Orthopaedic Surgery CAQ

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"I have been promoted and given higher pay and more responsibility since earning a CAQ."

     ~Mark Wright, 2011 CAQ in Orthopaedic Surgery

Read Why Take the NCCPA Orthopaedic Surgery Exam?” about a PA’s CAQ journey from registration through the exam. (reprinted with permission from The Journal of Orthopedics for Physician Assistants)

Earn a Certificate of Added Qualifications (CAQ) in Orthopaedic Surgery to show your advanced expertise in your specialty. Read what your peers are experiencing after earning a CAQ!

CAQ recipients seeking the following benefits have really reaped reward for their achievement:

  • Over 75% found or anticipate finding a new job

  • Over 40% successfully sought a promotion

  • 60% achieved or expect to increase their job responsibilities

  • Over 50% received or anticipate receiving a pay increase, and 33% received a cash bonus

  • Over 75% found the CAQ useful in documenting qualifications required for external accreditation

  • Over 33% achieved or anticipate a broadening of their eligibility for reimbursement

  • Almost 75% have received greater recognition or regard from physicians or other health care professionals

  • 66% reported greater respect or acceptance from patients

Earning a CAQ shows your employers that you are committed to your specialty. It demonstrates your dedication and passion to healthcare and the well-being of your patients.

Still unsure? Get a feel for the exam by reviewing some sample questions. Then read more about the requirements below.

Key Dates:

    • January 1, 2021 – Exam application registration opens for PAs applying to earn a CAQ
    • April 2, 2021 – Deadline to apply for a Spring CAQ exam administration at a Pearson VUE Test Center
    • April 5-10, 2021 – Spring administration window for all CAQ exams administered at Pearson VUE Test Centers
    • October 1, 2021 – Deadline to apply for a Fall CAQ exam administration at a Pearson VUE Test Center
    • October 4-9, 2021 – Fall administration window for all CAQ exams administered at Pearson VUE Test Centers

Introduction and Basic Prerequisites

Physician assistants seeking the Orthopaedic Surgery CAQ must demonstrate they have advanced knowledge and experience in orthopaedic surgery, above and beyond that expected of entry-level PAs or PAs working in a generalist practice. PAs seeking eligibility for the Orthopaedic Surgery Specialty Examination must meet requirements of specialty-specific CME and experience in the field. After initiating the CAQ process by submitting the requirements for one of the components and the $100 administrative fee, PAs will have six years within which to complete all four components for the CAQ, including passing the specialty exam.

Physician assistants seeking the Orthopaedic Surgery CAQ must also first satisfy two basic pre-requisites: (1) current PA-C certification and (2) possession of a valid, unrestricted license to practice as a PA in at least one jurisdiction in the United States or its territories, or unrestricted privileges to practice as a PA for a government agency. (Note: If a PA holds licenses in multiple stat es, all of the licenses must be unrestricted.) The licensure prerequisite is addressed more fully here.

In support of the procedures and patient case requirement, each applicant must provide attestation from a physician, lead/senior physician assistant, or physician/physician assistant post graduate program director who works in the specialty and is familiar with the physician assistant's practice and experience. PAs may find it helpful, however, to secure such a sponsor at the beginning of the process for the purpose of seeking guidance on the pursuit of the other requirements.

CME Requirement

In the six years preceding the date of application for the specialty exam, candidates must earn a minimum of 75 credits of Category 1 CME focused on orthopaedic surgery practice with a minimum of 25 of those credits having been earned within the two years prior to the date of exam application. The same 75 credits may also be used for maintenance of the PA-C credential.

PAs are encouraged to use their best judgment when determining whether individual CME activities are related to orthopaedic surgery, understanding that those credits may be subject to a CME auditing process.

Upon fulfillment of all CME requirements, candidates will attest to their completion at NCCPA's website.

Recommendations for CME Activities:
Physician and PA orthopaedic surgery leaders provided input in developing the following CME recommendations for PAs interested in pursuing a CAQ in that specialty.

Applicants should complete CME activities that are focused in orthopaedic surgery and at the level appropriate for a PA practicing in the specialty.

Experience Requirement

Physician assistants seeking the Orthopaedic Surgery CAQ must have gained at least 4,000 hours of experience (the equivalent of two years of full-time practice) working as a PA in that specialty within six years of the date they attest to NCCPA that the experience requirement has been satisfied. If selected for an audit, documentation substantiating that work experience will be required.

Procedures/Patient Case Requirement

Candidates for the CAQ must be able to apply the appropriate knowledge and skills needed for practice in orthopaedic surgery, as described below. In support of this requirement, each candidate must provide attestation from a physician, lead/senior physician assistant, or physician/physician assistant post graduate program director who works in the specialty and is familiar with the PA's practice and experience within 90 days after they receive their CAQ score. The attestation of knowledge and skills must indicate that the PA has performed the procedures and patient management relevant to the practice setting and/or understands how and when the procedures should be performed.

