VA Physician Assistant Professional Standards Boards Training VA

VA Physician Assistant Professional Standards Boards Training VA Physician Assistant Association Conference 2017 Houston, TX Denni J. Woodmansee, MS, PA-C

Introduction Denni J. Woodmansee, MS, PA-C Director, Physician Assistant Services Office of the ADUSH for Patient Care Service U. S. Department of Veterans Affairs denni. Woodmansee@va. gov

Objectives • Basic understanding of VA policy pertinent to • VA PA Professional Standards Boards composition and function • PA Qualification Standards • Grade promotion criteria and • Special Advancements • Probationary Reviews • Understanding of PSB process • Salary vs. Grade & Step determination • Reconsideration and Reviews

VA Policy Review • VA Handbook 5005 Staffing o Part II, Chapter 3, Section C. Professional Standards Boards o Part II, Appendix G 8 Physician Assistant Qualification Standards o Part III, Chapter 4. Promotion Reconsideration and Review o Part III, Appendix M. Processing Title 38 Promotions and Advancements • VA Handbook 5017 Employee Recognition and Awards o Part IV Title 38 Special Advancements and Cash Awards http: //vaww. va. gov/OHRM/ HR Policy Library

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 1. ESTABLISHMENT a. Professional Standards Boards (PSBs) act for, are responsible to, and are agents of the Under Secretary for Health for occupations listed in 38 U. S. C. 7401(1), 7401(3) b. Podiatrists, Optometrists, Chiropractors, [RN]s, Nurse Anesthetists, PAs and EFDAs. In matters concerning appointments, advancements, and probationary reviews for these occupations, PSBs will determine eligibility and recommend the appropriate Grade and Step for appointment, recommend candidates for advancement, and conduct probationary reviews.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 1. ESTABLISHMENT c. Members of boards serve in a dual capacity. They deal with matters in which they must divest themselves of their identity with the particular facility at which they are employed and must become representatives of and primarily concerned with the needs and problems of the entire VHA. d. VHA management officials are responsible for ensuring the effective functioning of boards under their jurisdiction.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 2. APPROVING AUTHORITIES FOR BOARD MEMBERSHIP. a. The following officials may approve or terminate board membership. A second Chair, or Co-Chair, may be appointed to a Board when the approving authority determines it is necessary and appropriate to do so. b. National Boards. The Under Secretary for Health, or designee, may approve or terminate membership on National boards, including appointment of the board Chair.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 2. APPROVING AUTHORITIES FOR BOARD MEMBERSHIP. c. VISN Boards. Except as provided in paragraph 3 a, the Network Director will establish VISN boards. The Network Director or designee may approve or terminate membership on VISN boards, including appointment of the board Chair d. Facility Boards. The facility Director may approve or terminate membership on facility boards, including appointment of the board Chair. The appropriate service chief or equivalent position will nominate board members and recommend a board Chair.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 2. APPROVING AUTHORITIES FOR BOARD MEMBERSHIP. e. Termination of Board Membership. Appointments to the board under paragraphs 2 a through 2 c above may be terminated whenever an individual's performance, conduct, or position is incompatible with board membership. Examples include receipt of performance rating of below the fully successful level (or equivalent), breach of confidentiality, failure to attend meetings or to complete assignments in a timely manner, expiration of term as Board member, and election or appointment as a union official.