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Specialty CAQs


In 2011 the NCCPA launched the specialty certification of added qualifications (CAQ for short).  The original 5 specialties were in emergency medicine, orthopedics, psychiatry, nephrology, and cardiovascular/thoracic surgery.  New CAQs have been added in hospital and pediatric medicine.  The original intent was two fold as stated by Janet Lanthrop, “One desire was to have some documentation to be able to show the hiring physician that they, as PAs, were in fact knowledgeable in certain specialty areas.” The second desire was “to give the hiring physicians—this was especially true in emergency medicine—the assurance that these PAs had the experience in ED medicine to come and jump in at a level of acuity a little bit higher than the average person.”

The physician assistant is a generalist by trade.  The far majority of  program will train physician assistants how to become a family practice practitioner; going over the basics of every organ system.  This added qualification was a way to show competency in in specialty fields that physician assistants have already been practicing in.  This will also show a minimum standard has been met.  The problem with being a generalist is that you cannot be an expert in any one thing.  You need to be good at everything, which makes it impossible to be great at everything.  Many of those seeking positions in cardiothoracic surgery, for example, need substantial post graduate training to be able to practice safely and efficiently.  It is for this reason that any physician assistant that wants to enter a specialty should strongly think about going into a residency, because on the job training is becoming a thing of the past.  Also, because of this generalist training, it is extremely difficult to get hospital privileges.  Even those physician assistants who have years of experience performing procedures, need to battle with the hospital to be granted permission to perform certain procedures.  The certification will demonstrate to the hospital and physician groups that you have demonstrated proficiency through experience and training in order to have been granted this CAQ.

The physician assistant model was not so different from the way physicians were trained years ago.  Originally, there weren’t any board certifications.  Everyone trained as a generalist, and were then free to work in any specialty they chose.  Those working in their respective specialty began to create board certification that was individualized to their field of medicine.  This ensured that a minimum standard was met in order to practice safe medicine.  Physician assistants are simply catching on to a similar practice model.

Another question to ask is if these CAQ will eventually allow those in specialties to take a different recertifying exam.  I find it silly to make a cardiothoracic physician assistant to retake a generalist exam every 6 years (10 years starting this year).  They have no interest in treating gynecologic problems, so why should they be expected to know about managing a pregnancy or treating a yeast infection?  All this proves, is that they are able to study a month before the exam and pass.  They will then go back to learning and practice cardiothoracic surgery.  In my opinion, for those who have earned a CAQ, they should be given the option to take a recertification exam in their field of medicine.  Medicine has grown and expanded so much, that it is impossible to know everything about everything.

As of right now the physician assistant must have current certification, and have unrestricted ability to practice in their state.  There are also four core requirements that must be met:

1. 150 hours of CAT 1 specialty CME

2. Minimum of 2,000-4,000 hours in specialty (hours depend on specialty)

3. Procedures and patient case experience appropriate for specialty (signed document by    supervising physician)

4. Pass the specialty exam

I agree with the need for specialty certification.  Physician assistants are trained as generalists; therefore, we are not competent to handle these specialties right after graduation.  Also, residencies are not mandatory, so there is no other way to know a physician assistant is competent other than by taking a specialty exam.  This is especially true for the new or recent graduates.  Those who have been practicing for over 30 years in a given field likely will not benefit much from this exam, but those with less than 5 years of practice will.  Many feel as if this will take away lateral mobility; the way I see it, is that this is already going away on its own.  As I have stated earlier, medicine is ever expanding, and for someone to think they can jump from dermatology to emergency medicine easily because of their generalist training should seriously reconsider.  There is no way someone can make this jump and be allowed to practice with full autonomy.  This has nothing to do with the PA profession, but this would also hold true for physicians.  So much time is spent learning your trade, that you will lose your skills in other fields of medicine.  This alone will cause the lateral mobility that physician assistants once had to become abandoned.  I support the specialty certification of added qualifications to show competence within their field of medicine.

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