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Good Morning, this is my first post. I just received the results from the Orthopaedic Surgery CAQ. I passed and am very happy. I took the exam as a challenge to myself. I understand there is quite a difference of opinions amongst PAs about what the CAQ really means. I was hoping to get some thoughts from other professionals. Thank you

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A great link above, however is also fairly esoteric with ER medicine.

 

How about some ortho thoughts with CAQ ?

 

A controversial subject, for sure.

I was at the last PAOS in Chicago and there was an NCCPA rep there speaking/promoting CAQ.

After a presentation, there was a Q & A session, which I think was longer

than the presentation--itself.

I'd like to think that the valid concerns were heard and taken back to the NCCPA, but I don't hold any real confidence that they were. A few main points brought up were how billing could very easily become an issue. It's not hard--whatsoever--to picture insurance not covering for PAs, who order tests/imaging studies, who aren't "specialized"/CAQ-certified.

I stood up and spoke at this and stated that I feel adding CAQ is only adding more confusion and ambiguity to an already confusing and ambiguous profession. The public, insurance companies, et al, have already a hard time understanding our profession. CAQ, IMHO, does not offer any real help for us and, in fact, could end up hurting us.

I'm sure there are other threads about CAQ in the forum. I only decided to comment here b/c we had an open floor discussion at the last PAOS so, relative to this specialty section here. I had specifically asked if the PAOS AND ALSO all PAs could hear back from the NCCPA about our valid concerns raised at this discussion. We were told they would be but--once again--I hold no real confidence that it would be followed through with, as promised.

Was anybody else at the PAOS conference in Chicago and at this particular session? Thoughts???

 

...um, ...anybody? ...anybody? ...Bueller?? ...Bueller??

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I am concerned about the validity of the ortho CAQ exam. Unlike ER and CT surgery, ortho is a broad spectrum of sub-specialties. How do you write the "general" ortho CAQ for a PA that specializes in hand or arthroplasty or ortho trauma or sports/arthroscopy or spine or ortho oncology or peds...? I practiced in general ortho for a few years before transitioning into a sub-specialty practice. What you do in general ortho is not the same care provided by a talented sub-specialty practice. So my question is... Is the ortho CAQ for the general ortho PA or for the sub-specialty PA? If it is for the general ortho PA, does the CAQ mean anything?

 

I am also concerned that the CAQ will do to the PAs what the specialty certifications have done to the NPs.... once you have a CAQ in ortho, will you be able to transition into ER medicine without going back and taking another CAQ? The beauty of being a PA is our flexibility to work in general medicine or transition into a specialty without going back for a residency.

 

Lastly, it's all about the $$. How long will it take until insurance companies deny payment or request for advanced imaging because I do not have a CAQ in ortho? We already see this happening to PCPs who refer patients to us because the patient needs an ortho exam before the MRI can be ordered.

 

Hopefully the NCCPA will realize this is not the answer to the long term success of PAs in clinical practice!

 

Noreaster - did you find the PAOS conference worth attending?

 

 

~Unique

PA-C in ortho for 8+ years.

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I am also concerned that the CAQ will do to the PAs what the specialty certifications have done to the NPs.... once you have a CAQ in ortho, will you be able to transition into ER medicine without going back and taking another CAQ? The beauty of being a PA is our flexibility to work in general medicine or transition into a specialty without going back for a residency.

 

~Unique

PA-C in ortho for 8+ years.

I think lateral mobility is going away one way or another....hospital credentialing and the joint commission will see to that.

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I think lateral mobility is going away one way or another....hospital credentialing and the joint commission will see to that.

 

NOPE....!!!!

 

Since PAs don't only work where the credentialing commitee of hospitals and JACHO have a say...

It definately ain't ALL about what happens in the confines of a hospital.

Try thinking OUTSIDE the box ... if but only for a second.

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fine, primary care/outpt medicine is always an option but if you don't want to do primary care someone else has more control of your practice. remember the majority of pa's today , like 60%, work in specialties....even for outpt med hmo's, insurance companies, etc have influence over your practice...ask mike about that....companies were telling him he couln't use botox, etc as a pa....others are told they can't do a variety of procedures without xyz cert....an fp pa friend of mine used to do sigs and vasectomies...now he can't because his malpractice company says fp pa's can't do those and won't cover him....a urology pa or gi pa can....

