NCCPA Forum on PAs Practicing in Specialties

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Saturday, June 24, 2006, Atlanta, Georgia

Janet Lathrop, NCCPA President/CEO called the Forum to order and welcomed attendees from 31 PA and physician specialty and PA professional organizations to Atlanta to participate in this meeting. She introduced NCCPA Chairman of the Board Bill Kohlhepp, MHA, PA-C, and NCCPA Task Force Chairman and fellow Board member Mark Christiansen, PA-C. In addition, Ms. Lathrop asked each of the task force members, who are also NCCPA Board members, to introduce themselves and name the organization that appoints them to the NCCPA Board.

Ms. Lathrop reviewed the day's agenda and referred attendees to materials that had been provided in their folders, including information submitted by the American Academy of Physician Assistants, the American College of Physicians, an interested pediatrician, the Gastroenterology Physician Assistants, and the Student Academy of the American Academy of Physician Assistants. Ms. Lathrop then turned the meeting over to Chairman Kohlhepp.

Chairman Kohlhepp then shared with attendees that this meeting is a major feat for the profession both because of the historical roots of the discussion and the landmark nature of the meeting with so many different organizations represented. Chairman Kohlhepp went on to highlight some of the key factors that played a role in NCCPA's decision to convene this Forum, including the historical context, the practice of general medicine in a specialty vs. specialized medicine conundrum, the patient expectations factor and the evolving PA competencies discussion. He stated that at this juncture, it is critical for NCCPA to be clear about what, if any, problem they are trying to solve. NCCPA functions as a credentialing and assessment body. It utilizes examinations as one tool, but remains open to considering other options. He cautioned representatives to be clear and specific in their language, particularly with regard to "certification" versus "recognition".

He explained that NCCPA had previously adopted a "wait and see" approach to the specialty recognition debate, but indicated that the NCCPA Board of Directors now believed that, given the prevalence of specializations, there may be a need to move forward with some form of action or response to the issue. This was the catalyst for the Board's decision this past May that approved the development of specialty recognition, including specialty exams. To lead our efforts in that area, the Board's next action created a task force to determine an appropriate course of action. The task force was to report to the Board in August on their progress. As a result, this fact-finding Forum was organized as an opportunity to hear the challenges that PAs are facing in their practices.

Chairman Kohlhepp added that the Forum is not an opportunity to discuss changes made to the recertification process, including the development of a repackaged PANRE or the elimination of Pathway II. Nor is the Forum an opportunity to discuss any other organizations that have an interest in specialty certification, noting specifically that NCCPA has no interest in keeping other people out of the marketplace. NCCPA is interested in developing the best possible plans to address the issue of PAs practicing in specialties by using its years of experience and expertise in the testing/assessment field. Finally, he indicated that the intent of this meeting was not to debate the merits of any one solution. In closing, he shared with the representatives that it was not NCCPA's intention to make changes to the Physician Assistant National Certifying Exam (PANCE) and that right now, the PANCE and the Physician Assistant National Recertifying Exam (PANRE) would continue to represent the mechanism to achieve and maintain NCCPA certification. Further, any specialty recognition program developed by the NCCPA would denote advanced knowledge and would be voluntary.

At this point, Chairman Kohlhepp indicated that the remainder of the morning would be dedicated to hearing from the three organizations with which NCCPA had already had dialogue regarding their need for NCCPA's support. These groups included the Association of Physician Assistants in Cardiovascular Surgery (APACVS), the American College of Emergency Physicians (ACEP) and the Society of Dermatology Physician Assistants (SDPA). Those groups then shared with the Forum attendees their views. Finally, the American Academy of Physician Assistants (AAPA) made a presentation to the Forum attendees from their vantage point as the PA professional membership organization. To conclude the morning events, discussion ensued about the morning's presentations.

After a brief lunch, Task Force Chairman Christiansen reconvened the meeting for the afternoon session. The afternoon was devoted to hearing from the remaining 27 PA and physician specialty and PA professional organizations regarding their thoughts about the challenges facing PAs in their practice and the environmental pressures impacting a decision regarding specialty recognition. Numerous groups also indicated their desire for or against specialty recognition and/or certification in their fields of specialization.

At the conclusion of these presentations, Task Force Chairman Christiansen indicated that there would be a brief time for discussion. However, since the intent of this meeting was fact-finding, he asked the task force members to articulate the key themes that they saw reiterated throughout the day and ask any questions that they might have. As each task force member shared their insights and the attendees agreed, the list below was compiled. During the compilation process, several individuals spoke to the individual themes.

  • For many, specialty recognition is acceptable, while specialty certification is not.
  • There is a core curriculum or core competencies that PAs practicing in specialties should possess. Garnering this additional knowledge could take many forms including course work, on-the-job training residencies, post-graduate training programs, or continuing medical education programs.
  • PAs are evolving to a higher level, and any new program should set a higher standard.
  • PAs do not want any new program to become a requirement.
  • PAs are part of the specialist team.
  • The profession should be mindful of the pitfalls of multiple credentials.
  • Exams, without education, are meaningless.
  • Ongoing competition with nurse practitioners and other credentialed health care practitioners, such as RPAs, AAs, etc.
  • There is a need for better education of employers, physicians, and credentialing boards on what a PA is, what they can do, and how the PA-MD team works.
  • PA organizations should work in tandem with their physician organization.
  • NCCPA should evaluate the implications of any decisions with regard to the effect on PA mobility, PA reimbursement, and burdens on PA students.
  • The supervising physician plays a key role in PA practice; however, some groups expressed that their supervising physician had limited time to teach.
  • Any new program should not create barriers to entry into a specialty, and should not eliminate opportunities for pioneers.
  • Each specialty has its own culture.
  • There is a potential need for a credentialing portfolio or another mechanism to assist PAs in documenting their procedures.
  • Additional training and recognition could avoid, and may serve as legal protection against, malpractice claims.
  • Two dichotomies seem to exist (surgical vs. medical specialties and PAs who are doing general tasks within specialties vs. PAs who are doing highly specialized tasks.)

In wrapping up, NCCPA leaders thanked the Forum attendees for their participation and explained that the Task Force would meet the following day to begin discussing the comments and insights shared during the Forum. The task force would also be assembling a report to provide to the NCCPA Board of Directors at their next meeting in early August.