Open Letter to NCCPA Regarding the New PANRE Model

Thank you for asking the PAEA Board of Directors to review and comment on NCCPA’s proposal to change the PANRE recertification process.

As educators, we treasure innovation and continuous quality improvement. These are critical components to delivering a world-class education to our students, ensuring that we are adopting the best emerging methods and then testing and adapting them to serve the needs of our students and our communities. We see in NCCPA’s proposal that same drive towards innovation, finding new ways to respond to a rapidly evolving landscape where the majority of PAs choose to specialize in a particular area of medicine.

As a professional community, we have a shared responsibility to elevate the credibility and recognition of PAs. Many of us are currently exploring and implementing new products, services, and assessments to objectively and reliably establish PA professional competence: from NCCPA’s Certificates of Added Qualifications, to niche certifications being explored by AAPA and some of the PA specialty societies, to our own End of Rotation™ exams.

We commend NCCPA for taking the initiative to share its proposal with the PA community for consideration and feedback prior to implementation. Regrettably, the current discourse around the proposal is, at times, littered with unproductive and argumentative language. This undermines the ability of PAs and other stakeholders to objectively consider the proposal, and may alienate others before they have the opportunity to read it.

We believe it is incumbent on the PA organizations to set a high standard for collegial and evidence-based peer review. Consequently, after careful consideration on how best to respond to NCCPA’s request for comments, we believe that a point-by-point analysis of the proposal would be a barren approach, locking us into a polarizing debate that doesn’t advance this important conversation.

Instead, and with the intention of opening a broader dialogue with NCCPA and the PA education community, we want to pose a series of questions.

Questions for NCCPA

1. PA education is generalist and competency based, the stakeholders in our profession value this flexible approach, and we consider it a cornerstone to PA practice. However, the current proposal places a similar value on both generalist and specialty assessment. How does NCCPA reconcile the inconsistency between the unified generalist focus of PA education and the split focus of PA recertification?
2. By assessing core medical knowledge with an unsecured take-at-home exam and reserving security, proctoring, and time limits for the specialty knowledge portion, NCCPA is signaling that generalist knowledge is less important and potentially less demanding than specialty knowledge. This conflicts with both the education and the professional identity of PAs. To correct that perception, we recommend that the generalist exam continue to be delivered through the secure system, while the specialty exam is initially deployed using the take-at-home format, with a re-evaluation after a few years. How would this affect the overall proposal?
3. By placing renewed and additional emphasis on specialty assessment, the proposal sends a strong message to employers that NCCPA considers these certifications to be important for clinical practice. This, in turn, could encourage employers to require specialty certifications for specialty practice, undermining the PA profession’s flexibility. What evidence does NCCPA have – or will it collect – regarding the link between increased specialty testing/assessment and the consequent employer requirements for these certifications?
4. An essential element of change management is evaluating the impact of changes made before additional moves are considered. What is NCCPA’s evaluation of the impact of the move to Self-Assessment CME and Performance Improvement CME?
5. Finally, how does NCCPA plan to evaluate the success of this new model and whether or not it achieves the goals that NCCPA has set forth for this proposal?

Questions to Help Refocus the Ongoing Dialogue

1. Given the biases that have already been introduced on this topic, online and offline, what can the PA organizations do to restore the community’s confidence in this process? How can these organizations refocus the conversation to an objective, evidence-based, and dispassionate analysis of the proposal?
2. Public discussion of this proposal has the potential to showcase the collaborative spirit of PAs, PA organizations, and PA leaders. How can we best seize this opportunity to position our recertification conversation in the most constructive manner?

There has been a great deal of controversy around this proposal in public forums. There is one thing on which we can all agree: our profession’s history of rigorous certification and recertification has inspired confidence in employers, insurers, policy makers, and the general public.

As long as the process to reach a decision is transparent and the decision itself is evidence-based, we are confident that NCCPA will make the right choice. The conversation around this proposal is another step in our profession’s continuing collaboration, and we look forward to working with NCCPA and others to build our future together.

Sincerely,

Jennifer Snyder, PhD, PA-C
President, Board of Directors
Physician Assistant Education Association