Physician Assistants have been required to adhere to a certification maintenance process for more than 30 years. Over time, the National Commission on Certification of Physician Assistants (NCCPA) certification maintenance requirements have been amended to reflect new mandates, advances in technology, and the profession’s embrace of lifelong learning.
PAs are now transitioning to the new certification maintenance cycles, approved in 2006. In 2014, new PAs and practicing PAs who completed their 6-year certification maintenance cycles became the first group to move to the new 10-year cycle. The profession’s transition will continue for the next 5 years, as other groups of PAs complete their final 6-year cycles before all are on the new 10-year certification maintenance cycle.
The changes in NCCPA certification maintenance requirements reflect best practices and anticipated modifications to licensure requirements and are a result of extensive consultation with the American Academy of Physician Assistants (AAPA) and the Physician Assistant Education Association (PAEA), as well as input from PAs at large and other medical professionals. Additionally, the new certification process is more broadly inclusive of the seven “Competencies for the Physician Assistant Profession”:
- Knowledge for Practice
- Interpersonal and Communications Skills
- Person-centered Care
- Interprofessional Collaboration
- Professionalism and Ethics
- Practice-based Learning and Quality Improvement
- Society and Population Health
The two changes likely to affect PAs most are a longer recertification cycle and two new categories of continuing medical education. The new certification maintenance process occurs over a 10-year period (five 2-year cycles, extending the time between exams from 6 years to 10), and the two new CME categories are self-assessment and performance improvement.
The New NCCPA Certification Maintenance Cycles
Like the former 6-year process, the new NCCPA certification maintenance process is divided into 2-year cycles during which PAs must earn and log 100 CME credits. There are now five cycles rather than three cycles. This means that over the course of the average PA’s career, they will not have to sit for PANRE as often. The new 10-year process offers the 2-year cycles with which PAs are familiar but in the fifth 2-year cycle, PAs will earn and log only 100 CME credits, then prepare for and pass PANRE.
Additionally, during the first four 2-year cycles, PAs must earn a total of 80 credits under the two new CME categories. Forty Self-Assessment CME (SA-CME) credits and 40 Performance Improvement CME (PI-CME) credits are now required in the first 8 years. The NCCPA coined a simple mnemonic to help you remember this: “40 and 40 in 4.”
| Cycle | Total CME & Minimum Category 1 CME | Minimum SA-CME & PI-CME |
|---|---|---|
| 1st CME cycle | 100 CME with a minimum of 50 Category 1 CME | 20 of 50 Category 1 CME must be SA-CME and/or PI-CME |
| 2nd CME cycle | 100 CME with a minimum of 50 Category 1 CME | 20 of 50 Category 1 CME must be SA-CME and/or PI-CME |
| 3rd CME cycle | 100 CME with a minimum of 50 Category 1 CME | 20 of 50 Category 1 CME must be SA-CME and/or PI-CME |
| 4th CME cycle | 100 CME with a minimum of 50 Category 1 CME | 20 of 50 Category 1 CME must be SA-CME and/or PI-CME |
| By end of 4th CME cycle | 400 CME with a minimum of 200 Category 1 CME | 40 SA-CME and 40 PI-CME in 4 cycles |
| 5th CME cycle | 100 CME with a minimum of 50 Category 1 CME and pass the PANRE | None required |
Going forward, all new PAs and those regaining certification will begin a 10-year cycle when they become certified. For practicing PAs, your transition is determined by the date your current 6-year cycle ends.
| Your last exam | Your next PANRE | Your first 10-year cycle PANRE |
|---|---|---|
| 2009 | 2015 | 2025 |
| 2010 | 2016 | 2026 |
| 2011 | 2017 | 2027 |
| 2012 | 2018 | 2028 |
| 2013 | 2019 | 2029 |
As you can see from the table above, all PAs will be integrated into the new process by 2019. If you’re wondering how this will affect you, review your personal certification record on the NCCPA dashboard. After logging in, you will find a message about your transition to the new certification maintenance cycle.
States and territories may have specific CME requirements. In many states, as long as the PA fulfills the NCCPA maintenance process (6-year or 10-year), no additional CME credits are required to be in compliance with state licensure requirements.
Earning Credit for Continuing Medical Education (CME)
Continuing medical education (CME) refers to clinical and professional education activities that address the six core PA competencies, which a PA uses to provide services for patients, the public, and the profession. This has not changed under the new certification maintenance process.
