Report on the 2016 Survey to Gather PA Feedback on the

April 2016 Page 1

Report on the 2016 Survey to

Gather PA Feedback on the

Proposed PANRE Model

April 2016

April 2016 Page 2

Executive Summary

During the past two years, the NCCPA Board of Directors has engaged in discussions to consider the

need for potential changes to the Physician Assistant National Recertifying Examination (PANRE), and in

November 2015, the Board selected a proposed model for further exploration. The proposed model

includes periodic take-at-home exams on general core medical knowledge and skills and a secure exam

in a specialty area selected by the PA. Both components feature multiple performance levels with an

option to complete directed Continuing Medical Education (CME) instead of retesting.

As part of a PANRE redesign effort, NCCPA embarked on initiatives to gather feedback on the proposed

model from key stakeholders. This report summarizes a survey that was one of the activities focused on

gathering and evaluating PAs’ opinions, and it should be noted that this was only one of several

opportunities that have been provided for PAs to voice their opinions on the model. Invitations to

participate in the online survey were e-mailed to 103,467 PAs who had active e-mail addresses on file

and had not previously opted out of surveys from NCCPA. A total of 30,492 PAs completed the survey (a

29.7% completion rate), and more than 92% of the respondents reported that they are regularly

engaged in clinical work. When compared with other NCCPA data, including responses from the PA

Profile, it appears that the respondents comprised a representative sample of the larger PA population.

The survey included both objective and open-response items. This summary report covers only the

objective, Likert-type items.

PAs’ Perspectives on Components of the Proposed PANRE Model Based on the survey results, the majority of PAs (62%) indicated a preference for the proposed model,

with 11% expressing no preference. This overall trend is similar across all specialties, with slightly more

non–primary care PAs preferring the proposed model. PAs who did not have an exam option in their

specialty area still favored the proposed model (58%) as compared to the current PANRE (29%). Other

groups that indicated a stronger preference for the proposed model are PAs who are in their first

recertification cycle and have not yet taken a recertification exam, PAs who had former experience with

the Pathway II recertification exam, and PAs who have failed one or more recertification attempts

throughout their certification history.

For the general core take-at-home assessments, PAs were asked to provide feedback on the number of

exams they prefer (recognizing that fewer exams would require more questions per exam) and how

much time should be provided to complete the exams. PAs—across all demographic and practice

variables—overwhelmingly preferred two test modules. The three-month and six-month test windows

were the strong preferences for time allowed for completion of an exam. Being informed of their overall

score on completion of the exam was important to 84% of PAs. In addition, more than 70% of PAs rated

the following three features as important characteristics of the core exams: a second opportunity to

answer a question, the ability to use resources to find information needed to answer the questions, and

completing the exam at a more relaxed pace.

Based on data available in the PA Profile, NCCPA has determined that 19 specialties have sufficient

numbers of PAs to meet the psychometric needs for the specialty exam component of the proposed

model. These 19 specialties were listed in the survey, and PAs were asked to select the specialty exam

they would choose if the proposed model were implemented. The four most frequently selected

April 2016 Page 3

specialty exams were family medicine, emergency medicine, general internal medicine, and orthopaedic

surgery, followed by dermatology, general surgery, and hospital medicine. A majority of PAs (79%)

selected a specialty exam that was aligned with their current practice. As expected, having the ability to

choose a specialty exam more closely related to their area of practice was important to the majority of

PAs, and even more so for those PAs practicing in non–primary care specialties.

The survey included questions that asked PAs to identify, from a predefined list, all the benefits of the

existing and proposed PANRE testing programs. Overall, most PAs saw the straightforward nature of the

existing PANRE as a benefit, and more than 60% appreciated that the existing PANRE requires only a

single test. Nearly 59% of respondents appreciated being able to use resources in responding to

questions on the core exams, and 60% noted a benefit in remediation through CME rather than

retesting. Few differences exist between PAs from different specialty areas regarding their perspectives

on the proposed model, but non–primary care PAs were far less likely to view the existing PANRE as a

relevant experience.

PAs’ Perspectives on CME Requirements The survey also included questions to gather feedback from PAs on the current certification

maintenance requirements. Since the requirements for Self-Assessment and Performance Improvement

CME went into effect for the 2014-2016 certification maintenance cycle, smaller numbers of PAs have

experience with those types of CME activities, with 7.6% for Performance Improvement CME and 15.7%

for Self-Assessment CME.

