Article: NCCPA Removes AAPA from Board, Creates New Seats for PAs at Large (posted 8/20/01)
Message from the NCCPA President (e-mailed/mailed to certified PAs on 8/21/01)
NCCPA President Responds to AAPA Board (posted 8/23/01)
NCCPA Removes AAPA from Board, Creates New Seats for PAs at Large
On August 17, the Board of Directors of the National Commission on Certification of Physician Assistants (NCCPA) met to discuss restructuring NCCPA’s governing body to ensure the appropriate participation of the organizations who appoint the members of the NCCPA Board and to address the need for broader representation of certified physician assistants. This discussion was prompted by a series of inappropriate actions and behaviors of the American Academy of Physician Assistants (AAPA) over the past few years, which threatened to interfere with the ability of AAPA-appointed directors to carry out their obligations to the NCCPA.
At that meeting, the Board voted to eliminate the AAPA’s ability to appoint directors to the NCCPA Board and created a new category of Board seats for PA directors at large.
Termination of AAPA’s Participation on the Board of Directors
AAPA’s removal from the NCCPA Board was precipitated by a pattern of disregard for the legally prescribed role of its NCCPA Board appointees.
"The Academy has failed to recognize that their appointees do not come to the NCCPA Board table to deliberate and vote on behalf of the Academy," says NCCPA President Elaine E. Grant, MPH, PA-C. "Legally and ethically, all of our Board members, including the AAPA’s appointees, must serve the best interests of NCCPA, with the mission of this organization in mind. What’s in the best interest of NCCPA’s certification mission is in the best interest of the Academy nine times out of ten. Unfortunately, during the last two years we’ve been wrestling with that tenth issue—the appropriate role of NCCPA in the CME logging process."
She continues, "During the course of the past year or so, AAPA leaders repeatedly pressured their appointees to abdicate their fiduciary obligation to NCCPA and vote as directed by the Academy. At some point, they crossed the line between legitimate lobbying and outright intimidation. The preservation of NCCPA’s independence and credibility as a certifying organization is imperative, and our Board felt that removing AAPA as a participating organization was the best, if painful, way to send a signal that no other organization can dictate the policies of NCCPA."
Adds NCCPA Executive Director Kate Hill, MEd, "This is a high stakes issue for all certified PAs. If state licensing boards, physician organizations, employers and others get the idea that the professional association is dictating the policies of NCCPA, our credibility and the credibility of your credential will be lost."
However, Grant was quick to add that in recognition of the Academy’s role as the largest national association of physician assistants, its participation in NCCPA and its long history of leadership within the PA profession, the Board also directed her to immediately open discussions with AAPA leaders about a way to repair the relationship.
In a letter to AAPA President Ed Freidmann, PA-C, Grant wrote: "Our most sincere hope is that through open discussions, the AAPA will come to accept the independence of the NCCPA, the fiduciary obligations of NCCPA directors, and the appropriate role of participating organizations. Once AAPA demonstrates an understanding of those issues, the NCCPA Board is certainly willing to discuss a renewal of AAPA’s involvement in the work of NCCPA and is, in fact, prepared to take action in that regard at its next meeting in November."
Earlier attempts to open a dialogue to repair the relationship between the two organizations did not come to fruition. After Friedmann broached the idea of a mediated discussion in a July 31 letter to Grant, NCCPA identified a team of representatives to participate in an August 16 meeting, and the organizations’ attorneys began working to identify an appropriate mediator. However, when it became apparent that AAPA leaders actually wanted to seek a third party’s opinion on the appropriate interpretation of NCCPA’s corporate bylaws and Georgia law, Grant called it off.
"We’re very interested in discussing—and repairing--the relationship between the two organizations. But the independence of NCCPA and the legal obligations of its directors are not negotiable," says Grant.
Creation of New PA Director-at-Large Positions
At the same meeting, the NCCPA Board voted to create a new category of Board seats for PAs at large.
Prior to the creation of those four new at-large seats, only physician assistants appointed by participating organizations, including AAPA, the Association of Physician Assistant Programs, the Department of Defense or the Department of Veterans Affairs, could serve on the NCCPA Board.
"While those PA appointees contribute mightily to the Board’s deliberations, we’ve become concerned that they may not adequately represent the larger population of certified physician assistants," says Grant. "We want to remedy that."