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 3. BOARD MEMBERSHIP a. Persons selected to serve on boards will be chosen from the most capable, experienced and responsible personnel. Board members must be at a grade and level that is equal to or higher than that of the candidate being considered. Board membership should also be sufficiently broad to cover the range of practice within an occupation and where possible include all grades and levels within an occupation. b. Recommending officials will not serve on boards considering their recommendations. Employees will not serve on boards for which they serve as the approving official.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 3. BOARD MEMBERSHIP c. Boards may be composed of three or five voting members who were appointed under 38 U. S. C. chapter 73 or 74. However, when necessary, the Under Secretary for Health or designee may appoint other qualified individuals to National boards. One of the members will be appointed as chairperson of the board. Board membership will also include a Secretary, who may or may not be one of the voting members. The role of the Secretary is to record, prepare and submit notes of the Board proceedings and relevant discussion to the PSB Chair. The Secretary is also responsible for completing page two of VA Form 10 -2543 and obtaining Board members’ signatures.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 3. BOARD MEMBERSHIP d. The Human Resources Management Officer or designee will serve as technical advisor on all board actions. Attendance at Board meetings by the Human Resources technical advisor is recommended but not required. e. Upon initial and all subsequent appointments to a Board, whether a facility, VISN, or national Board, all appointees, including the Chair, members, and the secretary, must take the Professional Standards Board training.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 4. COMPOSITION OF BOARDS a. Whenever possible, professional standards boards will be composed of three or five employees from the same occupation as the individual being considered. However, appropriately qualified individuals from other occupations may be appointed, provided the board is composed of a majority of the employees from the occupation involved. When the appropriate minimum number of employees in the occupation is not available or the number of employees is too small to provide for an independent review, an alternate board must be used.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 5. BOARD FUNCTIONS. The primary functions of boards are to: a. Review and act on employment applications and determine whether the applicant meets the requirements set forth in VA qualification standards. Sound professional and administrative judgment will be exercised in reviewing applications to ensure that VA obtains the best qualified personnel. b. Review completely an individual’s qualifications for advancement by an examination of the personnel folder, proficiency reports or performance appraisals, supervisory evaluations, and other pertinent records; and to make recommendations based on their findings.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 5. BOARD FUNCTIONS. The primary functions of boards are to: c. Conduct probationary reviews for individuals appointed under 38 U. S. C. 7401(1). d. Execute VA Form 10 -2543, Board Action. e. National boards make recommendations to the Under Secretary for Health or designee on appointments and advancements, and on probationary reviews of individuals appointed under 38 U. S. C. 7401(1), which require approval in Central Office and VACO Review and Reconsideration requests.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 6. EXCEPTIONS: The Under Secretary for Health or designee may establish procedures for appointing employees without action by a Professional Standards Board in instances such as: a. Temporary appointment under 38 U. S. C. 7405 pending processing by a Professional Standards Board for an appointment under 38 U. S. C. 7401(1) or 7401(3). b. Conversion of an employee appointed under 38 U. S. C. 7401(1) or 7401(3) to an appointment under 38 U. S. C. 7405(a)(1) or 7405(a)(2).

