AAPA

Recently NCCPA published a set of changes to the maintenance of certification (MOC) process that are under consideration, inviting all certified PAs to comment on the potential changes in hopes of improving the concepts before their adoption by March 31. As a reminder, there are three principle changes under consideration: the addition of a self-assessment activity every two years, the implementation of a clinical quality improvement project every two years, and -with those additional requirements--an extension of the recertification testing cycle from six years to 10.

Rather than take on the whole proposal or recount the history of this issue and how it's unfolding throughout the physician certifying boards, I want to use this ink to focus in on the proposed change that is proving most controversial among certified PAs: the clinical quality improvement project (already mercifully shortened to ClinQI). This idea was borne out of the two competency areas that are hard for educators to teach and for test writers to test: practice-based learning and improvement and system-based practice. However, read the description of those competencies, and it's impossible to deny their importance. (Read about all six areas of PA competence in "Competencies for the PA Profession" here.)

The ClinQI process involves identifying some aspect of your work, your practice, or your patients' health that could be improved; taking a systematic approach to focusing in on a specific method or methods of change; implementing the change; and taking stock of the results. This is not a doctoral thesis. This is a very practical, on-the-job endeavor.

There are some challenges that will have to be addressed. For one, PAs who aren't practicing clinically will need an alternative pathway to fulfill this requirement. The NCCPA team has developed several ideas about how to address this and will gladly consider others that emerge through the comment period. Also, we know there will need to be training available for those who are new to structured quality initiatives, tools that facilitate the process, and simple reporting mechanisms.

Beyond that, the arguments posited by those registering objections to this idea with NCCPA center around four points:

• "I am too busy." We all know this is true. Many of us spend most of our clinical hours just trying to keep up with the steady stream of patients and the paperwork that accompanies them. This is the heart of what we do, and PAs are, indeed, busy doing it. That said, one ClinQI project every two years does not have to take a lot of time. You could even focus in on an issue that eventually saves time: streamlining an outdated process, "down-streaming" tasks, improving patient adherence to a specific type of treatment plan (reducing return visits). Think small, think big, but never get trapped into believing that you're too busy to think about how things could be done better.

• "This is not my job." If looking for ways to improve your practice isn't your job, whose is it? I've been a PA for 29 years, and I have met, trained and worked with many of you over those years. I don't know anyone who could really believe that thoughtful improvement efforts are not part of the job.

• "This is just busywork that will not impact my practice." This is in the hands of the individual. Choose a project that constitutes busywork, and that's what it will be. Choose a project on an issue that presents a real challenge to you, your physician partner, your health care team and/or your patients, and you'll have more meaningful outcomes.

• "I already do this." Yes! NCCPA will work to make it as easy as we can for you to apply the quality improvement you already engage in towards this requirement.
The purpose of inviting feedback on these potential changes is to make them better. Offer your ideas by March 31 through the NCCPA survey available here.

Katherine Adamson, PA-C, MMSc, MA is a former chairman of NCCPA and now serves as the organization's director of external relations.