TWR Posted February 24, 2012 Share Posted February 24, 2012 No more written exam after initial certification. Every 2 years submit 100 hours of cat. 1 cme. Proof of maintenance of BLS. For the CME, 25 hours must show maintenance of primary care ie: cardio, pulmonary,peds, em, gi, psych, im, etc (to be determined) the remainder to be any damn thing you like. I think 1 conf. attendance during 2 year stretch is mandatory also. It could be 2-5 days. A notarized letter form supervisor to the "new" certifying agency also. Cost would be ??$200 Q 2 yr. You get a really nice certificate showing you have maintained your core requiements as well as favorite areas of medicine. No more written testting after initial certification upon graduation. Imagine, maintain proficiency and no test stress ever again. No more self doubt or embarrassment. Just a thought. Feedback welcome. Of course it needs some fine tuning but it is a start. Would love to sit around with some old timers and bounce this concept around. Link to comment Share on other sites More sharing options...
andersenpa Posted February 25, 2012 Share Posted February 25, 2012 I have no interest in doing primary CME, especially if I don't have to retest in it Furthermore I am a professional and can look after my own CME affairs- I don't need a letter from anyone saying that I am competent/skilled/show up for work on time/etc. There is a free market of employers out there and if I am no good then i won't have a job. A letter does nothing but give my SP one more busywork thing to do. All our CME should be in our field of practice. I would make equivalence with, every 2 yrs, one of the following: 100 hr CME in your specialty or two full conferences OR 50 hrs CME plus: Authoring a review paper or acting as a conivestiagtor for any peer reviewed publication Written review of a process you have particiapted in to improve your practice Detailed case review write-up of 5 patients you managed over that time period (teaching cases, phenomenoma etc) Documented evidence as preceptor ship of X # of students or role as clinical/visiting professor at PA program Lecturing at a PA conference I would be happy with being required to do ONE of the above every 2 yrs. Doing any of these things alone does more for continuing education of a PA than slogging through another PANRE full of non-practice related material which will be forgotten one week later. If you are FT faculty or don't practice clinically then there could be some other options. Link to comment Share on other sites More sharing options...
TWR Posted February 25, 2012 Author Share Posted February 25, 2012 In rethinking the op/sp letter, I would trash that piece. The rest however is simple and straight forward. What ever specialty we may practice in, it all came off of primary care. My Fp growing up delivered us, set my fx'ed radius, and took splinters from my arm. BTW this was mainstream America, Long Island, NY Link to comment Share on other sites More sharing options...
andersenpa Posted February 26, 2012 Share Posted February 26, 2012 We do start with generalist training, but why do i need to reboard in it? I'll never practice Peds/GYN/etc again. Specialty surgeons have the OPTION to reboard in general surgery. If I wanted to (for some godforsaken reason) go back to primary care, then I'm willing to re-sit for PANRE or even take PANCE again. Link to comment Share on other sites More sharing options...
terripa Posted February 26, 2012 Share Posted February 26, 2012 I don't believe we should have to re-certify. I feel the NCCPA is nothing more that money driven. We have to pay to log our CME hours, pay them to recertify. They make thousands of dollars off of our work. They do absolutely nothing other than keep a record of our CME. But in 2010 when I was audited, the NCCPA told me they pnly way they culd help is for me to go online and print a copy of my CME log - which the state didnt want. So I had to pull each of my CME ceritifcates out and copy them myself. So what is the purpose of NCCPA. As a practicing PA for 12 years, I completely support a new organization and doing away with NCCPA. I think 100 CME is fair, but shouldn't be limited to your field. We need to be aware of changes throughout all fields - patients come in all the time as ask if we know of XY procedure. Although I preface that I am not in that speciality I do like to have some knowledge. Link to comment Share on other sites More sharing options...
