Statement by Josanne Pagel following NCCPA’s November 18th PANRE Proposal Communication
On November 18, 2016, NCCPA announced that it had finalized its plans for modifying PA maintenance of certification requirements. It has discarded its proposal to require PAs to take a closed-book, proctored exam in a specialty area, as well as its plans to introduce either several take-home exams or other new requirements during each 10-year recertification cycle. NCCPA also announced its intention to modify the PANRE exam to focus on “core knowledge.”
We are grateful to the many PAs who have made and continue to make their voices heard on this issue. On their behalf, AAPA welcomes NCCPA’s decision to abandon some of the most onerous parts of its recertification proposal. But we continue to oppose high-stakes recertification exams.
AAPA opposes re-testing because there is no evidence that it improves patient outcomes or safety. We urge NCCPA to conduct research on the impact of PA recertification exams on patients.
In the meantime, we will redouble our efforts to remove state laws and regulations that require current NCCPA certification for license renewal. If we can change these provisions, at least PAs will not be at risk of losing their license if they fail NCCPA’s high stakes recertification exam. We have already contacted the State Chapters in the 20 states where this requirement exists, and we encourage you to join your State Chapter and help us work on this issue.
We continue to examine the feasibility of starting a new recertifying organization, and we look forward to a robust conversation on this topic with PAs at AAPA’s Leadership and Advocacy Summit (March 4-5) in Washington, D.C.
NCCPA Revises Potential Changes to the PA Recertification Exam
September 19, 2016
NCCPA advised AAPA, PAEA and ARC-PA at our meeting in Atlanta on September 6 that it is considering an alternative to its previous proposal for recertification testing. NCCPA did not ask the organizations present to endorse its proposal, nor did we offer to do so. We – AAPA, PAEA and ARC-PA – agreed to give NCCPA time to make an official announcement to the PA community before reaching out to our respective stakeholders. NCCPA distributed the alternative they are currently considering by email to PAs on September 9. Over the coming weeks, AAPA’s board will evaluate the new NCCPA proposal in light of AAPA policy, the views of our constituent organizations (COs) and those of individual PAs.
Listening to and being responsive to our membership is at the heart of AAPA. We will continue to provide transparency in our decision-making and actively seek the opinions of PAs and COs. Please continue making your voices heard by posting your views of the NCCPA alternative on our Facebook page, Twitter #PARecert or in Huddle. You can also send us your views by emailing AAPA at this address: firstname.lastname@example.org. We also encourage you to share your views directly with NCCPA.
AAPA’s House of Delegates Opposes NCCPA’s Recertification Exam Proposal
AAPA’s House of Delegates voted overwhelmingly to oppose the National Commission on Certification of PA’s (NCCPA) proposed changes to the PA recertification process. Studies show that recertification testing doesn’t improve patient outcomes or safety. The House of Delegates also passed a resolution urging NCCPA to maintain its current national recertification examination process until “representatives from the AAPA and NCCPA can agree on one that both demonstrates competency and comprehensively represents the needs of PAs in all practice settings.”
NCCPA’s proposal includes a proctored, closed-book exam in a specialty, as well as two or three take-home exams during every 10-year recertification cycle. AAPA delegates agreed that these exams would take valuable time away from patients and discourage PAs from staying in a profession that is in high demand. Further, the NCCPA specialty testing requirement would force PAs to choose a specialty and undermine their unique ability to fill care gaps in hospitals, health systems and communities.
PAs are experts in general medicine. They undergo rigorous medical training in the classroom and in clinical settings. PAs must graduate from an accredited PA program and take a test in general medicine in order to be licensed and certified. Like physicians and NPs, PAs must complete extensive continuing medical education throughout their careers.
AAPA stands firmly with other medical professions against recertification testing. A growing number of physician organizations, including the AMA, reject recertification testing as unnecessary and overly burdensome. AMA called these recertification exams high stakes, because “failure to pass can result in a physician's loss of privileges or employment” – a consequence that every PA also faces, along with putting their PA license at risk in 20 states. At least 19 state medical associations have adopted resolutions similar to AMA’s, thanks in part to an organized campaign of opposition to such maintenance-of-certification exams.
