Cert and Licensure Objectives

● Discuss history and organization of NCCPA

○ The only national certifying body for physician assistants
○ Founded in 1975
○ Independent, not-for-profit organization
○ Headquartered near Atlanta, Georgia
○ Staff of more than 40
○ Governed by a Board of Directors: appointees from several organizations, 2 public member
Directors-at-large (DAL), 2 Physician DAL, & 6 PA DAL
■ ¨American Academy of Physician Assistants
■ ¨American College of Physicians
■ ¨Amer. Medical Assoc.
■ ¨Amer. Osteopathic Assoc.
■ ¨Federation of State Medical Boards
■ ¨PA Education Association

● Tell the mission of NCCPA

○ To provide certification programs that reflect standards for clinical knowledge, clinical
reasoning and other medical skills and professional behaviors required upon entry into
practice and throughout the careers of PAs.
○
● Tell steps needed to gain certification
○ Graduate from ARC-PA program
○ Take PANCE and pass

● Tell the 10 nearest places (to Searcy) to take the PANCE

○ ¡Pearson Professional Centers- Little Rock, AR
○ Pearson Professional Centers- Texarkana, AR
○ ¡Pearson Professional Centers- Fort Smith, AR
○ ¡Pearson Professional Centers- Memphis (Midtown), TN
○ ¡Pearson Professional Centers- Memphis, TN
○ ¡Pearson Professional Centers- Springfield, MO
○ ¡Pearson Professional Centers- Tupelo, MS
○ ¡Pearson Professional Centers- Jackson (North), MS
○ ¡Pearson Professional Centers- Jackson, MS
○ Pearson Professional Centers- Shreveport, LA

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● Discuss the PANCE content blueprint

¨History Taking & Performing Physical Examination 17%

¨Using Diagnostic and Laboratory Studies 12%
¨Formulating Most Likely Diagnosis 18%
¨Health Maintenance, Patient Education 10%
¨Clinical Intervention 14%
¨Pharmaceutical Therapeutics 14%
¨Applying Basic Scientific Concepts 10%
¨Professional Practice 5%

¨Cardiovascular System 13%

¨Dermatologic System 5%
¨Endocrine System 7%
¨Eyes, Ears, Nose, Throat 7%
¨GI System/Nutrition 9%
¨GU System (Male & Female) 5%
¨Hematologic System 5%
¨Infectious Diseases 6%
¨Musculoskeletal System 8%
¨Neurologic System 7%
¨Psychiatry/Behavioral Science 6%
¨Pulmonary System 10%
¨Renal System 5%
¨Reproductive System (Male & Female) 7%

● Tell the steps necessary to apply for the PANCE

○ Setup NCCPA online record
○ Verify/update your personal contact information
○ ¨Background information questions
○ ¨Additional information
○ ¨Exam policies & procedures
○ ¨Payment
○ ¨Affirmation and authorization
○ ¨Confirmation

● Discuss the self-assessment test available through NCCPA

○ ¨$50 Online self assessment (Practice Exam)
○ ¨120 questions extracted from retired test questions (two 60-minute blocks) (PANCE and
PANRE)
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● Tell what to expect on PANCE test day
○ ¨Five-hour exam
■ 5 blocks of 60 questions, 60 minutes each
■ 45 minutes of break time for the entire day
■ Additional 15 minutes to view the Tutorial if desired
○ ¨Arrive 30 minutes early.
○ ¨Two forms of ID required (one photo ID)
■ ¡Be certain your name is the same as on application!
■ ¡Have you recently married/divorced/changed your name?
○ ¨Do not bring any other personal belongings.
■ Except money for the drink/snack machines
○ ¨Read ALL correspondence for detailed instructions about what to expect on exam day.