andersenpa Posted February 27, 2012 Share Posted February 27, 2012 I don't believe we should have to re-certify. I feel the NCCPA is nothing more that money driven. We have to pay to log our CME hours, pay them to recertify. They make thousands of dollars off of our work. They do absolutely nothing other than keep a record of our CME. But in 2010 when I was audited, the NCCPA told me they pnly way they culd help is for me to go online and print a copy of my CME log - which the state didnt want. So I had to pull each of my CME ceritifcates out and copy them myself. So what is the purpose of NCCPA. As a practicing PA for 12 years, I completely support a new organization and doing away with NCCPA. I think 100 CME is fair, but shouldn't be limited to your field. We need to be aware of changes throughout all fields - patients come in all the time as ask if we know of XY procedure. Although I preface that I am not in that speciality I do like to have some knowledge. I still don't follow this logic...how does CME outside our specialty make us better PAs? How does "being aware" of other specialties impact our patient care MORE than maintaining our CME on our area of practice? A nephrologist is not going to attend an interventional cardiology seminar on the off chance that his patient asks about stents.... And ID doc is not going to attend a rheumatology conference for his patients that want to know about the cutting edge treatment of gout... We stay up to date about the peripheral issues that affect our patients by staying honed on the latest focused CME in our field. If a patient wants to know about a neurosurgical or GYN procedure I am going to refer them to THAT specialty. Besides, the patient is served best by hearing the details from an expert in that field, not a PA from a different specialty who may have some trivial passing knowledge (and NO hands on experience) of that procedure themselves. Link to comment Share on other sites More sharing options...
burnpac Posted February 27, 2012 Share Posted February 27, 2012 I still don't follow this logic...how does CME outside our specialty make us better PAs? How does "being aware" of other specialties impact our patient care MORE than maintaining our CME on our area of practice? A nephrologist is not going to attend an interventional cardiology seminar on the off chance that his patient asks about stents.... And ID doc is not going to attend a rheumatology conference for his patients that want to know about the cutting edge treatment of gout... We stay up to date about the peripheral issues that affect our patients by staying honed on the latest focused CME in our field. If a patient wants to know about a neurosurgical or GYN procedure I am going to refer them to THAT specialty. Besides, the patient is served best by hearing the details from an expert in that field, not a PA from a different specialty who may have some trivial passing knowledge (and NO hands on experience) of that procedure themselves. I understand what you are saying, but I like a refresher in general medicine as a base. I work in plastic and reconstructive surgery, so I'm really specialized. However, I regularly admit patients with CVD, hypertension, diabetes, kidney failure, COPD, substance abuse, etc., including peds, and I like having a general understanding of current dx and tx of these and other co-morbidities as I co-manage these patients with our hospitalist team. This is also one reason that I think surgeon / PA teams are so effective in caring for sick surgical patients. The PA brings this general medical knowledge to the team and improves the overall effectiveness of the team. Also, this is my sixth specialty since graduation, and a good grounding in general medicine has helped my lateral mobility. I'm studying for my fifth or sixth recert right now and I've opted for the surgery focus this time around. Will let you know how it goes in May! This should be my last PANRE. :-) The reality is that we have to dance with who we brought at this point, in my opinion. States require PANCE and many require PANRE for maintaining licensure. Many health care organizations have adopted PANCE and PANRE for credentialling PAs. It would be hard, if not impossible to change to a different certification mechanism given how ingrained the PANCE is in the system now. Link to comment Share on other sites More sharing options...
Contrarian Posted February 27, 2012 Share Posted February 27, 2012 ^^^.... Agree with 99% of what was written... ^^^ I believe the "Generalist" nature of our training and testing is a asset. Personally I don't think there should be a "replacement" for the NCCPA. I DO think there should be a ALTERNATIVE to the NCCPA. Look at the NPs... they have several boards to choose to certify... with ANCC & AANP being the most common. Link to comment Share on other sites More sharing options...
andersenpa Posted February 27, 2012 Share Posted February 27, 2012 I understand what you are saying, but I like a refresher in general medicine as a base. I work in plastic and reconstructive surgery, so I'm really specialized. However, I regularly admit patients with CVD, hypertension, diabetes, kidney failure, COPD, substance abuse, etc., including peds, and I like having a general understanding of current dx and tx of these and other co-morbidities as I co-manage these patients with our hospitalist team. This is also one reason that I think surgeon / PA teams are so effective in caring for sick surgical patients. The PA brings this general medical knowledge to the team and improves the overall effectiveness of the team. Also, this is my sixth specialty since graduation, and a good grounding in general medicine has helped my lateral mobility. I'm studying for my fifth or sixth recert right now and I've opted for the surgery focus this time around. Will let you know how it goes in May! This should be my last PANRE. :-) The reality is that we have to dance with who we brought at this point, in my opinion. States require PANCE and many require PANRE for maintaining licensure. Many health care organizations have adopted PANCE and PANRE for credentialling PAs. It would be hard, if not impossible to change to a different certification mechanism given how ingrained the PANCE is in the system now. My opinion on this has evolved as I have become firmly grounded in my specialty over the past 11 yrs. In CT surgery I also manage patients with these commonly encountered comorbidities- HTN, DM, dyslipidemia, COPD, etc. While these are "general medicine" topics they are also part and parcel to the patient population, thus review of this (to me) is specialty focused. We manage these issues every day, discuss them with our colleagues in other fields (eg cardiology), and have no choice but to be "up to date". If you want to attend a general medicine CME to brush up on these topics, fine. But to continue to mandate irrelevant medicine topics, including things like peds and gyn which are far out of my normal practice, makes no sense. It take away valuable CME time and money that I could use to focus on things that I actually do. If PAs want lateral mobility, take the CME courses/seminars/read the journals etc, and educate yourself. The generalist PANRE no longer serves the general competency of PAs in the arena that they most commonly practice, and may even stunt our growth as what we are becoming- experts in our clinical role. Link to comment Share on other sites More sharing options...