AAPA does not oppose initial certification testing of PAs to obtain a license and ensure the highest standards of patient care. At the same time, PAs should not be singled out. PA maintenance of license requirements should mirror those of MDs, NPs and pharmacists, who are not required to take exams to retain their licenses.
A – AAPA believes NCCPA’s recertification testing proposal is unnecessary and overly burdensome. There is no evidence that recertification testing improves patient safety or outcomes, and the additional testing proposed by NCCPA could reduce patient access to care.
Q – What are some areas of potential agreement between AAPA and NCCPA?
A – AAPA would welcome working with NCCPA to provide tools for PAs to better understand what continuing medical education (CME) they and their patients might benefit from.
Q – What specifically does AAPA object to about NCCPA’s recertification testing proposal?
A – PAs’ first priority is their patients. AAPA opposes recertification testing because it has not been demonstrated to improve patient safety or outcomes. NCCPA’s proposed new testing requirements would also likely reduce patient access to care, because they would require PAs to spend even more time preparing for and taking exams instead of caring for patients. What’s more, recertification testing is unnecessary, since every PA already undergoes rigorous medical training to obtain their license and must complete continuing medical education throughout their career in order to keep their license to practice.
Q – What does AAPA believe when it comes to testing and recertification?
A – AAPA does not oppose testing for initial certification and licensing.
We oppose recertification testing because it takes valuable time away from patients and doesn’t improve patient outcomes or safety. We are particularly concerned about requirements for specialty testing because this would force PAs to choose a specialty and undermine their unique ability to fill care gaps in hospitals, health systems, and communities.
Like physicians and NPs, PAs must complete extensive continuing medical education throughout their careers – and AAPA supports those requirements. We would also support the use of other evidence-based alternatives to testing for recertification. For example, we think that NCCPA should consider recognizing, for recertification purposes, the completion of competency evaluation programs at hospitals and other institutions that credential and privilege the medical professionals they employ.
Q – Most MDs have to take exams to recertify. Why shouldn’t PAs be held to the same standard?
A – Physicians may choose to certify and recertify in a specialty area. Whether they choose to certify or recertify in a specialty area does not affect their license to practice medicine. Even so, many physician specialty certifying organizations are actively reconsidering whether to continue to require a “high stakes” recertification exam, for many of the same reasons that AAPA objects to the NCCPA recertification exam requirements.
And the fact is, among MDs, PAs, NPs, and pharmacists, PAs are the only ones that are required to recertify in order to retain their license to practice or prescribe in 23 states. Those are truly high stakes exams.
Q – Has AAPA created a new certification organization?
A – We have not. The Board has asked that staff investigate the business and financial requirements to create a new certifying organization.
Q – Will AAPA create a new certification organization?
A – We do not know. The AAPA board has requested additional information before it makes a decision about whether to do so.
Q – What actions has AAPA taken toward creating a new PA certification group?
A – AAPA’s Board of Directors voted in July to gather more information about the business and financial requirements for establishing a new certifying organization. This process is in the early stages.
As your advocate, AAPA is already taking steps to examine and respond to this proposal. To ensure that the collective voice of the profession is accurately represented, all PAs need to get informed and join the conversations that will culminate at the AAPA House of Delegates meeting in May.
We ask that PAs nationwide take the following steps now:
- Using the resources on this site, inform yourself about:
- NCCPA’s proposal
- AAPA’s actions to advocate for evidence-based methods to assess competency
- AAPA-hosted discussions that have already taken place
- Resources to help PAs and COs develop comments and responses to the proposal
- The potential risks to PAs and the potential impacts on both healthcare access and costs
BACKGROUND: AAPA and NCCPA Roles
As the national organization that advocates for the PA profession, AAPA represents the collective voice of PAs, and interacts with other organizations who make decisions that impact how PAs practice medicine.
