The current National Commission on Certification of Physician Assistants (NCCPA) alternative to Physician Assistant National Recertifying Exam (PANRE) is in its second year of its pilot program. According to the NCCPA, 18,500 PAs, or 60% of eligible PAs, have already signed up for the program.1

The program provides the opportunity for PAs to take the examination over 8 quarters with 25 questions provided each quarter. Questions may be answered on a variety of computers and devices, and participants may use resources to assist in answering the questions. Participants either have 3, 4, or 5 minutes per question. The NCCPA has an FAQ page with helpful information about the pilot program.  

The genesis of the pilot program originated from 2 distinct events. First was an effort by many PAs, including the American Academy of Physician Assistants (AAPA) House of Delegates, to propose alternatives to the cumbersome and inefficient recertification exams. Many physician recertification processes were undergoing evaluation following criticism that the exams were onerous, expensive, and did not effectively measure physician competence, similar to the complaints of the original NCCPA PANRE recertification.2 

The second event occurred when the AAPA announced that they wanted to explore working with a new recertification body as opposed to the NCCPA. Although communication became strained between the 2 groups, the NCCPA announced the pilot recertification program in 2017 to avoid severing ties with the AAPA.3


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I have been involved with the AAPA House of Delegates for many years and have been part of a specialty organization that has long proposed alternatives to the traditional recertification exam. Several years ago, the AAPA responded to concerns supporting the NCCPA moving from recertification occurring once every 6 years to once every 10 years. For PAs working in specialty areas, this primary care-centered recertification test became burdensome and unnecessary. 

As one of the 18,500 PAs who signed up for the pilot program, I still have concerns after completing the first year of the program. I salute my colleagues who are involved with the NCCPA and AAPA and their important and well-intentioned efforts to create a more relevant recertification testing tool. When things heated up between the AAPA and the NCCPA about clashing visions of recertification, both the AAPA and NCCPA did the right thing by looking for effective ways to extinguish the fire. Leadership in both organizations ultimately looked for ways to work together in finding the means to solve the problems being voiced.

A great deal of work and revisions went on to create the pilot, including the NCCPA’s working to identify “core skills.” According to the organization, these are the skills that are necessary to practice medicine in a variety of specialties.

But here’s my dilemma, and the dilemma facing many specialty PAs: I’m 1 year in on the pilot program, and while I greatly appreciate the spreading out of the questions and the ability to use other resources while testing, it still comes down to the lament of many in specialty practice. I’m being tested largely on diagnosis, evaluation, and care of primary care conditions that I’ve never dealt with and will likely never see. I’ve been a PA for almost 20 years, and while entering PA training with the clear intent of working in primary care, it turns out I’ve never worked a single day in the primary care field.  

While generalist recertification may be more relevant to some specialties, it proves to be much less relevant to others. For example, according to 2018 data from the AAPA, the top specialties for PAs are family medicine/general practice, surgical subspecialties, emergency medicine, internal medicine, dermatology, hospital medicine, general surgery, pediatrics, and obstetrics/gynecology.4 I happened to have spent almost all of my career in addiction medicine, specifically the opioid use disorder subspecialty. There are few questions on the recertification tests, alternative or traditional, that ask about the things I do on a daily basis.

There has been extensive conversation between interested parties about what the data says related to effective maintenance of competence by PAs and other medical/nursing/other providers. Some have asserted that little evidence exists of the superiority of testing vs performance of traditional continuing medical education (CME) activities, particularly for PAs in specialties. Many PA specialists assert that specialty-specific CME offers more relevance than the more generalist scope of recertification testing.

Luckily those PAs leading the AAPA and NCCPA are smart, sensitive, and curious people, and they are increasingly open to new ways of envisioning the important work of PA recertification. I’m pleased to see the way that the AAPA and NCCPA appear to be working together on what the future holds for recertification. Along with thousands of PAs in specialty medicine practice, I am keeping my fingers crossed that this partnership will yield ever-increasing relevance of recertification maintenance to PAs outside of primary care/generalist practice.      

References

1. Roberson J. NCCPA shares Q1 PANRE pilot results during AAPA 2019. American Academy of Physician Assistants. https://www.aapa.org/news-central/2019/06/nccpa-shares-q1-panre-pilot-results-during-aapa-2019/. Published June 5, 2019. Accessed April 28, 2020.

2. Landman K. Doctors revolt against medical skills tests — and rack up some wins. STAT News https://www.statnews.com/2016/05/10/doctors-revolt-moc-recertification/. Published May 10, 2016. Accessed April 28, 2020.

3. Finnegan J. A battle emerges over recertification of physician assistants. FierceHealthcare. https://www.fiercehealthcare.com/practices/a-battle-emerges-over-recertification-physician-assistants. Published July 25, 2020. Accessed April 28, 2020.

4. Wu BW. Specialties for Physician Assistants: what’s the cost to primary vare? Barton Associated. https://www.bartonassociates.com/blog/specialties-for-physician-assistants-whats-the-cost-to-primary-care. Published November 7, 2017. Accessed April 28, 2020.