NCCPA Position Statement (was: report)

[BruceBanner]

^Agree. 

 

A recert every decade isnt too onerous, but it dodges the issue of whether a formal standardized recert is really even necessary.

 

With PAs especially, we are usually under some level of charting/practice scrutiny. You cant be actively screwing up and doing people harm without losing your job or your license.

[Keepitrural]

What I have gathered from this thread so far basically points to a lot of disagreement about how we should pursue re-certification. It may very well be that we jump through more hoops than other providers or at the very least are subject to testing in a fashion somewhat unrelated to what we actually do.  

 

This forum (as well as others) has also pointed out the desire for our profession to have increased upward trajectory. Independent practice is usually the pinnacle. From my vantage point it would be nice to have some of this discussion (both AAPA and NCCPA included) aimed at how our certification/re-certification process could help to create a pathway or contribute to increased scope or independent practice.  Not trying to take away from the re-cert discussion but would like to see more focus on how whatever change is made may contribute to advancing our profession in the long run.    

[Houstonian]

I have taken and passed PANRE five times, and am studying for the sixth next month (still on six-year cycle).  As much as I hate preparing for it, afterwards I am always glad that I had to refresh my knowledge in all the fields that I don't use in day-to-day practice.  PAs can change work fields if desired.  Without a PANRE, there be no "proof" that your knowledge is current enough to be able to change fields of employment in medicine.  Several nurse practitioners that I know tell me that they wish they did have to recertify on all of medicine on a regular basis, just to keep their knowledge base up.

 

I think the resentment is that NP's are getting by without having to pass recertification exams, while we are required to do that...and we risk losing our professional credibility and job if we do not pass it.  And in the meantime we are competing with NPs for jobs, where in some states doctors don't have to supervise NP's, but they do have to supervise PA's, which puts PAs at an incredible disadvantage in those states. 

[Reality Check 2]

I don't mind taking a recent and agree with Houstonian - it keeps me fresh.

 

If any PA spends any amount of time in a specialty - one WILL lose some general knowledge. It is just the nature of the game.

 

Family Practice sees a lot of a lot of things and we have to keep up with all facets of medicine so as to know what, how, when and why to refer or what to do.

 

I have been in Ortho, ER, Occ Med and an ortho subspecialty. I didn't get the updates on general BP mgmt or the latest from Peds on otitis or changing thoughts on much of anything. I was extremely busy doing my own thing in my own little world.

 

As PAs we have the privilege of moving between specialties or working in two simultaneously - so we have to know a lot about a lot.

 

I don't see the test as a money making scheme or a conspiracy or even a limiting factor. 

 

It holds us to a higher standard than anyone around us and keeps us able to move fluidly between specialties. 

 

The test is far from perfect and could use an elected board to manage it and a CEO who doesn't make twice the average PA to manage it. I still push the idea that a national governing board keeps stats and makes licenses easily transportable from state to state and makes us Plug and Play everywhere we go. 

 

So - change the test, don't abolish it. Be proud that we are held to a standard and have the flexibility that docs don't really have. I won't go into the whole NP educational thing because I think it is deficient and not comparable to ours. 

 

Let's quit comparing ourselves and MAKE ourselves THE ONE TO CHOOSE. We are smart, we know how to work, we don't need babysitters, we come out of training wheels fast and we know how to do the right things. 

 

Take pride that we even have a national certification standard and embrace it to keep us as a unique entity that can impact healthcare in a huge way - and adapt it to do just that with more autonomy.

 

It's really not a negative - it could be a tool to enhance our advancement.

[corpsman89]

Some of you may not care, but here is my take on this from an outsider looking in (not a PA yet, but will start school in Jan)

 

I think its important to think about how the general public will react if the PA profession collectively decides to STOP retesting. Furthermore, if AAPA wins this and PAs no longer need to retest, this will give NPs / docs more stones to through at our profession (ironic because NPs don't have to retest, but anybody can manipulate anything into anything). My point is that if I were a patient and I had to choose between a provider who had to retest, and provider who did not, I would choose the former. But this brings up yet another issue. Why does AAPA not promote the fact that PAs do indeed retest to maintain proficiency, while NPs don't? This seems like a no brainer, and while I have researched, researched, and researched the PA/NP professions I have only recently learned that NPs do not have to retest, and yet they are the ones who are gaining independent practice?

