Discussions and collaboration with the National Commission on Certification of Physician Assistants continue to ensure that PAs are aware of certification maintenance changes scheduled to start for some PAs in the 2014-2016 two-year certification cycle. The changes will affect CME requirements as well as the amount of time PAs spend between recertification exams. The current six-year time period between recertification exams will be extended to 10 years. The 10-year recertification cycle and changing certification maintenance requirements to better reflect PA competence in practice have been discussed and debated among PAs for several years.
Some background: Between 2003-2005 NCCPA, AAPA, PAEA (Physician Assistant Education Association) and ARC-PA (Accreditation Review Commission on Education for the Physician Assistant) worked collaboratively to define a set of competencies for the PA profession. Once they developed these competencies, they concluded that the current certification maintenance process effectively addresses only one of the competencies—medical knowledge.
NCCPA’s goal in defining the new requirements was to effectively address all six competencies. NCCPA considered best practices from other medical boards, emerging requirements for state licensure, input from AAPA and PAEA, public comment and a pilot study all prior to defining the new requirements for certification maintenance.
Currently, PAs must earn 100 hours of CME every two years, half of which must be Category I CME, accredited by AAPA or an approved organization. The amount of CME PAs are required to earn won’t change under the new requirements. However, PAs will now be required to complete 20 of their 50 hours of Category I CME through either self-assessment CME or performance improvement CME, also known as PI-CME.
PI-CME encourages PAs to review their own clinical performance and attempt to improve care based on what they learn. According to NCCPA, PI-CME involves the PA making a comparison between some aspect of his or her practice and national guidelines or standards for best practice, developing a plan to improve in that area and then reassessing performance after the plan has been implemented.
“PI-CME is quality improvement in practice and about doing what is best for our patients,” says Leocadia Conlon, PA-C, director of quality improvement initiatives at AAPA.
AAPA is working to make resources available to best support PAs when these changes take place. To this end, AAPA convened a certification maintenance advisory panel comprised of the Academy’s Professional Education Commission, which includes practicing PAs, a NCCPA representative and several performance improvement experts. This panel developed the specific criteria for evaluating the new CME activities (self-assessment and PI-CME) and will affect how these activities are designed. The criteria emphasize practical, integrated-with-practice activities that matter to patient care.
“You need to make it [PI-CME activities] pertinent to your practice,” said Bernard Stuetz, PA-C, who served on the certification maintenance advisory panel and has published three articles on recertification. “Let’s say you select the charts of 10 patients who are diabetics to see if you tested their hemoglobin A1C. You may find that you only tested eight. The next month, if you find that you improved and gave tests to all 10 patients, that shows improvement and you will get PI-CME Category I credit for that.”
Of note, you do not need to demonstrate actual practice improvement in order to receive CME credit according to Daniel Pace, AAPA CME director and staff liaison to the AAPA Professional Education Commission. The primary intent is to help PAs reflect on their own practice, not to tie patient outcomes to CME credit. PAs can complete PI-CME individually or as a part of a team.
PAs will only be required to complete the 20 hours of self-assessment and/or PI-CME during the first four two-year cycles of the 10 years. During the last two years, they can earn their 50 hours of Category I CME using any combination of approved offerings.
Stuetz, a longtime critic of the six-year recertification cycle, said he welcomes the move to a 10-year cycle. Most major medical certifying organizations adhere to a 10-year cycle, he said. Stuetz expects that the extended recertification cycles will allow PAs more time to develop their skills and knowledge, making them more prepared for each examination. He also sees the change as an access-to-care issue.
According to NCCPA, PAs who pass the PANCE or PANRE in 2014 will be the first to move to the new cycle. The rest will transition over the subsequent five years. PAs will complete their current six-year cycles before transitioning to the 10-year cycle. PAs who pass the PANCE and earn their initial certification in 2014 will also be on the 10-year cycle.
Daniel Thibodeau, PA-C, former chair of the AAPA Board of Directors and editor-in-chief of McGraw Hill’s PA Easy PANCE and PANRE test review website and “Pearls of Wisdom Physician Assistant Exam Review, 4th Edition,” called the move to a 10-year cycle “a huge change for the profession and how we prepare.”
“A lot can happen in medicine over 10 years,” said Thibodeau, who is also an associate professor in the Eastern Virginia Medical School Physician Assistant Program. “Because of the types of content the PANRE has, every PA is still going to have to be responsible for making sure they’re competent in general medicine topics.”
While Thibodeau doesn’t expect the 10-year cycle to change the way most PAs prepare for the exam, PAs who tend to focus on their specialty when earning CME will have to stay current on general medicine topics. “It could be difficult for some people, because they might spend nine years doing CME in their specialty, and then the PANRE comes along. We still have to be prepared for the generalist model that our profession was founded upon, and we have to remind ourselves that recertification is a generalist exam.”
This content originally appeared here as a rerun of an article published in Advance for NPs and PAs on April 25, 2012. AAPA staff updated it on Dec. 14, 2012.