Thursday, September 29, 2016

NCCPA Wakes Up. Could somebody please shake the AAPA too?

NCCPA Responds to PA Concerns with Change to CME Requirements

At its meeting last weekend, the NCCPA Board of Directors responded to concerns from PAs and to a new analysis regarding the availability of self-assessment and PI-CME activities and reached a decision to relax the self-assessment and PI-CME requirements introduced with the new 10-year certification maintenance process.

Effective immediately, self-assessment CME and PI-CME are no longer required. However, in recognition of the value of these very interactive types of CME, NCCPA will weight those types of CME more heavily, awarding extra credit for these now optional types of CME.

Dear Colleagues:

From my perspective, this is a good adjustment and at least SOME evidence that our organizations actually listen to what we clinicians say to them.  I changed over to the 10 years cycle after my last (third) PANRE in October 2015.  In reviewing all the CME changes attached to the new cycle, I frankly couldn't discern anything that would make this a better process. The explanations of what constituted what, I found confusing.  It should like PI CME would be some collaborative process targeted to enhance the clinician's knowledge and skills in his/her practice setting, and that SA CME was simple that, self-assessment.  

Despite looking at the NCCPA site through it's changes over the past couple of years, a decent explanation of this I could not find.  That these have now been removed, serves to simplify the process for PA's who have been using a proven, flexible  and appropriate CME and re-certification process that has been in place for their entire career.  It wasn't broken, it didn't need to be "fixed" and now the failed "fix" has finally (and properly) been retired.  That's good, because it wasn't a good model to begin with.  

A major issue that I have with the NCCPA release on this subject if that the NCCPA is giving "extra credit" to the PI and SA programs it has previously approved / endorsed.  

"To encourage PAs to continue to pursue self-assessment activities, NCCPA will award 50% additional credit for all activities designated for self-assessment Category 1 CME credit (i.e., a self-assessment activity worth 10 credits will be converted to 15 credits by NCCPA). Also, the first 20 PI-CME credits logged during every two-year cycle will be doubled when logged with NCCPA."

I am not sure that the NCCPA can properly give Category I credit in excess of the number of hours for which that activity has been approved by the accrediting body.  If the AMA approves a program for 12 hours of Category I CME, then NCCPA can't simply give you six extra credits.  NCCPA is not an accrediting CME provider. It is a certifying body.  This policy might suggest that NCCPA somehow benefits from PA's purchasing these products.  Hopefully that's not the case, but certainly no stretch to see that as a real possibility.

AAPA and NCCPA need to work more cooperatively.  Ever since NCCPA stopped allowing PA's to log CME free through AAPA, there has been a running "pissing match" between the two organizations over one thing of another.  It's no wonder that may of my colleagues no longer maintain membership in the AAPA.  I am back and forth on the issue, mainly because there are few tangible benefits provided for us here in the trenches.  I have never seen a decent public service ad regarding PA's in my 20 years and people still ask me regularly about what PA's do.  The only recognition AAPA has provided is for the DFAAPA folks, mostly those involved in the politics of the profession.  You practice a couple of decades, train PA students, publish now and then, gain a specialty credential, that won't net you anything. Frankly I kinda roll my eyes at AAPA on that.  I think everyone certified PA member of the AAPA should be a FAAPA. The argument against this was that it wasn't like a "fellow" of a physician group, like FACS, FACEP, etc. Well, neither is DFAAPA.  I guess it makes some people feel special.  Certainly not the rest of us though.  

I'll give the NCCPA it's due on finally making specialty recognition happen after the AAPA turned a blind eye and deaf ear to AAPA members on the subject for years.  NCCPA used a great model that preserved the "generalist" credential along the way.  NCCPA kicking the mandatory SI and PI to the curb was another good decision.  Frankly, the "old method" allowed much more of the flexibility PA's need.  Hopefully, they won't try to further complicate the process.  PANCE - PANRE works just fine, places us at the top of chain in terms of maintaining currency and competence among health provider groups in the US.  My state doesn't require me to be NCCPA certified to maintain a license.  I like to have it, but if they muck about too much, I would NCCPA like a hot rock at then end of my current cycle.

AAPA's getting huffed up about the NCCPA and suggesting that they might seek an alternate certification model would be a disastrous move for out profession. That could lead to a fragmentation of our profession and bickering arguments about whose certification was valid or whether one was "better" that the other. I would hate to see us moving down the same road as our physician colleagues and their perpetual bickering about Board Certification. "My certification path is better than your certification path."  I can already see some of that affecting relationships among APN's.  We simply don't need that type of divisive rhetoric in our profession. PAs should always stand together.  Let the plethora of titled "doctors," argue, while we focus on providing the best possible care to our patients.

Let's try to get together on finding the most effective ways to train, certify and support some of the best and most dedicated medical care providers the U.S. has seen in the last 50 years (2017 is coming). It's either that or the possibility of letting our profession degenerate into something akin to the sad state of the 2016 Presidential Election.


R. Scott Best, PA-C