Specialty CAQs- Thoughts?

[cmpetschke]

I received an email from the NCCPA about new specialty CAQs being offered (specifically pediatrics) and I am intrigued. What is the general concensus regarding the value of obtaining a CAQ? Does anyone have experience in the process?

 

I guess I am wondering... Is it worth it?

 

Thanks for your input!

[EMEDPA]

I took the em caq the first day it was offered and have been offered 2 jobs specifically because I took and passed it and got better privileges at one of my jobs based only on that factor. A local lawyer called me and asked me to be an expert witness for a pa related case because he saw my name on the caq holders list....well worth the time and money in my opinion.

[Just Steve]

I was under the impression that the CAQ would replace the PANRE for those that opted for it...is this the case, or am I off?

[Medic207]

CAQs have pros and cons, many of which were discussed in previous threads. Here are some thoughts I have seen discussed:

 

PROS:

Recognition of your trade

Possibly higher wages (varying reports on this)

Possibly lead to expanded privileges

 

CONS: (mostly fears because know one knows yet on how it will fully pan out) the NCCPA desperately wants PAs to get the CAQ for some reason.

 

May limit a future PAs ability to easily change trades.

May become required before working as a PA in any particular trade.

May be required for reimbursement

Doesn't appear to replace PANRE

 

 

Those who have taken the exams are rightfully proud. Then there are those who have a healthy amount of skepticism about where this will lead in terms of future regulations. Many feel it is a great thing while many others see it as a money making scheme for the NCCPA.

[Febrifuge]

I'm vaguely uneasy about them, for reasons I can't articulate. It's just instinct/ Spidey-Sense for now, and I wish I could nail down some solid logical objections. I guess even though I graduated in 2009, I'm something of a throwback: second-career PA, little bit older, had a lot of experience as an ER tech before school. Something about CAQs just feels like moving away from a couple of the things that made PA a more attractive choice for me than MD/DO.

 

I really love being a generalist, basically.

[Just Steve]

This feels like degree creep and a restrictive categorization of the PA world. PA used to mean "practically anything" but that is being chipped away. As I come up to graduation, I find myself flirting with a few different fields of medicine. I am concerned about the rate that CAQs are gaining speed and if I decide to head in one direction then in a few years head in another, the CAQs will be a requirement to get hired. Trouble is, you can't sit for a CAQ without experience in that field.

 

For example...to illustrate my point...let us say I graduate and go into CT surgery. After a few years I still love the intensity but the hours are draining me so I decide to get a job in the ER. I am concerned that when I apply for the ER my lack of a CAQ will be a profound hindrance in acquiring a job or the pay that I am offered as a non CAQ applicant is such a dramatic pay cut from what I was making it will compell me to stay in surgery where I have already felt a desire to leave.

 

I feel as a new graduate, the world is my oyster. I live in a PA friendly part of the world, I have a strong background in medicine, I am networking well, and live in a rural area but commuting distance to the big city to the west or even further into no mans land to the east. I suppose that I am most concerned about being shut out of a field. My personal life got set on it's ear and I have a strong compulsion to bury myself in work to just hunker down, get out of debt, re establish myself, and stay busy enough that I don't dwell on the past. However, I also know that eventually I will want to come up for air and bring the pace back to a more controlled mayhem. The PA life used to support this type of flexibility but it feels like that is being taken away.

 

Is there any reassurance that this is not happening, or is the writing on the wall? Do we know the answer yet as this is all still pretty new?

[Guest JMPA]

Do Caq's allow us to practice independently? No , so they are only restrictive to the profession causing increased cost and greater restriction to practice.

[coastalPA]

Though its nice to have the option to take a specialty CAQ to have recognition in your specialty, overall I think it is detrimental to the PA profession and will become more of a professional barrier to PAs who want to transition to other specialties.

 

For example, I have tried to obtain positions in psychiatry (until exhaustion--sending many resumes to psych practices in private practice and hospital based who advertised for NP or PA positions all over the US and at times with recruiter assistance) over the past year...and I have not been considered due to the fact I do not have a CAQ in psychiatry.

 

Some employers would only consider NPs with mental health certification. If they were open to PAs, one had to have CAQ in psychiatry. It is very frustrating because it makes me feel like our general certification means nothing. More limiting is the fact that you cannot take the CAQ (in psych) unless you have 2000 contact hours, so only PAs who are currently working in psych or who have had psych experience previously can have the opportunity to take the CAQ exam.

 

One of the main reasons I chose this profession over MD/DO was to have the freedom to move from specialty to specialty; to not get pigeonholed. I get many offers for FM/UC/IM or hospitialist (4.5 years experince in IM/UC/FM) but transitioning into a specialty is elusive in part due to the CAQ. NCCPA has done a great disservice to the PA profession by introducing an "optional" way to recognize your skills/knowledge/experience but simultaneously putting more limitations on PAs and restriciting our ability to compete for positions and transition from one field to another as needed (or as desired).