The survey results indicated that PAs overwhelmingly agree that Category I CME is relevant and

improves patient care. A large portion of PAs were unsure about these same qualities with Performance

Improvement and Self-Assessment CME. For the most part, PAs seemed to agree with the amount of

time required, the costs, and the number of options available for regular Category I CME. This was not

the case with Performance Improvement CME. Similarly, with Self-Assessment CME, the majority of PAs

indicated disagreement with the costs and availability of activities, but the time required to complete

these activities was not as much of a factor. The majority of PAs would find the proposed PANRE model

more appealing if the Performance Improvement and Self-Assessment CME requirements were reduced.

Conclusion The proposed PANRE model appears to address some of the concerns PAs have expressed regarding the

current PANRE. Although only 13% of PAs believe the existing PANRE is relevant to their practice, this

increases to 50% with the proposed model. Nearly 70% of PAs believe that the proposed model will be

less stressful. Perhaps most important are the findings that 65% of PAs believe the take-at-home exams

will better promote staying current with general medical knowledge and 55% of PAs believe the

proposed model is best for improving patient care and safety.

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Introduction This report presents the results of a survey administered by NCCPA as one part of a larger effort to

gather comments and input from the PA community with regard to the proposed Physician Assistant

National Recertifying Examination (PANRE) model. The psychometric and research team, with review

and feedback provided by the NCCPA’s leadership and Board of Directors, developed this survey for two

main purposes: (1) to gather input about possible features of the proposed PANRE model and (2) to

gauge sentiment toward the model as compared to the existing PANRE testing program. The survey was

not designed to collect open commentary or to solicit alternative models. The survey instrument

contained 25 questions. Most of the questions were Likert-type items, but the survey did provide

several opportunities for PAs to provide open-ended responses. All 25 items were optional, which

allowed PAs to respond only to questions where they felt comfortable sharing an opinion. Most PAs

answered all of the questions they encountered.

There were four sections of the survey. The first two sections contained descriptions of the two main

components of the proposed model—the core medical knowledge component and the specialty

component—followed by several questions about the features of each component. The third section of

the survey solicited feedback on the current continuing medical education (CME) requirements for

certification maintenance. The last section asked for general feedback about the proposed model as

compared to the current PANRE.

NCCPA initially administered the survey instrument to a pilot sample of 15 PAs. The pilot sample

provided feedback on the clarity, length, and content of the questions. Before launching the survey,

NCCPA’s psychometric and research team addressed the recommended changes and comments. On

February 11, 2016, an e-mail invitation containing a link to the survey was sent to 103,467 PAs. The e-

mail list contained all currently certified PAs who had not previously opted out of surveys from NCCPA

and who had an active e-mail address on file. Reminder e-mails were sent on February 25 and March 9,

2016. Access to the survey was closed at 11:59 pm PDT on March 11, 2016. Of the 103,467 e-mail

invitations sent, 102,608 (99%) were successfully delivered and 64,715 (63%) were opened. A total of

31,487 PAs started the survey, with 30,492 completed responses (a 29.7% completion rate). On average,

the survey took 24 minutes to complete, with a median response time of 16 minutes.

At the conclusion of data collection, the research team exported the raw survey responses and merged

these results with other sources of demographic data. A demographic summary of the respondents is

provided in the next section of this report, although it is worth mentioning here than the sample

collected through this survey compares favorably with the data collected in the PA Profile and appears

to be a representative sample of the PA population. An external vendor with expertise in qualitative

analysis was contracted to conduct a mixed-method analysis of the qualitative data collected in the

open responses, and a report communicating those results will be provided separately. NCCPA’s

psychometric and research group analyzed the remaining portions of the survey. Given the size of the

sample, even the smallest differences are statistically significant. Because there is no identified and

meaningful effect size, the results of statistical tests are not included.

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Description of the Sample Overall, the sample of 30,492 PAs was consistent with the demographic indicators reported in the 2015

Statistical Profile of Certified Physician Assistants,1 which is based on data collected from the PA Profile

and through other NCCPA application processes. Table 1 compares the geographic distribution of the

sample with the data PAs have provided to NCCPA through other certification processes. Tables 2 and 3

display age, gender, and racial breakdowns for the sample of this survey. In each case, the sample data

closely resemble the PA community at large.

