The physician assistant (PA) recertification process, Maintenance of Certification (MOC), is a microcosm of the larger medical and nursing landscape. For decades, the certification model has required clinicians to take a high-stakes certification test when starting practice with repeat examinations taken every 6 to 10 years. However, a few years ago, many of the providers required to take recertification examinations to continue practicing decided that enough was enough.
There are many effective arguments against high-stake, expensive recertification examinations. While there are few data about the benefit and effectiveness of high-stake recertification examinations in gauging your ability to practice, a large body of data exist that suggest standard continuing medical education is every bit as effective in maintaining skills as studying for one gargantuan examination.
I’ve been a PA for more than 19 years, and I have yet to spend one day of practice in primary care. Instead, I’ve found myself in addiction/pain medicine for most of my career, which was completely unplanned. But that’s how it worked out, and this career path has made the high-pressure recertification examinations a nightmare for me as well as for other specialty PAs. The last examination I took was more than 6 years ago, and after spending 6 months studying all the medicine that I’ve never practiced, I walked into the examination center practically hallucinating with pressure and information overload. This added stress, magnified by the knowledge that if I failed this examination I might not be able to continue to work as a PA, was not enjoyable.
As the test began, I tried to have my game face on and feel ready to rock and roll. This momentum continued until I read the first 5 questions that listed conditions I have never heard of. “I’m toast,” I thought. “It’s over.” This is the way I have felt for every certification/recertification examination I’ve ever taken. Somehow, I’ve managed to eke out passing scores on them all.
There are many clinicians who have faced the same predicament, and many have been standing up and saying “enough.” For the past year, the American Board of Internal Medicine (ABIM) has initiated pushback for taking recertification examinations. An article published in Newsweek states, “Why should doctors be forced to keep ladling out cash and spending time away from their practices studying useless information simply because the ABIM is managerially incompetent? And when will ABIM finally start telling the truth to the doctors it supposedly represents?”1
Based on ongoing concerns among PAs, the American Academy of Physician Assistants (AAPA) has undertaken a vigorous collaboration with the independent PA certifying body, the National Commission on Certification of Physician Assistants (NCCPA), to look at possible alternatives to the 200-question examination. While from the outside it appears that some of this collaboration has been a little rocky, it has resulted in the creation of an NCCPA model pilot project that could significantly alter the PA recertification model.
Rather than going to a testing center and taking a 200-question examination once every 10 years, the model has PAs taking 25-question tests every quarter, with a total of 8 examinations completed in 2 years. Because the examination can be taken online, PAs can take the test all at once or in blocks. Test takers are also allowed to use reference material to answer the questions, although the time to answer the questions ranges from 3 to 5 minutes per question.
The pilot started in January of 2019 and will last through December 2020. Those who fail the examination will be given 1 year from that time to complete the standard 200-question recertification test.
More than 18,500 AAPA members signed up for the pilot project, reflecting a clear desire by many PAs to move to more user-friendly recertification project.2 I’m one of them, and while we’re only approaching the halfway mark through the 2-year process, I have found the pilot model to be much less stressful.
While there are many PAs who assert that the data do not support the usefulness of any ongoing recertification models, the pilot program is a big step toward rethinking the role and process of PA recertification. Once the pilot is completed, the AAPA and NCCPA will consider making these recertification options permanent, which will provide PAs who want an alternative to the 200-queston test a choice that may better fit their learning and testing style.
1. Eichenwald K. A certified medical controversy. Newsweek. https://www.newsweek.com/certified-medical-controversy-320495. April 7, 2015. Accessed October 9, 2019.
2. 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/. June 5, 2019. Accessed October 9, 2019.