 

Retesting sucks, and while it really may not be helpful to aiding our understanding of medicine or the specialty in which a PA works in, it is in no doubt an advantage that PAs have over NPs. We really should  embrace this advantage and brag about it so that the general public and patients will have more faith and respect for the PA profession.

 

Then again, maybe Ill change my mind when I have to start retesting. :)

 

Cheers 

[ventana]

^^^ Well put - perception by the public and other professions (coupled with AAPA's lack of appreciating this in the past) have really hurt us in the political realm in the past decade.....  

 

perception matters, as does AAPA's lobby to get us on even footing with NP and MD/DO

[slolar]

I have NO problem with the 10 year PANRE.  I like the fact that I can say I'm certified and can commiserate with my doc's about having to take boards.  There has to be SOME standard that is applied.  Most MDs, too, would lose their jobs if they fail their boards.  We should ally ourselves with the MD's when it comes to testing.

However, I think it is clear what NCCPA's goals became when they started adding MORE tests.  First it was the CAQs.  Then it was the SA and PI requirements. Now they want to add on a take home test every two years.  This is clearly nothing but a money grab on their part.  Thankfully there was a pushback and the SA/PI requirements were eliminated.  Let's not let the pendulum swing to far the other way.  A test every 10 years is not all that onerous.

 

Sara

[rev ronin]

If the NCCPA appreciated that perception matters, there would never be any serious discussion of a take-home exam.

[IDCtoPA]

I have been following this topic for quite a while and was refraining from posting since I am not yet a PA. I too will start class in January, But, I see this discussion and the ramifications of it will have a direct effect on my future career. So here are my thoughts.

It seems as if a significant segment of PAs want to push for increased autonomy and scope of practice and at the same time push for an end to MOC testing and at the same time a name change for the profession. These goals (especially the first two) seem at odds with one another to me. Any attempt to convince state legislatures and medical boards to increase scope of practice or autonomy can only be helped by the rigorous MOC system that PAs have had in place. You may argue that the changes that NCCPA proposed are too onerous and perhaps they were. But, to go from a resistance to the proposed change to a complete abandonment of the system at the same time the profession is pushing for increased scope and autonomy seems incredibly self defeating to me.

I can't help but think that at a time when the profession is facing increased competition from NPs it is not the right time for this particular fight. At least not the fight to completely abandon MOC testing.

In my opinion (for what it is worth) increased scope and autonomy should be the highest priority and everything else should take a back seat.

Based on everything I read on this forum and huddle:

Increased scope and autonomy will allow PAs to compete on more level footing with NPs.

Increased scope and autonomy will make PAs less dependent on MD/DOs for their livelihood.

Increased scope and autonomy will provide more control over career and compensation.

Increased scope and autonomy will provide more transparency in the value PAs provide to the health care system.

 

Ending MOC testing will provide none of these benefits nor will it make it easier to achieve any of them.

Changing the name will provide none of these benefits nor will it make it easier to achieve any of them.

 

Achieving increased scope and autonomy may very well make it easier to change the name. May make it easier to establish independent PA regulating boards in the states. Independent PA regulating boards would certainly make it easier to change the name and probably to alter the MOC requirements.

 

I worked in medicine for over 25 years I was and am well aware that people will misunderstand the role of a PA based on the title. When I decided that I wanted to become a PA I was aware that I would have to retest to maintain recertification. It is part of the bargain for getting to continue practicing medicine in the civilian world at a similar level as I did in the military without having to dedicate 7 years to medical school.

