Certificates of Added Qualifications for PAs

Kelsey Healy

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Since the Physician Assistant program began in the mid-1960s at Duke University, the options for specialization have ranged across primary care, surgical, and hospital settings.

At inception, the goal of the PA curriculum was to fill the need for physician shortages and inadequate distribution of physicians in the US. The education lasts an average of 27 months and focuses on creating generalist medical providers. As with many things, evolution occurs naturally as time passes.

Many PAs have found success and thrive in the physician-PA team in a specialty field.  These PAs have vast experience and knowledge, not recognized by any certification or board…until now. Certificates of Added Qualification (CAQs) from the National Commission on Certification of Physician Assistants (NCCPA) were first offered in late 2011.  The name had been changed from “Specialty Certification” to “Certificates of Added Qualification” to better reflect the initial primary care training and foundation of the profession and a desire to avoid automatic credentialing and privilege requirements in many hospital settings.  Not surprisingly, these are two of the hot-button issues hinging around CAQs.

Benefits of Obtaining CAQs

PAs in specialty fields have many reasons for wanting further designation that reflects the additional years of experience and expertise, such as:

  • Implication of knowledge, qualification, and skill
  • Provides the general population and employers reassurance
  • Opportunities for better employment, salary, and job security
  • Added ease in gaining clinical privileges

For many PAs that have been working in a specialty for years and have acquired significant experience and knowledge, the desire for documentation of these achievements was not driven by ego but rather the need to present physicians with credentials, providing assurances and enabling the PA to launch into work with a level of insight not available from PAs fresh out of school.

As stated above, the education of a PA has a generalist focus.  For PAs that have been in specialty placements for several years, CAQs are one of the few methods of showcasing the competency in the field and that a “minimum standard” has been met.  Significant post-graduate education and training are necessary to achieve the level required of PAs for many specialty positions, emergency medicine, and cardiothoracic surgery to name a few.  This post-graduate experience is increasingly hard to find in on-the-job training, and most PAs will now need residency training to land in a specialty.  The CAQ will help demonstrate the PAs acumen and proficiency in the respective specialty to physician groups and hospitals.

The recertification of PAs occurs every six years, and all PAs take the same generalist exam, regardless of specialty.  Many specialist PAs have come to find the results of the PANRE merely indicate how well they are able to study in the month before the exam and do not reflect how effectively they perform in their specialty.  The option to recertify in the field in which the PA practices should be available. Using an exam that places all PAs back at “square one” not only places experienced PAs on the same level as fresh, inexperienced PAs, but it also diminishes the competency in specialty.  Specialty exams should be available in order to assess PAs on the basis of their knowledge and experience of the specialty that they work in.  How else is it possible to know the best cardiothoracic or psychiatry PAs from the weaker ones?  The CAQs enable some form of acknowledgment and may be a precursor to an eventual change to the PANRE.

CAQs Implications to the Public

When given the opportunity to choose a provider with several designations behind their name as opposed to one, the general public is typically inclined to assume the individual with less is somehow deficient.  In the instance of the PA, the unfortunate lack of availability of additional credentials may have positioned them below, say a credentialed NP, who may or may not have the same experience, knowledge, and years in the specialty.

CAQs- Broken Down

The new CAQs offer this added designation to PAs in the fields of:

  • Cardiovascular & Thoracic Surgery
  • Emergency Medicine
  • Nephrology
  • Orthopedic Surgery
  • Psychiatry

There are two new fields being added to the CAQs available to PAs starting in 2014:

  • Pediatrics
  • Hospital Medicine

The vast majority of patients do not have any knowledge of how the PA’s initial education is founded in training for versatility and flexibility, geared towards a generalist medical training.  The path taken by the specialist PA beyond that initial training and the years of working in a Physician-PA specialty team certainly merit a designation.

CAQs are not a requirement in the PA field.  They are not meant to create mandatory accreditation by employers, nor are they intended to make it easier for third-party payors to add another requirement for reimbursement.  These CAQs are an indication of experience to everyone that these PAs are capable of doing the work, due to their significant post-graduate work.

Subsequent to satisfying the 2 pre-requisites, there are 4 primary requirements in the CAQ process:

  1. Category I specialty CME
  2. One to two years of experience
  3. Procedures and patient case experience appropriate for the specialty
  4. Respective specialty exam

The CAQ Exams are:

  • Shorter than PANCE or PANRE
  • 120 multiple choice, specialty questions
  • Written for the PA practicing in the specialty
  • Produced by specialists for specialists

Very much like the path taken by physicians in the early 20th century, specialty surgeons began forming their own societies and eventually, their own certifying boards.  Generalists trained physicians eventually became specialists and needed oversights and performance mandates. The PA was born out of necessity and fills a huge void in the US healthcare landscape. However, what has begun to take shape is significant with PA specialties and designations of such.  In light of the recent addition of two more specialties to the CAQ availabilities, it is likely that more will be available, and the evolution of the PA profession will continue.