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The following is a letter I composed last month, but never posted.  It contains some comments that pertain directly to your situation.  I would encourage all AAPA members to continue to support the removal of the PANRE.

To whom it may concern:

I thought I would pass along some thoughts after recently taking the PANRE and successfully recertifying for the next ten years. I would like this post to be more than just an accounting of time and energy lost, but also a comment on the inefficiency and high-stakes associated with this test.

Roughly four months ago, I began preparation for the taking the PANRE. Despite the daily struggles that we all endure with work, home, and our myriad of other commitments, I allotted myself one hour a day to review. I bought several review books, and subscribed to the HIPPO review program. Closer to my exam, I took a 5-day CME Resources review course. In all, this tallied up to 120 hours of home study, 40 hours of review seminar, and $2500.00 worth of CME expenses. I can’t help but think how this time and money could be better spent on training and education specific to my chosen discipline.

During my attendance at a recent review course, I was struck by two main concerns. First, several older, competent, well-respected PAs were at the course struggling to keep their certification. These were PAs who had practiced more than 30 years, and were in jeopardy of losing their ability to work and care for patients. One particularly sad tale involved a practitioner who was receiving cancer treatments and had been too ill to take his test on previously scheduled dates. This placed him up against the wall in late December. He was faced with taking a test that held not only his source of income in the balance, but his ability to retain health insurance and continue treatment.

Also at this conference, I was surprised how few PAs were aware of the current discussion regarding removing the need for the PANRE. It seemed that every PA that I spoke to about the current state of affairs, was very receptive to the idea of removing the test. Granted, they too were preparing for a test that could remove their ability to feed, clothe, and house their family. We need to encourage our colleges to join the AAPA and voice our concerns about the current high-risk exam and its inherent inefficiencies.

Finally, I would like to speak about the test itself. For obvious reasons, I cannot discuss specific questions. However, I think I can make some salient points while still speaking in general terms. I work with inpatient pulmonary medicine patients who oftentimes have a long list of associated comorbidities. This has kept me up to date in regards to cardiology, hematology, nephrology, endocrinology, and essentially every other discipline in adult medicine to some degree. That being said, I haven’t seen a pediatric patient in over 5 years. I haven’t dealt with women’s health issues in essentially the same period of time. And frankly, some of the questions in regards to my specific specialty were poorly written, or in some cases - just plain wrong. I constantly had to remind myself this was a generalist exam and approach the questions accordingly.

In conclusion, I passed the exam. I have nine years to go until the stress, cost, time away from my family, and finding the resolve to study after a 12 hour work day begins again. In that time, I will lose the pediatric immunization schedule, forget about fundal height, and the countless other points of memorized medical minutiae that has no bearing on my current practice. I encourage all concerned PAs to speak to your fellow colleagues and encourage them to become involved and make their thoughts known. If there is in fact a general consensus to rid ourselves of the PANRE, then let us be proactive and move forward.


Bjorn Spoon, PA-C

[bjorn] [spoon] PA-C

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