The study went on for two years and had two very heated sides of the debate. The problem: Many older PA’s were struggling to pass their PANRE. Changes over the years in the medical model that Physician Assistants operate under as well as specialization in medical niches lead to the long standing debate. Some believe that older PA’s were just lazy and should be expected to retain a basic level of knowledge regarding all medical specialties. Seeing as the body is a dynamic chemical system this appear to be logical. On the other side of the argument, why even have a re-certification exam at all? Isn’t every single work day a re-certification exam? Don’t PA’s prove their worth on a patient by patient basis? If a PA is consistently under performing due to lack of medical knowledge THEY WILL BE FIRED (I hope that every hospital in the nation would adhere to this policy.. but you never know)
The Older the PA the More Senile? Specialized
As an employee of a company the provides a PANRE Review Course, I have spoken to dozens of PA’s who have struggled to pass their PANRE exams. Those who were struggling tended to be within 5 years of retirement, members of a specialty, and a bit salty about having to study for a broad review exam which was largely unrelated to their daily work lives. Additionally, every single PA that I personally spoke to over the phone did not attempt to take any review course until after failing the first time. I would like to point out however that this cohort may not be fully representative of the whole. Most PA’s that I spoke with only called NPAE because they didn’t know how to operate a computer well enough to purchase and log into our course.
The Proposed PANRE Model
The uproar from frustrated and failing PA’s finally caused got so bad that the NCCPA finally addressed it. After a typically lengthy review they began releasing statements that they probably might soon possibly do something about it. A proposal for an updated PANRE model was released in November of 2015 in which in lieu of the PANRE PAs due for recertification would have to take:
- A closed book specialty exam -and-
- a series of several take-home exams -or-
- Complete other “new requirements” during each 10-year certification period.
The NCCPA additionally announced their intention to refocus the main content of the PANRE exam towards “core knowledge”.
What the NCCPA Decided
In short: To keep the PANRE but modify its content to focus on extremely generalized medicine. They scrapped all other proposed amendments.
Remember, the NCCPA has its own motivations in addition to those of the general PA community. Specifically, as an authority in the Physician Assistant realm the NCCPA (just like any other business- for or non-profit) intends to keep its authority. For them, the question of how will this benefit the PA community is just as important as how ticked off will the community be if we take X action. needs to be justified alongside a cost-benefit analysis and feasibility study. In the end, the NCCPA is there to help you and is doing a fantastic job in doing so. Incredibly, the NCCPA did admit in a press release (excerpts below) that the survey was biased in favor of accepting the proposal and hinted that a group of those in favor of redesigning the re-certification process are bringing a great deal of negativity to the debate and profession. [Interpretation from a 6 year old- a bunch of people who failed their test are complaining rather then taking responsibility]
The following is taken from the Press Release “The Proposed PANRE Model – Issues and Answers” released by the NCCPA:
We appreciate the importance of protecting PAs’ flexibility to change specialties or to work in multiple specialties. We believe that by maintaining the PA-C as a generalist credential – on the strength of the core medical knowledge exams – this model would preserve that flexibility, and those who base hiring or credentialing decisions on the generalist PA-C would continue to do so. Remember: this is not a specialty certification program, just a new way to maintain the same generalist PA-C credential you already have. NCCPA continues to seek data and other factual information related to this question or concern.
That’s true; it would not be feasible to develop exams in every specialty and sub-specialty in which PAs practice. However, depending on the array of specialties ultimately selected if this proposal goes forward, we expect that the options would cover 70% or more of PAs’ primary practice area (as reported by PAs through the NCCPA PA Professional Profile) and a higher percentage if you factor in secondary practice areas for those who work in multiple specialties. In the proposal, all PAs would have a much broader array of options to choose from, with the opportunity to pick from a menu of exam options the one that aligns best with their current practice, with another area of experience and expertise, or the one that most closely approximates the content of today’s PANRE (the family medicine option). In any case, this approach would give PAs the choice to focus their exam preparation on a narrower range of content than they must prepare for today. We anticipate expanding the menu of exam options over time.
PAs were involved in the development of this model (by the tens of thousands, including those who participated in the two profession-wide surveys NCCPA conducted last year), and NCCPA remains committed to obtaining PAs’ perspectives as it is being considered by the Board of Directors. The primary reason for launching and extending a public comment period is to inform the NCCPA Board’s decision about whether to make these or other changes to the recertification process. We have invited feedback at firstname.lastname@example.org since December and launched a profession-wide survey on February 10. We recently extended the public comment period for three more months to June 15 to ensure all PAs have the opportunity to provide input into the proposed model. We trust that this demonstrates our commitment to an honest dialogue where all PAs have the opportunity to provide constructive feedback and better inform consideration of the proposal to change the existing PANRE process.
