NPs and PAs may be colleagues, but when it comes to licensure, certification, and regulation, the professions could not be more different. Nonetheless, practice in specialty areas—and recognition of advanced training and knowledge in those fields—has been an agenda item for both professions, particularly in recent years.
Rather than attempt to combine apples and oranges, Clinician Reviews decided to tackle this topic separately for each group. The PA discussion begins immediately below; if you wish to skip to the NP section, scroll down.
PAs: Specialty Certification?
In the PA world, specialty certification has been on the table for discussion for several decades. Yes, decades. When Janet Lathrop, MBA, President and CEO of the National Commission on Certification of Physician Assistants (NCCPA), speaks to her board of directors or makes a presentation to another organization about specialty certification, one of her slides contains the verbiage of a motion related to the topic. “Everyone thinks they’re minutes from a very recent meeting,” she says, “and they’re from 1978.”
That said, the subject has become a particularly hot one in the past few years. In May 2006, NCCPA “passed a motion to develop specialty recognition, including examinations,” Lathrop says. A subsequent motion, passed by the NCCPA board in August of this year, laid out an 18-month time frame to explore how specialty recognition might be handled.
“It could be that in the 18 months that the workgroup talks about a model, they’ll come back and say, ‘There is no model; we don’t want to do this,’” Lathrop says. “Or they potentially could come back and say, ‘We need to do specialty certification.’ All options remain open for discussion.”
Last month, during its final board meeting of the year, NCCPA updated its points of consensus regarding specialty recognition, which state that the board “will develop and administer specialty recognition according to the following principles:
“a. Specialty recognition will be voluntary and will be independent of NCCPA’s certification and recertification process.
“b. Specialty recognition will support and reinforce relationships between PAs and physicians.
“c. NCCPA will seek input and cooperation from appropriate stakeholders.
“d. Specialty recognition will support the credentialing process and not create barriers to licensure and practice.”
Point “c” is particularly salient, because there are divergent views within the profession as to what form specialty recognition should take.
Joint Dialogue
Much has been made, in various channels, of the fact that NCCPA and the American Academy of Physician Assistants (AAPA) have opposing viewpoints when it comes to specialty certification. This is not entirely surprising, given the different missions that the organizations have. But Greg Thomas, PA, MPH, AAPA’s Senior Vice President for Education, Membership, and Resource Development, would like to dispel some myths.
“AAPA does in fact have policy in opposition to specialty certification, per se, that is based on examination,” he says. “But I think it’s very important to add that we are not only currently participating in, but encourage, the ongoing dialogue about this issue.”
Furthermore, Thomas points out that AAPA policy is not like a Supreme Court decision. “Policy is, by definition, a dynamic thing and can certainly, as times change and as circumstances change, be revisited and potentially changed,” he says. “I’m not saying that’s in the process of happening as we’re speaking. But I think that’s a misconception as well—that because something exists in policy, it cannot be changed.”
AAPA supports the concept of recognition of knowledge and skills in a specialty. “The terminology of certification is where there have been some differences of opinion,” Thomas says. “Our opposition is around certification, which could limit the potential mobility from one specialty to another. That may be a theoretical limitation, but that has been the basis of the opposition.”
Despite the differing perspectives, NCCPA and AAPA are keeping the lines of communication open. Thomas serves as an AAPA representative to the NCCPA, “so we’re not operating in a vacuum on this,” as Lathrop says.
“That doesn’t mean AAPA is supporting it—it means they’re being an appropriate, responsive business organization and saying, ‘OK, let us be in on this, let us hear what you have to say and let us have a voice at the table,’” she adds. “By participating, they’re not doing anything other than participating—finding out information, staying abreast. They don’t have to agree.
“But maybe,” she says, with a note of hope in her voice, “maybe we’ll come up with a model that serves the needs of everyone—most importantly, patients.”
Needs and Concerns
The logistics of what level of recognition is appropriate and acceptable for PAs practicing in specialties is the biggest piece of the puzzle. “In terms of what the specific mechanisms may be, I think it’s premature [to say],” Thomas explains. “That’s exactly the conversation that’s ongoing—not only within AAPA, but within PA specialty organizations, within the NCCPA, and frankly, even within some physician specialty organizations.”