PAEA Calls for Transparency Around Recertification Issue

The public discourse concerning the issue of the recertification process for PAs has been escalating over the past several months, culminating in the AAPA Board of Directors announcing its plans to formally investigate creating a competing PA certification organization.

This move has lead PAEA to issue a resolution urging AAPA to commit to a transparent, evidence-based, and inclusive dialog with the Four Orgs. PAEA is not taking sides on this issue but is calling for it to be discussed in a professional and dispassionate manner — in the best interest of the entire PA community.

To put this resolution in context, below, please see:

• a brief recap of the events that led up to where we are
• a set of answers to questions you might have about this resolution

Timeline

• November 2015. At the 2015 Education Forum, NCCPA announces their proposal to change the structure of the recertification exam.
• December 2015. NCCPA releases their formal statement and white paper on their proposal to change the recertification exam, and ask for comments by March 2016.
• January 2016. The PAEA Board of Directors discusses the proposal at the first 2016 Board meeting, and establishes a team to develop specific feedback for NCCPA.
• February 2016. AAPA launches a website dedicated to the PANRE proposal, AAPA News Center: A Seismic Shift for PAs.
• April 2016. The PAEA Board of Directors publishes an Open Letter to NCCPA Regarding the New PANRE Model, asking some pointed questions to NCCPA about the thinking behind their proposal. Our Open Letter also draws attention to the negative public conversation that has emerged around this issue.
• May 2016. AAPA alludes to the potential for legal action against NCCPA in the House of Delegates. NCCPA addresses the House of Delegates about the reasoning behind their PANRE proposal. AAPA passes the Board-submitted resolution “Elimination of High Stakes Recertification Testing for PAs”.
• June 2016. AAPA legal counsel sends a letter to NCCPA, expressing concerns about antitrust activity. NCCPA legal counsel responds with a letter to AAPA objecting to those concerns.
• July 2016. The AAPA Board of Directors announces that they will “take the next steps toward establishing a new certifying organization by gathering more information and developing the necessary documents.”
• August 2016. PAEA sends a letter to AAPA and NCCPA, signed by the Board of Directors and 112 program directors, expressing our disappointment in the public and combative way that this issue has been addressed by both organizations, and strongly urging a joint Four Org meeting to negotiate a more productive way forward.
• Early September 2016. The Four Orgs (AAPA, NCCPA, PAEA, and ARC-PA) meet in Atlanta to discuss the situation and come to an agreement on an evidence-based approach to the issues. The Four Orgs leave this meeting having established an agreement to conduct a more professional public dialogue.
• Late September 2016. Articles written and submitted prior to the Four Org meeting by both AAPA and NCCPA are finally published by Clinician Review (“PAs Should Focus on Patient Care, Not Unnecessary Testing”) and MedPage Today (“The PA Recertification Debate: We Need to Be Tested”). The subsequent controversy on AAPA’s social media and other channels regarding NCCPA’s MedPage Today article occurred without verification of the facts and context around NCCPA’s article. AAPA’s immediate response was to protest, rather than take the time to seek additional clarifying conversation with NCCPA.
• October 2016. PAEA prepares the attached resolution.

A Resolution Urging AAPA to Commit to a Transparent and Evidence-Based
Dialogue with the Four Orgs 

Whereas the Four Orgs — PAEA, ARC-PA, NCCPA, and AAPA — constitute a shared professional community built on both long tradition and mutual interdependence;

Whereas the members of a community must act in a way that preserves and strengthens their common interests, collaborative spirit, collegiality, and trust, which includes involving the members of that community in shared dialogue and deliberation on matters of mutual importance;

Whereas the Four Orgs serve as both national role models and ambassadors for the PA profession, embodying and demonstrating through their actions our professional values of collaboration, teamwork, and evidence-based decision making;

Whereas AAPA’s investigation of the steps required to establish a new certification organization has, in effect, declared a de facto vote of no confidence in NCCPA and, by extension, the Four Org model of participatory leadership in the PA community;

Whereas AAPA’s investigation of establishing a new certification organization was initiated based solely on internal conversations, without the benefit of dialogue with the Four Orgs and without publishing any impact analysis by an objective third-party before taking action;

Whereas PAEA and its educational program members, being the gatekeepers to the PA profession, have an obligation to our student constituents to address behavior that is incongruent with the PA professional identity we seek to develop;

Whereas PAEA holds as paramount the principle that decisions should be based on the conscientious, explicit, judicious, and reasonable use of the best modern evidence;

Whereas the other members of the Four Orgs have requested that AAPA use a participatory, transparent, and evidence-based decision-making process to investigate the potential impacts of establishing a new certification organization, but AAPA has declined to involve the Four Orgs in such a process to date, thereby inspiring uncertainty and doubt in our community and undermining the common interests, collaborative spirit, collegiality, and trust of the Four Orgs;

Whereas by foregoing a transparent and evidence-based decision-making approach, AAPA undermines the principles underlying the evidence-based medicine approach that PA programs are currently teaching PA students, and suggests a willingness to allow other considerations to influence the objective analysis and evaluation of evidence; and

Whereas any further action by AAPA to establish a new certification organization — without engaging the Four Orgs in a transparent and evidence-based dialogue — will continue to actively harm the PA community and the PA profession at large;

Now, therefore, be it resolved, that the Physician Assistant Education Association (PAEA):

1. strongly urges AAPA to immediately suspend any additional activity leading to the design or development of a new certification body;
2. strongly urges AAPA to publish the evidence and analysis that identifies and prioritizes the potential impacts of a new certification organization on both the PA community and the PA profession; and
3. strongly urges AAPA to publicly commit to a transparent and evidence-based dialogue with PAEA, NCCPA, and ARC-PA, on the potential impacts (both positive and negative) of any new certification organization.

Questions

1. Does this resolution mean that PAEA is taking sides in the dispute between AAPA and NCCPA? PAEA is on the side of transparent and evidence-based dialogue that advances the long-term vitality of the PA profession. We support the PA community as represented by the Four Orgs, and we think that the interests of that community are best served by dispassionate and evidence-based analyses that are not emotionally charged.
2. This resolution addresses AAPA directly. Why doesn’t it also address NCCPA’s shortcomings? Since the beginning of this process, NCCPA has committed to sharing its evidence-based approach, and has been responsive to criticisms from both AAPA and PAEA about the quality of that evidence — by collecting additional data, engaging an objective third party, and significantly revising their proposal based on new evidence. By contrast, AAPA announced their intention to investigate establishing their own certifying organization without any consultation with the other PA organizations. When PAEA provided direct feedback about their approach, AAPA responded that they intended to “stay the course,” with no changes considered or shared. This resolution is designed to address the absence of an evidence-based approach and the lack of a broader and more inclusive conversation on the need for a new certifying organization. The resolution does not address the merits of recertification testing or NCCPA’s specific proposal.
3. Doesn’t this resolution just contribute to the same unhealthy public dialogue that you have criticized? Unlike the fractious conversations on social media, the Huddle forum, and other similar channels, this resolution is intended to represent the formal and unified position of PAEA. Furthermore, this resolution is a call for AAPA to commit to a shared and inclusive Four Org process, which is the opposite of the divisive attitude taken in public to date.
4. I don’t think the PANRE proposal is good for the profession, and maybe a new certifying organization is a good idea. Why should I vote for this resolution? Regardless of your position on NCCPA’s proposal, we believe that decisions like establishing a new certifying organization would have an enormous impact on the profession as a whole. Decisions like these demand a transparent and evidence-based process across the entire Four Orgs, so that we carry out our joint duty as stewards of the PA profession.