As a member-at-large for the Society of Physician Assistants in Rheumatology (SPAR), I had the privilege of representing SPAR in an assembly last year at the request of the National Commission on Certification of Physician Assistants (NCCPA).

The meeting of representatives from about 30 PA organizations across the country was a somewhat historical event in PA history. I cannot quite recall so many specialty disciplines represented at the same time for the purpose of discussing an issue of national importance.

One by one, we were asked to make a five-minute presentation on our specialty's perspective regarding PA specialty certification. A seemingly endless stream of orators were paraded in front of us to comment on issues revolving around the need to recognize, by some formalized means, PAs choosing to work in a growing number of specialty areas. Some presentations were quite elaborate but most, like mine, were straight from the cuff.

Physician assistants practicing in the specialty of rheumatology are not or do not anticipate being under duress by any regulatory agencies to meet any specialty certification requirements. In fact, SPAR aligns itself with the position set forth in 2002 by the American Academy of Physician Assistants (AAPA), which opposes “specialty certification and the use of specialty exams that would reduce the profession’s versatility and flexibility, and drastically alter its value to society.”

In other words, the AAPA is of the opinion that specialty certification can become a barrier to all family practice PAs who want to enter a specialty field.

Several other specialty groups, such as the cardiovascular PAs, had a very different position. They have been under considerable pressure by state regulatory agencies and hospitals to prove competence in their highly technical field, and said they had no place to turn for such recognition. Other groups made similar remarks and stated their frustration in trying to demonstrate competence in sight of the general public.

The primary problem is that many specialties are subdivided into subspecialties. Within these subspecialties, they are subdivided even more. How then do you create a competency exam reflective of each specific area that demonstrates what is being required? Furthermore, how often do you demonstrate competency and do you need to pass some certification process prior to starting your job? Also, what about those who have already done the job for the past 30 years or more?

There were clearly more questions than answers. To further complicate things, some PA groups pointed to nurse practitioners (NPs), stating that there are many courses available in various disciplines that give a document upon completion but there is no standard to judge the value of the courses.

Among all of this banter, there was some light at the end of the tunnel. Many of the PA organizations agreed that some sort of specialty “recognition” option could satisfy many of the requirements and merited further discussion.

From my perspective, here is one possible scenario. If you are a PA moving into a specialty area, you can announce your intention to some recognized body, the NCCPA for example, and begin registering your areas of evolving competence that are validated by your supervising physician. This would then be on file and available by request for any outside government, insurance or employer organization to view. Some timeframe for completion would then make you qualified to say you have mastered certain didactic and technical elements of that specialty to the satisfaction of your supervising physician or a designated mentor. This idea seemed to appeal to some of the PAs present at this meeting but did not satisfy everyone. The debate continues.

According to a recent article in the January 2007 AAPA News, the NCCPA has approved “points of consensus” and principles for developing specialty recognition for PAs. The NCCPA said it would focus on two themes: the need for additional educational activities for PAs in various specialty areas and how to continue to collect ideas from affected organizations on different aspects of specialty recognition. The AAPA executive committee has not yet issued a position on this.

It appears this topic will remain in the spotlight for some time to come. However, certification applies to all of us. Unless you plan to stay in family practice throughout your career, you will probably face some requirements, yet to be determined, in order to practice in a specialty environment.

Editor’s note: For related articles, visit the archives at www.arthritispractitioner.com.