Contrarian Posted February 27, 2012 Share Posted February 27, 2012 ... [brevity edit]... The generalist PANRE no longer serves the general competency of PAs in the arena that they most commonly practice, and may even stunt our growth as what we are becoming- experts in our clinical role. The suggestion that studying and testing on a broad range of topics (general medicine-OB, GYn, EM, IM, Peds, Psych)... is somehow more "stunting" of clinical growth than studying and testing on a limited specialty (Surgery) seems a bit odd... TO ME. From where I sit... me just studying and testing in psychiatry would be A LOT more "stunting" than my regular testing in general medicine. Hell... most psychiatrist... think wbc s in urine equals UTI (neg estrase/cytes), that a AST and/or ALT of 40 is a "critical lab" and like orthopedists... don't even own stethescopes, As has been stated/suggested above... a HUGE portion of my value in the several psych settings that I work(Inpatient/Outpatient/Detox) is that I'm generally the only guy in the building that can decipher a CBC w/diff, CMP, and U/A... or the only person on site who understands the difference between Lantus and Novolog and how to set up a sliding scale. Link to comment Share on other sites More sharing options...
physasst Posted February 27, 2012 Share Posted February 27, 2012 I understand what you are saying, but I like a refresher in general medicine as a base. I work in plastic and reconstructive surgery, so I'm really specialized. However, I regularly admit patients with CVD, hypertension, diabetes, kidney failure, COPD, substance abuse, etc., including peds, and I like having a general understanding of current dx and tx of these and other co-morbidities as I co-manage these patients with our hospitalist team. This is also one reason that I think surgeon / PA teams are so effective in caring for sick surgical patients. The PA brings this general medical knowledge to the team and improves the overall effectiveness of the team. Also, this is my sixth specialty since graduation, and a good grounding in general medicine has helped my lateral mobility. I'm studying for my fifth or sixth recert right now and I've opted for the surgery focus this time around. Will let you know how it goes in May! This should be my last PANRE. :-) The reality is that we have to dance with who we brought at this point, in my opinion. States require PANCE and many require PANRE for maintaining licensure. Many health care organizations have adopted PANCE and PANRE for credentialling PAs. It would be hard, if not impossible to change to a different certification mechanism given how ingrained the PANCE is in the system now. I tend to agree with this. Plus, I think that we need to maintain certification as generalists for the greater good. PA's remain the best workforce commodity because of the mobilization potential. Hooker, et al, showed that 47% of PA's DO change specialties AT LEAST once in a career. That's a LOT of PA's... If we ever go to centralized workforce planning (my hope), we could control the number of PA openings in various specialties, and mobilize PA's into primary care if needed.... At any rate, if almost 1/2 of PA's have changed specialties, I think that maintaining the ability to do so should be pretty important for the profession....my 0.02 cents at least. Link to comment Share on other sites More sharing options...
terripa Posted February 27, 2012 Share Posted February 27, 2012 Your opinion differs from mine. I am not saying that a nephrologist should attend a cardiovascular seminar. But I work in Primary Care and if I only went to CME's about Primary care I truely feel that would be a disservice to my patients. We all know that specialists prefer to operate - that is there huge moneymaker. And sometimes patients go to specialists and then come to the Primary Care doctors that they know and trust with years of relationships and ask our opinion. I also tell a patient that I am not the specialist but do try to help them with any questions if possible. I also believe any knowledge is power. So just going to CME's in your speciality is very closed minded. I am not trying to perform by-pass, but limiting types of CME's we can be involved in is only keeping us inside the box. That is the "supposed" advantage of PA's - the flexibility of changing specialities. So why would we ever restrict that learning - it might eventually open a new interest that might become a new career path. Link to comment Share on other sites More sharing options...
