The American Academy of PAs is laying the groundwork to create a new organization to certify physician assistants after the body now overseeing the process proposed adding additional exams to its recertification requirements.
In November, the National Commission on Certification of PAs proposed changing the recertification exam to include a new specialty module in fields such as family medicine and general surgery. The proposal reflects changes within the field as PAs increasingly work in specialties. According to a 2014 report by the National Governors Association (PDF), nearly half of PAs report spending their careers in two or three areas of medicine.
The academy's board of directors voted unanimously July 15 to "take the next steps" to develop a new certifying organization, the AAPA said in a statement. "AAPA is reviewing what a new certifying organization must do in order to be accredited as well as reviewing other business and legal requirements."
The clash comes amid increasing reliance in healthcare on the swelling ranks of non-physician providers. The number of practicing physician assistants, for instance, has risen from about 20,000 in 1991 to an estimated 95,000 today.
"We produce insufficient numbers of primary-care physicians, so we need people to fill those roles. Increasingly, they're filled by nurse practitioners and physician assistants," said Edward Miller, a professor of gerontology and public policy at the University of Massachusetts, Boston, who has studied regulation of NPs and PAs in the U.S. "If there's greater use, there's greater need to expand their scope of practice and to increase confidence in the quality of care they provide,” Miller said.
PAs are required to complete continuing medical education as they work, and every 10 years they also must retake the Physician Assistant National Recertifying Exam, a four-hour multiple-choice test that follows a generalist model, reflecting PAs' traditional area of practice: primary care.
The NCCPA describes rigorous recertification exams and standards as essential to upholding the credibility of PAs and maintaining the public's trust in their skills.
“At a time when PAs are seeking to obtain greater practice authority ... PAs and policymakers need to reject anything that could undermine the professional credibility this profession has worked so hard to attain,” said Dawn Morton-Rias, president and CEO of NCCPA. She rejected the AAPA's claims that studies had shown that recertification did not improve patient outcomes or that requiring PAs to take these tests threatened to limit patient access to care.
All 50 states and the District of Columbia require PAs to pass the test in order to receive an initial license to practice. The AAPA has said it does not oppose this initial certification process but objects instead to retesting requirements that in 20 states are necessary for PAs to retain their licenses. It suggests these repeat tests are unnecessary and redundant.
“Re-certification testing takes valuable time away from our patients,” Josanne Pagel, the president of the AAPA, which represents PAs, said in a video statement. “It could discourage PAs, already in high demand, from staying in our profession.”
NCCPA's proposal to add a specialty component has not yet been approved. If it is, it would take several years to implement.
The AAPA says the proposal “would have such a significant detrimental impact” for PAs and their patients that “the AAPA Board decided it would be prudent to begin the work necessary to establish a new certifying body,” Pagel said in a statement. She added, “We continue to hope that NCCPA will accept our invitation...to discuss its recertification exam proposal with us.”
Miller, the UMass professor, said that this reckoning was in some ways unsurprising. "If you have greater activity on the part of the profession ... you're going to have different points of view about how to address questions related to the profession," he said. "It makes sense that it's happening right now."