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NCCPA to Offer Practice-Focused Recertification Exams

The National Commission on Certification of Physician Assistants plans to implement changes to the traditional PA recertification exam.

Beginning in 2009, PAs up for recertification will have the option of taking practice-focused PANRE exams, with questions slightly weighted towards a specific area of practice.

For 2009, the NCCPA will offer three versions of the PANRE: primary care, adult medicine and surgery.

The NCCPA board of directors had announced a reevaluation of the PANRE at the 2006 AAPA conference in San Francisco. Also announced at that time was the elimination of the take-home Pathway II recertification exam in 2010. The NCCPA board of directors approved the specific changes to the PANRE at its most recent meeting.

"(PANRE) will still be a generalist exam," NCCPA president Janet Lathrop said. "But we heard so much from people about (eliminating) Pathway II, so we felt that would be a good time to implement (practice-focused) exams."

All questions for the practice-focus exams will be drawn from the same pool of items as the current exam. But the new exams will draw 40% of their questions from specific areas of the question pool. The other 60% of the questions will be drawn from the question pool in the same percentages as the conventional PANRE (see charts below).

The primary care exam will actually be very similar to the current PANRE, Lathrop said.

"We're trying to meet the needs (of PAs) by creating a little customization (of the PANRE)," NCCPA communications manager Tiffany Flick said.

Lathrop emphasized that no changes to the PANRE are set in stone and said that the NCCPA will evaluate the success of the 2009 practice-focused exams in order to determine the future directions of the PA recertification process.


NCCPA Exam Blueprint
The NCCPA's general blueprint for its exams is online at the commission's Web site. The exam material can be organized in two ways, by task areas and by organ system.

Below are percentages of questions that the NCCPA expects PAs to encounter during an exam.

Organ Systems % of Exam Content
 Cardiovascular  16%
 Pulmonary  12%
 Endocrine  6%
 Eyes, ears, nose and throat  9 %
 Gastrointestinal/Nutritional  10%
 Genitourinary  6%
 Musculoskeletal  10%
 Reproductive  8%
 Neurologic system  6%
 Psychiatry/Behavioral  6%
 Dermatologic  5%
 Hematologic  3%
 Infectious diseases  3%
  Total   100%

Tasks % of Exam Content
 History taking and performing   physical examinations  16%
 Using laboratory and diagnostic studies  14%
 Formulating most likely diagnosis  18%
 Health maintenance  10%
 Clinical intervention  14%
 Pharmaceutical therapies  18%
 Applying basic science concepts  10%
 Total  100%

I have similar sentiments regarding the PANRE. I work in a part-time, inner city community psychiatry setting, in addition to full time employment as a clinical studies coordinator for a small clinical research group ( specializing in longevity, metabolism and endocrinology.

P.A.s employed in numerous specialty and subspecialty fields are a fact of life. We fulfill a unique niche in the world of medicine. It is virtually impossible for the NCCPA to adequately address quality practice standards for any of us who have practiced for any length of time. It is ludicrous and monstrously absurd to believe "passing the PANRE" somehow qualifies a PA to continue to practice in his/her area of endeavor. What poppycock!

The NCCPA has been entrenched in the role of gatekeeper too long. And the AAPA, in its 'infinite wisdom" continues its collusion and support of NCCPA in its restrictive endeavors. In my view, NCCPA should be reduced to certifying entry level P.A.s in a manner similar to how specialty boards test competencies ONE TIME. The PA profession is the only one, at least to my knowledge, that insists on recertification.

P.A.s are stuck between a rock and a hard place for, when searching for a P.A., most employers seek national certification. And most are probably oblivious that recert exams are required in order to maintain that "C." "Credential creep" has swept P.A.s along in the stream that flows as word salad on our business cards. Never mind that it commonly causes bewilderment and confusion of roles versus titles among lay persons, to wit: a PA with a PhD in education is now "Dr. so and so." But I digress.

And so NCCPA rides midstream in the confusing detritus amid titles and mandatory credentialing. It collects its fraudulent monetary "poll tax every six years. Why is it that our profession continues taking "hits below the belt" from the boondoggle that is NCCPA recertification? Oh, should we dare continue to practice without getting that particularly demanding "ticket punched" q 6 years?

Our passive national body continues to allow NCCPA demands to continue this lack of reality-based testing. Yet NCCPA fails miserably in its attempt to address specialties. Could any of you out there imagine the brouhaha that would occur if suddenly medical/surgical specialty boards announced six-year mandatory review boards?