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 6. EXCEPTIONS: c. Conversion of an employee from an appointment under 38 U. S. C. 7405(a)(1) to an appointment under 38 U. S. C. 7401(1) or 7401(3), provided the employee had previously acquired permanent status under 38 U. S. C. 7401(1) or 7401(3)and has had continuous service under 38 U. S. C. , chapter 73 or 74 since acquiring such status. d. Appointment of graduate technicians pending licensure, certification, or registration, student technicians pending graduation, and other individuals appointed under 38 U. S. C. 7405(a)(1) pending completion of requirements for appointment.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 Section C. PROFESSIONAL STANDARDS BOARDS 7. APPROVING OFFICIAL’S DECISIONS. When the facility Director is the approving official for a board action, the Director’s decision is final. This does not preclude employees from requesting promotion reconsideration under the provisions of part III, chapter 4, sections A or B (whichever is appropriate), of this handbook.

Professional Standards Boards Processing Board Actions and Documentation • HR Technical Consultant o Conduit between Service, PSB, and Approving Official o Facilitator of external Alternate Boards o PSB recommendations consistent with technical requirements o Processing SF-52 –Appointment, Promotion, or Advancement

Professional Standards Boards Processing Board Actions and Documentation • Review all materials available o Candidates Proficiency Report o Supervisor/Service Chief memo of support/justification o Functional Statement (if applicable) o Other Supporting Documentation • Comparison with Qualification Standards or Established Criteria • Deliberation/Vote

Professional Standards Boards Processing Board Actions and Documentation • Recommendations o Submission of Recommendations o Documentation –Completion of VA Form 10 -2543 o Meeting Notes § § Attendance-Including grade of members Summary of Deliberations Recommendations Rationale for Recommendations

Professional Standards Board Actions-Board Action (Form 10 -2543)

Professional Standards Boards VA Handbook 5005 Staffing Part III Appendix M Processing of Title 38 Promotions and Advancements • Upon receipt of VA Form 5 -97, Notice of Pending Personnel Action, the HRM Office will forward the original copy to the employee’s service chief through the Chief of Staff, as appropriate. (eligibility of promotion) • The service chief may submit a request to the PA Professional Standards Board to promote the PA. • The promotion request will be submitted through HR • The Service Chief will include in promotion request (recommendation) detailed examples of how the PA meets the criteria for the grade requested.

Professional Standards Boards VA Handbook 5005 Staffing Part III Appendix M Processing of Title 38 Promotions and Advancements • The PA PSB will review the request and all documentation submitted in support of the request. • Additional information may be obtained at the direction of the board. • The Board’s recommendation as documented on VA Form 10 -2543 is submitted to the Approving Authority (Medical Center Director) • Approving Authority renders a decision. • Action by the Approving Authority is required even when promotion is not recommended. • Approving Authority documents decision on the Board Action form and returns to HR for appropriate action.

Professional Standards Boards VA Handbook 5005 Staffing Part III Appendix M Processing of Title 38 Promotions and Advancements • The health care facility Director or a designee will notify the employee of the results of promotion consideration. • If the employee is not promoted, the appropriate official will discuss with the employee the reasons for non-promotion and what the employee should do to meet the promotion requirements.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW b. Notice of Decision. Supervisors must advise employees of any decision not to promote them, of the reason(s) for the decision, and of their right to request reconsideration. c. Informal Discussion. The employee must discuss his or her dissatisfaction with their immediate supervisor prior to submitting a request for reconsideration.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – Facility level o The employee may submit a request for reconsideration if the employee believes the supervisor’s explanation for denial is satisfactory. o The request must be in writing within 14 days of the decision to not promote. o The 14 -day period may be extended at the written request of the employee is unable to submit the information for reasons beyond the employee’s control.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – Facility Level o The request for reconsideration must include indicate when the informal discussion was held with the supervisor and cite the specific reason(s) why the employee believes the decision was not proper. Supervisors are to review and comment on the employee’s request in writing, and provide copies of those comments to the employee. o The request for reconsideration is referred to the facility PA PSB for review. o The PA PSB re-reviews all documentation previously considered any new information provided

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – Facility Level o The PSB submits recommendations on the reconsideration to the Medical Center Director o The Medical Center Director considers the recommendations and makes final decision o The health care facility Director or a designee will notify the employee of the results of promotion consideration.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – VACO o If request for promotion is denied after reconsideration by the Medical Center the employee may request Central Office review o Request for Review and Reconsideration must submitting in writing o Request is made through the supervisor to the Medical Center Director

