Veterans Affairs Physicians Assistant Association

September 5, 2014 PA Quality Standards

STAFFING 

1.  REASON FOR ISSUE:  To revise the Department of Veterans Affairs (VA) qualification standard for the appointment of Physician Assistants, VN/AD-0603, appointed under 38 U.S.C. 7401(1)

and 38 U.S.C. 7405 in VHA. 

2.  SUMMARY OF CONTENTS/MAJOR CHANGES:  This handbook contains mandatory procedures on staffing.  The pages in this handbook replace the existing Physician Assistant Qualification Standard in VA Handbook 5005, Appendix II-G8 in its entirety.  The new standards are effective on the date of issuance of this handbook.  These changes will be incorporated into the electronic version of VA Handbook 5005, Staffing, that is maintained on the Office of Human Resources Management Web site.  Significant changes include: 

     a.  Changes the education to require a Bachelor’s Degree from an accredited physician assistant training program or another health sciences related field from an accredit college or university. 

     b.  Clarifies that certification by the National Commission on Certification of Physician Assistants (NCCPA) is required for employment in VHA.  This certification must be maintained. 

3.  RESPONSIBLE OFFICE:  Recruitment and Placement Policy Service (059), Office of the Deputy Assistant Secretary for Human Resources Management. 

4.  RELATED DIRECTIVES:  VA Directive 5005, Staffing. 

5.  RESCISSIONS:  VA Handbook 5005, Part II, Appendix G8, dated April 15, 2002.  

CERTIFIED BY:                                                           BY DIRECTION OF THE SECRETARY

                                                                                          OF VETERANS AFFAIRS: 

/s/Stephen W. Warren                                                       /s/Gina S. Farrisee

Executive in Charge and Chief Information Officer        Assistant Secretary for

Office of Information and Technology                            Human Resources and Administration

 

ELECTRONIC DISTRIBUTION ONLY 

APPENDIX G8.  PHYSICIAN ASSISTANT QUALIFICATION STANDARD 

[1.  COVERAGE.  The following are the requirements for appointment as a Physician Assistant (PA) in the Veterans Health Administration (VHA).  These requirements apply to all PAs employed in the VN/AD 603 series appointed under 38 U.S.C 7401(1) or 38 U.S. C. 7405 in VHA. 

2.  BASIC REQUIREMENTS 

     a.  Citizenship.  Citizen of the United States.  (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with chapter 3, section A, paragraph 3, g, of this part.) 

     b.  Education.  The candidate must meet the following: 

     (1)  Graduate of a PA training program, or of a surgical assistant program which is accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or one of its predecessor organizations; and 

     (2)  A Bachelor’s degree from an accredited PA training program or in another health sciences related field from an accredited college or university recognized by the U.S. Department of Education. 

     c.  Certification 

     (1)  Current and continuous certification by the National Commission on Certification of Physician Assistants (NCCPA) is required for employment in VHA. 

     (2)  Recent PA graduates who are eligible to take the Physician Assistant National Certifying Examination (PANCE) may be employed by VA on a temporary basis (38 U.S.C. 7405), for a period not to exceed two years, as provided in VA Handbook 5005, Part II, Chapter 3, Section G, Paragraph 5. 

     (3)  If a PA’s NCCPA certification is suspended, revoked or expires, the PA must be removed from the occupation which may result in termination of employment. 

     d.  Physical Standards.  See VA Directive and Handbook 5019, Part II, Appendix A. 

     e.  English Language Proficiency.  PAs appointed to direct patient-care positions must be proficient in spoken and written English as required by 38 U.S.C. 7402(d). 

     f.  Restriction.  Under no circumstances may this occupation be used to employ physicians or other health care providers who do not meet the applicable qualification standards for their occupation.  All PAs must meet the requirements in paragraphs 2a through f above. 

