Navigating the evolving PA certification process

Increased primary care demand not evenly distributed
Increased primary care demand not evenly distributed

Washington, D.C. – Helping physician assistants (PAs) wade through the most recent changes to the PA certification process was the professed mission of Greg Thomas, PA, MPH, Director of External Relations at the National Commission on Certification of Physician Assistants (NCCPA) at IMPACT 2013.

Changes to the current certification process are slated to take effect Jan. 1, 2014. Certification maintenance today consists of two components. The first part is that PAs are required to amass 100 CME credits every two years, and at least 50 of those credits must be classified as Category 1. The second component of current certification guidelines is passage of the Physician Assistant National Recertifying Examination (PANRE) exam every six years.

Clinicians currently must decide whether to recertify in year five or year six. There are two opportunities in both the fifth and sixth year to pass the PANRE. Taking the exam in year five offers more opportunities to pass and does not change the clinician's six-year cycle.

There are three versions of the practice-focused PANRE from which to choose: adult medicine, surgery and primary care. The content blueprint is the same regardless of the area chosen. “Far and away, the majority of PAs opt for the primary-care version,” Thomas noted.

Changes to the certification maintenance process

Calls for greater accountability and higher quality in health care first spurred major changes in physician certification and certification-maintenance programs, with movement away from CME towards continuous professional development.

The NCCPA felt it appropriate to consider whether similar changes were needed for PAs.  Historically, there has been a bit of a disconnect between the CME PAs complete and their clinical practice, Thomas acknowledged.

“There is no one looking specifically at what those CME credits are and whether the directly relate to what a PA is doing in practice, and this is a significant part of the rationale for why changes are being made.”

Under the new guidelines, NCCPA has since committed to defining PA competencies and then using them as the basis for a holistic review.  

“It was very obvious that our certification-maintenance process really only touched on the medical knowledge competency,” said Thomas. “Part of this new process is to do a better job of addressing the other competencies, which most acknowledge are integral to being a PA.”

These six competency areas include: medical knowledge, patient care, interpersonal and communication skills, professionalism, system-based practice, and practice-based learning improvement.

Under the new process, the intervals for PANRE recertification have been expanded from every six years to every 10 years. Additionally, 20 of the 50 required Category 1 CME credits must be “directed” CME credits that are designated as either self-assessment or performance-improvement credits.

The NCCPA defines self-assessment as “the process of conducting a systematic review of one's own performance, knowledge base, or skill set, usually for the purpose of improving future performance, expanding knowledge, or honing skills.” As such, self-assessment activities often involve a learning experience.

Performance-improvement CME consists of active learning, and applying what's been learned to improve PA practice. This can be done in partnership with a supervising physician and others in practice.

The performance-improvement process involves three steps:

  • Compare an aspect of practice to national benchmarks, performance guidelines, or other established evidence-based metric or standard
  • Based on the comparison, develop and implement a plan for improvement
  • Evaluate the impact of the improvement effort by comparing the results of the original comparison with the new results or outcomes.

“No one is looking over your shoulder,” Thomas emphasized. “This is all about letting you go through the process of reflecting on how you are practicing in whatever specific area you choose.”

To illustrate the new certification-maintenance process, Thomas broke everything down into five two-year CME cycles. During each cycle, PAs must earn 100 CME credits, including 50 Category 1 credits, with 20 credits earned through self-assessment or performance-improvement activities.

By the end of the fourth cycle, PAs must have earned at least 40 Category 1 CME credits through self-assessment activities and at least 40 Category 1 CME credits through performance-improvement activities. In the fifth cycle, there are no special CME requirements. PAs must earn 100 CME credits, including 50 Category 1 credits, and pass PANRE.

Positive implications

Changes to the certification-maintenance process proactively address higher practice standards for PAs and provide an opportunity to enhance the PA-physician relationship, according to Thomas.

Perhaps more important, the new process results in fewer exams. In a 30-year career under the current six-year cycle, most PAs will face recertification five times; the changes in the new 10-year cycle reduce that number to three.

Online practice exams are available for both PANRE and the Physician Assistant National Certifying Exam (PANCE), the test necessary to become a physician assistant.

The practice exams consist of 120 questions taken from the NCCPA test question bank and cost $35. For more details and to register online, visit the NCCPA website (www.nccpa.net).

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