NCCPA, the national certifying body for PAs, is one such organization and they are responsible for administering the PA certification and recertification exams. In November 2015, NCCPA made public its proposal to change the PA recertification exam process – a transformation that would be a seismic shift for PAs.
OVERVIEW: NCCPA Recertification Exam Proposal
According to the NCCPA proposal, to maintain certification, a PA will be required to take the following exams:
- Core medical knowledge would be assessed during every 10-year cycle through periodic take-at-home exams.
- Specialty-related knowledge would be assessed through a secure, proctored, timed exam during the final years of every 10-year cycle.
- 10-12 specialty exam options would be offered, including family medicine (which would approximate the current PANRE in terms of breadth of content for those who prefer a general exam).
- Scoring of the specialty exam would include four possible levels:
- The choice of specialty exam completed will be visible only to the PA on the exam score report.
- All PAs would continue to be certified as generalists with the PA-C credential, regardless of which specialty exam is taken.
On May 16, 2016, the final day of its meeting, the AAPA House of Delegates (HOD) expressed its opposition to the National Commission on Certification of PAs’ (NCCPA) proposed changes to the PA recertification process, overwhelmingly passing the AAPA Board-submitted resolution (B-01), “Elimination of High Stakes Recertification Testing for PAs.” The NCCPA’s proposed new model would include in the recertification process a proctored, closed-book exam in one of 10-12 specialty areas as well as periodic take-home exams during the 10-year recertification cycle.
The House also passed two related resolutions, one endorsing the Federation of State Medical Boards’ maintenance of licensure principles, and one urging NCCPA to maintain its current national recertification examination process until “representatives from the AAPA and NCCPA can agree on one that both demonstrates competency and comprehensively represents the needs of PAs in all practice settings.” Several other related resolutions were rejected, in most cases because their intent was already captured in the Board resolution.
In an unprecedented move, NCCPA Board Chair Denni Woodmansee, MS, PA-C, was allowed to address the House from the podium prior to the start of the reference committee hearings on the issue, to present NCCPA’s rationale for the proposed changes (the presentation may be accessed here and the testimony may be accessed here). He received a respectful and collegial reception from the delegates.
The House action follows several months of interactions between AAPA and NCCPA on this issue, since NCCPA announced its proposed new recertification model in November 2015. AAPA has been proactive in providing information to PAs on the proposal and its implications, as well as analyses of NCCPA’s survey and the supporting literature it cited in support of the proposal.
“We believe that the balanced information and resources we have proactively and consistently provided about the proposal have resulted in an educated and collegial conversation on this important matter among PAs across the country, and that the House of Delegates appropriately reflected the views of its constituents during its deliberations,” said AAPA President Jeffrey Katz, PA-C, DFAAPA.
A timeline of actions on this issue, as well as copies of communications, AAPA analyses, and letters from AAPA constituent organizations, can be found in the AAPA News Center: NCCPA’s PANRE Proposal.
AAPA’s opposition to the NCCPA proposal centers on concerns that it would threaten the clinical flexibility of PAs and detract from patients’ access to care by taking PAs away from their practice to study for and take unnecessary exams. During testimony on the resolution, AAPA Board member William T. Reynolds, Jr., MPAS, PA-C, DFAAPA, said, “It is the view of the Board that these proposed requirements, particularly when coupled with the CME requirements already in place for PAs, are unnecessary and potentially harmful to patients and PAs.” A copy of Reynolds’ prepared remarks can be found here.
The Resolution passed by the House of Delegates included six statements of AAPA policy:
1. AAPA supports assessing general medical knowledge for initial certification and licensing of PAs.
2. AAPA supports the use of evidence-based alternatives to testing for maintenance of certification.
3. AAPA opposes any requirement that PAs take a closed-book, proctored exam in a specialty area for maintenance of certification.
4. AAPA opposes any requirement that PAs take multiple examinations during a 10-year recertification cycle.
5. AAPA supports uncoupling maintenance of certification requirements from maintenance of license and prescribing privileges in state laws.