The NCCPA Board voted to appoint Kathy Adamson, PA-C, and Disty Pearson, PA-C to fill two of the PA director-at-large seats. Among the four directors removed by AAPA in June, Adamson and Pearson were serving as NCCPA’s president elect and treasurer, respectively.
"The sudden removal of four of our experienced PA directors, including two officers, definitely compromised our progress on some key issues," says Hill. "Returning at least the two who had been elected by their peers to serve in leadership roles just makes good common sense."
During the next several months, Board committees will develop a nomination and selection process for the PA director-at-large seats, with the hope of filling all remaining vacancies by the middle of next year.
Message from the NCCPA President
(e-mailed/mailed to certified PAs on 8/21/01)
As you're probably already aware, the last year has been a particularly trying one for the relationship between NCCPA and the American Academy of Physician Assistants (AAPA). I wanted to take this opportunity to share with you some information about the current situation and my hopes for the future.
Tensions escalated between the two organizations during discussions about the appropriate role of NCCPA in the CME logging process. As I've stated elsewhere, what’s in the best interest of NCCPA's certification mission is in the best interest of the Academy nine times out of ten. Unfortunately, during the last two years we’ve been wrestling with that tenth issue. Through those discussions and the interactions that have occurred since then, AAPA repeatedly demonstrated a lack of respect for the independence of NCCPA as a certifying body and a disregard for the legally prescribed obligations of its appointees to the NCCPA Board. Somewhere along the line, from the perspective of the NCCPA, AAPA leaders crossed the line between lobbying its NCCPA appointees and threatening to interfere with their ability to carry out their responsibilities as NCCPA Board members.
The NCCPA Board of Directors met last Friday, August 17, to discuss those issues, to ensure the appropriate participation of the organizations that appoint members to our Board of Directors, and to address the need for broader representation of certified physician assistants. During that meeting, the Board voted to remove AAPA as a participating organization, eliminating its ability to appoint directors to the NCCPA Board.
Though a painful decision, the Board felt the need to send a strong, clear message to AAPA leaders that their behavior was inappropriate. This is a critical issue for all of us. If the groups who look to this credential for some assurance of our knowledge and clinical skills--state licensing boards, physician organizations, employers, and others--start to think that AAPA or any other organization is controlling the policies of NCCPA, our credibility and the value of the PA-C designation could be irreparably damaged.
But this should not signify an ending. My fellow directors and I hope it is the beginning of a new relationship with AAPA--one based on mutual respect for our organizations' distinct missions, purposes and competencies. I've re-opened a dialogue with AAPA President Ed Friedmann that I hope will result in a meeting very soon, during which we can start rebuilding a bridge between the two organizations.
We know you want us to work together. The NCCPA Board is committed to continuing to try to do just that. I personally believe that the AAPA is committed to that goal as well.
The NCCPA is equally committed to ensuring that certified PAs are represented at our Board table. I'm excited to announce that at our August 17 meeting, we created four new PA director-at-large positions. When added to the other five already serving on the Board, we'll have nine PAs at the table, with the potential to increase those numbers down the road. During the next few months, we'll work out the details for a selection and appointment process that we'll announce just as soon as possible. We also have a Board committee developing plans to create more opportunities for PAs in the field to provide their input on issues before the Board and its committees. We should have those plans in place before our next Board meeting.
In the meantime, please continue to visit our Web site and read our newsletter for more information about how you can become more involved in the work of NCCPA. And for another look at the August 17 meeting, read our article at: http://www.nccpa.net/pages/augustbod.htm
Most sincerely,
Elaine E. Grant, MPH, PA-C
President, NCCPA
NCCPA President Responds to AAPA Board
(posted 8/23/01)
On August 21, a response to NCCPA’s decision to remove AAPA from our Board of Directors was posted on AAPA’s Web site. That statement prompted NCCPA President Elaine Grant, MPH, PA-C to offer one final public statement to clarify the events that have transpired.
The article posted on this Web site and my e-mail message/letter that was broadcast to PAs on August 21 convey the decisions the NCCPA Board made at its August 17 meeting and the reasoning behind them. I do not seek to repeat that information here.
Rather, I would like to clarify some key points and correct several misstatements made by AAPA.
