To NCCPA From a PA in Ophthalmology

Dear Dawn Morton-Rias,

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 (2/25/16).

Before I do this, I would like to give you a brief summary of my present situation as a PA-C since my graduation in 1979.  I am currently 69 years old and will be 70 in December. For the past 28 years, I have been practicing some form of plastic surgery: 25 of those in oculoplastic surgery in the Geisinger Healthcare System. Currently there are very few PAs in ophthalmology, let alone in oculoplastics.

Bear with me for a minute, as in order to make a point; I will need to point out my strengths in this field. I am quite good at the things that I do. For many years, I was the only PA-C in our ophthalmology/residency program with six residents and rotating medical students and approximately 15 staff physicians at the Geisinger home base location. We now have a second PA and one RNP. About 90 percent of my time is spent doing oculoplastic surgery procedures at four different locations. I do entropion/ectropion repair, excision of all types and pathology of skin and lid lesions, blepharoplasties, levator advancements, ptosis repair, MOHs repair via direct closure, rotation and advancement flaps, full and split thickness skin grafting, creating eyelids from available local tissue when lost due to MOHS, temporal artery biopsies, and a host of other peri-orbital procedures. I personally am involved in the training of ophthalmology residents to do these same procedures in my department. And I have considerable autonomy. What I don’t do is most other aspects of medical practice. I have very little need to write prescriptions, order labs, treat or diagnosis diseases, or make hospital rounds, although I have done these things in my distant past as a practicing PA-C in a very rural family practice and emergency medicine settings.

Each time (x6) that I have recertified, I have received a passing score, but the grade results themselves have decreased progressively over the years. 2016 is my recertification year and most probably my last time to recertify as I will be 70 years old and am thinking about retiring or decreasing my work-time significantly in the next few years. I am in fairly good health, and my surgeons want me to continue to be of assistance with procedures and the training of ophthalmology residents, even if only part-time.

And therein lies “the rub.” My experience and ability to practice this very specialized field is being held hostage by the ability to pass a written board exam over general medical knowledge that is of no, or very limited value to the field in which I practice.  I attempted to do the fifth-year test, and for the first time since 1979, did not receive a passing grade.  I do not believe that my future and career should be dependent on a “life or death” exam that bears little application to the field in which I am a very valued contributor.

My recommendations are as follows:

First off, it is my understanding that PAs who have been practicing for over 10 years have pretty much found their “niche” and most probably won’t be changing to another scope of practice.  Even so, those that do change have found a position in a type of practice that is willing to utilize any training that will bring them up to speed.

I believe that an initial certification exam after graduating from an AAPA/NCCPA approved program is warranted, and possibly one other at a 6-10 year interval from the initial exam. Beyond that point, very little value, but an enormous amount of stress, is added to a PAs life and practice in continuing exams that will in reality, do nothing to enhance their current scope of practice.

CME should continue as it is and possibly include a letter of satisfaction from a current practice attending physician.

Again, we as an organization need to abolish this idea that an individual PAs ability to practice and earn their livelihood is subject to a written test that I have found not to be as “generalized” as sometimes stated. In reality, after a certain point in time and with certain parameters met (i.e. age, experience, years), being “grandfathered in” to the re-certification process would doubtless not be of harm to the profession as a whole.

Thank you for your consideration on this matter.