6. AAPA urges NCCPA and the NCCPA Foundation to undertake rigorous and replicable research to determine the relationship, if any, between taking the NCCPA recertification test and patient outcomes, safety and satisfaction
NCCPA’s public comment period on its recertification proposal ends on June 15. In February, NCCPA agreed to postpone this date in order to allow the HOD to debate the issues and take a position on the matter. No date has been announced for NCCPA’s decision on its proposal.
AAPA will continue to closely monitor NCCPA’s actions on this issue, strongly advocate against adoption of the NCCPA proposal to change the recertification exam process, and take any action necessary to protect patient access to medical care and the flexibility of the PA profession.
Eight separate resolutions regarding the NCCPA proposed recertification model have been submitted for discussion during the AAPA House of Delegates (HOD) on May 14-16, 2016 in San Antonio. AAPA members can access each of the resolutions through the links below.
- 2016-B-01-BOD Elimination of High Stakes Recertification Testing of PAs
- 2016-B-02-RI PA Licensure
- 2016-B-03-OH Maintenance of NCCPA Certification
- 2016-B-04-RI Maintenance of Licensure
- 2016-B-05-NY NCCPA Recertification Examination
- 2016-B-06-OH Elimination of the NCCPA Recertification Exam
- 2016-B-07-SPAAM Certification Model
- 2016-B-08-RI Use of Proper Terminology Regarding PA Certification
The 275 elected HOD members, representing 92 PA organizations, including PA specialty organizations, AAPA state and federal service chapters, PA caucuses, and the Student Academy, will deliberate and determine the AAPA Policy on the issues involved.
We will post any resolutions the HOD passes on the News Center following the meetings.
NCCPA Comments to HOD
BOD Comments to HOD
AAPA's Legal Counsel's Letter to NCCPA
On June 2, AAPA’s legal counsel submitted a letter to NCCPA to further inform their deliberations regarding their proposal for the PANRE.
AAPA President Letter to NCCPA Leadership
AAPA President Jeff Katz letter to NCCPA leadership regarding AAPA’s House of Delegates Resolutions.
AAPA Response to NCCPA May Document Release
In NCCPA’s May 10, 2016 release of additional information regarding its recertification proposal, NCCPA has unfortunately distorted the AAPA Board’s position, as well as the results and conclusions of research studies and literature reviews, and released an inadequate report on results of its survey.
AAPA Communication to the Federation of State Medical Boards (FSMB)
AAPA shares concerns about NCCPA recertification proposal with FSMB in advance of the organization’s conference the week of April 25, 2016.
AAPA Addresses NCCPA Queries
AAPA expresses appreciation to NCCPA for agreeing to extend its consideration of the proposed PANRE recertification changes, so that they can hear from and take into account the voice of the elected representatives of PAs who will gather in May at the AAPA House of Delegates meeting. AAPA also addresses specific queries NCCPA posed in their February 16 communication.
AAPA Request of NCCPA
To enable the PA profession’s representative body – the AAPA House of Delegates – the opportunity to debate and determine its position on the matter, AAPA requested that NCCPA postpone final consideration of the proposed recertification exam model.
AAPA Request for Studies/Supporting Literature
AAPA follow up request for supporting literature behind the new recertification exam model, as promised on AAPA/NCCPA Board call.
Huddle Discussions About Proposed Model
See what PAs have to say about the PANRE Model proposal and join the conversation.
PA and CO Questions and Concerns About the Proposed Model
Questions and concerns shared by CO leaders and participants in the 2016 LAS forum on February 5, 2016.
Letter from CAPA Regarding the Proposed PANRE Changes
A letter from the Colorado Academy of PAs regarding NCCPA's proposed PANRE model.
Letter from SEMPA Regarding the Proposed PANRE Changes
A letter from the Society of Emergency Medicine PAs regarding NCCPA's proposed PANRE model.
Letter from NCAPA Regarding the Proposed PANRE Changes
A letter from the North Carolina Academy of PAs regarding NCCPA's proposed PANRE model.