I say again "IN THE CLEAR" abolish the recert.abolish the NCCPA, more's the pity.

FRANK GUCCIARDO,  Staff PA,  Terros Behavioral Health Services September 22, 2007
Phoenix, AZ

Let's be fair and realistic

My comment is not really about the PANRE or Pathway II changes, but is more directed to something disturbing that I heard about but am not sure of its authenticity. I have heard that anyone who writes questions for the NCCPA board exam or is on such a committee does not have to take a recertification exam every six years. The rumor is they are exempt.

If that is the case, it makes absolutely no sense. Are these people still practicing? If they are then this adds another branch of inequality to the disparity tree and validates Mr. Irwin Fish's (no relation) comment,"Of course the idea that we unlike our Physician colleges must pass a recert exam every 6 years or we can not practice is poor in how it treats medical professional unequally." If the rumor is true, we now have inequitable treatment even within our own profession.

Does it mean that because I write questions for an exam such as this or sit on a committee to discuss the exam, that I am so much more in-the-know, clinically than my colleagues that I don't need to take an exam to prove my proficiency anymore. There seems to be a double standard being set here. Since when does writing exam questions and reviewing exams make one immune to providing proof of proficiency like the rest of us? At least those PAs who took the Pathway II route in the past, for whatever reason, had to put a lot of time into the process of being recertified.

I have to ask myself from a patient's perspective (and you should ask yourself) who would I/you rather be seen by: PA (a), who has written and reviewed board questions and is therefore exempt from taking any form of recertification exam; PA (b) who has taken and successfully completed the Pathway II; or PA (c) who has taken and passed the recertification exam as required? Clock is ticking, someone please buzz in on this question before I do.

Tell me the rumor is not true.

Barry Fish, PA-C, M.Ed
Director of Curriculum/Technology
Des Moines University PA Program

Barry Fish,  PA,  DMU September 14, 2007
Des Moines, IA

The title of this should have been "NCCPA Falls Short on Specialty Recognition". The idea of the focused PANRE exam does nothing but dilute the validity of the test for the entire profession. The NCCPA has long had a good generalist knowledge-based exam that few have had problems completing successfully and this should be maintained. The most ideal method of providing PAs with specialty recognition would be the provision of addition "extended core" examinations, similar to the surgery exam currently available. On completion of such an extended core exam, the PA would receive a letter and endorsement seal providing "Special Recognition" in Family Practice, Surgery, Pediatrics, Emergency Medicine, etc. This mechanism has been in place for over a decade and it seems an obvious solution to what those in the profession are looking for, but once again the ball has been dropped. Given the growth in the profession over the last decade, the clamor for specialty recognition and the stagnancy of the AAPA and NCCPA, it will not be long before organization will step in take the lead on this issue.

R Scott Best,  PA-C, MPAS,  Rex Hospital September 14, 2007
Raleigh, NC
For those of us who do very little Peds and OB-Gyn the focused exam may prove helpful. Of course the idea that we unlike our Physician colleges must pass a recert exam every 6 years or we can not practice is poor in how it treats medical professional unequally. Even our NP Colleges do not have a recertification exam to take every 6 years. Have to wonder were the equalness is in this system or it just that the Nursing Profession has better lobbiests.

Irwin Fish,  MPAS, PA-C,  NOAAS Ron Brown September 14, 2007
Open Oceans of the World, SC

I am completely in favor of eliminating the Pathway II exam. PAs are unique in their ability to remain "quasi-familiar" with all specialties of medicine, and thus we are not restricted in our specialization options. The new advent of a somewhat practice-focused exam is a great step forward. I work in a large, private HIV practice in urban Chicago that deals with a primarily gay Caucasian population. I have absolutely ZERO exposure to pediatrics or (for the most part) womens' health. Does that mean I should be oblivious to those aspects of modern medicine? NO! PAs need to keep our wide-ranging knowledge of medicine and its specialties up-to-date, and I applaud the NCCPA for taking the steps it has to revamp our recertification process. I may offend some of my fellow practitioners by saying this, but those opposed to these changes are likely "old-school" PAs that want to keep their heads buried in the sand. If a PA were treating you and your loved ones would you prefer one certified on a take-home exam or one that clearly has knowledge of most facets of medicine as evidenced by the PANRE of today? Just my two cents...and once again I apologize to my esteemed colleagues whom disagree.