[EMEDPA]

Lateral mobility is going away anyway as a direct result of the joint commission and hospital credentialing bodies requiring providers have a skill already to perform it. our new PAs are not getting credentialed for things like LP's,

etc because they can not demonstrate competence and a procedure log showing they can do these things. this is where a residency comes in, it gets you the procedure log and the ability to credential for any skill within your field.

This means in the future the best jobs will be limited to folks with experience or those willing to do residencies or take entry level positions and work their way up over time.

[EMEDPA]

I was under the impression that the CAQ would replace the PANRE for those that opted for it...is this the case, or am I off?

UNLIKELY, but it will probably count towards the new nccpa personal improvement project requirement that starts in 2014.

[GREEN]

This feels like degree creep

 

Yep, end of discussion. It doesn't matter if, "it got me job A, more money etc, etc." because it's a self fulfilling prophecy that's being fed into by...cough cough...certain PAs.

[EMEDPA]

Yep, end of discussion. It doesn't matter if, "it got me job A, more money etc, etc." because it's a self fulfilling prophecy that's being fed into by...cough cough...certain PAs.

certain cough, cough, employed PAs who will retain their jobs and be able to have their choice of future jobs within their field when competing against those who do not have gold standard credentials........

all kidding aside, the docs are pushing for these CAQs. that's why they came into being. they are also the ones pushing for residencies. their model is "go to school, do a residency, pass a test" and they want PAs to conform to that model as well. you can either do so or get stuck with the low end jobs that no one else wants....also(at least for em) the pa organizations-in this case SEMPA- have endorsed the caq as a valid way to demonstate competence within the specialty.

the future for PAs will be to follow the physician model of training/residency/test whether PAs like it or not as physicians will decide that they want to hire certain folks and support certain types of training. those without the training physician organizations want will be left with the jobs no one wants. it's hard to fight against the tide. I have been fighting against the conversion to emr's for example for over a decade but as it becomes reality I have had to adapt.

taking a CAQ and/or doing a residency keeps you ahead of the curve and in the good graces of the docs who at the end of the day decide if we work or not.

[Dynamo24]

certain cough, cough, employed PAs who will retain their jobs and be able to have their choice of future jobs within their field when competing against those who do not have gold standard credentials........

all kidding aside, the docs are pushing for these CAQs. that's why they came into being. they are also the ones pushing for residencies. their model is "go to school, do a residency, pass a test" and they want PAs to conform to that model as well. you can either do so or get stuck with the low end jobs that no one else wants....also(at least for em) the pa organizations-in this case SEMPA- have endorsed the caq as a valid way to demonstate competence within the specialty.

the future for PAs will be to follow the physician model of training/residency/test whether PAs like it or not as physicians will decide that they want to hire certain folks and support certain types of training. those without the training physician organizations want will be left with the jobs no one wants. it's hard to fight against the tide. I have been fighting against the conversion to emr's for example for over a decade but as it becomes reality I have had to adapt.

taking a CAQ and/or doing a residency keeps you ahead of the curve and in the good graces of the docs who at the end of the day decide if we work or not.

 

I agree with what you are saying. As a Pre-PA student, Iowa became my #1 choice over my home school (UNMC) simply because I tack on that one year residency w/o having to move my family, do the CAQ and be as competitive as a 3-5 year practicing PA all the while having the confidence to step into a job and not feel like I'm dragging down the doc or other PAs with questions all day long. If the CAQ was tacked with the residency, do you think that would change everyone's view on it?

[EMEDPA]

A few of the residencies(maybe 3 out of 19) require the caq as the exit exam. I think this will become the standard and eventually a residency will be required to take the caq.

[ATCLATEMTB]

I'm not sure in the future the CAQ will translate into higher salaries, as it seems to have done so currently for some. As residency programs increase, as does the number of CAQ exams, I think we will see more requirements as an entry exam to practice. This is concerning as I sincerely doubt the CAQ will add to the base salary in the future as PA's who have ended their formal education and now are going to practice full time go seek jobs. With limited years of guided practice behind them and a CAQ I can see HR departments saying you are essentially a new grad since you just got your CAQ.

 

Despite the fact that it simply is added qualification, not a board exam such as a physician might take after residency. I think those that have this credential need to highlight it is simply a Certificate of Added Qualifications. Not an entry level situation....and certainly not the gateway to PA practice. Practicing PA's need to frame this credential as an advancement in an individuals practice NOT as a gateway.

 

What I find more concerning is the addition of the most recent exams, seems like it won't be long before they have a family practice or internal medicine exam. Oh wait don't we have that already? After all most PA programs are geared to general medicine / primary care medicine / underserved primary care AND all Pas must pass the PANCE.

