Above all, in my more than seven years of writing editorials for Clinician Reviews, I have endeavored to engage thought and stir emotion in my PA and NP colleagues. You may not always have agreed with me, but I hope you were inspired to consider your own opinions on various topics—some controversial. This month, I must apologize to my NP readers for focusing on what is (at least, in terms of specifics) a PA-centric issue.
The big buzz in the PA world at the moment is the proposed changes in the recertification process by the National Commission on the Certification of Physician Assistants (NCCPA). Having been certified through the first board exams in 1974 and served in various leadership roles with NCCPA and the American Academy of Physician Assistants (AAPA), I admittedly have a personal stake in this process. But then, this is personal for every certified PA.
The PA profession has spent its first 50 years undergoing extensive entry-level, post-professional, and continuing education reform. Although this is an ongoing process, we are at the point when we, as a profession, must begin to critically review the means of professional entry: certification and licensure.
It is important to understand that the responsibility of a national professional certification agency is first and foremost patient safety through assurance of medical knowledge and then second, a reliable system of certification (or in this case recertification) congruent with the practice setting. Therein lies the contradiction: when a recertification examination no longer assesses the body of knowledge needed for those it certifies. Let’s face the facts: Sorting out core knowledge is a very difficult task. We must begin by defining what core knowledge is and how we identify the commonality we all share despite our individual specialty areas of practice.
The NCCPA instituted professional certification of PAs in 1974. In the 40+ years since the inception of certification, the process has undergone several significant transformations, most notably in the 1980s, when maintenance of certification through a recertification exam was instituted, and in 2014, when recertification moved from a six-year to a 10-year cycle. The Commission has dutifully served the public by assuring quality through establishment of a certification process for entry-level PAs and maintaining quality assurance by requiring ongoing continuing education and regular re-examination of its certificants. In 2014, the NCCPA certified its 100,000th PA.
The objective of the first PA programs in the mid-1960s was to equip new practitioners to fill the void in primary care.1 Through the 1990s, most PAs worked in primary care, so it stands to reason that the entry-level PA certification exam (PANCE) and the recertification exam (PANRE) have been primary care oriented. Yet today, more than 73% of certified PAs practice outside primary care specialties.2 While the recertification exam maintains a broad-based focus, many complain that it has minimal relationship to their day-to-day clinical practice. This relevance issue is at the heart of today’s debate and triggers the most controversy.
Within health care and medicine, certifications are most commonly used to delineate advanced areas of training, such as a physician who is board certified in endocrinology or in other specialties. Rarely in clinical health care or medicine is certification used as the entry-level benchmark. The NCCPA credential is an exception to that rule. What is disingenuous is that we use the “C” for both entry-level and ongoing certification.
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