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – VACO o Request must be submitted within 14 calendar days of receiving notice of the reconsideration decision. o The Medical Center Director or designee may extend the 14 -day period at the written request of an employee if the employee is unable to submit the information timely for reasons beyond the employee’s control. o The appropriate Professional Standards Board at the facility will review the information submitted by the employee and make a recommendation to the approving official.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – VACO o When a request for Central Office review is submitted to the appropriate VA Central Office Professional Standards Board, the Under Secretary for Health or a designee becomes the promotion approving authority. o The National PA Professional Standards Board is to review the information submitted by the facility and make a recommendation to the approving official. o If necessary, the Central Office Board may request additional information.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Chapter 3 SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial) • Reconsideration Request – VACO o Upon competing its review, the Central Office Board is to forward its recommendation to the approving official. Designated to be the VHA Assistant Deputy Under Secretary for Health for Patient Care Services (ADUSH) o ADUSH reviews National PA PSB recommendations and makes a final decision o Decision can be to promote or not to promoted o Local facility is notified of final decision o VACO is final. No further recourse.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS Basic Requirements c. Certification (1) Current and continuous certification by the National Commission on Certification of Physician Assistants (NCCPA) is required for employment (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 (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS Basic Requirements d. Physical Standards. See VA Directive and Handbook 5019 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 2 a through f above.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 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 (September 5, 2014) who do not meet the minimum academic level of a Bachelor’s degree are exempted from this requirement.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 3. GRANDFATHERING PROVISION 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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS- Full Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Full Grade (2) Clinical Competencies (a) Clinical Proficiency 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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Full Grade (2) Clinical Competencies (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. .

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Full Grade (2) Clinical Competencies (e) Research 1. Demonstrates awareness of research application to practice. 2. Researches medical literature and applies evidenced-based medicine to improve clinical practice.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS b. Intermediate Grade. In addition to meeting the basic requirements, 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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Intermediate Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Intermediate Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS 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

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Senior Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Senior Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Senior Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Senior Grade (4) Professional Development (a) Acts as a consultant/mentor to PAs in lower grades and other clinical and support staff. (b) Serves as a clinical preceptor for students or organizes and participates in facility clinical educational programs. (c) Makes sustained contribution to health care by sharing expertise within and/or outside the medical facility. (5) Ethics. Identifies and addresses ethical issues that impact patients and staff including participation in ethics consultations if appropriate to the area of assignment.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Senior Grade (6) Interpersonal Skills (a) Communicates and collaborates effectively with other facility staff and outside institutions when applicable to the area of assignment. (b) Effectively promotes the physician assistant profession to health care staff, patients and other stakeholders at the local level. (c) Makes significant contributions which serve to enhance the distinctive role of PAs within the local institution and the health care system. (7)Research (a) Collaborates with others in research activities to improve patient care, or; (b) Authors, or collaborates with others, on a paper or study for publication.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS 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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (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;

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade 2. Management/Administrative (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.

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (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;

Professional Standards Boards VA Handbook 5005 Staffing Part II, Appendix G 8 PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (3) Clinical Competencies (a) Clinical Proficiency 4. Exhibits exceptional clinical skills and consistently demonstrates a high level of expertise in diagnosing and treating seriously ill, multi-symptomatic patients.

Professional Standards Boards Training VA Handbook 5005 Staffing: PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (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;

Professional Standards Boards Training VA Handbook 5005 Staffing: PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (b) Professional Development 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.

Professional Standards Boards Training VA Handbook 5005 Staffing: PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (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.

Professional Standards Boards Training VA Handbook 5005 Staffing: PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 4. GRADE REQUIREMENTS – Chief Grade (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.

Professional Standards Boards Training VA Handbook 5005 Staffing: PHYSICIAN ASSISTANT QUALIFICATION STANDARDS 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.

Professional Standards Boards Training VA Handbook 5005 Staffing Part II, Section A Appointment Requirements and Determinations. (4) Grade Level Determinations. The grade to which an applicant is appointed will be determined by the individual’s qualifications and assignment. Under the Title 38 “rank-in-person” system, candidates are to be appointed at the highest grade or level within the grade for which they are fully qualified up to the full performance level. For positions above the full-performance (journey level) the complexity of the assignment and scope of responsibility are considered in determining grades. (5) Grade and/or Step Adjustments. If, on review of board actions by the appropriate Professional Standards Board, it is determined that an employee has been appointed at a grade and step rate within the grade which is not commensurate with qualifications, the approving authority for initial appointment may approve an adjustment in the grade and/or step rate within the grade. NOTE: [ ] Service in a lower step rate prior to adjustment of step(s) within the grade will not be credited toward meeting the required waiting period for periodic step increase.