C- try getting coverage to do e.c.t. in your pratice...bet you couln't do it as insurance companies and the state would not allow it...

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And again.... please remind me how actually playing to the nonsense by participating and taking the CAQ for another meaningless "bauble" to frame and put on your wall is helping HOW...???

 

Enlighten us...

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I didn't say it was good or bad, I said it's the future, docs want it and we have to deal with it.

now, tell me all about lateral mobility again when others tell you what you can and can't do based on your particular background....your practice is a niche market with very few procedures. it isn't applicable to the vast majority of pa's....most folks can't run cash only practices....insurance companies, etc are a reality and having better credentials can only help you as an individual to set you apart from others trying to do your job.

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Ummm....

 

You're a bit confused about me.

 

You are correct in the fact that the practice I own is cash only and niche...

 

What you apparently don't know is that I specifically/intentionally chose the UNMC Masters over a few others... BECAUSE I could concentrate it in PSYCHIATRY just so I could compete with the Psych NPs... and stop the nonsense about insurance companies not wanting to pay for Psych work done by PAs.

 

Now... I work at two different Psych Facilities doing Psychosomatic Medicine as part of the Psych Staff... and am on par with the Psych NPs and Psychiatrists... with NO problems from billing and insurance companies.

 

Folks ask me if I'm going to take the Psych CAQ... and my response is "Why should I"...??? My actual Masters degree and the accompanying transcript that says "Psychiatry" on them will trump a "pay to play" psych test anyday...

 

So yeah... I get it... that outside entities are trying to pigeon-hole us.

What I don't get is why seemingly smart individuals are OK with and basically assiting outside entities pigeon-holing us...

 

In plain language...

Why are YOU ok with outsiders (physicians, insurance companies, hospitals, nurses, etc.) who couldn't care any less and gives "jack schitt" about YOUR profession slowly eroding the lateral mobility we have...???

 

Why would YOU trade that for a pretty piece of parchment paper thats NOT worth the cost of the added exam...???

 

Do tell...

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I'm a realist. it's going to happen whether I like it or not so it's easier to play their game, get the cert, and assure my future. I may still do a residency for the same reason...the docs(our bosses) want us to have additional training and certs and are/will be hiring preferentially those who jump through their hoops....truth of the matter is that the only lateral mobility which interests me personally would be from em to fp and that will be an option without a specialty cert for my entire career.

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So are YOU saying that YOU don't give a Schitt if anyone else in OUR PROFESSION retains lateral mobility for what interests them in medicine... as long as YOU can retain lateral mobility from EM back to FP then being a "patsy" for "the man" is OK "cause you be a realist"...???

 

Please clarify...

 

Thanks

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I think it is unrealistic for anyone to think that 10 yrs from now they could easily go ortho to nephrology to interventional radiology without additional training or certification. they can feel free to try and I support their ability to try but it won't happen without a residency/fellowship/caq/something to show proficiency. credentialing committees are a *****. you need to show you have done something to be able to do it. it's a catch-22. even as a full time pa in one specialty it is challenging to keep up #s to practice the procedures unique to my single specialty. there is no way my hospital would certify anyone who isn't an em pa to do my job with my scope. fast track, sure, but not sick pts with adv. procedures. there is no mechanism for informal otj training in most inpt settings today like there has been in the past.

you will notice that i specified personally in my statement....I never considered lateral mobility as a decision criteria even 25 yrs ago when looking at becoming a pa. it was a non-issue. em and fp interest me and really not much else.

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So for clarity...

Is your answer that since you don't care about "lateral mobility" for YOU in anything but EM and FP ... you don't care if any other PA in our profession retains "lateral mobility" in whatever they are interested in for themselves outside of EM-->FP...???

 

If this is the case... it sure seems a bit ... umm... "self-centered."

 

Please elucidate....