● Discuss exam development and scoring

○ NCCPA test committee members, including PAs and physicians from a variety of practice
specialties and settings, write all items.
■ Committees review items for style and to validate every aspect of the question.
■ Items are then pre-tested. Statistical analyses determine whether the question should
be thrown out, returned to the committee, or made part of the NCCPA item bank.
■ Dynamic process allows questions to be continuously reviewed and updated or
eliminated.
○ ¨NCCPA uses a content-based standard setting process.
■ An absolute standard is established.
■ Everyone who meets the standard passes.
■ Your score is not determined by the score of others taking the test on that same day.
● Much more sophisticated than norm-referenced standard setting (i.e., the bell-
curve)
● Discuss accessing and receiving your scores
○ NCCPA provides electronic, online score reports.
○ When they receive your scores, they will email instructions for accessing your score report
in your secure record online.
○ Usually get results in 2 weeks.
○ 2017 HUPA pass rate was 100%
● Tell requirements to maintain certification
○ 10-Year certification maintenance cycle comprised of 5 two-year blocks
○ After passing the PANCE, PAs will be certified for approximately 2 years
○ First 4 CME Cycles: Log 100 hours of CME every 2 years and submit $130 certification
maintenance fee
■ 50 of these hours must be Category I
○ Fifth Cycle: Earn 100 CME credits including ≥50 Category I, take and pass the PANRE
○ New grads: the first year after graduating can log CMEs right away-Dec 31 but pay $150 for
recertification
○ Can log CMEs May 1st-Dec 31st every year after the first time

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● Define Category I and II CME and tell requirements for logging both
○ Category I CME –The activity or provider is preapproved by the AAPA, AMA, AAFP, AOA,
European Accreditation Council for Continuing Medical Education, Royal College of
Physicians and Surgeons of Canada, the College of Family Physicians of Canada, or the
Physician Assistant Certification Council of Canada
■ Other activities that satisfy NCCPA’s definitions for self-assessment CME or PI-CME
are considered by NCCPA to be Category I CME
■ How do you know it’s Category I? Some clues:
● Certificate upon completion that makes reference to one of the sponsors.
● Someone paid for you to participate.
○ Category II (Elective) CME – Any other practice-related educational activity pursued outside
of your employment. No minimum requirement.
■ Category II hours should be logged hour-per-hour.
● Reading medical journals
● Postgraduate coursework
● Precepting PA students
● Time spent studying for PANRE

● Discuss recertification and the PANRE

○ Currently 240 questions, multiple choice exam, $350, 4 sections of 60, 45 min break
○ You can register for and take the recertification exam in year 9 or year 10 of your ten-year
cycle
■ Provides you up to four opportunities total (up to two the 9th year, up to three the
10th year) to attempt the exam
● Taking the exam early in year 9 will NOT change your certification
maintenance cycle and you’ll still need to log CME for that two-year cycle
before taking the PANRE!
● Tell the web address for NCCPA
○ ¨www.nccpa.net
● Tell the web address for the Arkansas State Medical Board (ASMB)
○ www.armedicalboard.org
● Name the ASMB Chairman
○ Sylvia D. Simon, M.D.
● List the members of the PA Advisory Committee
○ Robert Breving, MD, Chairman
○ ¨David Staggs, MD
○ ¨John Scribner, MD
○ ¨Chris Davis, PA-C
○ ¨Kelly Leuders, PA-C

● Discuss the requirements for licensure in AR

○ Submit an application on forms approved by the board
○ Pay the appropriate fees as determined by the board
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 ○ Successfully complete an educational program and pass the PANCE
○ Certify that he/she is mentally and physically able to engage safely in practice as a PA
○ Have no licensure, certification, or registration as a PA under current discipline, revocation,
suspension, or probation for cause resulting from the applicant’s practice as a PA, unless
the board considers such condition and agrees to licensure
○ Be of good moral character
○ Submit to the board any other information the board deems necessary to evaluate the
applicant’s qualifications
○ Be approved by the board
○ Be at least 21 years of age
○ Have at least a bachelor’s degree in some field of study from a regionally accredited
college or university, unless the applicant has:
■ Prior service as a military corpsman and is a graduate of a PA education program
recognized by the Committee on Allied Health Education and Accreditation (CAHEA)
or the Commission on Accreditation of Allied Health Education Programs (CAAHEP)
or the applicant is currently certified by the National Commission on Certification of
Physician Assistants
■ Was serving as a PA in a federal facility located in the State of Arkansas on or after
July 1, 1999, and who is a graduate of a PA education program recognized by the
CAHEA or the CAAHEP
■ Was licensed in good standing on June 30, 1999, by the Arkansas State Medical
Board
■ Was enrolled on or before July 1, 1999, in a PA program recognized by the CAAHEP
● Discuss Temporary PA licensure in AR
○ May be granted to an applicant who meets all the qualifications for licensure but is awaiting
the next scheduled meeting of the board
■ Per ASMB Website FAQs, you may only perform the duties listed on the sample
protocol prior to your meeting with the PA Advisory Committee and getting a full
license
● Discuss Inactive License for PAs in AR
○ Any PA may elect to place his/her license on an inactive status by applying to the board on
prescribed forms
○ No need to pay annual renewal fees while inactive
○ May not practice as a PA while inactive
○ May request restoration from inactive status by:
■ Submitting the appropriate fee as determined by the board
■ Completing the appropriate forms
■ Meeting any other requirements set forth by the board
● Discuss exemption from PA licensure in AR
○ A PA student enrolled in an accredited program
○ A PA employed in the service of the federal government while performing duties incident to
that employment
○ A PA in the service of the State Military Department or the Arkansas National Guard or both.
These PAs shall be allowed to perform their PA practice duties, including prescribing, in the
same manner as they would if federalized by the US Government