More than 92% of the sample reported engagement in regular clinical work. Of the 8% who did not

report regular clinical work, 3% reported working occasionally in clinical settings and 5% reported no

current clinical practice. Tables 4 and 5 compare the principal practice setting and practice area across

the survey sample and the 2015 statistical report. Practice setting is extremely consistent across the two

data sets. Primary care providers2 are represented at a slightly higher rate (a difference of 3.3%) in the

survey sample as compared to the PA Profile data. Overall, this survey sample is consistent with the

NCCPA’s demographic and practice data and appears to be a representative sample.

Table 1: Geographic region

NCCPA Data

Current Survey

New England (CT, ME, MA, NH, RI, VT) 6% 7%

Northeast (NJ, NY) 12% 11%

National Capital Region (DC, DE, MD, PA, VA, WV) 13% 14%

Southeast Sunbelt (AL, FL, GA, KY, MS, NC, SC, TN) 19% 18%

Great Lakes (IL, IN, MI, MN, OH, WI) 15% 16%

Greater Southwest (AR, LA, NM, OK, TX) 10% 10%

Heartland (IA, KS, MO, NE) 4% 4%

Rocky Mountain (CO, MT, ND, SD, UT, WY) 5% 5%

Pacific Rim (AZ, CA, GU, HI, NV) 11% 10%

Northwest (AK, ID, OR, WA) 5% 5%

Other (AA, AE, AP, FM, MP, PR, VI) 0% 0%

1 National Commission on Certification of Physician Assistants, Inc. (2016, March). 2015 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants. 2 Defined here as PAs who reported working in family medicine/general practice, general internal medicine, or

general pediatrics.

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Table 2: Age and gender

Age Group (years)

Female Male All

NCCPA Data

Current Survey

NCCPA Data

Current Survey

NCCPA Data

Current Survey

Under 30 14.5% 13.6% 3.1% 2.5% 15.6% 17.6%

30-39 27.5% 27.0% 9.5% 9.0% 35.9% 37.0%

40-49 13.7% 14.4% 9.4% 9.2% 23.6% 23.1%

50-59 8.0% 9.3% 6.2% 6.9% 16.2% 14.2%

60+ 3.5% 3.9% 4.6% 4.9% 8.8% 8.1%

Total 67.2% 68.1% 32.8% 32.5% 100.0% 100.0%

Table 3: Race

PA

Profile Current Survey

American Indian/Alaska Native 0.4% 0.4%

Asian 5.3% 4.6%

Black/African American 3.9% 3.3%

White 86.7% 88.6%

Native Hawaiian/Pacific Islander 0.4% 0.3%

Other 3.3% 2.9%

Table 4: Current practice setting

PA


Office-based private practice 43.6% 44.3%

Hospital 37.7% 37.9%

Federal government facility/hospital/unit 6.2% 5.7%

Community health center 3.7% 3.4% Rural health clinic 2.5% 2.5% Public or community health clinic (non-federally qualified) 1.6% 1.5% Occupational health setting 1.2% 1.4% School-based or college-based health center 1.0% 1.1% Extended care facility/nursing home 0.7% 0.6% Behavioral/mental health facility 0.5% 0.5% Ambulatory surgical center 0.4% 0.3% Rehabilitation facility 0.3% 0.3% Free clinic 0.3% 0.3% Home health care agency 0.1% 0.1%

Hospice <0.1% 0.1%

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Table 5: Primary practice area

PA


Primary care 28.3% 31.6%

Surgical specialties 21.6% 23.4%

Other medical specialties 50.1% 45.0%

In addition to demographic and practice considerations, the recertification history of the sample was

analyzed. Figure 1 shows the number of recertification cycles completed by PAs who completed the

survey. Approximately 31% of the sample3 have not yet experienced a recertification exam. Of those

who have recertified at least once, 5.57% have failed at least one recertification attempt and 10%4

opted to complete the Pathway II exam for at least one recertification attempt.

Figure 1: Number of recertification cycles completed.

3 NCCPA’s data suggest that 34.9% of all currently certified PAs have yet to complete their first recertification cycle. 4 NCCPA’s data suggest that 11.7% of all PAs who have recertified attempted the Pathway II exam at least once.

