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James Cannon's (NCCPA DAL) article re: the post-CAQ survey of certificate recipients:



James Cannon, DHA, PA-C, is a director-at-large for the NCCPA and a commander in the US Coast Guard where he works as a healthcare executive while still practicing in psychiatry with an emphasis in substance abuse.

The Case for the CAQ by James Cannon, DHA, PA-C

The National Commission on Certification of Physician Assistants (NCCPA) awarded 232 certified PAs the organization’s first Certificates of Added Qualifications (CAQs) at the end of 2011. There was no white coat ceremony, no pomp and circumstance, just the crisp new certificates silently churning out of a printer at NCCPA headquarters. This was, however, a very big deal that marked the culmination of years (decades, really) of discussions and difficult decision-making.

As a member of the NCCPA Board, I can tell you that our aims are lofty and our hopes are high for this new credential. How is it doing so far?

Six months after those first CAQs were issued, NCCPA checked in with those recipients to find out how the CAQ has impacted their professional lives so far and how they’re feeling about the CAQ program. Based on responses from 130 (57 percent of those surveyed), we can now report that just six months after earning a CAQ, among those who sought each of the following benefits

Changing Role

  • 69 percent have found or anticipate finding a new job
  • 60 percent who went after an expansion of their role now have or expect to soon have increased/more complex responsibilities
  • 46 percent have seen or expect an expansion of clinical privileges
  • 42 percent have been promoted or expect a promotion

Financial Benefits

  • 51 percent have been granted or anticipate a pay increase
  • 49 percent have achieved or anticipate a broadening of their eligibility for reimbursement
  • 43 percent have earned or expect higher levels of reimbursement for services provided to patients
  • 31 percent were awarded or anticipate a one-time bonus or cash award
  • 26 percent have experienced or anticipate a reduction in malpractice insurance premiums

Recognition & Respect

  • 52 percent have been publicly recognized in the workplace
  • 53 percent have been publicly recognized within their community
  • 46 percent have experienced greater respect or acceptance from new patients

Given that the CAQ program is so new and thus not yet widely recognized, these early results are especially promising. As the program continues to grow, so should the positive effects of earning a CAQ.

In one specialty area, some especially promising changes are brewing.

Hope for Psychiatry PAs

In 2008, when NCCPA leaders were still weighing which specialties to include in what would eventually be the CAQ program, staff from NCCPA and the American Academy of Physician Assistants (AAPA) interviewed representatives from 19 PA specialty organizations. They gathered information about the current practice environment, challenges and issues facing PAs in that area or seeking entry to it, the specialty organization’s response to those challenges, and opportunities for one or more of the national organizations to address or support others’ efforts to address their challenges. Interview participants from the Physician Assistants in Psychiatry (now known as the Association of Physician Associates in Psychiatry or APAP) raised concerns about PAs’ lack of documentation of their qualifications in the specialty and challenges to reimbursement. Those issues factored heavily into NCCPA’s decision to include this relatively small specialty in the new CAQ program. Today, it looks like that decision may soon pay off for psychiatry PAs.

As a psychiatry PA myself, this issue is of great personal importance to me. Other APAP leaders and I have already had very promising conversations with executives at one of the largest mental health insurance companies. They indicated that they were impressed with the new Psychiatry CAQ and would formally review their reimbursement policies for PAs who have earned it. I’m very optimistic that we’re on the leading edge of a major shift for reimbursement for psych PAs.

APAP recently conducted a survey of psychiatry PAs to learn more about the depth and breadth of this issue, and preliminary results suggest that inadequate reimbursement is a widespread issue. APAP will work on this as long as it takes to improve the reimbursement environment for psychiatric PAs.

The CAQ program is not without its detractors, but if it can open doors that were previously closed to PAs in a specialty like psychiatry where the need for providers is so critical, then that’s clearly a good thing. In fact, the APAP survey results indicate that 73 percent of psychiatric PAs would earn the CAQ if the credential improved reimbursement.

Earning a CAQ

In addition to psychiatry, NCCPA currently offers CAQs in emergency medicine, cardiovascular and thoracic surgery, orthopaedic surgery and nephrology. In 2014, pediatrics and hospital medicine will be added to that list.

To qualify to begin the CAQ process, PAs must be certified and hold valid, unrestricted licenses in every jurisdiction in which they are licensed to practice or unrestricted practice privileges to practice as a government employee.

To earn a CAQ, certified PAs must have 150 Category I specialty CME hours (earned over a six-year period), one to two years of experience in the specialty, and procedures and patient case experience appropriate for the specialty and their role in it. Once those requirements are satisfied, the final step is passing a specialty exam.

Given the early positive results for those who earned CAQs at the end of 2011, it is no surprise that more than 70 percent said they would recommend the CAQ program to all other PAs in their specialty.

In the words of one CAQ recipient, Saeri Lee, PA-C: “I would highly recommend pursuing CAQ. It’s a great way to have proof of meeting a set of professional standards in the eyes of potential employers, and it is a great way to obtain validation and recognition of one’s hard work on a more personal level. Obtaining a CAQ has many benefits for the individual PA, but it also collectively benefits the entire PA profession. PAs always have been pioneers, and pursuing a CAQ undoubtedly will help to pave more opportunities for PAs and further help to develop our profession to better serve the growing and increasingly diversified needs of our current health care system.”

More details about the requirements for each specialty and an outline of the content covered on the specialty exams are available online at http://www.nccpa.net/SpecialtyCAQs.aspx.

Registration is now open for the 2012 CAQ exams, which will be administered on September 10 at PearsonVUE testing centers throughout the US. The cost is $100 (payable at the start of CAQ process) and $250 for the exam.

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I have never met James Cannon but he has been a reasonable friend to those of us in the name change movement. At one glance this may seem like an advertisement piece from an NCCPA rep for the CAQ

The numbers cited from the survey make it seem difficult to tease out if these effects (expanding privileges, new roles, raises etc) are solely due to the CAQ, even just partly. I'm not dismissing the results but I'm trying to understand how a bunch of "crisp new certificates silently churning out of a printer at NCCPA headquarters" is having such an extensive effect. Most employers have a slim understanding of PA practice outside of how it effects their bottom line and liability. How are they suddenly extending raises and increased scope on a certificate/exam in its first year? With no track record? Odd.

Is this all perception on the part of the CAQ recipients?

Do they feel persuaded, even subconsciously, to see some immediate effect from and exam that they invested time and energy into?


Interested in hearing the thoughts from the forum.

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Guest Paula

I would like to see the survey questions. There are a lot of positive answers to the questions for anticipation and expectations the CAQ recipients have, the doesn't tell us anything about if they actually received raises, had expansion of duties, got a promotion, got a new job, had a decrease in malpractice insurance rates, or received cash bonuses.


They did receive public recognition.

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