Ask Questions, Make Changes
Editor's Note: Below is a blog post from Bob Blumm, MA, PA-C, DFAAPA, 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.
PA specialty certification was the topic of an article I wrote for ADVANCE for Physician Assistants about eight years ago. Specialty certification puts PAs at risk of losing their ability to work in numerous practice settings.
Many have weighed in on this possible consequence of PA specialty certification, and many think there is nothing to fear. But I am most concerned about the PAs that have entered the field in the past 10 years who may never have the privilege of entering other sub-specialties. Perhaps the words of the former liaison from the American College of Surgeons, Stanton Nolan, MD, FACS, affected me more than I could imagine. When speaking of specialty certification for the PA profession, he said, "I am not sure what they will gain, but I am sure what they will lose."
As chief of cardiothoracic surgery, Nolan can practice in thoracic, vascular and cardiac surgery. But as a surgical PA, I can be in thoracic surgery one day, ob/gyn the next, general surgery the day after and orthopedics and plastic surgery at the end of the week. Whenever I want to expand my horizons and try something different, I can go to the ER or family practice. That is what I call a full professional life with the opportunity to become skilled in multiple fields.
I am going to bring up some questions from my previous article and make a few comments with the goal of challenging your thinking on this issue. We cannot afford to be apathetic and keep our heads in the ground like ostriches. Rather, we need to be proactive and write our state and specialty organizations with the purpose of voicing our opinions.
Questions from past article:
- Is the PA profession interested in the safety of the public? If so, do we think that the present caregivers who work in specialty areas are minimally educated or incompetent as compared to a PA who passes a specialty exam?
- Thinking long term, what are the possibilities of some PAs losing their jobs because they didn't take an exam?
- We know who writes, safeguards and administers the exams, and we know how often we may need to re-certify (possibility of 10 years). We also know who will become financially enriched, and that there needs to be a committee to decide on an application requirement (which has been accomplished as I write). I think well enough of the NCCPA to believe that they are not doing this for financial gain, as I was on the Ad Hoc Committee for Recertification in 2002 for the NCCPA when this idea surfaced. They can be challenged concerning a conflict of interest, although I do not think this to be the case.
- How many of the interested candidates wish to take this exam for another certificate or rating or because they may be weak in primary care? As a surgical specialist I know that I am not as strong as my colleagues in family practice, yet I do have the ability to work in this area on a somewhat lesser panel of disease entities.
- Is there a defined body of knowledge, minimum standard of education and special skill set that can be universally tested? Does this necessarily mean that they have greater competence? And how will competence be tested, particularly in an operating room?
- Will there be an expected percentage of greater outcomes or best practices that become evident because of this testing?
- Above all, there should be no statement that infers that there is no other manner in which to have the same degree of competence. This would be professional suicide for many in our profession.
These are the concerns I have heard and shared with my colleagues. I am willing to be the target of those who differ in opinion; I do this willingly for a profession I love.
Bob Blumm, MA, PA-C, DFAAPA
Past President AASPA, APSPA, ACC, NYSSPA