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Key Findings As part of the survey, PAs were asked the following four questions as a holistic gauge of how they feel

about the proposed PANRE model as compared to the existing PANRE.

Which of the following do you feel would be the most beneficial in helping you stay up to date

on general medical knowledge?

Which of the following do you feel would be a less stressful testing process?

Which of the following do you feel is best for improving patient care and safety?

Given the description of the proposed model for recertification, which recertification process do

you prefer?

In response to each question, PAs could select the proposed model, the existing PANRE model, or no

difference/preference. Table 6 displays the responses of the entire sample. Figures 2 to 5 show the

response to the same four questions broken across specialty area, experience with recertification,

experience with the Pathway II exam, and failure on one or more recertification attempts. Some key

findings include the following:

Overall, 62% of PAs preferred the proposed model, with 11% expressing no preference.

Nearly 70% believed that the proposed model will be less stressful.

Nearly two-thirds (65%) felt that the take-at-home exams will better promote staying current

with general medical knowledge than the existing PANRE.

The overall trend was similar across specialties, with slightly more non–primary care PAs

preferring the proposed model.

PAs who have yet to experience recertification preferred the proposed model at a higher rate

than PAs who have experienced recertification.

PAs who are former Pathway II test-takers or who have failed one or more recertification

attempts preferred the proposed model.

More than one-half (58%) of PAs who did not have an exam option in their specialty area

favored the proposed model. Of the remaining PAs, 29% preferred the current PANRE and 13%

had no preference.

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Table 6: Summary of questions about model perception

Current PANRE

Proposed Model

No Difference/No

Preference

Which of the following do you feel would be the most beneficial in helping you stay up to date on general medical knowledge?

22% 65% 13%

Which of the following do you feel would be a less stressful testing process?

20% 68% 12%

Which of the following do you feel is best for improving patient care and safety?

15% 55% 29%

Given the description of the proposed model for recertification, which recertification process do you prefer?

27% 62% 11%

Figure 2: Model perception by specialty.

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Figure 3: Model perception by experience with recertification.

Figure 4: Model perception by experience with the Pathway II exam.

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Figure 5: Model perception by failure on one or more recertification exams.

CME and Current Maintenance Requirements The survey contained several questions on the current CME requirements required for maintenance of

certification. In the survey, 87.6% of PAs reported completing regular Category I CME, while only 7.6%

and 15.7% have completed Performance Improvement (PI) or Self-Assessment (SA) CME, respectively.

PAs were asked to consider each type of CME and then consider how strongly they agree with two

statements:

The CME type helps improve patient care and safety.

The CME type is a meaningful activity that is relevant to my practice.

Because a majority of PA have not yet experienced PI or SA CME, the response options for each question

allowed PAs to select that they were “Unsure.” Table 7 summarizes the responses to each of these

questions. The PAs in this sample overwhelmingly agreed that Category I CME is relevant and improves

patient care. A large portion of the sample was unsure about the relevance of PI and SA CME and how

they relate to patient care. Of those who did express an opinion, very few agreed strongly that these

types of CME are relevant or improve patient care. Figures 6 and 7 show that, in general, these trends

hold true regardless of a PA’s specialty or expressed model preference.

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Table 7: PAs’ opinions on meaningfulness of different CME types

Statement CME Activity Strongly

Agree Agree Disagree Strongly Disagree Unsure

Helps improve patient care and safety

Regular Category I 44.1% 45.3% 4.9% 2.5% 3.2%

PI 6.2% 19.0% 15.3% 17.3% 42.3%

SA 8.1% 23.5% 15.2% 14.3% 39.0%

Category II 25.9% 49.5% 10.9% 3.5% 10.3%

Meaningful activity that is relevant to my practice

Regular Category I 52.8% 38.7% 3.9% 2.6% 2.0%

PI 6.3% 18.3% 16.2% 19.0% 40.3%

SA 8.5% 24.4% 15.2% 14.6% 37.2%

Category II 29.3% 50.9% 8.9% 3.2% 7.8%

Figure 6: Percent of PAs in each specialty area who strongly agreed or agreed that each type of CME is a relevant experience and improves patient care.

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Figure 7: Percent of PAs by PANRE model preference who strongly agreed or agreed that each type of CME is a relevant experience and improves patient care.

