In a commentary published on the Clinical Advisor website in February 2020, Jim Anderson, PA-C, MPAS, DFAAPA, accurately describes the creation of the new pilot PANRE recertification test for physician assistants (PAs).1 The article refers to the American Board of Internal Medicine (ABIM) and expresses concerns about the recertification testing program in general.2 The National Commission on Certification of Physician Assistants (NCCPA) has provided this alternative test as a pilot program, implying it is experimental, and have not yet agreed on a final passing determination for the examination.3

This leads us to question: what value is there to recertification testing at all? Is there any proof that recertification testing enhances medical care? I have conducted research on this matter for over 10 years and have found little evidence that testing changes medical care for the better.4,5 Continuing Medical Education (CME) is the only proven and published way to change medical care.6-8  An article in The San Diego Tribune by Paul Tierstein, chief of cardiology at Scripps Clinic in La Jolla, California, highlights a whole new way of certification.9 In the article, he suggests the National Board of Physicians and Surgeons do away with recertification exams and instead base certification on CME.

What Do Other Medical Boards Do?

Those offering non-examination alternatives are the ABIM, American Board of Anesthesiology (ABA), and the American Board of Pediatricians (ABP).

The ABA uses the MOCA minute, an interactive learning tool that replaces the recertification exam. The ABP provides 20 multiple choice questions quarterly. At the end of 8 quarters, test takers may drop their lowest 4 scores, which are not counted in the final score.


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Medical Boards’ Response to the Pandemic

Multiple boards of medicine have responded to the novel coronavirus (COVID-19) pandemic by announcing that no clinician will lose their certification in 2020.10 They have cancelled their certification requirements for 2020 and moved them to 2021. The American Board of Family Medicine (ABFM) released a statement that summarizes the changes due to COVID-19: “Our commitment is that no family physician will lose their ABFM certification because of the extraordinary patient care pressures associated with this pandemic. Additionally, if you are unable to participate in certification activities in 2020 because of the demands of this pandemic, it will not jeopardize your certificate or your ability to continue your certification. We do not want ABFM requirements to play any role in the decisions you need to make to provide the best personal and public health response to this pandemic. We will work with you.”10

Pass Everyone

Since there is no proof that recertification testing changes medical care, what other alternatives are there to change medical care for the better? Since CME has been proven to change medical care, test takers who do not meet the NCCPA passing score should attend CME in areas of weakness.6-8 Participants would take 25 Category 1 CME credits in weak testing areas within 1 year. These credits would apply toward recertification.

Why is this so important? First, there is no proof that the recertification exam or the pilot test changes medical care; second, PAs are critically needed in all areas of medicine; third, nurse practitioners (NPs) are not required to take a recertification exam; and fourth, crises like the opioid use disorder epidemic, high rates of obesity, as well as the COVID-19 pandemic require the full attention of PAs. To prevent PAs from practicing fully because of an unproven test is a tragedy, especially when there is such a tremendous need for PAs to provide essential medical care and bring our nation back to health.               

PAs are also needed to replace those who have left us because of the current pandemic.10 If the above recertification criteria were established, the NCCPA would appear to be innovative, creative, and an advocate for a future-centered PA workforce. If they provide a proven way to change medical care as an alternative to a pass/fail examination, the future of recertification would be changed for the better. After all, isn’t that the purpose of an experimental pilot test?

Bernard Stuetz, PA-C, MA, is Chief Delegate to the AAPA HOD, Society of PAs in Addiction Medicine and a member of the 2012 AAPA Committee Advising NCCPA on the Ten Year Recertification Program.

References

1. Anderson J. Say goodbye to high-stakes recertification? NCCPA pilots alternative recertification testing. Clinical Advisor website. https://www.clinicaladvisor.com/home/the-waiting-room/say-goodbye-to-high-stakes-recertification-nccpa-pilots-alternative-recertification-testing/. Published February 5, 2020. Accessed April 30, 2020.

2. Eichenwald K. A certified medical controversy. Newsweek. https://www.newsweek.com/certified-medical-controversy-320495. Published April 7, 2015. Accessed April 30, 2020.

3. Alternative to PANRE: A Pilot Program. NCCPA website. https://www.nccpa.net/alternative-to-panre. Accessed April 30, 2020.

4. Stuetz B. Recertification: a new model for PAs. ADVANCE for Physician Assistants.  2008.

5. Stuetz B. PA recertification and access to care. ADVANCE NP PA website. Published November 4, 2011. Accessed July 16, 2020.

6. Cervero R, Gaines J. The impact of CME on physician performance and patient health outcomes: an updated synthesis of systematic reviews. J Contin Educ Health Prof. 2015;35(2):131-138.

7. Robertson MK, Umble KE, Cervero RM. Impact studies in continuing education for health professions: update. J Contin Educ Health Prof. 2003;23(3):146-156.

8. Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep). 2007;149:1-69.

9. Sisson P. Doctor challenges how physicians are evaluated. San Diego Tribune. https://www.sandiegouniontribune.com/news/health/sdut-board-certification-paul-teirstein-doctors-2015nov14-story.html. Published November 14, 2015. Accessed April 30, 2020.

10. In Memoriam: Healthcare Workers Who Have Died of COVID-19. Medscape website.  https://www.medscape.com/viewarticle/927976?nlid=134997_3901&src=wnl_newsalrt_200412_MSCPEDIT&uac=231251AR&impID=2344371&faf=1. Published April 1, 2020. Accessed April 30, 2020.