[EMEDPA]

the push for caqs is coming from physician specialty organizations.

we can already do primary care. everyone knows that. the FP and IM docs don't want us to have a specialty credential saying we can do it as they already view us as direct competition and don't want us to have any added ammo in that fight so I don't see any primary care caqs anytime soon.

[ventana]

the push for caqs is coming from physician specialty organizations.

we can already do primary care. everyone knows that. the FP and IM docs don't want us to have a specialty credential saying we can do it as they already view us as direct competition and don't want us to have any added ammo in that fight so I don't see any primary care caqs anytime soon.

 

 

They see us as competition and this is why we need the CAQ cause the NPs are killing us

 

I would be first in line if when they offer a IM CAQ

 

 

honestly I think it is silly to think in 6 semester we can come even close to being a good PA provider - heck med school is longer, harder and then they go work 80 hour weeks for 3-10 years to actually learn medicine.

 

CAQ are a good thing, now we need an IM post grad program of some type that allows us a lot more independence, ie corp ownership (unrestricted), direct billing, much more portable supervision.....

[LT_Oneal_PAC]

They see us as competition and this is why we need the CAQ cause the NPs are killing us

 

I would be first in line if when they offer a IM CAQ

 

 

honestly I think it is silly to think in 6 semester we can come even close to being a good PA provider - heck med school is longer, harder and then they go work 80 hour weeks for 3-10 years to actually learn medicine.

 

CAQ are a good thing, now we need an IM post grad program of some type that allows us a lot more independence, ie corp ownership (unrestricted), direct billing, much more portable supervision.....

 

Overheard at Impact they are making one for hospitalist and peds.

[Just Steve]

They see us as competition and this is why we need the CAQ cause the NPs are killing us

 

I would be first in line if when they offer a IM CAQ

 

 

honestly I think it is silly to think in 6 semester we can come even close to being a good PA provider - heck med school is longer, harder and then they go work 80 hour weeks for 3-10 years to actually learn medicine.

 

CAQ are a good thing, now we need an IM post grad program of some type that allows us a lot more independence, ie corp ownership (unrestricted), direct billing, much more portable supervision.....

 

This is exactly why quality, hands on health care experience is so bloody important prior to PA school. The proliferation of schools that allow students who have less than direct hands on, or even no HCE, has contributed to the need to find other alternative training models. I hate being a doomsdayer but it feels like we are a snake swallowing our own tail. I am personally frustrated as I had entered the path to this profession reliant upon my extensive background with the comfort that I will have a wide variety of options open to me. That door is closing quickly and it irks me. /rant

[cinntsp]

Further development of residencies/fellowships and to a larger degree CAQs are essential if we don't want to be assistants forever IMO.

[vet-up]

Further development of residencies/fellowships and to a larger degree, CAQs are essential if we don't want to be assistants forever IMO.

So without CAQs, you think physician assistants have been "physician's assistants"?

[EMEDPA]

So without CAQs, you think physician assistants have been "physician's assistants"?

worse, DLH's ( doctor's little helpers).

[cinntsp]

worse, DLH's ( doctor's little helpers).

 

Heck, we may end up as NPLHs(NP's little helper) if everyone continues to accept the status quo.

[ventana]

This is exactly why quality, hands on health care experience is so bloody important prior to PA school. The proliferation of schools that allow students who have less than direct hands on, or even no HCE, has contributed to the need to find other alternative training models. I hate being a doomsdayer but it feels like we are a snake swallowing our own tail. I am personally frustrated as I had entered the path to this profession reliant upon my extensive background with the comfort that I will have a wide variety of options open to me. That door is closing quickly and it irks me. /rant

 

 

that train has already left the station......

 

 

We need to look forward to how we intergrate into the true main stream of medicine....

look at the numbers - (purely from memory and likely wrong but close)

PA- 130,000

NP - ? 150,000

MD/DO - something like 850,000

 

 

Most of the PA growth has been in the past 10 years

 

 

We need to stop complaining that prior HCE is going down.... instead we need to develop systems to train great PAs just like the docs do...... residency and CAQs and then independent/collaborative practice....

[rcdavis]

that train has already left the station......

 

 

We need to look forward to how we intergrate into the true main stream of medicine....

look at the numbers - (purely from memory and likely wrong but close)

PA- 130,000

NP - ? 150,000

MD/DO - something like 850,000

 

 

Most of the PA growth has been in the past 10 years

 

 

We need to stop complaining that prior HCE is going down.... instead we need to develop systems to train great PAs just like the docs do...... residency and CAQs and then independent/collaborative practice....

 

I want to agree, I really do.

 

But the calculus of PA school, and residency as the new standard for basic PA, and I will no longer be able endorce PA over MD pathway when asked.

The payback simply isn't worth it