PAs were also asked to consider each type of CME and reflect on whether the time, cost, and availability

was “too much,” “just right,” or “too few/little.” Table 8 summarizes the percent of PAs who reported

that each type of CME costs too much, requires too much time, or has limited availability. Only PAs who

had engaged in these activities were used in these tabulations. Figures 8 and 9 display these same

responses compared across specialty and model preference. A majority of PAs reported that the

required time was too much, cost was too high, and availability of activities was too few for PI CME.

Similar trends, although less extreme, are observed for SA CME. Slightly more than 40% of PAs believed

that the cost of Category I CME is too high, but very few felt the required time or availability of activities

were overly onerous. The trends are similar across specialties, but non–primary care PAs reported more

challenges with all three factors for both PI and SA CME. PAs who preferred the existing PANRE

expressed more frustration with PI and SA CME than those who preferred the proposed model, although

it is unclear if this represents the true opinion or simply a negative response bias on all survey questions

for those who opposed the proposed model.

Table 8: Percent of PAs who felt each type of CME activity requires too much time, too much money, or has limited availability

CME Activity Requires Too Much Time Costs Too Much Too Few Available

Regular Category I 14.2% 40.8% 17.1%

PI 57.1% 68.7% 64.6% SA 47.6% 59.2% 57.6%

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Figure 8: Percent of PAs in each specialty area who felt each type of CME requires too much time, costs too much, or has a lack of availability.

Figure 9: Percent of PAs by PANRE model preference who felt each type of CME requires too much time, costs too much, or has a lack of availability.

April 2016 Page 15

PAs were asked if the appeal of the proposed model would change if its implementation were coupled

with reductions in CME requirements. As shown in Table 9, in general, PAs would find the new model

more appealing if reductions to CME requirements were made. This sentiment is strongest with regard

to reductions in PI and SA CME. PAs who already prefer the proposed model and those who have no

preference expressed these opinions strongest. PAs who prefer the existing PANRE were far less likely to

find the model much more appealing with CME reductions, but nearly 40% suggested that the model

increased in appeal with a reduction in PI CME requirements. However, 23% of these PAs suggested that

changes to CME in any way would make the proposed model far less desirable. It is unclear if this

reflects a true opinion or if those who do not approve of the proposed model were more likely to have a

negative response bias to all items.

Table 9: Change in opinion on the proposed model given a reduction in CME requirements

How do I feel about the new model if NCCPA

reduces ________?

Model Preference

Proposed PANRE

Model Is Much More

Appealing

Proposed PANRE

Model Is More

Appealing

No Change in Opinion on Proposed

PANRE Model

Proposed PANRE

Model Is Less

Appealing

Proposed PANRE

Model Is Much Less

Appealing

Regular category I

No preference 8.1% 28.2% 50.7% 5.1% 4.1%

Existing PANRE 4.4% 14.7% 40.3% 12.3% 26.0%

Proposed PANRE 29.8% 39.1% 25.3% 2.2% 2.0%

All 18.3% 27.9% 28.8% 4.7% 7.8%

PI

No preference 21.7% 26.2% 37.1% 3.8% 5.5%

Existing PANRE 16.8% 18.8% 28.7% 9.0% 23.1%

Proposed model 38.5% 31.7% 22.1% 2.2% 2.6%

All 27.4% 24.6% 22.8% 3.8% 7.6%

SA

No preference 20.0% 25.5% 39.2% 4.2% 5.6%

Existing PANRE 15.5% 18.7% 29.9% 8.9% 23.2%

Proposed model 36.7% 31.9% 23.7% 2.3% 2.5%

All 25.9% 24.7% 24.2% 3.9% 7.5%

Core Medical Knowledge Component The survey asked four questions about the core medical knowledge component of the proposed PANRE

model. Table 10 shows a cross-tabulation of the two questions addressing preferred format and

duration of the core medical knowledge components. PAs were asked if they would prefer two long test

modules, three moderate test modules, or four short test modules spread across the 10-year

recertification cycle. They were also asked, given their answer about the test format (two, three, or four

modules), how much time they would prefer to complete each module. PAs across all demographic and

practice variables overwhelming preferred two test modules. The three-month and six-month test

April 2016 Page 16

windows were the overwhelming choices for test time. The two most popular combinations of these

questions are shown in red in Table 10.

