The way in which PAs enter clinical practice is similar to, but differs somewhat, from the process for other healthcare providers.
One of the strengths of the PA profession is its utility within medicine. PAs practice medicine collaboratively in teams with other healthcare providers. Prior to entering the clinical workforce, PAs have broad general medical knowledge with didactic education, which is then augmented by a minimum of 2,000 hours of clinical rotations in both outpatient clinics and in hospitals, in all specialties and areas.
PAs get their generalist credentials, apply for licensure through their local PA or medical board, and then enter clinical practice. While there are specialty residency and fellowship programs for PAs, most of the specialty training that they historically receive is on-the-job training. This model has served the healthcare system in this country well since the first PAs graduated from Duke University in 1967.
Recently, the NCCPA (the certifying organization for PAs) has begun to implement certificates of added qualifications (CAQ) in specialty areas of medicine. They are putting more emphasis on the CAQs within the proposed model. They have also recommended moving to a 10-year recertification cycle (PAs have to sit for a recertification exam every six-to-10 years depending on where you're at in your cycle). As a long time PA, and one who has practiced in six different specialties, I have to say that I am worried that placing importance on adopting CAQs will be highly negative for both the PA profession as well as the healthcare system in the U.S.
Jeffery Katz, PA-C, president and chair of the Board of the American Academy of PAs, recently stated:
“… requiring all PAs to identify a specialty and pass an exam in a specialty is problematic for many reasons. Among them are:
1. It creates unnecessary barriers for PAs who seek to change the area of medicine in which they practice.
2. It places an additional financial burden on PAs and/or employers, with no demonstrated impact on the quality of patient care.
3. It creates unnecessary barriers for employers to fully utilize PAs in multiple disciplines, and will discourage the hiring of PAs.
PAs are licensed to practice medicine as generalists in a team-based model. Requiring a PA to pass an additional specialty test undermines the very foundation of our profession.”
I can’t help but think that there is another reason, and that is this will financially benefit the NCCPA, but will do so in a way that establishes barriers to PA practice and the hiring of PAs across the country. This will create yet another testing process of its certificate holders that employers may begin to require, even though it is not necessary.
While there are many similarities in PA and physician training, the path that PAs take to become providers in the United States healthcare system is significantly different. I am concerned that employers, healthcare systems, and healthcare facilities, among other entities, will begin to use these CAQs as a qualification and create a barrier to otherwise excellently qualified PAs.
I ask myself at times like this, “What is the problem that we are trying to fix here?” The NCCPA has evolved over the years. They see themselves as a consumer protection organization. It therefore makes sense that NCCPA is examining this testing process as a credible measure of the competence of the PA population that they are vouching for and certifying. The problem is that there is little objective evidence that testing processes such as certification examinations have any correlation with the competence of the population that they are testing or any correlation with increasing the quality of patient care or improving patient outcomes overall.
PAs have consistently had high marks in areas of patient satisfaction and improved outcomes.
Additionally, employers want and value PAs extensively, within our current model. Demand for PAs increased more than 300 percent from 2011 to 2014, according to the national healthcare search firm Merritt Hawkins.
I truly believe that my personal satisfaction with my lifelong profession directly relates to my ability to be mobile within the healthcare system, while our education model ensures we fully understand the healthcare system and the needs of our patients. This truly sets us apart from many other healthcare professions. This should not be tampered with without good cause and solid data. We do not need to “fix” something that is not broken.
At a time when we have an overwhelming need to train and employ many more providers of all types, now is not the time to create barriers to mobility for candidates to work in their chosen field and or specialty. Before we interfere with the education and flexibility that has been the hallmark and strength of the PA profession, we must further examine these proposed recommendations to ensure that they meet our shared goal of building a healthier nation.
This is an idea which obviously needs further study. I would hope that the NCCPA listens to the profession and other experts, and treads softly and slowly in this area before we cause irreparable harm to the professional utility and mobility that has been the hallmark and strength of the PA profession.