First, we want AAPA to be involved in the work of NCCPA. In fact, as soon as AAPA leaders demonstrate that they understand and intend to respect the boundaries between the organization and its NCCPA Board appointees, we will gladly consider issuing an invitation to the Academy to once again name appointees to this governance body. Since those boundaries are clearly established by law, that should be an issue we could quickly resolve. However, their statement that, "All AAPA has requested is that reasonable and open communications between its appointed commissioners and AAPA occur," is disingenuous. In my book, threats made to coerce NCCPA directors to act in certain ways, threats that were subsequently acted upon, do not constitute "requests" for anything. The AAPA has not attempted to communicate, but to control.
However, even during these difficult times NCCPA will continue to seek opinions and input from AAPA. In fact, at our May 31 meeting, this Board agreed that the most appropriate place for the participation of non-Board members is at our committee meetings. That is, after all, where the substantive discussions take place from which recommendations to the Board arise. To that end, for instance, we have issued invitations to the next meeting of NCCPA’s Eligibility Committee, the group that deals with certification policy issues, to AAPA’s director of government affairs and to a representative of the Student Academy of AAPA. Both have accepted, and we look forward to their participation in our discussions.
Secondly, we want to hear your voice. No single organization, even one as large as AAPA, can fully represent the needs and desires of the diverse members of the PA profession. We want to broaden the representation of the PA profession on this Board, and creating four PA director-at-large positions was the first step in that direction. Right now, seven PAs (including two former presidents of AAPA) serve on the NCCPA Board, and two additional vacant PA director-at-large seats are to be filled just as soon as we’re able to develop a sound process for doing so. Rest assured that will be a central issue when our committees meet in mid-September, and—like you—we want to fill those vacancies just as quickly as we can.
Thirdly, we’re committed to an open process. Though we have decided to limit attendance at our Board meetings to directors, staff and invited guests—the standard practice for most certifying bodies and our own parliamentary standards (Sturgis)—we are committed to the participation of others in more appropriate ways. One issue slated for discussion during our September committee meetings is: How can we enhance the abilities of our stakeholders to have input into NCCPA’s decisions while preserving the freedom of the Board to have the candid and privileged discussions needed to conduct NCCPA business? To that end, two of our Board committees will develop specific plans to create more opportunities for the involvement of the organizations that appoint our Board members, other PA organizations (including AAPA, the Student Academy and PA state and specialty organizations), as well as the PAs we certify to share their thoughts, opinions and concerns with the NCCPA Board. Those plans and mechanisms should be in place before the next meeting of this Board, scheduled for November.
Now, I’d like to take a moment to answer the specific questions posed to the NCCPA Board in AAPA’s article.
- AAPA’s Board has asked if this is just an
"honest disagreement." AAPA
threats—made and carried out--go well beyond
an "honest disagreement."
- The mere fact that the AAPA’s Board has
asked whether NCCPA has "confused the
broader fiduciary responsibilities of its
commissioners to the public and the PAs"
underscores the fact that they don’t
understand or refuse to accept the legal (and
only) definition of "fiduciary
responsibilities." That phrase simply means
that members of the Board of Directors of this
corporation or any corporation are legally
obligated to act in the best interests of the
corporation. For NCCPA, that means that our Board
members come to the table, have open discussions
and even convey information and opinions from
others when that’s appropriate. But at the
end of the day, they must vote in the best
interests of NCCPA’s certification mission,
not as directed by their appointing organization
or anyone else.
- As I mentioned above, standard practice for
corporate Boards, especially of certification
organizations, is to have closed Board meetings.
Nonetheless, we’re committed to an open
process. Within the next few months, we’ll
be creating more opportunities than ever before
for any PA to have a voice in NCCPA’s
discussions. The internet and other technologies
extend "participation" light years
beyond a physical presence in a Board room.
- NCCPA is accountable to all of its stakeholders, including the public, PAs, PA educators, PA students, state licensing Boards, physicians, and employers. No one of those groups and no single organization can be allowed to control NCCPA decision making.
Finally, we know you want us all to put politics aside and get back to work for you and our other stakeholders. That’s just what we’re going to do. I hope that very soon a small team of representatives from both organizations will convene to try to address the fundamental issues that have divided us. The rest of us at NCCPA are moving on with other business—the business of certifying PAs and continuing to try to improve that certification process.
Elaine E. Grant, MPH, PA-C
President, NCCPA
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