A Primer in PA Certification

With more than 100,000 physician assistants in practice, medical staff leaders must familiarize themselves with the profession, including ways to assess competence, state laws regarding licensure, and the certification process.

This article is excerpted from an article originally published on the Credentialing Resource Center, May 8, 2017.

Upon completing an accredited PA program, PAs must pass a certification examination in order to become licensed to practice. Those who pass the Physician Assistant National Certifying Examination (PANCE) are issued the Physician Assistant—Certified (PA-C) credential by the National Commission on Certification of Physician Assistants (NCCPA). All states require PAs to be initially certified by NCCPA in order to practice. However, like physicians, recertification is a gray area—not all states/healthcare organizations require maintenance of certification.

PAs who have never been certified are eligible to take PANCE for up to six years after completing their educational program. During that six-year period, PANCE may be taken a total of six times. When either the six attempts or six years are up, the individual loses eligibility to take the exam. At that point, the PA must complete a full-length, accredited PA educational program again.

“For students who have sat through 2.5–3 years’ program of education, that certification exam is like a culminating event. It brings together their entire curriculum and entire clinical training,” says Dawn Morton-Rias, Ed.D, PA-C, president & CEO of NCCPA.

“In a way it serves the same purpose as physician certification. Back in the day, there were general practitioners. Now when people say they are board-certified physicians, it puts another layer on their expertise. I think the same is true for PAs,” says Ann Davis, MS, PA-C, vice president of constituent organization outreach and advocacy for the American Academy of Physician Assistants (AAPA).

The PANCE certification is not specialty-specific; instead it assesses basic medical and surgical knowledge. Daniel Pace, chief strategy officer/vice president of education and research for AAPA, says that this generalist certification has allowed PAs to be adaptable to the changing needs of the healthcare system. “The fact that a PA can be certified and work in one specialty and then move to another specialty where there may be a shortage has always been an asset to individual PAs and the healthcare system.”

Organizations must decide how they will use certification when assessing the competence of PAs.

Pace suggests looking beyond certification for credentialing and privileging. “One option is portfolios or other demonstrations of expertise and experience in the actual practice setting. That is something that the AAPA would support instead of or in adjunct to certification as a way of demonstrating experience and competence.”

Davis adds that this is not unlike what hospitals do when they grant privileges to physicians. “They look for a certain number of procedures performed and observation of those procedures.”

In fact, CMS states in its Conditions of Participation that “the medical staff may not make its recommendation solely on the basis of the presence or absence of board certification but must consider evidence of current licensure, evidence of training and professional education, documented experience, and supporting references of competence.”

The AAPA suggests when credentialing a PA, using the following primary sources:

• State licensing board to confirm that the applicant is properly licensed
• Accredited PA program for graduation information
• NCCPA to confirm initial/ongoing certification
• NPDB for malpractice and adverse actions history

When it comes to privileging PAs, the AAPA suggests medical staffs use the following to assess PAs’ competence to perform the privilege:

• Attestations to the PA’s competence by physicians and PA peers
• Hospital systems that track clinical activity
• Data collected for initiatives such as the Surgical Care Improvement Project or the Physician Quality Reporting System
• Requiring a certain percentage of CME credits specific to the specialty
• Requiring maintenance of pertinent certifications such as basic life support, advanced cardiac life support, etc.
• Completion of relevant clinical courses
• Use of simulation labs to assess cognitive and procedural competence
• Professional portfolio in which the PA documents procedures and patient care provided