andersenpa Posted February 28, 2012 Share Posted February 28, 2012 The suggestion that studying and testing on a broad range of topics (general medicine-OB, GYn, EM, IM, Peds, Psych)... is somehow more "stunting" of clinical growth than studying and testing on a limited specialty (Surgery) seems a bit odd... TO ME. From where I sit... me just studying and testing in psychiatry would be A LOT more "stunting" than my regular testing in general medicine. Hell... most psychiatrist... think wbc s in urine equals UTI (neg estrase/cytes), that a AST and/or ALT of 40 is a "critical lab" and like orthopedists... don't even own stethescopes, As has been stated/suggested above... a HUGE portion of my value in the several psych settings that I work(Inpatient/Outpatient/Detox) is that I'm generally the only guy in the building that can decipher a CBC w/diff, CMP, and U/A... or the only person on site who understands the difference between Lantus and Novolog and how to set up a sliding scale. We are trained in the medical model yet our recertification process does not reflect that (in how our specialty physcian colleagues reboard) because the cert/recert process has not fully embraced specialty PAs. The new surgery focus exam is the first thing since the now defunct "bonus" surgery exam from years ago. It may seem odd "TO YOU" because your work is an offshoot of internal medicine, the basis of the primary care focused PANCE/PANRE. Why don't we flip it around...if I as a surgical PA need to recertfy in general medicine-OB, GYn, EM, IM, Peds, Psych etc to stay "well rounded"....in the event that my patients suffer from fibroids or Sjogren's or bipolar...then why not mandate that all primary care PAs should cert/recert in a similarly broad range of specialty surgical fields... vascular and otolarygology and thoracic (to the same degree that PANRE goes into with IM/PC topics)... just to make sure that THEY stay "well rounded" in the event that their IM patients suffer from various "surgical diseases"..... We all know the PANCE/PANRE covers basic surgical topics but it is still, largely, a PC/IM exam. This is a medicine-centric philosophy that we need to repeatedly hammer in IM topics into PAs in order to make them "well rounded" (so that they can decipher the WBCs in urine or LFTs) but there is no such apporach towards specialty/surgery PAs. And I maintain that for PAs with limited resources and fixed CME reimbursement, it IS stunting their role in the primary practice to waste time at a generalist conference covering topics that they NEVER encounter in their clinical practice (pediatric ortho? advances in hepatitis management?) when they could focus their time and money on a relevant conference which would I guess some of us are still in the mindset that we must remain "jack of all trades" who can decipher the thyroid function panel for their orthopedic SP, rather than fully developing the role of surgical PAs as perioperative specialists. Jack of all trades, master of none. This was a common term I heard throughout my early PA training and I resented it every time I heard it. If we want to further our place in the medical hierarchy then we need to recognize the critical role PAs have in subspecialty practice. Maintaining diversions into PC serves only those who see PAs as interchangeable widgets. Contrarian the fact that you describe surgery as a "limited specialty" reveals what is probably a common misperception about surgical PAs, one that needs to be broken. Furthermore I wonder how , as a PA practicing in a "limited specialty", have been able to conitnue to manage a broad range of common medical diagnoses with the assistance of only one PANRE 5 yrs ago. There are a multitude of other avenues for specialty PAs to further their generalist leanings, that don't require a sham exam that costs hundreds of dollars and valuable professional time/funds from my employer. Link to comment Share on other sites More sharing options...
andersenpa Posted February 28, 2012 Share Posted February 28, 2012 I tend to agree with this. Plus, I think that we need to maintain certification as generalists for the greater good. PA's remain the best workforce commodity because of the mobilization potential. Hooker, et al, showed that 47% of PA's DO change specialties AT LEAST once in a career. That's a LOT of PA's... If we ever go to centralized workforce planning (my hope), we could control the number of PA openings in various specialties, and mobilize PA's into primary care if needed.... At any rate, if almost 1/2 of PA's have changed specialties, I think that maintaining the ability to do so should be pretty important for the profession....my 0.02 cents at least. Then leave it optional. Surgical CME +/- exam for those in surgery/specialty. Generalist CME +/- exam for all those PAs who want to change jobs. These exams are now offered at computer based test centers year round and an exam requirement is not a barrier to mobility any more than an employer not wanting to hire an inexperienced PA changing specialties. Link to comment Share on other sites More sharing options...
