The Second-Most Important Work that NCCPA Does

by Katherine A. Adamson, MMS, MA, PA-C

When most physician assistants think of the National Commission on Certification of Physician Assistants (NCCPA), we think of exams. Certainly, the development and administration of the initial certification exam and recertification exams are of paramount importance to NCCPA as the nation’s certification authority for the PA profession. I would argue that the second-most important function the NCCPA fulfills is one that many readers may not be aware of in their busy day-to-day lives as certified PAs. But all of them should.

By way of introduction, my association with NCCPA has spanned three decades and has taken different forms. Like most of you, I’m a certified PA (and have been since 1982). For five years, I interacted with NCCPA as the academic coordinator of the Interservice PA Program. I’ve also had the opportunity to serve on the board of directors of NCCPA, including a term in 2002 as its chair, an experience that gave me a deep appreciation for just how seriously the organization takes its responsibility to serve the public’s interest and protect the integrity of the PA-C credential. Today I serve NCCPA as a medical consultant and advisor to the panel who renders decisions on PA disciplinary matters – a role that is both sobering and incredibly rewarding. And it’s that work – the often difficult and always weighty work of making decisions that affect both individuals and the collective – that I would argue is second in significance only to the actual development and administration of valid and reliable exams.

NCCPA has always enforced at least a narrow code of conduct, handling cases that involved the falsification of PA-C credentials or cheating on exams. In 2002, NCCPA took a much more aggressive stance in the interest of protecting the public and the integrity of the PA-C credential. Like anything of that magnitude in not-for-profit organizations, that shift took place only after several years of discussions at the committee and board levels. I can tell you what kicked it off, though: someone on the NCCPA staff realized that he was mailing a certificate to a PA in a state prison – and the PA wasn’t there on the medical staff. That sparked new discussions about NCCPA’s role and our responsibilities to the PA and to the public. In the end, the board decided that NCCPA certification should be an indicator that the PA is held to high professional or ethical standards.

Thus, in 2004, the organization began reviewing cases arising from disciplinary actions taken against PAs by state licensing boards. PAs were also asked for the first time to self-report issues that may warrant consideration for those determining eligibility for NCCPA certification. Today PAs answer three background questions every time they register for an exam or complete a certification maintenance cycle, questions pertaining to adverse licensure actions, misdemeanors and felonies, and adjudication of mental incompetence. So while youthful indiscretions aren’t going to cost your certification, what you do in practice just might.

At its heart, the standards – articulated in NCCPA’s Code of Conduct for Certified and Certifying PAs – boils down to just two things. Certified and certifying PAs must:

1. Protect the integrity of the certification and recertification process, and

2. Comply with laws, regulations & standards governing professional practice.

Most of us will go our entire careers without ever running afoul of either of those principles. A few will knowingly cross the line having weighed the pros and cons and decided that the gain – the profit, the relationship, the thrill – is worth the risk. A larger group, however, will find themselves on the wrong side of the Code of Conduct having stumbled into trouble, letting one bad decision snowball into another and another. It’s that relatively small group that motivates this column.

In my remaining space this month, I’m going to explain more about how cases come to NCCPA and how they’re handled. In future columns, I’ll share more about the issues that are getting some of our PA colleagues into hot water; some of the things I’ll share will surprise you, some will sadden you, and some will anger you. I hope that they all, however, serve to raise your awareness of the importance of living and practicing with integrity and never forgetting that we must always put the well-being of our patients first.

Issues come to the attention of the Review and Appeals Department of NCCPA through one of five channels: the aforementioned questions we all answer on NCCPA applications; reports on state board actions provided to NCCPA by the Federation of State Medical Boards (FSMB) and by the handful of boards that don’t report that information to the FSMB; reports on disciplinary action taken by a government agency, such as a branch of the US military or the Department of Veterans Affairs; and complaints brought directly to NCCPA by an individual. The vast majority of cases considered by NCCPA arise from state board actions.

The staff reviews all cases that may constitute a violation of the Code of Conduct and gathers appropriate documentation (i.e., medical board actions, licensure status, certification history, criminal reports, etc.). If the case then warrants further review for potential disciplinary sanction, the PA is notified in writing that the issue will be considered in accordance with NCCPA’s Disciplinary Policy, and he or she is given the opportunity to submit a written statement regarding the situation. The staff then reviews all of the documentation, considers guidelines established by earlier cases, and renders one of the following decisions: take no action, issue a letter of concern (a private communication between NCCPA and the PA that basically serves as a warning), issue a letter of censure, revoke certification, revoke eligibility for certification, and – only occasionally – impose other penalties such as fines or completion of CME on specific topics related to the case. The staff then sends a letter to the PA that outlines the action they are recommending and the appeals process through which the PA can petition for a different outcome.

Decisions that are appealed are referred to NCCPA’s Review Panel, a group of board members, the majority of whom are as a matter of policy always PAs. The Review Panel members consider all of the documentation associated with the case, including that submitted by the PA, and may affirm or modify the staff’s decision.

A second level of appeal to the NCCPA Executive Committee is available if the board chair determines that a procedural violation has occurred in the process or that an “arbitrary or capricious” decision was rendered earlier in the case.

At every step in the process, those involved strive to serve the interest of the public first and foremost while being fair and judicious toward the PA.

In my next column, I’ll share more about the types of issues that ensnare PAs and prompt disciplinary review in the first place.

Katherine Adamson, MMS, MA, PA-C serves as medical consultant to NCCPA and as an advisor to the Appeals and Review Staff and the NCCPA Review Panel. A healthcare professional since 1973, Ms. Adamson retired from the US Air Force with the rank of lieutenant colonel in (2008).

If you would like to contribute as a NEWS-Line Guest Blogger, contact me at jbuck@news-line.com.