The Latest on PA Certification from Mark P. Christiansen, PA-C, PhD

Presentation Outline About NCCPA The Latest on Certification Requirements Maintenance of Certification The New Specialty CAQ Program

About NCCPA Independent, not-for-profit organization Mission: To serve the public through exemplary programs that evaluate critical PA competencies and that require the pursuit of life-long learning and improvement Committed to striving for excellence in all we do, particularly in our service to certified and certifying PAs Ultimately, we serve the public

Our Board of Directors 2 public representatives, 4 PA directors-at- large and appointees from… American Academies of:  Family Physicians  Pediatrics  Physician Assistants American Colleges of:  Emergency Physicians  Physicians  Surgeons  Amer. Hospital Assoc.  Amer. Medical Assoc.  Amer. Osteopathic Assoc.  Assoc. of Amer. Medical Colleges  Federation of State Medical Boards  PA Education Association  US Department of Veterans Affairs

THE LATEST ON CERTIFICATION REQUIREMENTS

Certification Maintenance Two-Step 1.CME –100 hours every 2 years 2.Recertification exam –Every 6 years

CME Requirements The certification maintenance fee is $130, BUT… Meet the June 30 deadline, and get a $50 discount. –You’ll be paying the same $80 as always if you’re usually on time. Miss the deadline, and miss the discount. –But you’ll still pay $50 less than under the old fee schedule.

Recertification Decisions 1.Year 5 or year 6? 2.Which version of PANRE to take?  Taking the exam in year 5 gives you more opportunities to pass  Doesn’t change your 6-year cycle  Opportunity to plan around life’s events.

Practice-Focused PANRE 60% of the exam: same as always Then choose a concentration of questions in one of three areas: –Adult medicine –Surgery –General

More on PANRE Available almost year-round Practice Exams available online –120 questions taken from NCCPA test item bank –Just $35! –Great way to see how you should focus your preparation. –Get more details and register online at

Exam Content Blueprint Percentage of questions by organ system and task area Based on a practice analysis –Determines set of knowledge, skills and abilities used by PAs –Conducted every 5 to 7 years with focus groups and extensive survey research Practice analysis just completed and validated the current blueprints of the PANCE and PANRE. (No changes coming.)

TOP TEN LIST Tips for Keeping Your PA-C

1.Notify NCCPA immediately of any postal or e- mail address changes. 2.Read all NCCPA correspondence. 3.Understand the requirements. 4.“Bookmark” the NCCPA Web site, and know how to access your personal certification record. 5.Plan for life’s little surprises—don’t procrastinate!

6.Log CME as you earn it. 7.Save your Category I CME documentation. 8.Take personal responsibility for your certification. 9.Get information about certification from the source. 10.Remember that certification is often your ticket to practice—so take it seriously!

POTENTIAL CHANGES TO MAINTENANCE OF CERTIFICATION (MOC)

What is Being Considered? Existing CME earning and logging requirements Two new requirements –Self-assessment activities –Clinical quality improvement activities Extension of recertification cycle to 10 years

How It All Began Calls for greater accountability and higher quality in health care spurred major change in physician certification and certification maintenance programs NCCPA felt it appropriate to consider whether similar changes were needed for PAs—with our commitment to the public’s interest in mind We committed first, though, to defining PA competencies and using them as the basis for a holistic review of what we are and what we should be assessing

The Purpose of the Competencies Document “To communicate to the PA profession and the public a set of competencies that physician assistants are expected to acquire and maintain throughout their careers. It serves as a map for the individual PA and organizations that are committed to promoting the development and maintenance of these professional competencies among physician assistants.”

6 Areas of PA Competencies 4.Professionalism 5.System-based practice 6.Practice-based learning and improvement 1.Medical knowledge 2.Patient care 3.Interpersonal & communication skills Purpose of the new proposal is to bring in more of those other areas.

What’s Happening Now? April 2010: FSMB approved a new “Maintenance of Licensure” process for physicians defined: “The process by which a licensee provides, as a condition of license renewal, evidence that he or she is actively participating in a program of continuous professional development that is practice relevant, informed by objective data sources, and includes activities aimed at improving performance in practice.”