This is simply not true. As a certification body, our duty is to provide assessments that are relevant, meaningful and valid. Central to the ability of any certification body to do that is regular and ongoing study of the current state of professional practice. With data showing that almost 75% of PAs now practice outside of primary care, NCCPA conducted a profession-wide study in 2015 that probed deeply into the nature of practice across and within primary care and other specialties. Over 70 PAs across a breadth of specialties, including those in primary care, contributed to the development of the survey instrument, and over 16,000 PAs participated in the survey (thank you for doing that). That study showed that PAs practicing in specialty areas are providing specialty care, doing different things than those in primary care or in other specialties. That is a key evidence base used to inform the development of this proposal. There is also a considerable body of research (search “testing effect”) that supports the value of testing as a means of enriching the learning process and improving knowledge retention. There is also a sizeable body of literature (search “spaced education”) that supports the value of testing more often in smaller increments for better accuracy and long-term retention. That research informed the design of the core medical knowledge, take-at-home component of the proposed model. We have more on this topic on our website. As in medicine, new findings and technology also change the practices of education and assessment. We will continue to study those findings, conduct research of our own, and look for ways to improve the certification process for PAs over time and ensure that it continues to keep pace with changes in PA practice.
As part of consideration of this proposed model for recertification, the NCCPA Board will also consider all other requirements for certification maintenance. That’s why we included questions related to CME requirements on the PA survey being conducted in February-March 2016. Ultimately, the goal is to arrive at a certification maintenance process that includes activities and exams that support and provide an externally validated measure of maintenance of a relevant body of knowledge, skills and abilities while minimizing the amount of time PAs will need to put into demonstrating they have the competencies necessary to provide high quality and safe patient care. Our ultimate goal is to help ensure that every PA has demonstrated the current, relevant knowledge to provide the care patients need and deserve. In terms of the current MD and NP processes, we have the utmost respect for our physician and NP colleagues, but our focus is on providing a valid and reliable certification process for the PA profession, PAs and their patients, not just now but in the future. In addition, it is our hope to lead in the area of recertification, not to follow, which is what the PA profession has done since its inception as the first group of professionals to practice medicine other than our physician colleagues. In this era of greater transparency and accountability, the need for some form of external validation of abilities is not likely to diminish; we are working to make it as relevant and meaningful as we can while balancing issues of time and cost.
We appreciate that the amount of time required to fulfill certification maintenance requirements is an important factor. The take-at-home exams would be educational in nature, providing not just an assessment but a learning opportunity. They would be taken over a matter of months and would not be designed to require research. In addition, directed (but not additional) CME would allow PAs to remediate without retesting. As for the specialty exams, they would also be shorter than the current PANRE and would allow many PAs to focus exam preparation on the practice area with which they are already most familiar. This should reduce the time and cost of preparation for that exam.
The Board of Directors considered six potential recertification models (all of which were influenced by earlier PA input), including the current PANRE. This survey is focused on the one selected for further exploration because its purpose is to elicit feedback on this model. Some seem to have expected a simple vote up or down on the proposed model. That would not give us insight into the preferred and less favored elements in this proposal, nor would it give us the additional PA input we need to finalize some of the details of what this new model would entail, if approved. (For example, the frequency/ length of the take-at-home exams is something we are soliciting PA input on through this survey. We are also looking for insight into what exam option PAs would select, not presuming that everyone would necessarily choose to test in their current practice area.) The last section of the survey does include the question: “Given the description of the proposed model for recertification, which recertification process do you prefer? PANRE in its current form, proposed model, or no preference.” We also included an open-ended comment box at the end for free expression of opinions and other ideas.
We trust that most certified PAs understand NCCPA’s duty and the intent of the survey and will provide meaningful responses. We will publish a report on the survey results.
We couldn’t agree more, and it concerns us. Our approach has been – and continues to be – to work to inform collegial dialogue about this issue. We encourage those who disagree to channel their effort and energy into proposing alternative solutions to the challenge of (1) updating the recertification exam process to reflect PAs’ clear movement outside of primary care while (2) maintaining the generalist nature of the PA-C credential. We believe this proposed model accomplishes that in a way that offers many other benefits to certified PAs while also serving the public’s interest well. We encourage those with other ideas that achieve those ends to share them with us during this public comment period.
In my opinion the NCCPA did a great job listening the PA community at a time that some members felt betrayed. If the reasons for denying change are further backed up through the publication of the survey results, this was an incredibly thoughtful, logical, and respectful response to the community’s concern. The NCCPA appears to have taken these concerns seriously by conducting a thorough and non-biased review then promptly slamming the gavel and screaming “We told you so”. Given the eloquently vindictive tone of the NCCPA’s press releases as of late- they are either a bunch of English speaking perfectionist robots or they had a PR firm/professional writer author their statements while they riled in the background.
Update: I was right. Greg Thomas PA MPH serves as directer of external relations for the NCCPA and is the brain behind this Shakespearean-passive-aggressive-slander-compliment slash “We told you so” tone of writing. I wish I could write like you sir.