Table 10: Format of core medical knowledge component

Test Format Months to Complete

Total 18 12 9 6 3

Two tests, 150 items each 3.8% 10.0% 2.3% 27.6% 35.8% 79.57%

Three tests, 100 items each 0.2% 0.8% 0.3% 2.5% 3.2% 7.07%

Four tests, 75 items each 0.6% 1.8% 0.3% 4.4% 6.2% 13.36%

Total 4.6% 12.6% 2.9% 34.6% 45.3% 100.00%

The survey also asked what types of feedback on exam performance would be desirable. PAs were given

a list of four options and could check any or all that they felt would be useful.

84% of PAs would like to know their overall score upon completion.

65% would like to be presented a reference for each question they encounter.

59% would like feedback on specific subcategories of items.

56% would like to be presented feedback on exam performance relative to other PAs.

The last question in this section highlighted some of the possible features of the core component and

asked PAs to rate the importance of each feature. Table 11 summarizes how PAs (overall and by

specialty area) rated the importance of these features. Overall, more than 70% of all PAs rated the

following three features as very important or important: (1) a second opportunity to answer an item, (2)

ability to use resources to help me find the information needed to answer the questions, and (3)

completing the exam at a more relaxed pace. Surgical PAs were more likely to rate all three of these

features as very important. Figures 10 and 11 show the percentage of former Pathway II test-takers and

PAs who have failed one or more recertification attempts who rated each core test feature as very

important or important. Both of these subgroups rated all of the test features as important more often

than the overall sample. Figure 12 shows the percentage of PAs who rated each general test feature as

very important or important by PANRE model preference.

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Table 11: Importance of core component features

Feature Specialty Very

Important Important

Somewhat Important

Not Important

Answering questions correctly would result in a shorter test

Other specialties 18.8% 36.5% 25.3% 12.6%

Primary care specialties 18.3% 38.3% 25.8% 12.4%

Surgical specialties 17.4% 37.2% 27.7% 11.8%

All 18.0% 36.6% 25.7% 12.4%

I would immediately know if the answer to a question was correct or incorrect




All 25.3% 33.1% 20.0% 15.6%

I could use resources to help me find the information needed to answer the questions




All 35.5% 33.3% 16.8% 8.3%

I would be able to complete the exam at a more relaxed pace instead of the traditional one minute per question




All 39.0% 27.5% 15.4% 12.1%

If I miss a question, I would have a second opportunity to answer it correctly after I have been able to access resources

Other specialties 39.4% 31.4% 15.4% 8.2% Primary care specialties 38.1% 34.0% 16.1% 7.9%


All 38.6% 31.9% 15.5% 7.9%

April 2016 Page 18

Figure 10: Percent rating features as very important or important by former Pathway II test-takers.

Figure 11: Percent rating features as very important or important by PAs who have failed one or more recertification attempts.

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Figure 12: Percent rating features as very important or important by PANRE model preference.

Specialty Component Before the administration of the survey, NCCPA’s research team used the PA Profile data to investigate

which specialty areas were potentially large enough to support the psychometric needs for the specialty

exam component of the proposed model. A total of 19 areas were identified as potentially suitable, and

PAs were asked to select the area they would most likely choose for their specialty exam from that list.

In total, 79% of PAs selected a test aligned with their current practice. The 21% of PAs who did not

choose a specialty exam aligned with their current area of practice were asked why they selected a

different exam. The reasons cited in the survey include the following:

11% reported that an appropriate specialty exam was not included in the list of options.

3% selected an area where the PA had more work experience.

4% selected an area where the PA expected a better overall test performance.

1% selected an area where the PA expected to be working in the near future.

Table 12 shows the percent of PAs who selected each specialty exam as their preferred testing option

and the percent of PAs who reported working in each specialty area. Higher numbers of PAs selected

family medicine, general internal medicine, general pediatrics, and general surgery as a testing option

than actually practice in these areas. PAs who indicated they were not currently clinically practicing

selected the family medicine or general internal medicine option most often (52.4% and 37.1%,

respectively). PAs who did not choose their current specialty as their exam choice even though their

specialty was included on the list selected exams as follows:

31.1% selected family medicine, compared to 26.7% who selected this option overall.

18.7% selected general internal medicine, compared to 11.1% who selected this option overall.

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PAs who did not have a specialty exam option in their current practice area chose family medicine most

frequently, but they also selected internal medicine, pediatrics, surgery, and hospital medicine at rates

higher than the overall sample.