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 ○ A PA who is temporarily transiting through the State of Arkansas while caring for a patient,
provided that he or she remains under the supervision of his or her supervising physician
○ A PA providing services through a program in partnership with federal Innovative Readiness
Training if the PA has obtained a license to practice from another state, commonwealth,
territory, or the District of Columbia
● Discuss restrictions for PAs
○ Examine the human eye or visual system for the purpose of prescribing glasses or contact
lenses or the determination of the refractive power for surgical procedures;
○ Adapt, fill, duplicate, modify, supply, or sell contact lenses or prescription eyeglasses; or
○ Prescribe, direct the use of, or use any optical device in connection with ocular exercises,
vision training, or orthoptics.
● Discuss prescriptive authority for PAs
○ Supervising physician may delegate prescriptive authority to PAs to include prescribing,
ordering, and administering Schedule III-V controlled substances, all legend drugs, and all
non-schedule prescription medications and medical devices. All prescriptions and orders
issued by a PA shall also identify his or her supervising physician.
○ A PA may prescribe hydrocodone combination products reclassified from Schedule III to
Schedule II as of October 6, 2014, if authorized by the PA’s supervising physician and in
accordance with other requirements of this section.
○ At no time shall a PA’s level of prescriptive authority exceed that of the supervising
physician.
○ PAs who prescribe controlled substances must register with the DEA.
○ The ASMB shall promptly adopt rules concerning PAs that are consistent with the ASMB’s
rules governing the prescription of dangerous drugs and controlled substances by
physicians.
● Discuss supervision and the supervising physician
○ Supervision shall be continuous but shall not be construed as necessarily requiring the
physical presence of the supervising physician at the time and place that the services are
rendered.
○ Physician & PA must ensure:
■ PA’s scope of practice is identified
■ Delegation of medical tasks is appropriate to the PA’s level of competence
■ The relationship and access to the supervising physician is defined
■ A process of evaluation of the PA’s performance is established
○ Back-up physician(s) may be designated to supervise the PA during the absence of the
supervising physician.
○ Supervising physician must:
■ Be licensed in Arkansas
■ Notify the ASMB of his/her intent to supervise a PA
■ Submit a statement to the board that he/she will exercise supervision over the PA in
accordance with any rules adopted by the board
● Discuss identification requirements for PAs
○ Licensed PAs shall keep their license available for inspection at their primary place of
business and when engaged in their professional activities shall wear a name tag identifying
themselves as a physician assistant.