Professional Standards Boards Training VA Handbook 5005 Staffing Part II, Section A 2. APPOINTMENT ABOVE THE MINIMUM FOR SUPERIOR QUALIFICATIONS a. Full-time, part-time, or intermittent [ ] podiatrists, optometrists, chiropractors, nurse anesthetists, PAs and EFDAs, who meet the qualification requirements for appointment, may have their initial rate of pay fixed at a step rate above the minimum of the appropriate grade in recognition of superior qualifications, experience, and/or achievement exceeding the expected standards for the grade. The initial rate of pay may be set at any step rate within the grade b. Individuals appointed under authority of 38 U. S. C. 7401(3), or under authority of 38 U. S. C. 7405 to occupations identified in section 7401(3), may be appointed above the minimum step of the grade under provision of VA Directive and Handbook 5007. c. Appointment at a step rate above the minimum shall be based on conclusive evidence of superior qualifications which equates to the step rate assigned. Qualifications used to meet minimum grade level requirements in the qualification standard will not be used to also justify appointment at a step rate above the minimum of the grade. The following are examples of appropriate criteria.

Professional Standards Boards Training VA Handbook 5005 Staffing: • Full Performance Level vs. Above Full Performance Level • Chief Grade –Full Performance Level for PA Occupation • Full Performance Level Grade and below Based on Individual’s Qualifications • Above Full Performance Level Based on the Position of Assignment’s Qualifications • Change in assignment requires “re-boarding”

Professional Standards Boards Training VA Handbook 5005 Staffing: Qualifications for Step Placement 1) Significant and distinguished contribution in some phase of the appropriate occupation as evidenced by difficult and original research, writing and publications in professional media of stature, or special recognition in teaching or professional practice. (2) Special competence in the occupation as evidenced by service with professionally recognized committees, groups or responsible offices in professional societies above the local level, or consultative services within the occupation. The competence attained must be supported by achievement of renown on a regional or wider basis. (3) Educational preparation that clearly exceeds requirements for the grade, expertise in specialized treatment modalities, outstanding competence as a clinical practitioner, or significant contributions concerning some aspect of the occupation.

Professional Standards Boards Training VA Handbook 5005 Staffing: Qualifications for Step Placement (4) Eligibility for certification by an American Specialty Board. (5) Certification by the appropriate national certifying body to formally recognize a level of excellence based on demonstrated superior performance in clinical practice, assessment of knowledge, and colleague endorsement. (6) Other appropriate evidence of professional stature. NOTE: Prior to recommending approval or approving actions based on certification, Professional Standards Boards will verify the possession of such recognition by the individual.

Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards Special Advancements and Awards 6. Criteria for Special Advancement for Performance d. Physician Assistants. The employee must have demonstrated a sustained high level of performance and ability over and above that normally expected of employees in the particular grade and profession or there must have been noted contributions in some aspect of health care. Criteria for one-step advancement will be demonstrated by superior performance as evidenced by: (1) Assumption of a major responsibility in administering a major patient care program. (2) Significant accomplishments associated with an academic program conducted in affiliation with the facility where the physician assistant is employed.

Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards Special Advancements and Awards 4. Criteria for Special Advancement for Achievement c. Physician Assistants. Full-time, part-time and intermittent physician assistants may be advanced within the grade from one to five steps on the basis of professional achievement above that expected for the grade level or assignment provided they have demonstrated excellence in performance and potential for assumption of greater responsibility. Examples of such achievements include, but are not limited to: (1) A graduate level degree in a field related to the Department’s health care mission; (2) Appointment to a university faculty position;

Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards Special Advancements and Awards 4. Criteria for Special Advancement for Achievement (3) Significant contributions to the Department’s health care mission. Such accomplishments may result from leadership or exceptional efforts on facility, regional or national task forces or committees, or by serving as a consultant on matters relating to education research, health care management, or quality of care issues; (4) Recognition of outstanding and exceptional achievement by a professional or academic organization; (5) Election to office in a professional organization at the State or national level;

Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards Special Advancements and Awards 4. Criteria for Special Advancement for Achievement (6) Independently producing or serving as a principal assistant or major contributing member on research producing publishable results that advance patient care or medical science; or (7) Attainment of specialty certification within the occupation. This does not include certification as a physician assistant by the National Commission on Certification of Physician’s Assistants, which is a condition of employment as a physician assistant in VHA.