26.65% selected family medicine, compared to 26.68% who selected this option overall.

21.59% selected general internal medicine, compared to 11.11% who selected this option

overall.

9.17% selected hospital medicine, compared to 4.34% who selected this option overall.

8.65% selected general surgery, compared to 4.35% who selected this option overall.

5.96% selected general pediatrics, compared to 3.47% who selected this option overall.

Table 12: Specialty exam choice

Specialty Area PAs Working in the Specialty Area Specialty Exam

Choice PA Profile Survey Data

Family Medicine 21.0% 21.8% 26.7%

Emergency Medicine 13.4% 12.5% 13.2%

General Internal Medicine 1.1% 7.3% 11.1%

Orthopaedic Surgery 11.2% 10.6% 10.6%

Dermatology 4.0% 4.7% 4.7%

General Surgery 3.0% 3.4% 4.4%

Hospital Medicine (Hospitalist) 3.3% 3.2% 4.3%

General Pediatrics 2.0% 2.5% 3.5%

Cardiology 2.8% 3.1% 3.3%

Cardiothoracic Surgery 2.6% 2.6% 2.6%

Neurosurgery 2.2% 2.4% 2.4%

Gastroenterology 1.7% 2.0% 2.1%

OB/GYN 1.6% 1.9% 2.0%

Psychiatry 1.3% 1.6% 1.7%

Oncology 5.3% 1.6% 1.6%

Urology 1.5% 1.6% 1.6%

Occupational Medicine 1.6% 1.6% 1.5%

Otolaryngology 1.1% 1.3% 1.4%

Physical Medicine/Rehabilitation 1.0% 1.0% 1.3%

Specialties not included as exam options 18.5% 13.5% 0%

Totals 100.00% 100.00% 100.00%

The last question in the survey section on the specialty exam component of the proposed PANRE model

asked PAs about the importance of several of the proposed features of this exam component. Table 13

shows the importance rating of these features for all PAs as well as for PAs in primary care and other

specialty areas. Unsurprisingly, PAs working in non–primary care specialty areas viewed the specialty

exam features (ie, “I can select a specialty exam more closely related to my area of practice;” “I have the

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flexibility to choose a specialty exam from a number of options”) as very important. Primary care PAs

were overwhelmingly supportive of having exam options related to general medical knowledge (“I can

select an exam that allows me to stay current with general medical practice“). Figures 13 to 16 display

the percent of PAs who rated these features as very important or important broken down across

specialties, former Pathway II test-takers, PAs who have failed at least one recertification exam attempt,

and PAs who have and have not experienced recertification. Overall, former Pathway II test-takers, PAs

who have experienced some difficulty with recertification exams in the past, and PAs who have yet to

experience PANRE were more enthusiastic about the features of the model. Figure 17 displays the

percent of PAs who rated these features as very important or important by model preference. It is

unsurprising that those who endorsed the proposed model rated nearly all exam features higher than

those who did not endorse the proposed model.

Table 13: Importance of specialty exam features

Feature Specialty Very

Important Important

Somewhat Important

Not Important

I can take a specialty exam that would have less questions than the current PANRE




All 21.4% 29.9% 21.5% 18.5%

The specialty exam includes a performance level that allows me to remediate by completing targeted CME instead of retesting




All 38.0% 32.4% 13.1% 7.7%

I can select a specialty exam more closely related to my area of practice




All 39.8% 29.5% 12.4% 9.3%

I can select an exam that allows me to stay current with general medical practice




All 29.3% 37.9% 17.4% 6.6%

My exam preparation will be more relevant because it will focus on content more closely related to my area of practice




All 38.3% 32.8% 12.3% 7.7%

I have the flexibility to choose a specialty exam from a number of options




All 31.6% 34.2% 15.4% 9.8%

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Figure 13: Percent rating features as very important or important across specialty groups.

Figure 14: Percent rating features as very important or important by former Pathway II test-takers.

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Figure 15: Percent rating features as very important or important by PAs who have failed one or more recertification attempts.

Figure 16: Percent rating features as very important or important by PAs who have not recertified.

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Figure 17: Percent rating features as very important or important by PANRE model preference.

