Physician Assistant Certification and Licensure

By an allied health world contributing writer
Published: February 4th, 2010

Specifics of credentialing, certification and licensure differ from state to state, but some aspects are the same throughout the country. In order to swap the initials PA-S (physician assistant student) with PA-C (physician assistant-certified) or PA-R (the registered designation is available in a few states) after one’s name, a candidate must submit an application and fee, pass a national exam, submit to a background criminal and financial investigation, be fingerprinted and photographed. Candidates must also have graduated from an accredited physician assistant program and completed a national exam. This is self-enforcing, since only those who graduate from an accredited physician assistant education program are permitted to sit for the test.

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The four- to six-hour multiple-choice computer-based Physician Assistant National Certifying Exam (PANCE) can be taken at testing centers nationwide. PANCE is somewhat equivalent to the medical boards for which doctors must sit before being licensed to practice. The test includes 360 questions that include demonstrating memorization of body parts, analyzing symptoms, identifying the best pharmaceutical dosage for a given problem and interpreting images of patient radiographs or photographs (e.g., a skin Physician Assistant Certification and Licensure

Physician Assistant Certification and Licensure

disorder may be displayed and the answers are different dermatological diagnoses). It is noteworthy that even if a physician assistant has chosen to specialize in orthopedic surgery, he or she must know enough about, say, pancreatic diseases to pass the PANCE. The administrating body, the National Commission on Certification of Physician Assistants (NCCPA), requires PA-S candidates to sit for the exam within six years of graduation and allows six tries to pass the exam. Failure to meet these two requirements means a candidate must start physician assistant school all over again.

The exam is split between knowledge of skills (assessing and diagnosing, bedside manner, protocol) and identification of organs, systems and disorders of the human body.

The skills exam questions are broken into seven areas:

Clinical intervention
Pharmaceutical therapy
Basic science
Maintaining patient health
How to reach a diagnosis
Lab and diagnostic studies
Taking patient history and performing an exam

The organ/system questions are broken into 13 areas:

Infectious disease
Hematology
Dermatology
Neurology
The reproductive system
Psychiatric and behavioral science
Eyes, ears, nose and throat
The cardiovascular system
The endocrine system
The pulmonary system
The genitourinary system
Nutrition and the gastrointestinal system
The musculoskeletal system

Maintaining a national PA-C certification requires earning at least 100 hours of continuing medical education credits every two years and passing a recertifying exam again every six years (the Physician Assistant National Recertifying Exam, or PANRE). Alternately, PA-Cs may undergo a refresher program called Pathway II, an open-book that ends with the completion of a take-home examination. However, Pathway II ends in 2010, so PA-Cs whose certifications expire in 2011 or later must take the PANRE.

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Certification and licensing are public knowledge, and any employer or patient can research the status of a healthcare provider’s credentials (often via the Internet). Complaints against physician assistants are often handled by the licensing state and are also a matter of public record. When a physician assistant moves to another state and seeks a license through reciprocity, any negative professional history is guaranteed to follow, as a state license application will specifically ask a PA-C to cite these incidents and their ultimate resolution.