Changes Ahead in PA and Physician Recertification

AAPA-Commissioned RAND Report on Evidence-Based Alternatives due in September 2018

June 7, 2018

By Daniel Pace

There’s a lot going on in the recertification arena for PAs and physicians. Both NCCPA and AAPA have taken some important and positive steps toward improving PA recertification. Among physician groups, recertification also continues to be an important topic, and similar discussions and changes are taking place.

AAPA’s RAND Study on Alternatives to Recertification Exams

In July 2017, AAPA’s Board decided to contract with a highly respected, unbiased, independent research organization in order to review the literature regarding the impact of various recertification requirements on patients and providers, and to identify evidence-based alternatives to closed-book, pass/fail recertification testing.  Following a request for proposals process, in January 2018, AAPA executed an agreement with the RAND Corporation to accomplish the following:

  • Document the recertification requirements for health professions in both the U.S. and in other countries, including both closed-book examinations and other complementary or alternative approaches;
  • Review and synthesize the evidence about the impact of various approaches to recertification requirements for health professions in the U.S. and in other countries on patients (i.e., outcomes, safety, and access to care) and provider experience (i.e., cost, stress);
  • Explore in further depth the rationales, alternatives, and future plans regarding recertification requirements among health professional certifying bodies in the U.S. and other countries that currently employ recertification approaches other than closed-book examinations; and
  • Provide a publicly available report presenting key project findings.

The AAPA Board believes this research will help AAPA and its members assess the implications of new recertification proposals and add to the body of knowledge that the NCCPA, which is supportive of this research project, can draw upon as it pursues an alternative approach to recertification. The RAND report, which will be subject to a rigorous peer review process, is expected to be publicly released in September 2018.

NCCPA PANRE Revision and Pilot Alternative

NCCPA has concentrated on revising PANRE to focus on core knowledge and piloting an alternative to the current closed book exam.  In March 2018, NCCPA released the updated exam blueprint for PANRE, effective January 2019, completing the move from a general medicine exam to a core medical knowledge assessment.

The pilot alternative to PANRE is also expected to be launched in January 2019, and is available to PAs whose certification expires in 2018 or 2019.  As of May 2018, more than 12,000 PAs had registered to participate.  Pilot participants will be required to answer 25 questions online per quarter through 2020, for a total of 200 questions.  The test can be taken at home or at work; no travel to a testing site will be required. According to NCCPA, the pilot is intended to test “walking around knowledge,” and, thus, should require no advance preparation. During the online exam, participants are permitted to access reference materials, but will have only 1 to 5 minutes to respond to each question. PAs who successfully complete the pilot (pass/fail standards have not yet been announced) will be deemed by NCCPA to have satisfied the PANRE requirement. Those who do not successfully complete the pilot will have one year to pass PANRE.

Physician Recertification Updates

Earlier this year, the American Board of Internal Medicine (ABIM) rolled out a program similar to NCCPA’s pilot, which it describes as a “knowledge check-in,” as an alternative to the current 10-year maintenance of certification test for internists and nephrologists. The new 90-minute exam can be taken at home, in the office or at a testing site, and physicians will be able to consult UpToDate during the exam. Similar to NCCPA’s pilot plan, during the first two years of implementation, physicians will face no consequences for failing an exam; they can take it again in 2020 without losing certification. After 2019, however, if a physician fails two consecutive “knowledge check-ins,” they must take the 10-year exam in order to remain board certified.

Last month, the Board of Directors of the American Academy of Family Physicians (AAFP) voted to explore finding an alternative certifying organization for family physicians (MDs), and, while not currently being pursued, the possibility of starting a new certifying body. The current certifying organization, the American Board of Family Medicine (ABFM), is affiliated with American Board of Medical Specialties (ABMS), but each certifying board has autonomy within the ABMS framework.  In the meantime, ABMS has launched its own initiative to re-think the physician recertification process.  Announced last September and dubbed “Continuing Board Certification: Vision for the Future,” the ABMS commission is expected to conduct an assessment of the current system, obtain input from stakeholders, and get feedback on concepts and ideas for change within 12-15 months.

AAPA is committed to advocating for evidence-based recertification and updating members as it and other organizations seek to modernize the process.

Daniel Pace is vice president, education and research and chief strategy officer at AAPA. Contact him at [email protected]

Related News:

AAPA board takes action on recertification issues

AAPA Responds to NCCPA PANRE Alternative Pilot Process

AAPA Engages RAND Corporation to Research Evidence-Based Alternative Solutions to PA Recertification