PA recertification debate rages on

Upon completing an accredited physician assistant (PA) program, PAs must pass a certification examination in order to become licensed to practice. Those who pass the Physician Assistant National Certifying Examination are issued the Physician Assistant—Certified (PA-C) credential by the National Commission on Certification of Physician Assistants (NCCPA). All states require PAs to be initially certified by NCCPA in order to practice. However, like physicians, recertification is a gray area.

As of 2014, recertification is required every 10 years, which aligns with most physician recertification exams. Before this, it was required every six years. This cycle is broken into five, two-year periods in which PAs must earn a minimum of 100 credits of CME, including at least 50 Category 1 CME credits. At the 10-year mark, PAs sit for a recertification exam—the Physician Assistant National Recertifying Exam (PANRE). The multiple-choice exam tests general medical and surgical knowledge.

“I think the 10-year mark is a good mark. You don’t want to be burdensome; you don’t want to make the profession inaccessible. A 10-year interval is consistent with our physician colleagues in terms of their recertification period,” says Dawn Morton-Rias, Ed.D, PA-C, president & CEO of theNCCPA.

Recertification is not required in all states to maintain PA licensure. Twenty-two states currently require it, including three states that only require it for osteopathic or prescribing PAs.

“What I think is interesting is the number of PAs who maintain certification regardless of what the law is in their state,” says Morton-Rias. “I think they do that because employers, insurers, and payers require it. They want to know that the PAs they are hiring have obtained the highest credential possible in their profession and they have demonstrated that baseline competency. The recertification process is rigorous and credible and is required by many employers, and I think that is quite appropriate.”

The recertification process has been met with some opposition, including from the American Academy of Physician Assistants (AAPA).

“Just as in the physician world, several groups have questioned whether high-stakes testing is the best option, as opposed to other education and assessment requirements. There is more understanding of the options available and high-stakes testing is just one option, and perhaps not the best,” says Ann Davis, MS, PA-C, vice president of constituent organization outreach and advocacy for AAPA.

“The goal of certification is to assess and demonstrate competence,” says Daniel Pace, chief strategy officer/vice president of education and research for AAPA. “There are ways you can assess that the competence is being maintained that are not quite as punitive and provide more opportunity for development.”

Morton-Rias describes the goal of certification differently. “Certification ensures that PAs are staying up-to-date on medical knowledge and serves as an objective measure to patients, employers, and others that those who maintain certification are keeping up with changes in treatment options and standards.”

The argument over high-stakes testing is also being debated among the physician community, most notably among the American Board of Internal Medicine. Detractors of the internal medicine recertification process argue that the test covers areas of internal medicine that a physician may no longer practice. A similar argument has been posed in the PA community, since the recertification exam is based on general clinical knowledge and PAs have the ability to practice in a variety of specialty areas. According to Morton-Rias, more than half of PAs have reported changing disciplines during their career. However, she sees this as a reason for general recertification.

“There is a body of literature that supports the notion that we lose it over time and if you don’t use it, you lose it. Nobody wants to admit that. Our fund of knowledge degrades as time goes by and that is compounded by some of our practice areas; if you are not practicing in certain areas, that information may become even more remote to you.

“There is also literature that points to the benefit of recertification processes that are active, that involve assessment, and the outcomes that are achieved from those activities. If I have to study for a test, and spend three months of fairly consistent review, that matters. That makes a difference in what I have readily available in my mind as I see patients, and that translates to good care.”

Pace disagrees, saying that there is no evidence that indicates mandatory recertification testing has a positive impact on patient care or patient safety. “While studying for a recertification exam may increase what a PA has in their mind when seeing patients, the content they must study to do well on these recertification exams is often 18-36 months out of date. Compare that approach to the now common clinical activity of simply looking up the most current information at the point of care via EMR or smartphone apps.”

Morton-Rias, who is a certified PA, has gone through the recertification process. She is the first president and CEO of NCCPA who is also a PA. She admits she has a unique view of the recertification process: She is responsible for the NCCPA organization and PA profession on a macro level, but she also understands the perspective of the busy PA who does not want to, after a day of working, go home and study while trying to take care of a family or have a personal life.

NCCPA is working to transition PANRE from a broad-based, generalist exam to a core knowledge exam, narrowing content to that which all PAs should be expected to maintain in any area of practice.

Source: CRC News & Analysis