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● Discuss PA patient care orders
○ Patient care orders generated by a PA shall be construed as having the same medical,
health, and legal force and effect as if the orders were generated by their supervising
physician, provided that the supervising physician’s name is identified in the patient care
order.
○ The orders shall be complied with and carried out as if the orders had been issued by the
PA’s supervising physician.
● Discuss requirements as listed in Regulation 24 of the Arkansas State Medical Board
○ ¨Regulation 24 is an Arkansas State Medical Board (ASMB) regulation
■ Changes do not require legislative action
■ Changes are made by the ASMB
○ ¨A PA must possess a license issued by the ASMB prior to engaging in such occupation
○ ¨To obtain a license from the ASMB the PA must do the following:
■ Answer all questions to include the providing of all documentation requested on an
application form as provided by the ASMB;
■ Pay the required fee for licensure as delineated elsewhere in this regulation;
■ Provide proof of successful completion of PANCE as administered by NCCPA;
■ Certify and provide such documentation as the ASMB should require that the
applicant is mentally and physically able to engage safely in the role as a PA;
■ Certify that the applicant is not under any current discipline, revocation, suspension
or probation or investigation from any other licensing board;
■ Provide letters of recommendation as to good moral character and quality of practice
history;
■ The applicant should be at least 21 years of age;
■ Show proof of graduation with a Bachelor’s Degree from an accredited college or
university or prior service as a military corpsman;
■ Provide proof of graduation of a PA education program recognized by CAHEA or
CAAHEP;
■ The submission and approval by the Board of a protocol delineating the scope of
practice that the PA will engage in, the program of evaluation and supervision by the
supervising physician;
■ The receipt and approval by the ASMB of the supervising physician for the PA on
such forms as issued by the ASMB.
○ If an applicant for a license submits all of the required information, complies with all the
requirements for licensure except receiving Board approval of a protocol, then the applicant
may request a Letter of Intent from the Board and the Board may issue the same.
■ Said Letter of Intent from the Board will state that the applicant has complied with all
licensure requirements of the Board except the submission of a protocol and
supervising physician and that upon those being submitted and approved by the
Board, it is the intent of the board to license the applicant as a physician assistant.
Said Letter of Intent will expire six (6) months from date of issue.
○ ¨The Protocol
■ Must be completed and signed by the PA and his designated supervising physician
● Must be written in the form issued by the ASMB
■ Must be accepted and approved by the ASMB prior to licensure of the PA

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 ● *Any change must be submitted to the Board and approved by the Board prior
to any change in the protocol being enacted by the PA
○ PA must be authorized by his supervising physician to prescribe legend drugs and
scheduled medicine for patients
■ Must be stated in the protocol
■ Supervising physician may only authorize a PA to prescribe schedule medication that
the physician is authorized to prescribe
■ PA may only be authorized to prescribe schedule III through V medications except
that a PA may prescribe hydrocodone combination products
■ Name of medication, strength, dosage, quantity, directions, refills, signature of PA,
printed name of supervising physician
■ PAs who prescribe controlled substances shall register with the DEA
○ Supervising physician must be available via telephone any time the PA renders services to
the public
○ Supervising physician must:
■ Submit forms to ASMB requesting supervising physician status
■ Provide his name, business address, licensure, qualifications in the field of practice of
the PA and the name(s) of the PAs he intends to supervise
■ Notarized letter stating he has read the PA regulations, understands them, and will
take full responsibility
■ Back-up supervising physicians must adhere to the same rules
○ Supervising physician and back-up supervising physician must be skilled and trained in the
same scope of practice as the tasks that have been assigned to and will be performed by
the PA they will supervise.
○ PAs will have to provide medical services to the patients consistent with the standards that a
licensed physician would provide to a patient.
○ PA must wear a badge/name plate with the words “physician assistant” appearing thereon.
○ PA will not receive money directly from a patient or an insurance provider of a patient.
○ Supervising physician (SP) is liable for the acts of a PA if acts arise out of the powers
granted the PA by the supervising physician.
○ Continuing Medical Education
■ PA with active license must complete 20 credit hours per year of CME
● CME hours are counted from birth month to birth month and do not have do be
a particular category (from FAQ for PAs)
○ Board may grant an extension if requested due to illness, military service, medical or
religious missionary activity, residence in a foreign country, or other extenuating
circumstances
○ Each year PA must certify that he/she has met the CME requirements.
○ CME records must be kept by the PA in an orderly manner
○ A PA who is authorized to prescribe Schedule II hydrocodone combination products must
complete at least five CME hours in the area of pain management
○ PAs shall adhere to Regulation 16 concerning HIV, HBV, and HCV
■ “A practitioner who performs or participates in an invasive procedure or performs a
function ancillary to an invasive procedure shall, in the performance of or participation
in any such procedure or function be familiar with, observe and rigorously adhere to

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 both general infection control practices in universal blood and body fluid precautions
as then recommended by the Federal Centers for Disease Control to minimize the
risk of HBV, HCV, or HIV from a practitioner to a patient, from a patient to a
practitioner, or from a patient to a patient.”
● Mr. Hill’s Questions
○ How many questions are on the PANCE?
■ 300
○ In Arkansas, a PA who prescribes Hydrocodone containing products must complete
how many hours of CME in the area of pain management?
■ 5 hours
○ Who needs to sign the PA Protocol?
■ Supervising physician
■ Back-up supervising physician
■ PA
○ How often can you take the PANCE if you fail?
■ Three times in a calendar year
■ Once in a 90-day period
■ Six times in 6 years