 

Retesting to me makes sense. Even if no one else has to. It doesn't have to improve patient outcomes, is should not be relied upon to keep your knowledge up to date with the cutting edge. Your CME should keep your knowledge up to date. And if you are doing quality CME and you know you have to pass a broad medical exam you should dedicate a portion of your CME to all aspects of general medicine. You retest for CPR, you retest for ACLS. I obviously have not taken the PANRE. I trust people that say it needs to change to be more relevant. The vast majority of PAs are passing the test regardless. I suspect that if you allow yourself to get to a point where you can not pass recertification (that the overwhelming majority of your peers pass)  after 3 tries and with a 10 year notice that the test is coming then that is likely more a reflection of you than the test. The consequences of what happens to you after that failure is something that PAs would have much more control over if they had independent PA regulating boards and increased scope and autonomy.

 

My thoughts are my own. I recognize that I am an outsider looking in. I appreciate the experience presented on this forum, it has allowed me to learn an incredible amount since I joined.

[BruceBanner]

Clearly the problem with our lack of autonomy has little if anything to do with retesting. No one has an effing clue about who retests and who doesn't except for individuals within a particular profession.

 

Lack of re-cert never held up the NPs from independence. For that mater neither did lack of standardized rigorous education.

 

Autonomy is purely a political problem, and we lack the numbers (relative to nursing), the leadership (which may change), and the lobby force to turn over a stone this big.

 

Chances are the re-cert will remain, because board cert is required by so many states and institutions. An alternative scenario would be that once you get the C, it never drops off, allowing us to remain "board certified" as long as we are doing CMEs.

[rev ronin]

Autonomy is purely a political problem, and we lack the numbers (relative to nursing), the leadership (which may change), and the lobby force to turn over a stone this big.

Given that the PA profession doesn't have the same numbers/history/clout that nursing has, do you agree that it might *help* PAs to have the ability to advertise our more rigorous education/recertification model?  I think that's a large part of IDCtoPA's point, and I don't disagree.

[mmiller3]

Given that the PA profession doesn't have the same numbers/history/clout that nursing has, do you agree that it might *help* PAs to have the ability to advertise our more rigorous education/recertification model?  I think that's a large part of IDCtoPA's point, and I don't disagree.

Who will it appeal to?

 

Patients want to see either the provider they see every time, or whomever can get them in fastest. Our current attempts at advertising haven't been very effective in my opinion--many patients still don't know exactly what a PA is, even after years of us trying to educate them. I still get asked when I will be a "real doctor". The medical public is blissfully ignorant until something goes wrong.

 

Physicians don't care if we re-cert; they hire NPs ad nauseum, and they don't re-cert. They want whomever will make them money with the least amount of oversight and hassle.

 

So, who will this educational campaign be aimed at?

[LT_Oneal_PAC]

Given that the PA profession doesn't have the same numbers/history/clout that nursing has, do you agree that it might *help* PAs to have the ability to advertise our more rigorous education/recertification model? I think that's a large part of IDCtoPA's point, and I don't disagree.

I agree. If we are going to push for autonomy, we should wait to get rid of the recert until after we fully control our own profession. It may make a minor difference, but we are going to need every leg up we can get to take control of our profession back from physicians. After that, we can revisit the discussion of a life long certification. This will also give time for the physicians time to set the precedent, making the road a lot easier for us to travel. FYI, while I personal believe in the certification, I'm think it's ironic when people say "The docs do it." Apparently it isn't well known that AMA passed a resolution advocating the removal of all board recertification testing.

[BruceBanner]

Given that the PA profession doesn't have the same numbers/history/clout that nursing has, do you agree that it might *help* PAs to have the ability to advertise our more rigorous education/recertification model?  I think that's a large part of IDCtoPA's point, and I don't disagree.

 

It certainly wouldn't hurt. I'm just not convinced it will make a measurable difference in our progress towards an independent profession. It's misdirected effort, and advertising our credentials already has done basically nothing. Recertification could quietly go away and really no one would be the wiser except for the PAs who are ecstatic they no longer have to sit for boards.

 

And to reiterate the obvious, divorcing ourselves from physician oversight is a huge undertaking. All state laws would need to be amended, the AMA would have to be convinced (or bought), and we would need not only unification in leadership but a $trong political lobby to make that happen.