While there are two new types of CME to earn and log, it is helpful to note that the CME provider and Category 1 CME sponsors have not changed under the new NCCPA certification maintenance requirements. The CME provider is the hospital, organization, school or company where the PA completes the training or attends the seminar. All Category 1 CME must be preapproved by a sponsor. The Category 1 CME sponsors include:
- American Academy of Family Physicians (AAFP)
- American Academy of Physician Assistants (AAPA)
- American Medical Association (AMA) (providers accredited by ACCME)
- American Osteopathic Association (AOA)
- Royal College of Physicians and Surgeons of Canada (RCPSC)
- The College of Family Physicians of Canada (CFPC)
- Physician Assistant Certification Council of Canada (PACCC)
So, What Has Changed About CME?
There are two new categories of CME, and PAs must earn a minimum of these new CME during your 2-year cycles and at the end of eight years. These categories are: self-assessment (SA-CME) and performance improvement (PI-CME). You can decide when and in what order to earn these credits, but you must earn 20 credits of AAPA-approved SA-CME and/or PI- CME each 2-year cycle for a total of 40 credits of each at the end of the fourth CME cycle.
There are no changes in the total number of CME from the 6-year process. PAs still need 100 CME per cycle with a minimum of 50 Category 1 CME.
Self-Assessment (SA) CME
Most self-assessment CME is in the form of a self-administered exam on which you receive immediate feedback and earn credit for passing. Not a passive style of learning, the SA-CME can also come in the form of virtual patient encounters. One example of a self-administered exam through which PAs can earn SA-CME credit is the NEJM Knowledge+ Family Medicine Board Review. Other examples of AAPA approved SA-CME can be found on the AAPA website and include the American College of Cardiology Foundation general and interventional cardiology MOC modules and the American Society for Surgery of the Hand self-assessment examination.
Performance Improvement (PI) CME
Performance improvement CME involves active learning and the application of learning to improve your practice. PI-CME credits can be earned individually or with other professionals, such as a supervising physician and/or PA colleagues. A collaborative effort results in credits for all.
PI-CME is an activity with three stages:
- A performance measurement with which PAs assess their practice in comparison to benchmarks, guidelines, and data in a specific clinical area
- An intervention/improvement plan designed to improve the PA’s practice
- A re-measurement tool to assess the effects of the improvement plan.
PI-CME programs must be approved by the AAPA. The AAPA provides a complete list of approved PI-CME activities which include:
- The American Academy of Allergy, Asthma & Immunology “Asthma IQ for Primary Care”
- The American Academy of Neurology “NeuroPI: Parkinson’s Disease: Safety Issues, Autonomic Dysfunction, Therapy and Treatment Options”
- The University of Pennsylvania School of Medicine “Type 2 Diabetes Performance Improvement CME”
As more CME activities are developed and identified, AAPA will expand the current selection of approved credits.
For PAs who are not in clinical practice, such as PA educators, AAPA has approved options that allow these PAs to meet the PI-CME requirement. Examples of such activities focus on patient safety and the principles and competencies of the role of interprofessional education (IPE) in interprofessional collaborative practice. Other activities are under development.
And What Hasn’t Changed
You may still earn some of your CME as you have in the past, by completing or teaching certification programs, attending seminars and conferences, through online education, and in the case of Category 2 (elective) CME, through “medically related activity that enhances your role as a PA.” Category 2 CME may be earned by preparing and teaching certification programs; serving as a preceptor to PA students or students from other professions; reading journals; lobbying on behalf of the PA profession; and serving on local, state, or national committees that enhance the role of the PA, to name a few examples. There are no changes to Category 2 (elective) CME under the new NCCPA certification maintenance requirements.
At this time there are no changes to PANRE except that physician assistants must take and pass the exam once every 10, instead of 6, years.
The changes to the NCCPA certification maintenance requirements should not affect the cost to PAs. Fees remain the same for the 2-year CME cycle and the PANRE. If, however, a PA has relied on free offerings to earn all CME, there likely will be some new costs incurred. While there are some free self-assessment and PI-CME programs, most are fee-based programs.
You can read more about the NCCPA certification maintenance requirements on the NCCPA website as well as here, on our Learning+ blog:
- Physician Assistant Certification
- NCCPA Certification Maintenance Requirements
- PANCE/PANRE Review Resources
Do you have any advice for PAs currently negotiating the changes to the NCCPA certification maintenance requirements?