Curtis Hainds,  Director of Clinical Research,  Northstar Medical Center September 14, 2007
Chicago, IL

I disagree with the way the so-called customization will be implemented. So many of us are in highly specialized fields, that it seems even with the reforms it will continue to be a primary care based exam in which many of us may only see 40% of the topics at best. When we do see patients with chronic illnesses they are usually presenting for tertiary care regarding a very specific issue. Eliminating Pathway II and not adjusting for PA's in specialities is a big mistake.

Maysoon  Dayoub,  PA-C,  Lankenau Hospital September 13, 2007
Wynnewood, PA

I strongly object decision to eliminate Pathway II exam. When one works for many years in very specialized field it is extremely chalenging to stay up to date in other fields of medicine. What kind of reaction some would expect from OBGYN docs who in order to be recertified need to answer adult, peds, ent e.t.c questions? What we REALY need -specialty exams.

Mikhail ,  PA-C,  Hospital September 13, 2007
Pittsburgh, PA

The PATH II should have stayed; the written questions were an excellent review of general medicine, requiring critical skills of diagnosis and treatment. As a PA who has always been and probably always will be in Dermatology, I think Path II much better addressed the requirement to stay familiar with medicine, being a self-study and test in one. The requirement for additional CME demonstrated one's commitment to the profession, to continued learning, to more than Multiple choice test taking skills.

Melissa Raue,  PA September 13, 2007

I disagree with the decision to eliminate the Pathway II examination. Even though many of the questions were unrelated to the scope of my practice, I have to say that I did learn from it. Just sitting and answering random questions and not knowing what was correct or incorrect is a waste of time. Researching the questions and reading for the Pathway II makes more sense.Let's keep it!

todd  freedman,  physician assistant,  flushing hospital September 13, 2007
queens, NY

I have to disagree with the decision to eliminate the Pathway II examination. Though the questions were totally unrealistic. I feel taking the option away from the PAs shows just how far, NCCPA has moved away from us the PAs. We have created a monster !!

James Bradley,  PA-C,  VAOPC September 13, 2007
New Port Richey, FL

I have worked for several years in chronic pain care and interventional pain medicine, do lots of injections and manage chronic pain medicines. My practice setting is a 70 member multi-specialty group. The recertification process in general medicine seems to ignore the fact that many PA's today are in highly specialized fields of care. PA's working in highly specialized care should be able to have Pathway II as an option.

Michael Tindera,  PA-C,  AP&S September 13, 2007
Terre Haute, IN

I have to disagree with the decision to eliminate the Pathway II examination. I actually found it to be a useful exercise. In era of computerized resources, I found it to be a more realistic in the way most of us practice. You are posed with a question (a patient with a condition), you check available information, and you decide on the best treatment alternative. Compared to the stress of studying for the PANRE, I would take the Pathway II every time.

Julie Purcell,  PA-C,  Mt. Auburn Hospital September 13, 2007
Cambridge, MA


I disagree with the elimination of the pathway II, what is the difference if someone studies and learns from a test or studies and has 4 chances to pass a test in a testing environment. Their are a lot of people who are very competent in their ability and skills as a PA and are excellent clinicians, but have test anxiety. Eliminating this option takes away this option for people with test anxiety. Book smart/test smart and clinical smart are two different animals. Do you realize that 25% of PA certifying for the second time fail the recert exam, that many people can't be falling off, what is wrong with our testing? We are all different people and need different options.

Brandy Embry,  PA-CAugust 26, 2010
Dunn, NC

Wow, still getting hits! I think that for people that actually work for a living, take call, work week-ends, and have variable schedules, Pathway II was the way to go. I think we are being ripped off financially and being squeezed into one-size fits all testing. The rumor was PII was stopped since it was not intended to be a "learning experience." I found it to be the only practical way to recert q6y (which I think is gross overkill, but it keeps a bunch of non-clinical experts employed). I will celebrate the day I retire and can stop the biannual and 6 yearly torture.

Frank ,  PA-C,  ClinicApril 20, 2010
Southern, CA

I disagree with removing the Pathway II Exam. It is an excellent opportunity to gain knowledge of new treatment modalities. It is in itself a learning activity which is challenging.

Sara Snowden,  PA ,  SRCApril 13, 2010
fayetteville , NC

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