Commentary

PA Specialty Certification, Inside Out

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This past month, the National Commission on Certification of Physician Assistants (NCCPA) notified all its stakeholders of a new voluntary specialty certification program for PAs in emergency medicine, orthopedic surgery, cardiovascular surgery, nephrology, and psychiatry to be launched in 2011—with the expectation that other specialties will follow. Many PAs have applauded this event; others have been critical of its potential effect on the profession.

Since I am the chair of the NCCPA’s workgroup on specialty certification and have been intimately involved for the past 3+ years with this topic, this editorial is written from that experience. As with most editorials, it is biased. A further disclaimer: These are my thoughts and experiences and should not be construed to be the policy of the NCCPA. I speak only for myself and offer my apologies to my NP colleagues for focusing on a PA-specific topic this month.

The Rationale
The starting place for our discussion at the NCCPA centered on acknowledging significant changes in the past decade within our health care system, coinciding with the growing clinical diversity of PA practice. Both of these issues indicated to the NCCPA that—after three decades of debate and discussion about the complexities and potential risks and rewards of certifying PAs in specialties—now is the appropriate time to do it.

Why? Simply put, NCCPA understands patients’ need for access to affordable, high-quality health care and believes passionately that certified PAs are integral to meeting that need. NCCPA’s responsibility in that equation is ensuring that certified PAs have the knowledge and skills to deliver the care and the documentation of their training, experience, and expertise needed to achieve and maintain their rightful place on the health care delivery team.

Of course, other environmental factors brought the issue to the forefront. It is a well-known fact that there has been a significant increase in the number of PAs practicing in specialty areas rather than primary care. At the same time, employers and governmental agencies (eg, AHRQ, NIH, IOM) are placing heightened emphasis on patient safety and risk management. State regulatory boards are taking a closer look at supervising responsibilities of physicians and the education of their PA partners. It is also clear that the complexities and increased demands of current health care practice place constraints and increased burden on supervision and other time-consuming aspects of the physician-PA relationship.

Even more compelling than those generalities, PAs in different parts of the country, in various specialties and practice settings, are increasingly facing real and significant challenges. Have you talked to many PAs practicing in psychiatry lately? If so, chances are you’ve heard about some real challenges to reimbursement. Practicing in a surgical specialty? If you haven’t been challenged to provide documentation of surgical training or expertise yourself, you probably know someone who has.

Based on the direction of health care and the rest of the world around us, there’s no good reason to think those issues are going to go away on their own. In fact, it looks more like the beginning of a new trend. Witness, for example, the significant changes that have taken place in physician certification over the past few years, as the process for maintaining certification was intensified and broadened to include a much larger spectrum of competencies and activities. This kind of trend is not something we can just continue to duck if we want to stay relevant—especially in the face of health care reform.

Decision-Making Process
With all of those issues in the background, the NCCPA created four foundational thoughts for the discussion on specialty certification. It was clear from the beginning to all parties discussing this concept that specialty recognition of any kind should be voluntary and independent of the existing generalist certification/recertification process. It was also critical that any certification program support and reinforce the relationship between PAs and their supervising physicians.

From the beginning of the discussion, NCCPA also felt it important to seek input and cooperation from all the appropriate stakeholders, particularly the AAPA and PA specialty professional organizations. (That’s why more than three years passed between NCCPA’s 2006 announcement that the organization would develop some form of specialty recognition and last month’s more detailed announcement about how the new process will work.) Lastly, and perhaps most importantly, specialty recognition must support the credentialing process while not creating barriers to licensure and practice.

By far the last issue was the most difficult to address. Opponents of specialty certification are concerned that any additional certification will create a barrier to mobility. There are also concerns that PAs who choose not to participate may find their résumés are sent to the bottom of the applicant pile. Sympathetic to these concerns, NCCPA committed to doing its part to maintain and promote the PA-C designation and state licensure as the sole “tickets” to practice by making both of those items prerequisites for the new specialty certification program.

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