A Viable Alternative
Editor's Note: Below is a blog post from Glen E. Combs, MA, PA-C, on the subject of PA specialty certification. Check back each Monday for a new post, and please feel free to leave comments. If you would like to contribute a blog entry, e-mail assistant editor Heather Simons at hsimons@advanceweb.com. Thanks.
When NCCPA's specialty certification becomes a permanent feature of the PA profession, our practice lives are going to be affected and our very livelihood may be threatened.
We depend on favorable reimbursement policies, hospital privileges and employment opportunities. Could the NCCPA specialty certification program affect these coveted features of the PA profession? In my opinion, the answer is clearly YES. Controlling agencies that impact our profession will take notice of this new credential and will transfer the same NCCPA gold standard afforded to the entry-level primary care certification examination - the Physician Assistant National Certification Examination (PANCE). Reference to the new "specialty certification" will be misunderstood and misplaced. It is rather unthinkable that the NCCPA would spend one dime on marketing a plan to declare that the "specialty certification" is different in quality to the PANCE. Qualifying for "specialty certification" will not be on the same level of the PANCE, though controlling agencies will assume that the specialty certification is a testament to the "specialty" PA's clinical competence. A false assumption.
Frankly, I am proud of the integrity and public service that the Commission has provided to the PA profession since its inception. For over 30 years the NCCPA has done an outstanding job in promoting the PA profession and protecting the public from unqualified practitioners. The Commission has opened doors to secure state PA-enabling legislation. It has given needed creditability to many of our congressional challenges. It is an organization that is made up of many powerful physician organizational representatives that interact and support the PA physician team concept. The NCCPA is one of the most influential PA organizations of the 21st century, and we should take pride in its accomplishments.
Furthermore, the Commission is perfectly suited for validating the entry level PANCE, but I cannot see that it has the ability or knowledge to put together a specialty examination for the identified PA groups, namely psychiatry, emergency medicine, orthopedics, cardiothoracic surgery and nephrology. It will take expert specialty clinicians to size up the individual PA specialty practice perimeters and create an exam that reflects the actual activities of specialist PAs. If even possible, exam development will cost hundreds of thousands of dollars. Getting agreement on core specialty knowledge will be a difficult and onerous task. Once the exam becomes available, specialty PAs are going to have to prepare intensively in order to pass the examination. The cut score may have to be lowered significantly to insure that the 80,000 PA examinees pass the examination in order to continue to practice in their chosen discipline. Will passing an online specialty exam prove clinical specialty competence? How will state medical boards react to a PA who has unfortunately failed this new certification examination? And, how will the exam stand up to intense scrutiny by a plaintiff's attorney in a malpractice law suit? OK, specialty PA: What makes you so special?
NCCPA no longer contracts the testing support services of the National Board of Medical Examiners. The Commission has brought the examinations, PANCE and PANRE, in-house. Taking on field testing and demonstrating the desired psychometrics needed for exam validity and reliability will be a Herculean task. Many of us are skeptical that obtaining 25 CME hours in a given specialty will have much impact on practice behaviors. Keeping patient logs is a reasonable requirement, but who will be responsible for reviewing thousands of log sheets for correctness and give feedback to the candidates?
Historically, specialty organizations have been looked upon as the gold standard for passing judgment on clinical competence of their own colleagues who are likeminded and favor the promotion of their medical/surgical specialty. These organizations are referred to as American Boards. The boards use a very extensive and scientifically-based program to distinguish a candidate who goes the extra mile and demonstrates acceptable peer review beyond basic entry-level requirements. Many of these boards require a formal accredited residency or clinical mentorship before the candidate is eligible to sit for their specialty board examinations
Setting up a viable and prestigious credentialing board to recognize a PA's commitment to learn new clinical knowledge beyond basic entry-level competencies only makes sense to me. Offering a formal twelve-month online program coupled with a practice mentor/evaluator to oversee the formal specialty education of the PA candidate should be considered as a viable alternative to the NCCPA's new specialty certification program. Using this alternative program, the PA would be allowed to make a PA salary while at the same time use the technology of distance e-learning to acquire their new credential--PA board recognition. Support for the PA's efforts to complete board recognition requirements would come from the employer.
Developing a PA specialty board that would raise the bar on PA specialty standards of care has a number of appealing features. For the lack of a name let's call this PA board the American Board of PA Practice or ABPAP. This new proposed organization would be designed to assist the PA to deliver higher care standards and add greater value while carrying out physician services. ABPAP would not be a testing agency, nor would it be a quasi-regulating organization. It could represent an institute of higher clinical learning specifically for the advancement of the PA profession. The new electronic institute would become a central depository of specialty content, evaluation methodologies and a powerful search engine that could be used to support the candidate's efforts to complete a prescribed list of learning objectives that would be required for specialty board recognition.
Patients want the best care their physician and PA can provide. Experience and knowledge is what they are counting on in seeing their providers. They want to know that their doctor and PA know what they are doing. They want assurances that the team of health care providers has the experience and ability to heal and care for their disease or condition. Most importantly, they want to be assured that the PA/physician clinical team has a record of positive outcomes. Patients could not care less if the provider has passed or failed an examination or registered 25 hours of specialty CME. Have you ever been asked what you scored on your NCCPA examinations or asked if you've fulfilled your CME requirements? I think not.
Here's the rub: 1) Where is the accountability and creditability that supports this new NCCPA PA credentialing process? 2) Will the specialty certification offered by the NCCPA demonstrate acquired advanced specialty knowledge? 3) Will it have any substantial benefit to society? 3) Is this a program that we all can get behind and feel proud of?
The creation and establishment of the American Board of PA Practice would represent a viable alternative to the presented NCCPA specialty certification program. ABPAP would be an organization run by specialty PAs for PAs whose whole purpose would be to elevate PA practice standards while promoting the PA profession from within. Demonstrating added value to PA services and a commitment to life long learning seems to me a better use of our finite resources and precious time.