[mgriffiths]

As an almost newly graduated PA, I'm curious about all of this, but have one major question.  A lot of people here are advocating to remove the PANRE, and the response is that this is required to maintain our certification.  Some have even mentioned that this could never happen because federal and state laws would have to change, along with insurance agreements.

 

My question: Could AAPA or NCCPA not just change the requirements for certification?  Instead of requiring that we pass an exam, we complete CME to maintain our certification.  Would this not "fix" the issue with having to change laws and insurance agreements?  We would still be certified.

 

P.S. I have not developed an opinion on whether PANRE should be scuttled, just curious.  I do see some benefit professionally to having an actual exam, but in reality I am not sure it makes any difference.

[Guest JMPA]

why not eliminate the panre altogether and just require cme for maintenance of certification. this eliminates the lost time from family and work while also eliminating stress and fulfills updated medical knowledge. i'm ok wth nccpa providing the cmes.any changes by nccpa should be for the IMPROVEMENT of the PA professional, not for self enrichment at the cost of the individual. this is a wonderful opportunity for nccpa to shine

[BruceBanner]

why not eliminate the panre altogether and just require cme for maintenance of certification. this eliminates the lost time from family and work while also eliminating stress and fulfills updated medical knowledge. i'm ok wth nccpa providing the cmes.any changes by nccpa should be for the IMPROVEMENT of the PA professional, not for self enrichment at the cost of the individual. this is a wonderful opportunity for nccpa to shine

 

I'm in. I think if it does happen this is the direction they will go. The "C" will never drop, just the requirements to maintain it.

[mgriffiths]

why not eliminate the panre altogether and just require cme for maintenance of certification. this eliminates the lost time from family and work while also eliminating stress and fulfills updated medical knowledge. i'm ok wth nccpa providing the cmes.any changes by nccpa should be for the IMPROVEMENT of the PA professional, not for self enrichment at the cost of the individual. this is a wonderful opportunity for nccpa to shine

Pretty much what I was trying to ask, but I think you worded it better!

[electric130]

I really can see both sides of the argument.  I understand why some feel like we should continue with the PANRE to maintain credibility.  On the other hand, we are one of the few professions that have this recertification test to go through, and it certainly does not make us any more credible with the docs or the general public in my opinion.  My father is a CRNA and he does not have to re test every 10 years, he said exactly as another post earlier in this thread that if you don't know what you are doing, you will be weeded out.  He maintains CMEs and even does lectures and has had a long successful career.  Of course NPs do not re test either.  Some of the MDs I work with do not maintain board certification either, although seems most younger docs do.  

I honestly don't think the public even has a clue as to our education and testing.  That should not be a reason to retest or not to retest, but just what I have noticed.  

As a PA that has practiced almost my entire 14 years in a specialty, the testing is a pain and not relevant to what I do at all.  I just re tested and did fine, but I doubt I will test again in 10 years as I plan to be out of clinical practice at that point.  I completely agree that we need PANCE for initial certification, other than that though, I don't know I have mixed feelings.  

[sillycibin]

Evidence please that the certification positively impacts patient outcomes.

[Reality Check 2]

I don't really care if the certification PROVES patient outcomes - in my years I haven't seen any study that can definitively prove that. We don't have Uncertified PAs to compare Certified PAs to on patient morbidity, mortality, errors, etc. So, we have no database for such. 

 

The certification to me proves that the provider has a modicum of knowledge base and can continue to move amongst specialties since we are the one and only profession that can do that well with our base of training knowledge. 

 

The certification proves that the provider has the dedication to the profession to take a test ONCE EVERY TEN YEARS and stay current. CME is NOT provable, necessarily testable and it can come in so many forms that it can't be compared across the board. 

 

By maintaining certification, state licensure and having credentialing processes - we know who isn't passing muster or who isn't using awesome judgment perhaps. I would hate to have our ONLY measure of success being - "hey, no record of this PA ever killing anyone....." or just searching the state boards and seeing "no actions taken".

 

Statistically how many PAs have failed PANCE/PANRE and been "forced" out of the profession??? That is the question I think we need to ask. If the number is very low - then why are worried about this? Not everyone is cut out to be a PA and the weeding process is there. You get 3 chances and 2 full years to take the test. We all went to regulated schools with regulated curriculum. 