Letter from PSPA Regarding the Proposed PANRE Changes
A letter from the Pennsylvania Society of PAs regarding NCCPA's proposed PANRE model.
Letter from VAPAA to NCCPA
A letter from the Veteran Affairs PA Association to NCCPA.
Article from NAPA on NCCPA's Proposed Changes
An article from the Nevada Association of PAs newsletter: "Separating Facts from Feelings. The Proposed NCCPA PANRE Changes."
Letter from MAPA to NCCPA
A letter from the Minnesota Academy of PAs to NCCPA.
OAPA Member Survey on Proposed PANRE Changes
A survey from the Oklahoma Academy of PAs regarding the NCCPA PANRE proposal.
OAPA Member Comments Regarding the Proposed PANRE Model
Member comments from the Oklahoma Academy of PAs on NCCPA's proposed PANRE model.
Letter from PAEA to NCCPA
A letter from the PA Education Association to NCCPA.
SDPA Member Survey on Proposed PANRE Change
A survey from the Society of Dermatology PAs regarding the NCCPA PANRE proposal.
Letter from SDPA to NCCPA
A letter from the Society of Dermatology PAs to NCCPA.
PAOS BOD Position Statement and Survey on Proposed PANRE Change
A position statement and survey from the PAs in Orthopaedic Surgery.
Letter from IAPA to NCCPA
A letter from the Illinois Academy of PAs to NCCPA.
Letter from ConnAPA to NCCPA
A letter from the Connecticut Academy of PAs to NCCPA.
Letter from HAPA to NCCPA
A letter from the Hawaii Academy of PAs to NCCPA.
Letter from OAPA to NCCPA
A letter from the Ohio Association of PAs to NCCPA.
Letter from CAPA to NCCPA
A letter from the California Academy of PAs to NCCPA.
Letter from AANPA to NCCPA
A letter from the American Academy of Nephrology PAs to NCCPA.
Letter from WAPA to NCCPA
A letter from the Wisconsin Academy of PAs to NCCPA.
OSPA Member Survey Regarding NCCPA’s PANRE Proposal
A survey from the Oregon Society of PAs regarding the NCCPA PANRE proposal.
To NCCPA From a PA in Geriatrics
“I graduated from PA school about two years ago as a career change from social work. I work in geriatrics, a specialty which will not be represented on a new exam and does not lend itself well to a family practice exam anymore then a pediatrics does.”
To NCCPA From a PA in Dermatology
“I have been practicing dermatology continuously for almost 26 years. I have no intention of changing specialties.”
To NCCPA From A PA in New Hampshire
"My main concern is that we just barely implemented a new 10-year certification maintenance process that was said to allow us to be more in line with the way physicians are doing their certification maintenance."
To NCCPA From the University of Rochester Medical Center PA Executive Committee
"We recommend caution in proceeding with yet another significant change in PA certification requirements."
To NCCPA From A PA in Orthopaedics
"No other medical profession needs to take exams to maintain certification. It is a fact."
To NCCPA From A PA in Neurosurgery
"I have been a licensed and certified PA for 13 years. I am writing this letter to again express my opposition of the new proposed PA recertification model."
To NCCPA From A PA in Ohio
"I do agree a change is needed, but I do not agree with your proposed changes nor do I agree with current models used for testing and recertification."
To NCCPA From A PA in Michigan
"Since completing your recent survey of those of us in the PA profession in regards to your proposed change to the certification and recert. process I have felt compelled to write you regarding the flawed survey instrument. "
To NCCPA From A PA in Texas
"What other medical profession has take-home exams on top of recertification testing AND CME?"
To NCCPA From AMC PA Students
"As students, we entered school with the understanding that the PA profession embraces the generalist model. ... To move away from this generalist model is distressing to most of the students here at AMC ... "
To NCCPA From a PA in Washington
"The frequency of recertification at six years was much too often, and 10 years is still too frequent, based on the test itself supposedly being proof of clinical competency. This is ridiculous."
To NCCPA From a PA in Pennsylvania
“I am opposed to the proposed changes to the PANRE. I don't feel that it adequately tests our patient care ability any more than the current model ..."