Again, the PA may not have experience with each procedure, but he or she must be knowledgeable of the basics of the procedures, in what situation the procedures should be done, and the associated management of patients.

In determining whether an applicant can satisfy the Specialty Procedures and Patient Case Requirement, consideration should be given to the following areas:


• Local anesthesia including digital block
• Procedural anesthesia, conscious sedation
• Regional anesthesia

Advanced Wound Management

• Superficial/deep wound closure
• Wound debridement, incision and drainage
• Placement/removal of wound vacs, drains
• Tendon repair
• K-wire removal, hardware removal

Compartment Pressure Measurement/ Management

Diagnostic/Therapeutic Needle Aspiration/ Injections

• Joints, tendons, trigger points, bursa, cysts
• Needle biopsy

Diagnostic Radiography/Other Modalities

• Proper positioning and techniques for skeletal radiographs
• Interpretation of skeletal, soft tissue radiographs
• Interpretation of CT scan, MRIs
• Electromyography interpretation

Fracture, Dislocation Management

• Universal hip, shoulder, etc. reduction and relocation
• Application of braces, splints, casts, appliances
• Application of skeletal traction, skin traction
• Percutaneous pinning of fractures

Operative /Perioperative Care

• Preoperative consultation, evaluation
• First surgical assist
• Postoperative care, management

Prevention, Recognition, Management of Common Orthopaedic Complications/Conditions

• Deep venous thrombosis
• Pulmonary embolization
• Osteoporosis
• Osteomyelitis

The Orthopaedic Surgery Specialty Exam

Once PAs have satisfied other requirements for the Orthopaedic Surgery CAQ, they can apply for the Orthopaedic Surgery Specialty Exam -- 120 multiple-choice questions related to orthopaedic surgery targeted for PAs with experience in the practice of that specialty. It will be based on the Content Blueprint, developed using data gathered during the 2009-2015 PA Practice Analysis conducted by NCCPA.

To review sample questions, click here.

You'll need Adobe Acrobat Reader to open this file. If you do not have Acrobat Reader, you can download a free version by clicking here.

The Orthopaedic Surgery CAQ Exam will be offered nationwide on April 6-11, 2020 and September 14-19, 2020 at Pearson VUE testing centers. Application registration opens Jan. 1, 2020 and we encourage PAs to apply and schedule early to improve the likelihood of a convenient testing location. The last day to apply for the exam is April 3, 2020 and September 11, 2020 respectively. 

Though produced for PANCE and PANRE applicants, the short video on What to Expect on Test Day will be helpful to those preparing for this exam as well.

Maintaining the Orthopaedic Surgery CAQ

The Orthopaedic Surgery CAQ awarded to successful candidates will be valid for ten years. To maintain the CAQ beyond that timeframe, PAs must continue to meet the same PA-C and licensure requirements required of those seeking the CAQ for the first time, pass the Orthopaedic Surgery Specialty Examination before the expiration of the current CAQ, and -- during the ten-year CAQ cycle -- earn and log at least 125 credits of Category 1 CME focused on the specialty. Those CME credits may also be used to satisfy the CME requirement for maintenance of the PA-C credential.

Other Policies


To ensure the reliability and accuracy of the CAQ and maintenance processes, NCCPA may audit the requirements of physician assistants who have applied for a CAQ or have successfully completed the CAQ process. PAs who fail the audit or refuse to submit to an audit may be subject to loss of the CAQ and/or other disciplinary actions as deemed appropriate by NCCPA and in accordance with the Policy and Procedures for Disciplinary Review.

Loss of Eligibility

If a physician assistant loses eligibility for a CAQ after submitting the application and fee, he or she will be deemed ineligible and restricted from registering for the exam or from maintenance of CAQ activity, or will be withdrawn from the examination or maintenance activity if registration has already been processed.

Financial Requirements

PAs must fulfill all outstanding financial debts and any applicable fees to NCCPA prior to becoming eligible to apply for a CAQ or for CAQ maintenance.

If a PA loses eligibility for a CAQ or CAQ maintenance after submitting the respective application and fees or if, at any time, it is determined that a PA provided incorrect eligibility information on any NCCPA application, the PA shall forfeit all fees.

Exam Scores

Scores from the CAQ exams will be released to examinees after NCCPA has completed all scoring and validation processes. Physician assistants may not register to repeat an examination if they have scores pending from a previous administration of the same examination. If a PA is deemed ineligible for the CAQ after taking the exam but prior to the release of exam scores, the exam scores will be invalidated and not reported to the PA.

Disciplinary Review

Nothing in this policy shall limit or prevent NCCPA from imposing sanctions as set forth in its Policy and Procedures for Disciplinary Review.

Regaining a Certificate of Added Qualifications

Physician assistants who lose a CAQ for any reason must begin the CAQ process anew by meeting all eligibility requirements for the CAQ, including passing the CAQ examination.