Physician assistants work in a profession that prides itself on constantly evolving to be the best it can be. There’s been a lot of buzz in the news lately about the National Commission on Certification of Physician Assistants (NCCPA) – specifically, that the NCCPA is considering changing the way that physician assistants are recertified.

Currently, depending on when we were last certified, a PA has to recertify by taking a single 300 question test every 6 to 10 years. On the surface, I love this idea. When the time comes, PAs can study for the test, take the test, and then not worry about the test for years to come. But, when I really think about this concept, I can see that it’s fairly flawed. As physician assistants, we’re required to recertify by taking a test that’s based on primary care medicine, but according to the NCCPA, 75% of physician assistants aren’t practicing in primary care.[1] Therefore, we’re spending valuable time and money to study for a test that’s not relative to our practice on a daily basis. It’s a backwards idea and, in reality, makes no sense. Fortunately, the NCCPA has set out to improve this flaw.

Recently, the NCCPA sent out surveys asking PAs for our opinion on the test. These surveys include proposed models of recertification. The proposed NCCPA models are really interesting, and they all share the same general idea: more frequent testing coupled with shorter tests. Every physician assistant would be required to demonstrate they have “core medical knowledge” by completing at-home tests distributed throughout the 10-year recertification period. How frequently we would be required to complete these tests is still to be determined. This is a very interesting concept, but I’m torn as to how I feel about this.

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On one hand, I love take-home tests and the idea that I can look up any answer I want by any method possible. While working in the emergency department, clinicians are constantly looking things up to refresh our knowledge or answer a question that arises. Therefore, I don’t foresee any problems with this take-at-home concept. On the other hand, the morality police living inside me questions this idea. If these questions cover core medical knowledge, shouldn’t we be able to demonstrate our ability to correctly answer questions on this topic without having the ability to look the answers up first?

The proposed model also includes the requirement to complete a recertification test that is timed, proctored, and held at a secure testing site. Similar to the old model, these tests would be completed in 10-year cycles. However, each PA could select the type of test they would like to take. The tests would be more specialized, and PAs could choose from approximately 10 to 12 options. I am totally on board with this concept. I’ve often felt that the time and effort being put in to refreshing ourselves on questions that are based on family medicine is a lost opportunity to refresh ourselves on information that is more central to our area of specialty.  If we are going to spend all of this time studying, why can’t it be on information that we will actually use?

Another interesting idea is that the pass/fail testing model will be replaced with different levels of aptitude. A PA could fail the test, but would have the option to take required, remedial CME courses in areas of weakness. A high enough score would satisfy the requirements for a Certificate of Added Qualification (CAQ). The concept of taking remedial CME courses forces clinicians to study and improve on their weakness; instead of re-studying a broad area of information we’re given the option to target the areas we need to focus on.  

The CAQ could bring up some interesting changes as well. As of now, I don’t know anyone that has sat for this test. I don’t have a reason to sit for it myself, because it doesn’t change how marketable I am at this time, and I don’t feel like spending the money if I don’t need to. However, under the new testing model, automatically qualifying for the CAQ without having to take an additional test for it will create a whole new group of CAQ PAs. In the future, employers may require that you achieve this level before being selected for their practice. This could create a new level of competition, and it will be interesting to see how this evolves in the next couple of years.

If the NCCPA does incorporate this new model, another question to consider is whether or not it will the change the Physician Assistant National Certifying Examination (PANCE). When I went to PA school, our common core of knowledge was focused on primary care medicine. Every test we took was given in the PANCE format in order to familiarize us with the process. It will be interesting to see if the PANCE remains the way it is – being primarily family medicine based – or if any changes will be made. The PANCE provides such a wide breadth of information that it is a good starting point for all physician assistants. Also, I think it is important to have a single test for which to compare all new physician assistants. I hope the PANCE remains the way it is.

One of the most exciting aspects of being a physician assistant is the fact that we do not have to be board certified in our area of practice and can start a new career at any time. Will this new model make it more difficult to switch specialties? Will employers only accept you if you have been certified in their area of specialty? Unfortunately, I think this is a situation where only time will tell.

In conclusion, I really like the idea of having specialized recertification tests. As with any large change, I think that there will be a lot of problems that arise that will need to be ironed out along the way. This may alter the way PAs change areas of specialty, create a new set of requirements for employment, and even change the way PA schools are formatted. The first set of tests may turn out to be a complete disaster if we don’t know what type of questions to expect. These changes bring about excitement and concern, and also raise a lot of questions. We are extremely fortunate to be in a unique profession where our leaders are listening to us and want our opinions on the matter. Although it’s impossible to create a change that pleases everyone, the NCCPA is trying to change in a way that is beneficial to the most people possible.  Being in a profession that is striving to make us the best we can be is one of the reasons why I love being a PA.

Jillian Knowles, MMS, PA-C works as an emergency medicine physician assistant in the Philadelphia area.


  1. New PANRE model being explored [news release]. Johns Creek, GA: The National Commission on Certification of Physician Assistants. Accessed March 9, 2016.