Physician specialty and subspecialty groups have had a role to play in the latest go-round on this topic. PAs practicing in some specialty areas have approached NCCPA about specialty recognition, indicating that the physician organizations governing their specialty have requested some means of confirming that PAs have an appropriate level of training to perform relevant tasks or procedures.
“You can’t just walk out of PA school and put a Swan-Ganz catheter in somebody,” says Clinician Reviews PA Editor-in-Chief Randy D. Danielsen, PhD, PA-C, who is Immediate Past Chair of the NCCPA and current Chair of NCCPA’s Specialty Task Force. “You have to have some additional training, and then the question becomes, ‘How do we assure the public that the PA has the training?’”
The primary concern is that PAs might end up required to certify in order to practice in a specialty. Or, as Danielsen puts it, “The biggest fear is that PAs will not be able to cross between specialties without jumping through some hoops.”
That has been part of AAPA’s concern, since the PA profession was founded on a generalist medicine model. But members of NCCPA understand the potential limitations as well. “That’s the concern of the profession,” Lathrop acknowledges. “If we build it, will they come? Even if you develop this recognition through NCCPA and even if you don’t require it, if it’s voluntary, it could end up required by the states.”
Anything Is Possible, Nothing Is Definite
So what’s the solution? “If you could figure something out, let me know,” Lathrop says. She is reluctant to comment on what NCCPA’s model (if they develop one) might consist of, “because we don’t know.”
Danielsen is more willing to muse aloud, with the clear understanding that he’s tossing ideas out there and not representing NCCPA, or making suggestions, when he does so. If PAs “hang our hat on the star called ‘physician,’” as he puts it, “maybe we should have the initial certification exam be our licensing exam and then anything else we do be a voluntary board certification, where somebody chooses either formally or informally to go through an educational process and then take a specialty exam.”
Moving outside the realm of examinations, some PA specialty organizations that see the greatest need for this type of recognition have already taken matters into their own hands. “A few have established an advanced membership category for PAs within those specialties who meet certain criteria, such as number of years of practice in that specialty or advanced education or CME that is specifically related,” Thomas points out.
A good example is the distance-learning program that the Society of Dermatology PAs launched this summer through the University of Texas Southwestern. Experienced derm PAs are eligible to participate in Web-based educational modules, with diplomate membership status awarded to those who participate. Whether such programs will suffice to assure physicians—and patients—that PAs have adequate knowledge remains to be seen.
Working with specialty groups is an avenue that AAPA is exploring. “One of the things that AAPA is certainly looking at very seriously is trying to partner with other organizations, notably physician specialty organizations,” Thomas says, “to provide what we’re referring to as ‘intensive educational opportunities’ in a whole host of specialty and subspecialty areas.” He notes that some physician specialty groups already offer or are discussing the possibility of offering affiliate or associate membership to PAs who meet certain criteria.
How the matter of specialty recognition will play out is still anyone’s guess. Truly. “There are people who say we know what we’re going to do, that we’ve known it all along, and this is just smoke and mirrors,” Lathrop says. “But it’s really not. I can honestly say, with all sincerity, I have no idea. I just know that we’re going to work through this for the next 18 months, and hopefully come up with something.”
NPs: Nonregulated Specialties
It may have taken five years and the collaborative efforts of more than 50 organizations, but the nursing community has developed a Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (available at the National Council of State Boards of Nursing [NCSBN] Web site, www.ncsbn.org). The model, as its subtitle indicates, outlines the role of an APRN (which includes certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners), as well as the six population foci in which an APRN may choose to be educated.
The NCSBN endorsed the model this summer, providing credibility at the national level, and now, much like the Nurse Licensure Compact, the model will be taken to the states for approval. If a state signs on to the consensus model and subsequently amends any relevant laws or regulations to conform with its principles, NPs and other APRNs would have a level of reciprocity, enabling them to relocate to any other states that have signed on without having to jump through regulatory hoops.