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. It’s incredibly old school, especially in a recertification process for somebody who is already established in practice, this notion that I’m going to have to memorize and then regurgitate in a secure environment is, frankly, a little insulting. Especially things that have nothing to do with what I practice.

The current way we practice now, if I’m sitting at the bedside—and this happens all the time, I’ve got my computer with me—and I’m not sure about something, I’m not going to draw on the memory that I had from studying for boards. I’m actually going to go online and do a search and find it out. If it’s outside of my area of expertise, I’m going to ask for help. We work in teams. We have other experts who handle these things. For anyone to represent themselves as being an expert in a certain clinical area on the basis of taking this exam is a little naive.

The testing environment itself is truly painful and insulting.  I’ve got an established practice specializing in interventional cardiology for 20 years, To arrive at a test facility and be asked to empty my pockets and put the contents in a locker—they literally have you do this, you reach into your pockets, and you empty your pockets to prove you have nothing in them. You then sit in a quiet room. There are video cameras trained upon you, and you sit with a bunch of people in front of a screen, checking off A, B, C, D, or E for three two-hour sessions. I’m not sure what that has to do with clinical practice, honestly. It seems kind of childish. There’s no evidence to back it.

Firstly why was pathway 2 take home exam cut out? I find it funny how now you’re asking us (PAs) about various ways to recertify, why didn’t you ask if we wanted the take home test cut out. This has worked for a very long time to recertify PAs. To abruptly stop it when you have no other option to recertify except to take an exam that has very little to do with clinical practice and subspecialty? This is unjustified and doesn’t make any sense. We as PAs are losing faith in the recertification system.

I have failed recently my PANRE once and my test was invalidated a second time. I now have to sit a third time?  Having being certified and practicing as a PA for almost 20 years, this was very insulting!

The exam was extremely difficult especially given you have one minute to answer a question. There were large amount of questions that I felt were excessive, inappropriately worded and not clinically relevant for us practicing PAs.

Secondly, this exam has very little to do with my area of expertise and clinical skills which is in the field of interventional cardiology. I have been a PA for almost 20 years practicing in the field of interventional cardiology. This is a highly specialized area which involves performing procedures such as cardiac catheterization, coronary angioplasty, STEMI, Insertion of intra-aortic balloon pump as well as many other skillful procedures at which I am very proficient. So to me, taking an exam which involves many questions in certain areas such as OB/GYN, pediatrics, orthopedics, etc., which I don’t practice is just very unfair!

Many PAs are now very specialized, much different than 20 years ago when many were practicing primary care. For the last 2 recert exams, I took the take home test which I felt was a difficult exam but an excellent way for PAs to at least become re-certified and familiarize themselves more about internal medicine and other areas of medicine that they don’t practice.  What would make sense is an open book or take home exam in the PAs specialty or not retest at all.  I am very disappointed and not sure why the take home exam was discontinued.

Do you think PAs should lose their job because they can’t answer questions unrelated to their specialty? This is not good for the PA profession. I am asking you as CEO/ President of NCCPA to please immediately call for a board room meeting  to discuss bringing  back the pathway 2 exam as an option for PAs to recertify.

In summary, highly -specialized PAs should not be penalized and lose their certification because of a primary care exam that has very little to do with their practice and level of expertise.

Thank you for your consideration to this matter.