“Maintenance of Licensure” Intent described as: –Quality improvement and continuous professional development –Encouragement of “lifelong learning” and provision of a verifiable system of individual practice improvement efforts

“Maintenance of Licensure” Components of MOL –Self-assessment –Performance in practice (using a variety of methods to assess their performance and guide improvement) –Assessment of knowledge

What’s Next? ClinQI Pilot Project –PAs in a variety of settings and specialties, implementing ClinQI projects and providing data about their experience and the results Discussions about the potential changes will continue next year so the result of the pilot can be considered prior to policy development.

THE NEW SPECIALTY CAQ PROGRAM

Take a Guess! Today, more than of PAs are in specialty practice.

Other Things that Have Changed More focus on quality & accountability = growing demand for credentials Shortage of providers = greater demands on PAs and others More technicians are emerging to help close the gaps—PAs are looking less qualified. Today’s PA graduates have less clinical experience than their predecessors.

Ultimately, it’s all about…

The Background Years of debate culminated in a February 2006 decision to develop a new specialty program. Lots of fact-finding and discussions since then, i.e. –June 2006 meeting with 30+ PA and physician specialty groups –Meetings with four PA specialty organizations –Dec summit with specialty groups, AAPA, PAEA, ARC-PA, APPAP, & NCCPA

What Was Accomplished? All five organizations left that December 2007 summit appreciating the serious challenges facing PAs in specialty practice, agreeing that something must be done to address those challenges and that each organization in the room has a role to play. “If we don’t do it, someone else will!”

“… losing jobs to less qualified technicians.” “…need to be sure we maintain flexibility to move from one specialty to another.” “…desperate need for more PAs in this specialty.” “…got to keep costs down.” “…employers are looking for documentation of qualifications in specialty practice.” “…be sure PAs are able to be part of the solution to our health care system challenges.” “…need more education for PAs entering specialty practice.” “…no new barriers to practice.” We Heard…

SPECIALTY CERTIFICATION IS NOW SPECIALTY CAQ?

Key Principles of the Specialty Program NCCPA (and many stakeholders) agree that the PA-C must maintain its position as the primary credential for all PAs. As PAs fill varied roles across specialties, the program has been developed to be as inclusive as possible, recognizing the individual differences among and within specialties. NCCPA has remained committed to developing a specialty program that would be voluntary.

The Problem with the Specialty Certification Label We had good reasons to choose the specialty certification label, but… Recently we were presented with hospital credentialing forms that specifically asked: “Is certification available in your specialty?” We realized that the label itself was going to cause some to begin to require it.

Why We’re Happy with the CAQ Name Emphasizes that the specialty credential is achieved in addition to the PA-C Emphasizes that PAs are grounded first in generalist medicine and then pursue additional qualifications in specialties Avoids confusion that may have been created by the addition of a new PA “certification” program and a new specialty certification designation

Obvious why PA-C is important. The Case for Licensure: 1.It addresses the area of professionalism, one of the six areas of core competency as defined in Competencies for the PA Profession. 2.It parallels ABMS requirements. 3.It pre-empts state boards from requiring our specialty certification for PA licensure. That is key to maintaining PAs’ ability to move between specialties during their career. Basic Prerequisites: Unrestricted License and PA-C Certification

Specialty CAQ Process License + PA-C CME, Experience, Cases and/or Procedures Specialty Exam Maintenance Process: 75 hrs specialty CME 6 years to finish 6-year CAQ cycle

It’s Not “One-Size-Fits-All”

Variations Among Specialties in the Areas of… CME requirements (i.e., ACLS is required for some but not all, recommendations re: other topics) Experience (ranges from 1 year to 2 years) Specific procedures/cases that PAs should have experience with or knowledge of Details by specialty available at

What Specialties? Factors Considered: Population Size Assessment of Need Focus on Procedures Criticality of Patients PA Mobility Trends Support of PA Specialty Org Degree Specialty is Hospital-Based Still not an easy decision, but we knew we had to start somewhere.

What Specialties? Emergency medicine Cardiovascular & thoracic surgery Orthopaedic surgery Nephrology Psychiatry

Thanks! Questions?