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did you even read my post?

see the bolded part that says "I supprt their ability to try".

party on, practice a different specialty every day of the week. enjoy. I support your ability to do so but don't see it as realistic in the future. remember the part about me being a realist? doctors, medical boards, insurance companies, and hospital credentailling committees have significant impact on almost every pa's job. to deny that is being unrealistic. practicing medicine is getting harder every yr. for everyone. docs used to be able to just say they were er docs, or surgeons, or ob docs. now they have to do residencies and pass tests. that's just the way it is, for them now and for us in the future. I'm all for ojt and being a jack of all trades. just hard to do that in 2012 within the confines of the u.s.(note my grad degree aspirations and plan to work outside the u.s. as much as possible).

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It seems we're getting to the meat of the discussion...

Where do we as generalist PAs stand in a world of increasing specialization and credentiling?

E and C, you both have strong valid points.

While we should be hesitant to chase credentials form outside forces, we also need to understand that we may one day be held against those credentials as the standard. C, we have said it here before: perception creates reality. If, one day, the majority of PAs in your field (lets say psych) hold the CAQ, you will likely encounter a barrier if you don't have it. Like it or not. I see this as EMED’s point. I didn’t take the CTS CAQ but I expect I will in the future. Just like the UNMC MPAS, I didn’t want to be left out in the cold one day for lacking a credential which has been established (right or wrong) as a standard in my specialty.

Re: lateral mobility….well, I see this as a casualty of the progress we have made as PAs. We have developed both clinically and financially. PAs have significant scope in many fields and we get paid well. We practice medicine (in a unique way-with dependence) but we have done so in a nontraditional pathway and proven that we can be competent providers in essentially ANY SETTING. To do so with 2 yrs of postgrad education may mean that we will have to sacrifice the TRADTIONAL sense of lateral mobility. Our modern lateral freedom may require a few more hoops- CAQ, documentation of clinical practice, physician sign-off etc.

It may just be that what one PA sees as a loss of one of the profession’s historical elements (Contrarian) is seen as the evolution of the profession by another (EMEDPA).

 

Is it simply possible that we can’t have it all- total freedom of lateral mobility with a 2 yr PA program and a generalist PANCE?

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next question-

after initial certification via pance does anyone think it is likely that caq's will replace panre?

I can see both sides of this issue. I think staying grounded in primary care is important(but easy for me to say working in em, essentially a primary care subspecialty) vs the subspecialty pa who never sees kids or does ob who just wants an interventional rads exam because that is all they do and all they ever intend to do. "after all docs don't have to recertify in primary care" will be the arguement. historical tidbit: know why they dropped the physical exams from pance and made it a computer test? to be more like usmle. seriously, that was the arguement. shortly thereafter usmle developed a required practical but we were too far along the computer test joyride to turn back. damn shame.

we live in interesting times.

nccpa has already tweaked panre a bit with 3 different exam options although there is "core primary care knowledge" on all of them. what's next? I hope it isn't required projects and busy work as has been discussed for recerts...

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I think lateral mobility is going away one way or another....hospital credentialing and the joint commission will see to that.

 

Why would any of us want to help that along?

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Why would any of us want to help that along?

I'm talking about recognizing it for what it is, the inevitable future. docs tried to fight requirements of specialization and lost. I don't think we will be more successful than they were. I will still hire someone without a residency or CAQ but all else being equal it is a factor that has to be considered. Talking with several seasoned em pa's about the CAQ we all agreed that you need to be an em pa to pass it so as a screening tool it's actually not a bad way to look at applicants in addition to their CV, letters of rec., etc

I work for a group which historically only hires experienced em pa's so while a great CV will get you an interview a CAQ wouldn't hurt. I know of at least one em pa residency soon to open which is considering requiring that all their residents pass it to graduate. it's a feather in your cap and the more feathers the better.

who would you rather hire all else being equal:

pa 1 has 5 yrs experience and acls and pals + a bs in pa studies. his letter of rec. is from the director of a community hospital er.

pa 2 has 5 yrs experience and acls, pals, fccs, difficult airway, atls, abls, and an mpas in emergency medicine. he has written em articles for 5 pa journals and teaches emergency medicine to md residents and pa students at his current job. his letter of rec. comes from dr. peter rosen one of the founders of emergency medicine and he has completed the baylor DSc emergency medicine residency.

both are great guys and technically excellent.

from an article this month:

POSTGRADUATE TRAINING

Both the NP and PA professions have looked at the future and recognized the need for additional post-degree training, especially in the specialties. NP education has become steadily broader-based, and most NPs are trained in family practice. Meanwhile, many predict that PA training will include a postgraduate, physician-level residency—shorter than an MD’s or DO’s, but otherwise identical in content. Today, there are 50 such residency programs in different specialties,with many more opening.[6] The NP profession seems to be moving towards a doctorate degree as a basic qualification. How popular these changes will be and how fast they will emerge remains to be seen, but they are here to stay. The savvy marketer might be well advised to keep a finger on the pulse of these programs just as he or she does on the physician’s education.

source: http://www.pm360online.com/f3_Bio_Pharma_NPs_PAs_healthcare_reform_0112

 

 

(ps read your blog and clicked a link...don't say I never did anything for you....:) )

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This thread has jumped off track a bit for an ortho specific header. Are there any PAs practicing in ortho who would like to share thoughts on my questions/comments related to the ortho CAQ. ... maybe MBculley or others who have taken the ortho CAQ.

 

 

thanks,

 

 

Unique

 

I am concerned about the validity of the ortho CAQ exam. Unlike ER and CT surgery, ortho is a broad spectrum of sub-specialties. How do you write the "general" ortho CAQ for a PA that specializes in hand or arthroplasty or ortho trauma or sports/arthroscopy or spine or ortho oncology or peds...? I practiced in general ortho for a few years before transitioning into a sub-specialty practice. What you do in general ortho is not the same care provided by a talented sub-specialty practice. So my question is... Is the ortho CAQ for the general ortho PA or for the sub-specialty PA? If it is for the general ortho PA, does the CAQ mean anything?

 

I am also concerned that the CAQ will do to the PAs what the specialty certifications have done to the NPs.... once you have a CAQ in ortho, will you be able to transition into ER medicine without going back and taking another CAQ? The beauty of being a PA is our flexibility to work in general medicine or transition into a specialty without going back for a residency.

 

Lastly, it's all about the $$. How long will it take until insurance companies deny payment or request for advanced imaging because I do not have a CAQ in ortho? We already see this happening to PCPs who refer patients to us because the patient needs an ortho exam before the MRI can be ordered.

 

Hopefully the NCCPA will realize this is not the answer to the long term success of PAs in clinical practice!

 

Noreaster - did you find the PAOS conference worth attending?

 

 

~Unique

PA-C in ortho for 8+ years.

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Unique.. I did find the PAOS conference good. I'm not sure what you mean by helpful. I found it helpful, insofar as getting CMEs and it being all ortho.

I found the CAQ presentation at the PAOS conference helpful but not too-too much. I guess I would've hoped that the open discussion afterwards would've been more helpful but I just think the NCCPA rep wanted to "preach" to us a bit and get through her agenda. I did not feel any sense of realness, in terms of taking our real and genuine concerns into account. Rather, I got a pretty strong sense that the NCCPA rep would leave and not really advocate for us--the PAs--who spoke out at this meeting.

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Unique.. I did find the PAOS conference good. I'm not sure what you mean by helpful. I found it helpful, insofar as getting CMEs and it being all ortho.

I found the CAQ presentation at the PAOS conference helpful but not too-too much. I guess I would've hoped that the open discussion afterwards would've been more helpful but I just think the NCCPA rep wanted to "preach" to us a bit and get through her agenda. I did not feel any sense of realness, in terms of taking our real and genuine concerns into account. Rather, I got a pretty strong sense that the NCCPA rep would leave and not really advocate for us--the PAs--who spoke out at this meeting.

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To those few who took the ortho CAQ exam....how long until you got your results? I m taking it Monday AM and am just curious.

 

For the ongoing discussion....I am taking this exam because my employer will be more likely to give me a raise if I do and they are paying for it. To a hospital led organization, letters behind your name mean EVERYTHING. However, as someone who moonlights in FP and ER, I plan on taking the ER CAQ next year. I figure getting in as many as I can now will help me down the road if/when it becomes impossible to switch without some "proof" you know what you are doing in other specialties.

 

As much as I HATE it, we all know things are headed that way...

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it took 3 months to get results from the em caq.

make sure you meet all the course and hrs requirements for the em caq. they require 3000 hrs, acls/atls/pals/difficult airway, procedures list.

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