3.  GRANDFATHERING PROVISION.  Effective with the issuance of this new qualification standard all PA’s are required to have a Bachelor’s Degree and maintain certification.  For employees who do not meet all the basic requirements required in this standard, but who met the qualifications applicable to the position at the time they were appointed to it, the following provisions apply:

     a.  PAs on VA rolls prior to the implementation date of this standard who do not meet the minimum academic level of a Bachelor’s degree are exempted from this requirement. 

     b.  PAs on VA rolls prior to March 12, 1993 who are not NCCPA certified remain exempt from the NCCPA certification requirement.  However, a PA who subsequently became or becomes certified is no longer exempt and must maintain certification as a condition of employment. 

     c.  PAs who have been grandfathered and subsequently leave the PA occupation lose the grandfathered status and must meet the full VA qualification standard requirements in effect at the time of reentry to the PA occupation, unless a waiver is approved by the Under Secretary for Health. 

4.  GRADE REQUIREMENTS.  In addition to the basic requirements stated in paragraph 2 above, the following qualifications criteria must be met in determining the appropriate grade for appointment or promotion eligibility.  Requirements for appointment or promotion to a specific grade are based on the candidate’s ability to demonstrate the elements described. 

     a.  Full Grade.  In addition to meeting the basic requirements in paragraph 2, individuals appointed to this grade must meet all the following requirements: 

     (1)  Experience / Education.  None beyond the basic requirements in paragraph 2 of this standard. 

     (2)  Clinical Competencies 

     (a)  Clinical Proficiency 

     1.  Provides effective care to patients characterized by the use of sound judgment in assessing, planning, implementing, documenting, and evaluating patient care for assigned patients.  This includes possessing the skill and competency to obtain thorough medical histories, perform comprehensive physical examinations, order appropriate diagnostic studies, interpret and analyze medical data, establish diagnoses, formulate and implement treatment plans, and modify treatment plans when appropriate. 

     2.  Works effectively and makes appropriate requests for assistance from the assigned physician and recognizes complex patient care situations where referral is appropriate. 

     3.  References quality improvement information and organizes patient care needs to assure safe, efficient and cost-effective care. 

     4.  Initiates effective actions in emergencies. 

     (b)  Professional Development 

     1.  Obtains additional knowledge and skills appropriate to the practice setting to improve performance. 

     2.  Provides patient education in an effective manner. 

     (c)  Ethics.  Safeguards patient privacy and confidentiality.  Provides care in a nonjudgmental, non-discriminatory manner respecting the patient’s values and beliefs. 

     (d)  Interpersonal Skills.  Works effectively with patients, families, caregivers, and other professional and support personnel. 

     (e)  Research 

     1.  Demonstrates awareness of research application to practice. 

     2.  Researches medical literature and applies evidenced-based medicine to improve clinical practice. 

     b.  Intermediate Grade.  In addition to meeting the basic requirements under paragraph 2 above, candidates must meet all requirements described in this standard for Full Grade through VA employment or non-VA PA positions with equivalent scope and complexity.  Individuals appointed or advanced to Intermediate Grade will have demonstrated the ability to analyze and solve more complex medical problems and meet the following requirements: 

     (1)  Experience / Education 

     (a)  1 year of professional practice as a PA; or 

     (b)  Successful completion of a PA post-graduate residency program accredited by ARC-PA or by the U.S. Armed Forces; or 

     (c)  A Master’s degree from a PA training program certified by ARC-PA or in another health-related field from an accredited college or university recognized by the U.S. Department of Education. 

     (2)  Clinical Competencies 

     (a)  Clinical Proficiency 

     1.  Effectively treats patients with more complex medical problems requiring a higher degree of clinical skill and competency than that expected of the previous grade. 

     2.  Performs more complex diagnostic and therapeutic procedures requiring skills and competency, as applicable to the assignment, beyond that expected in the previous grade. 

     3.  Practices with a higher degree of autonomy and seeks guidance from the assigned physician less frequently than expected of the previous grade. 

     4.  Evaluates the delivery system of patient care within the area of assignment, presents findings and recommendations, and contributes to changes that enhance the quality and timeliness of care. 