Comparing Current and Future PANRE The last section of the survey contained two questions that asked PAs to identify, from a predefined list,

all the benefits of the existing and proposed PANRE testing programs. Table 14 shows the percent of PAs

who selected each potential benefit. Overall, most PAs saw the straightforward nature of the existing

PANRE as a benefit, and more than 60% appreciated that the existing PANRE requires only a single test.

However, only 13% of PAs believed the existing PANRE is relevant to their practice.5 Half of PAs believed

the proposed model will be more relevant to their practice, nearly 59% appreciated being able to use

resources in responding to questions, and 60% believed there is a benefit in remediation through CME

rather than retesting. Figures 18 through 27 show the perceived benefits of both the existing and

proposed PANRE models broken down across subgroups. Not surprisingly, PAs who have experienced

failure on a recertification exam (Figures 18 and 19) were less likely to find any feature of the existing

model as beneficial. These PAs were more likely to see the benefit of using resources on the core

medical knowledge section of the test and the ability to remediate rather than retest. Similar trends

were observed for PAs who have previously taken the Pathway II exam (Figures 20 and 21). PAs who

have yet to experience a recertification exam were similar to those who have recertified with regard to

the benefits of the existing PANRE but were more likely to identify the features of the proposed model

as beneficial (Figure 23). Few differences exist between PAs from different specialty areas regarding

their perspectives on the proposed model, but non–primary care PAs were far less likely to view the

5 The percent of PAs who reported PANRE is a relevant exam is markedly lower than in a survey NCCPA conducted in August 2015 following the PANRE focus group. There are several possible reasons for this decrease, although the two most likely reasons are the way the question was phrased. On this survey, the question asked PAs to indicate if they thought the relevance of PANRE was a benefit of the current model. The August survey allowed to PAs to indicate the degree to which they agreed with the statement “The content on PANRE is relevant to my practice.”

April 2016 Page 25

existing PANRE as a relevant experience. Last, and as expected, PAs who prefer the proposed model saw

more benefit in the features of the proposed model, and the converse was true for those who prefer the

existing PANRE.

Table 14: Percent of PAs identifying features of the existing and proposed PANRE models as benefits

Benefits of Existing or Proposed PANRE Existing PANRE

Proposed PANRE

Requires an appropriate amount of preparation for the exam 31.6% 27.0%

The process is straightforward 52.4% 18.4%

The exam is relevant to my practice 13.3% 50.0%

Allows mobility to change my specialty areas of practice 37.4% 32.3%

Promotes patient safety and care 21.1% 29.3%

Requires a single test 61.1%

More convenient to take one exam at a secure location 34.9%

The exam contains only general medical knowledge 26.7%

Ability to choose a focus area (Adult Medicine, Primary Care, or Surgery) for a portion of my exam

19.6%

The proposed model would result in the same PA-C credential I get today 56.3%

If desired, the specialty exam could allow me to fulfill the exam component for a CAQ

41.7%

Ability to access resources and references on the general take-at-home exam 58.7%

Shorter, more frequent general core exams that offer opportunities to learn 51.5%

Enhanced feedback that promotes learning 52.3%

More convenience and flexibility with when and where I complete the general core exam

49.1%

Opportunity to remediate through targeted CME rather than retesting on both the general core and specialty exams

60.0%

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Figure 18: Perceived benefits of the existing PANRE model by PAs who have failed one or more recertification attempts. GMK, general medical knowledge.

Figure 19: Perceived benefits of the proposed PANRE model by PAs who have failed one or more recertification attempts.

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Figure 20: Perceived benefits of the existing PANRE model by PAs who previously completed at least one Pathway II exam. GMK, general medical knowledge.

Figure 21: Perceived benefits of the proposed PANRE model by PAs who previously completed at least one Pathway II exam.

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Figure 22: Perceived benefits of the existing PANRE model by PAs who have yet to experience recertification. GMK, general medical knowledge.

Figure 23: Perceived benefits of the proposed PANRE model by PAs who have yet to experience recertification.

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Figure 24: Perceived benefits of the existing PANRE model by PAs across specialty areas. GMK, general medical knowledge.

Figure 25: Perceived benefits of the proposed PANRE model by PAs across specialty areas.

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Figure 26: Perceived benefits of the existing PANRE model by PANRE model preference. GMK, general medical knowledge.

Figure 27: Perceived benefits of the proposed PANRE model by PANRE model preference.

Documents

Report on the 2016 Survey to Gather PA Feedback on the