A jurisdictional battle breaks out over physician assistant certification

For nearly a year now, the American Academy of Physician Assistants (AAPA) has been bickering with a separate organization, the National Commission on Certification of Physician Assistants (NCCPA) over how PAs are certified. Most recently, AAPA issued a news release announcing the intention “to investigate the creation of an alternative certifying body for PAs ... in response to the large number of concerns voiced by PAs [that] ... reflects the priority of PAs to put patient care ahead of burdensome and unnecessary recertification testing.” The irony in the AAPA decision is that it began with a proposed (not final) revision from NCCPA on the certification process. NCCPA issued a press release complaining of AAPA’s “unwillingness to engage in dialogue around this important issue,” and that AAPA has “reversed course on over three decades of support for the recertification examination model.”

To varying degrees in most states, PAs are permitted to write prescriptions; like most other healthcare providers, their legal status is controlled by state boards. PAs work under the authority of a “coordinating physician” but can operate independently. Many are employed in various publicly funded healthcare functions (the Veterans Administration; public health clinics and the like) and are also widely used in health systems.

AAPA’s beef with proposed NCCPA changes have to do with the requirement for a recertification process at 10-year points during a PA career, and the use of a proctored, timed exam, also at 10-year points, for the specialty area of the PA. AAPA’s contention is that PAs are one of the few healthcare professions that require the 10-year recertification, and that the process of specialty testing is too onerous; failing the test could cause the PA’s license to be yanked in some states. Some of this dispute seems to go all the way back to the origins of the PA profession—the certification process was initially developed under the aegis of the American Medical Assn.—and medical doctors themselves are not required to recertify at 10-year levels. (Continuing medical education, a requirement of most healthcare professions, is not in dispute between AAPA and NCCPA.)

Perhaps the greatest significance for the US pharma industry isn’t how this certification process will change, but simply the fact that PAs are a growing part of healthcare, especially publicly-funded parts. Recent surveys show that there are now over 108,000 PAs at work; that 70% of them work in specialty areas, and that the implementation of the Affordable Care Act over the past couple years has greatly increased demand for their services. However the dispute is resolved, it is likely to take years for the certification process to flow through to the state authorities.