     (b)  Professional Development 

     1.  Acquires knowledge and skills to maintain expertise in area of practice. 

     2.  Shares medical literature research findings with colleagues to enhance patient care delivery. 

     3.  Participates in educational activities to improve clinical knowledge and enhance role performance. 

     4.  Serves as a clinical preceptor to healthcare students. 

     5.  Serves on service level committees or subcommittees when assigned. 

     (c)  Ethics 

     1.  Identifies medical ethical issues and takes appropriate actions. 

     2.  Supports and enhances patient self-determination. 

     (d)  Interpersonal Skills.  Collaborates effectively with other occupations and services to identify, analyze, and resolve patient care problems. 

     (e)  Research 

     1.  Shares medical literature research findings with colleagues to enhance patient care delivery. 

     2.  Uses a body of research to validate or change group practice. 

     c.  Senior Grade.  In addition to meeting the basic requirements under paragraph 2 above, candidates must meet all requirements described in this standard for Intermediate Grade through VA employment or non-VA PA positions with equivalent scope and complexity.  Individuals appointed or advanced to Senior Grade will have demonstrated the behaviors or responsibilities listed in one or more of the following categories:  Clinical Proficiency, Education, Professional Development, Management/Administrative, and Research, as applicable to the assignment   

     (1)  Experience / Education 

     (a)  3 years of professional practice as a PA; or 

     (b)  2 years of professional practice as a PA and successful completion of a PA post-graduate residency program accredited by ARC-PA or by the U.S. Armed Forces; or 

     (c)  2 years of professional practice as a PA and a Master’s degree from a PA training program certified by ARC-PA or in another health-related field from an accredited college or university recognized by the U.S. Department of Education; or 

     (d)  A Doctoral degree in a health-related field from an accredited college or university recognized by the U. S. Department of Education. 

     (2)  Management/Administrative.  One of the following responsibilities must be demonstrated: 

     (a)  Evaluates service level patient care delivery systems and validates or identifies barriers to safe, effective care.  Presents findings and recommendations to appropriate management officials and participates in implementation of changes. 

     (b)  Manages patient quality management data bases such as the National Surgical Quality Improvement Program (NSQIP) if assigned. 

     (c)  Serves on service or facility committees/task forces if applicable to the assignment. 

     (d)  Coordinates consult referrals within the service assigned. 

     (e)  Coordinates and facilitates inter-service agreements. 

     (3)  Clinical Competencies 

     (a)  Clinical Proficiency 

     1.  Manages patients with complex or multi-system medical problems. 

     2.  Practices with a significant degree of autonomy and seeks guidance from assigned physicians with less frequency than expected at the previous grade. 

     3.  Performs more complex diagnostic and therapeutic procedures beyond what is expected at the previous grade. 

     4.  First or second assists in surgical procedures. 

     (b)  Professional Development 

     1.  Acts as a consultant/mentor to PAs in lower grades and other clinical and support staff. 

     2.  Serves as a clinical preceptor for students or organizes and participates in facility clinical educational programs. 

     3.  Makes sustained contribution to health care by sharing expertise within and/or outside the medical facility. 

     (c)  Ethics.  Identifies and addresses ethical issues that impact patients and staff including participation in ethics consultations if appropriate to the area of assignment. 

     (d)  Interpersonal Skills 

     1.  Communicates and collaborates effectively with other facility staff and outside institutions when applicable to the area of assignment. 

     2.  Effectively promotes the physician assistant profession to health care staff, patients and other stakeholders at the local level. 

     3.  Makes significant contributions which serve to enhance the distinctive role of PAs within the local institution and the health care system. 

     (e)  Research 

     1.  Collaborates with others in research activities to improve patient care, or; 

     2.  Authors, or collaborates with others, on a paper or study for publication. 

     d.  Chief Grade.  In addition to meeting the basic requirements under paragraph 2 above, candidates must meet all requirements described in this standard for Senior Grade through VA employment or non-VA PA positions with equivalent scope and complexity.  Appointment or promotion to Chief Grade is based on the individual’s demonstrated high level of clinical expertise, leadership ability, and the ability to function with a high degree of autonomy.  Further, the PA candidate for Chief Grade will have demonstrated all the requirements of one or more of the following categories:  Management/Administrative, Clinical Proficiency, Professional Development and Research. 

