a requirement.

 

I agree that those FP and IM ED docs usually are a very self sufficient breed. I also think that group is not getting replaced for several reasons. So PAs and NPs are filling the void. PAs can set themselves apart with the CAQ and newer PAs with residency/fellowship. It is likely that more urban sites will require the CAQ due to resources available and a desire to ensure a standard. It will spread out into the hinterland over the next decade and what was once unusual and controversial will be the norm and expected. 

 

G Brothers PA-C

[whoRyou]

I have considered it, but I think I told you before that I was likely gonna go for a JD before an MD, to help carve out a non-clinical niche once I got older. 

 

And thanks :)

TA: What niche are you looking at if you do not mind me asking? Forensics?

[True Anomaly]

TA: What niche are you looking at if you do not mind me asking? Forensics?

Not sure, but it would involve my PA education/experience somehow. I thought med mal, but now not so sure- maybe legal with a physician group or hospital? My sister-in-law, who is an attorney, has talked up patent law to me due to it's technical aspects

[whoRyou]

Not sure, but it would involve my PA education/experience somehow. I thought med mal, but now not so sure- maybe legal with a physician group or hospital? My sister-in-law, who is an attorney, has talked up patent law to me due to it's technical aspects

TA: Have you considered MedMal Consulting or Tort Law or would you consider being an expert witness? If you are in TX I 'might' know someone who can possibly talk to you. 

[True Anomaly]

TA: Have you considered MedMal Consulting or Tort Law or would you consider being an expert witness? If you are in TX I 'might' know someone who can possibly talk to you. 

 

MedMal would be a big interest- not sure about tort law.  

 

But even if I do the JD, we're talking at least 5-10 years before I would pursue it

[RichardLPeeA]

Your hypothetical is working as a hospitalist. Let them take the general med PANRE. That covers hospitalist and FP pretty well.

If people want to continue to take the generalist PANRE then so be it, to cover all their bases (as well as that exam can cover them).

 

I work in CT surgery. I get VERY little clinical yield out ofthe current PANRE. Instead of worrying about how to make specialty exams work for PAs who jump specialties, I ask what is NCCPA doing to serve the specialty PAs who are indedicated practice for many years. I should not need to take 2 exams (PANRE and CT Surg CAQ) when the first one is nearly meaningless.

I think having CAQ replace PANRE is a good idea so long as you stay within that specialty.  If you want to venture out into let's say FP, then you should also take PANRE or have FP CAQ.

[Guest Paula]

An emerging concept is something called Established Professional Activities (EPA).  It is an activity that has been objectively validated in both assessment, performance, and management of complication.   I do not know much about it but we at PAFT will be discussing it at our next board meeting. 

 

Once an EPA has been validated the "tether"  (to a physician) could be cut  or autonomously performed perhaps.

 

So our profession has to show a valid way to prove we are competent in our SOP and maybe at some point these EPAs will be the key? 

 

Since I just learned of this concept about 3 days ago I cannot answer any questions about it.  I need to find out more info myself. 

[Guest Paula]

The correct term may be : Entrustable Professional Activities.  EPA.  At least that is what the Medical associations and education gurus call it.  It's been around for a couple of years now to establish competency for 1st year residents and what they should know before starting PGY1.

 

Let's just merge the PA and MD/DO professions.  

[primadonna22274]

I haven't heard the EPA term Paula but it does sound like our residency "milestones" that must be reached to demonstrate competency.

Here's something funny: I only have to do 2 I&Ds supervised at my program to reach the milestone for that procedure--but I can't do them unsupervised in my program until then (despite the fact I've done, oh, I don't know, several hundred or maybe a thousand in my 14-year PA career??).

I will look into the EPA concept.

[primadonna22274]

Very new concept indeed. Gotta love the medical education ivory tower, always rebranding old ideas and calling them new ☺️

See the link below. Slides 21-22. Soooooo general. Certainly not anything "procedural". I suspect PAs would need to demonstrate meeting the "EPAs expected for any practicing physician" on the Venn diagram a few slides before--don't know yet what procedures are included there. Also note that these EPAs for any physician entering residency are no different than any PA program expects of its graduates. ????

https://www.aamc.org/download/379308/data/coreentrustableprofessionalactivities.pdf

[Guest Paula]

^^^^ Exactly.  PAs have core competency standards too and are similar to the ones you listed.  The medical professions start to blur into one.

[christopherjmu]

While I think there are some PAs whom think CAQs are just another NCCPA grab for $$, the reality is that there does need to be a confirmation of skills and experience in specialty practice. The CAQ helps address this. New grads may benefit from residency in the future but those of us whom have been toiling away in specific specialties for decades are under or may be under pressure to actually prove we know what we are doing regardless of our everyday performance. I actually know Greg from the NCCPA and have talked with him at length about the CAQ process. Not only is he a good guy, he makes a very necessar and coherent argument that the CAQ is a necessary step in a PA's career. This is driven in part by national physician specialist organizations wanting some sort of standard put in place due to the initial general training PAs undergo without any follow through residencies or fellowships but instead years to decades of OTJ training. It also helps those of us whom have a certificate (myself) or BS in physician assistant studies to differentiate from the masters level PA being made now and cements our professionalism.

 

The above quoted article is a great example of where PAs can make a difference in a specialty that is in dire need of help. At my community hospital we have a psychiatrist that visits once every several weeks, is booked solid for months out and does not take call nor contribute much to the care of the acute psychiatric patient either in the attached clinic or the ED. This tepid support and presence from the psychiatric community is a shame but could be alleviated by PAs trained in psychiatry and the psychiatry CAQ can serve as a benchmark to strive for to ensure quality of care.

 

Whether this designation gets you more money or prestige or closer parking space is moot. We live in a time where the public wants and demands credentialing. Anyone who naysays is in danger of being left behind sooner or later. Personally, when I got the CAQ in EM, there was a perceptible appreciation from the medical staff and the hospital that I chose to get a designation that no one forced me to but did because I thought it was the proper thing to do as the senior PA here. The bottom line is that many long practicing PAs in certain specialties have plenty of hours to qualify, have done the procedures listed and can likely pass the exam with a bit of self directed study. The issue is the cost, about $300. Have your employer pay it or use CME funds if that will break the bank, thats what you negotiated for.

 

G Brothers PA-C

The article is humorous . I'm a psychiatry PA and also work in a Urgent Care. I just finished my CAQ test for psychiatry.  The doctor that said PA's will always be reliant on a physician has never seen where I work apparently.  I work without supervision at both jobs.  If I need advice regarding a difficult patient, then I consult one, just like they do with one another.

[sillycibin]

CAQs are terrible ideas.  Once they get a foothold, hospitals will require you to have your CAQ to practice in that area.  My hospital requires me to maintain my NCCPA certification.  Why?  Because it exists.  It isn't to practice medicine, because North Carolina does not require me to maintain it.