foreveryoung Posted February 28, 2012 Share Posted February 28, 2012 I hate to say it, but OB is hardly general medicine... even most FP docs no longer practice it. I think if the boards stuck to things that all PAs should know, it would be one thing, but the idea of what generalist knowledge is too broad. I agree we should maintain a certian degree of basic internal medicine. There should be a line though and definately not as broad as it is now. Link to comment Share on other sites More sharing options...
Contrarian Posted February 28, 2012 Share Posted February 28, 2012 Cool... Soon a REQUIRED exam for every specialty and subspecialty. Where have we seen this before...??? Ummm... yeah... here: ACHPN (Advanced Certified Hospice & Palliative Nurse) ACNP (Acute Care NP) ACPNP (Acute Care Pediatric NP) ANP (Adult NP) (Specialty Programs: Adult Cardiovascular Care NP, Adult Primary Care NP, Adult Critical Care NP,[30] Adult Acute Care NP [31]) AOCNP or AOCNS (Advanced Oncology Certified Nurse Practitioner or Clinical Nurse Specialist—by ONCC) APMHNP (Adult Psychiatric/Mental Health NP) BC-ADM (Board Certified - Advanced Diabetes Management) BC-PCM (Board Certified - Palliative Care Management, discontinued by ANCC) ENP (Emergency NP) FNP (Family NP) FPMHNP (Family Psychiatric/Mental Health NP) GNP (Geriatric NP) HNP (Holistic NP; APN program [32]) NNP (Neonatal NP) OHNP (Occupational Health NP) ONP (Oncology NP) PA/CCNP (Pediatric Acute/Chronic Care NP [33]) PCCNP (Pediatric Critical Care NP) PCNP (Palliative Care NP; APN program [34]) PMHNP (Psychiatric/Mental Health NP) PNP (Pediatric NP) PONP (Pediatric Oncology NP) WHNP (Women's Health NP) "-C" and "-BC" indicate "Certified" and "Board Certified" by a national certifying organization such as the American Nurses Credentialing Center, American Academy of Nurse Practitioners, or the National Certification Corporation(e.g., FNP-BC, NNP-BC, ANP-C, NP-C, WHNP-BC, etc.) :O_O: Link to comment Share on other sites More sharing options...
physasst Posted February 28, 2012 Share Posted February 28, 2012 Then leave it optional. Surgical CME +/- exam for those in surgery/specialty.Generalist CME +/- exam for all those PAs who want to change jobs. These exams are now offered at computer based test centers year round and an exam requirement is not a barrier to mobility any more than an employer not wanting to hire an inexperienced PA changing specialties. I don't know, I'd rather see it kept the way it is, because I'd like (putting on my workforce management hat) to have the ability to draw on a large pool of primary care trained and certified providers if needed. Let's say we encounter a situation in the future, where we have a HUGE need in primary care. We could, using financial incentives (IE; refusing to pay or reimburse for ANY specialty PA care) mobilize vast numbers of PA's into primary care. Or, if there were a pandemic the likes of which we have never seen, and makeshift hospitals are needed all over. To be able to simply remove PA's from their current specialties and place them into a hospitalist role if needed would be an incredible asset. PA's remain the best medical workforce asset because we are the "jack of all trades". I think trading in our generalist training would be a HUGE mistake. But...I also understand that others feel differently. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 28, 2012 Moderator Share Posted February 28, 2012 I like the idea of maintaining a base certification in primary care with optional specialty exams(caq or equivalent). I would combine it into a single exam in a perfect world: panre/em , panre/surg, etc for example. everyone takes a primary care exam and on the day of the exam you choose an optional specialty component if desred. I would make everyone take pance to start and then optionally specialize at yr 5/6(or after whatever min time was agreed upon for eligibility). I have only had the caq em for 2 months but have been asked about it multiple times and docs have been impressed that I have a specialty em certification. it may land me a dream job next summer....work in progress.... Link to comment Share on other sites More sharing options...