     (1)  Experience / Education 

     (a)  Generally, an individual in this grade is able to demonstrate the behaviors listed in the areas below after 5 years of professional practice as a PA; and,

     (b)  The minimum education for this grade is a Master’s Degree from a PA training program accredited by ARC-PA or in a health-related field of study.  However, experience as a PA may be substituted for the Master’s degree where the individual has an equivalent knowledge of the profession and has successfully undertaken a combination of difficult or complex assignments in several clinical, administrative, research and educational arenas which required a high degree of competence.

     (2)  Management/Administrative

     (a)  Accepts substantial and continuing responsibility for managing or coordinating a healthcare program including follow-up actions to ensure compliance with regulatory bodies required by internal and external review organizations and accrediting bodies, and; 

     (b)  Successfully integrates the activities of the employee’s assignment with other patient care programs at the facility or with similar programs on a broader geographic basis, and; 

     (c)  Develops policies and procedures and participates in executive level decision making deliberations, and;

     (d)  Participates in long range program planning and model development for effective delivery of services, and;

     (e)  Performs a full range of administrative duties relative to the assignment. 

     (3)  Clinical Competencies 

     (a)  Clinical Proficiency 

     1.  Evaluates facility patient care delivery systems and validates or identifies barriers to safe, effective care.  Presents findings and recommendations to appropriate management officials and participates in implementation of changes, and;

     2.  Exhibits leadership in initiating changes in patient care programs based on current concepts and findings from research and/or studies, and;

     3.  Facilitates the delivery of patient care in collaboration with health professionals, health managers and other health care personnel, and;

     4.  Exhibits exceptional clinical skills and consistently demonstrates a high level of expertise in diagnosing and treating seriously ill, multi-symptomatic patients.

     (b)  Professional Development 

     1.  Develops and implements education and training programs involving a variety of specialties in widely diversified activities, and;

     2.  Provides personnel with the vital link between education and practice. 

     3.  Coordinates clinical training of healthcare students including facilitation of clinical rotations, recruitment preceptors and evaluation of student, and; 

     4.  Maintains close relationships with affiliated schools and healthcare training programs and coordinates clinical rotations with curriculum needs, and; 

     5.  Serves on education and training committees, advisory groups and special task forces concerned with managing education and career development activities. 

     (c)  Ethics

     1.  Provides leadership in addressing ethical issues that impact patients and staff at the medical facility and the local health care community. 

     2.  Participates in the education of facility staff in ethical concepts and encourages staff participation in ethics educational programs. 

     (d)  Interpersonal Skills 

     1.  Demonstrates leadership in developing productive working relationships with groups in other programs, services, academic settings, and community agencies. 

     2.  Effectively collaborates and interacts with other regional medical facilities to enhance seamless coordination of inter-facility patient care.

      (e)  Research

      1.  Conducts approved, merit-reviewed research projects; performs independent research; serves as a contributing member of a research team or serves as a member of a research committee; formulates research proposals and protocol submissions for merit review; and develops publishable material for appropriate professional journals or speaks to peer groups, and;

      2.  Effectively researches problems of major scope; directs independent research of considerable interest and value, where the research contribution is highly productive and of such quality and originality as to have marked the PA as a significant contributor to advances in patient care and services.

 5.  DEVIATIONS

      a.  The Facility Director may approve a waiver of the grade requirements at Chief Grade and below for PAs whose accomplishments, performance, qualifications, and demonstrated competence warrant such action. 

      b.  Under no circumstances can the requirement for certification be waived.

      c.  The placement of individuals in grade levels or assignments not described in this qualification standard must be approved by the Under Secretary for Health or designee in VHA Central Office.

 Authority:  38 U.S.C. 7304, 7402.]


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