 

Again, it is no big deal to me to take one test every ten years and show that I have basic medical knowledge.

 

NOW, the argument for me spins to making sure the test questions are real and exist in true life situations and are valid. Not that I have to TAKE a test but is the test realistic.

[MT2PA]

Some of you may not care, but here is my take on this from an outsider looking in (not a PA yet, but will start school in Jan)

 

I think its important to think about how the general public will react if the PA profession collectively decides to STOP retesting. Furthermore, if AAPA wins this and PAs no longer need to retest, this will give NPs / docs more stones to through at our profession (ironic because NPs don't have to retest, but anybody can manipulate anything into anything). My point is that if I were a patient and I had to choose between a provider who had to retest, and provider who did not, I would choose the former. But this brings up yet another issue. Why does AAPA not promote the fact that PAs do indeed retest to maintain proficiency, while NPs don't? This seems like a no brainer, and while I have researched, researched, and researched the PA/NP professions I have only recently learned that NPs do not have to retest, and yet they are the ones who are gaining independent practice?

 

Retesting sucks, and while it really may not be helpful to aiding our understanding of medicine or the specialty in which a PA works in, it is in no doubt an advantage that PAs have over NPs. We really should  embrace this advantage and brag about it so that the general public and patients will have more faith and respect for the PA profession.

 

Then again, maybe Ill change my mind when I have to start retesting. :)

 

Cheers 

 

While I agree that our retesting SHOULD gain us favor with the public - like someone else mentioned, the general public has no idea how we are different or what retesting means.  In their eyes, retesting could mean we didn't learn it well enough the first time and we need to be checked periodically to make sure we still know what we need to while NPs don't need that oversight.

 

If we're going to worry about public perception, our title or the general lack of understanding of our profession is more of a hindrance than our retesting status.  I know this has been discussed to death so I won't get into it, but truly, if we are worried about how we are perceived compared to NPs or how to gain more autonomy, our retesting status likely isn't the key to our success.  Hopefully it also isn't the key to our demise.

[Reality Check 2]

So, based on our concern for public perception - AAPA/NCCPA should listen and take up a campaign to promote the profession nationwide - all out info on who we are, how we are trained, what we know, why we recert, our flexibility, our history.

 

Would AAPA/NCCPA put funds toward this? Would everyone as a CERTIFIED PA be willing to pony up $50-100 to pay for ads. If there are 108000 PAs in the US who need representation - what is each of us willing to do to promote our profession?

 

Not every PA is AAPA member, most of us ARE NCCPA certified. 

 

How do we go about this? We want education of the public to help gain more of their respect. We want to justify our existence and the recertification process. 

 

WHAT ARE WE WILLING TO DO BESIDES TALK ON THIS FORUM?

[needmorecoffee]

I haven't even applied to PA school yet but I see the value in an educational advertising campaign. I'll contribute

 

 

Sent from my iPhone using Tapatalk

[Guest JMPA]

So, based on our concern for public perception - AAPA/NCCPA should listen and take up a campaign to promote the profession nationwide - all out info on who we are, how we are trained, what we know, why we recert, our flexibility, our history.

 

Would AAPA/NCCPA put funds toward this? Would everyone as a CERTIFIED PA be willing to pony up $50-100 to pay for ads. If there are 108000 PAs in the US who need representation - what is each of us willing to do to promote our profession?

 

Not every PA is AAPA member, most of us ARE NCCPA certified. 

 

How do we go about this? We want education of the public to help gain more of their respect. We want to justify our existence and the recertification process. 

 

WHAT ARE WE WILLING TO DO BESIDES TALK ON THIS FORUM?

50-100 dollars? Why isnt our money that is dished out for useless retesting put towards this?

is our profession sooooo different from MD/NP that we must constantly prove ourselves by subjecting our RIGHT of earning a living to retesting that proves nothing?

what does the individual PA gain by this test that cannot be gained by cme?

i educate the public every day by practicing medicine as a PA.