Contrarian Posted February 28, 2012 Share Posted February 28, 2012 ... Let's say we encounter a situation in the future, where we have a HUGE need in primary care. We could, using financial incentives (IE; refusing to pay or reimburse for ANY specialty PA care) mobilize vast numbers of PA's into primary care. Or, if there were a pandemic the likes of which we have never seen, and makeshift hospitals are needed all over. To be able to simply remove PA's from their current specialties and place them into a hospitalist role if needed would be an incredible asset. PA's remain the best medical workforce asset because we are the "jack of all trades". I think trading in our generalist training would be a HUGE mistake. But...I also understand that others feel differently. Why not just "remove" specialist physicians and "place" them in these roles...??? Why just PAs...??? Compulsory anything except a Draft (required by act of congress) is UN-American...!!! Sounds pretty dystopian and communist "TO ME"... No thanks Captain "Skynet"... I'll just stay home... maybe set up a "underground" clinic and lead the resistence "John Conner-esque" style... :wink: A man chooses; a slave obeys. Link to comment Share on other sites More sharing options...
andersenpa Posted February 28, 2012 Share Posted February 28, 2012 Cool...Soon a REQUIRED exam for every specialty and subspecialty..... Byzantine, isn't it??? I don't think we have to go that far..... I don't want to get away from my main point- that mandatory reboarding in primary care doesn't serve the interests of modern specialty PAs....and, indirectly, their patients. Link to comment Share on other sites More sharing options...
andersenpa Posted February 28, 2012 Share Posted February 28, 2012 I don't know, I'd rather see it kept the way it is, because I'd like (putting on my workforce management hat) to have the ability to draw on a large pool of primary care trained and certified providers if needed. Let's say we encounter a situation in the future, where we have a HUGE need in primary care. We could, using financial incentives (IE; refusing to pay or reimburse for ANY specialty PA care) mobilize vast numbers of PA's into primary care. Or, if there were a pandemic the likes of which we have never seen, and makeshift hospitals are needed all over. To be able to simply remove PA's from their current specialties and place them into a hospitalist role if needed would be an incredible asset. PA's remain the best medical workforce asset because we are the "jack of all trades". I think trading in our generalist training would be a HUGE mistake. But...I also understand that others feel differently. We don't have to trade in our generalist training. The lateral flexibility is there for those who wish to practice primary care/IM. If I complete my generalist program and wish to do PC, I can board in it. Gven that most PAs have no idea what they will be doing in their early career, I'd guess most would keep their generalist credentials. We should plan our cert process around the commonalities- what PAs deal with, day in day out, not low liklihood anomolies like a national diasaster. When 9/11 happened, and docs/etc were pitching in to help, they weren't triaging them based on their BC/BE status. PAs, once established in their practice, follow the same patterns as their physician collegaues: they do what they do and do it well, and aren't going to jump into another specialty unless they have considerable training- regardless of what they studied for on the PANCE or PANRE. Like I said, I took my last PANRE 5 yrs ago. I can't tell you jack squat about the peds immunization schedule, how to treat RMSF, or the initial apporach to DUB. So to state that taking that exam every 6 yrs makes more flexible is a joke. Link to comment Share on other sites More sharing options...
Gonadometrics Posted February 28, 2012 Share Posted February 28, 2012 Interesting thread topic and comments. I wonder how we could ever accomplish changing or replacing the NCCPA though. It seems unlikely that the Board of Directors would be persuaded to vote on a measure that assures their own self-destruction. Even the Physician Assistants on the Board of Directors are often allied with organizations in such a way that they cannot vote in the best interest of the profession. PA Directors affiliated with the PAEA, AAPA, Federation of State Medical Boards and PA schools are unlikely to behave in a way that harms the NCCPA's revenue stream. So, any changes would requires replacing PAs on the Board with those who have support a unified vision for the profession. I am not acquainted with the bylaws of the NCCPA but most organizations prevent an overthrow of power by limiting the number of directors who can be elected in any year. By limiting the seats available for election, it can take years to replace a board; an unlikely prospect. Once a monster is created, it is very difficult to kill it. Link to comment Share on other sites More sharing options...
Contrarian Posted February 28, 2012 Share Posted February 28, 2012 ^^^... Agree Which is why I say don't try to "replace" them... but do give them some competition and incentive by forming an alternative. Right now... they have a monopoly... it needs to be broken if we ever really expect them to be responsive to the needs and wants of PAs. Link to comment Share on other sites More sharing options...
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