To NCCPA From a PA in North Carolina
“As a PA who has practiced for nearly 21 years, I am writing to express my concern about the NCCPA’s proposed changes to the PANRE process ..."
To NCCPA From a PA in Florida
“I have been a Paramedic, RN, and now a PA for over 13 years . None of my other professions required me to recertify, and I have never committed malpractice ..."
To NCCPA From a PA in Ophthalmology
“I would like to take this opportunity to make some recommendations pursuant to your 'call for comments, collegiality, and consideration of the future of the PA profession' sent out via email last month …”
To NCCPA From a PA in Hepatology
“Regarding the current model: The PANRE every six or 10 years is fine along with the 100 CME every two years …”
To NCCPA From a PA in Indiana
“I feel the old option of 100 CME every two years and re-certification every six years was MORE than adequate and there was NO absolutely NO need for change …”
To NCCPA From a PA in Dermatology
“I recently completed the survey that was emailed to me. Unfortunately, I feel that the survey was not an adequate assessment of my true opinion about the proposed changes!”
To NCCPA From a PA in Interventional Cardiology
“I am writing this letter to express my disappointment with the NCCPA and Board. This is the way I feel about the closed-book exam process and its relevance to this digital era, when we can just look things up …”
To NCCPA From a PA in Dermatology
“I recently completed the survey that was emailed to me. Unfortunately, I feel that the survey was not an adequate assessment of my true opinion about the proposed changes!”
To NCCPA From a PA in Wisconsin
“It is very distressing to have NCCPA look at yet another version of certification hoops for PAs …”
To NCCPA From a PA in Virginia
“I was elated about the 10-year cycle process for the PANRE because I thought it would be fairer for working PAs …”
To NCCPA From a PA in New York
“First of all THANK YOU for: An Assessment of the NCCPA Survey Gathering Feedback From Certified PAs on the Proposed New Recertification Model. It speaks to my thoughts completely. I had not read it before I took the survey, but I had the same feelings and frustrations as I took it. Such logical fallacies at work!”
To NCCPA From a PA in New York
“I am writing to you after submitting my survey and speaking to many PAs about the proposed PANRE changes. I must alert you, if you are not already aware, PAs are very disturbed and downright angry with the NCCPA ..."
February Comments from PAs to NCCPA
A collection of comments sent by PAs regarding NCCPA's proposal.
AAPA Assessment of the NCCPA Survey
AAPA asked an independent researcher with a PhD in survey design to review NCCPA’s survey regarding the proposed recertification model and current PANRE and CME requirements. Their assessment? The survey may not be what most PAs expected and that the survey instrument itself is problematic.
AAPA Review of NCCPA's "Supporting" Literature
AAPA reviewed the literature cited by NCCPA as the foundation for their recertification proposal. Our conclusion? There's no evidence here that recertification testing has an impact on patient safety or patient outcomes. And, there's evidence that active-learning CME is superior to passive-learning CME.
JAAPA: Unraveling the Recertification Conundrum
A JAAPA commentary to point out important limitations in the information gathered thus far regarding the recertification proposal, appeal to PAs to take advantage of the profession-wide survey to share their opinions, and challenge readers to consider that the PA professional identity may be at the heart of this recertification conundrum.
NEJM Knowledge +: New PANRE Model from the NCCPA Concerns Some PAs
Balanced review of the NCCPA PANRE model from NEJM Knowledge+.
JAAPA: Maintenance of certification practices—a look at internists and APRNs
An exploration of current and emerging practices for maintenance of certification among PA peers in medicine and APRN roles.
The Lifecycle of Licensure, Certification, and Maintenance of Certification in Selected Health Professions
A summary of requirements that selected health professionals must meet after they complete their formal training in order to gain entry into their respective professions and remain in good standing.
Licensure and Certification Requirements for Selected Healthcare Professions
Only PAs are required by their certifying organization to pass a recertification exam on a periodic basis in order to satisfy state maintenance of license requirements.