Professional Standards Boards Training Mock Board Actions:

Professional Standards Boards Training Mock Board Actions: The PA PSB has received a Board Action request to determine the grade of appointment for a new PA hire, Mr. Brandon Newbie. Mr. Newbie is a graduate of a local PA training program where he was awarded a Masters Degree. Mr. Newbie worked for 2 years for a surgical group at a local hospital. He has submitted references from his former supervising physicians attesting to his outstanding surgical skills. The candidate has served as a clinical instructor for his alma matter and has published several articles for PA journals. He holds a current, active, full, and unrestricted state PA license and is currently certified by NCCPA. Mr. Newbie is requesting a starting salary that is equivalent to Senior Grade, step 7. The service has indicated that this candidate is highly desirable due to his superior surgical and clinical skills. They are requesting that his salary request be met.

Professional Standards Boards Training Mock Board Actions: The PA PSB has received a Board Action request to promote Ms. Kate T. Didd from Full Grade (9) to Senior Grade (12). Ms. Didd’s supervisor and Service Chief have submitted a memorandum of support for her promotion. The memorandum describes the level of her clinical activities and how she meets the qualification standards for Senior Grade. Ms. Didd has a combined experience of 4 years as a practicing physician assistant. The candidate has recently been awarded a Masters Degree in Physician Assistant Studies from a post graduate PA training program. Ms. Didd’s last Proficiency Report was rated as Excellent. The HRMS Technical Consultant has confirmed that Ms. Didd has met the time-in-grade and experience requirements.

Professional Standards Boards Training Mock Board Actions: The PA PSB has received a Board Action requesting promotion Ms. Twyla Starr to Chief Grade. Ms. Starr is currently at Senior Grade, step 10. Mr. Starr graduated from an accredited PA training program with a Bachelors degree and was recently awarded a Masters degree in Physician Assistant Studies from a PA post graduate program. She has been employed by her VA facility for 20 years. Her current assignment is in the Primary Care clinic where she is responsible for a panel of 1, 200 patients. She is considered to be the most experienced and competent PA in the facility. She is often asked to assist in clinic coverage in other areas and acts as a resource for other PAs. Ms. Starr serves on the facility Education Funding Committee and precepts PA students in her clinic. She also volunteers to provide medical support to an annual veteran winter sports event. Ms. Starr’s supervising physician and Service Chief is supportive of the promotion request. The supervising physician indicates in his memorandum of support that the promotion would increase her salary to the level other mid-level practitioners receive that are performing similar duties.

Professional Standards Boards Training Mock Board Actions: The PA PSB has received a Board Action requesting promotion of Ms. Ida Wahna to Chief Grade. Ms. Wahna is currently at Senior Grade, step 8. She is due for a Periodic Step Increase in two months. The candidate graduated from an accredited PA training program with a Masters of Science in Physician Assistant Studies. She has been employed by her VA facility as a PA for the past 9 years. She has held a number of clinical assignments in her VA career in Dermatology, GI, and most recently in Primary Care. She has been selected for a position as the Women’s Health Clinic Coordinator where she will be overseeing care the care given to women veterans, coordinating staff coverage, and supervising support staff. Ms. Wahna also coordinates clinical rotations at her facility for PA students from a local training program and has received an appointment as Associate Professor. Letters of support have been received by the Women’s Health Medical Director and her current supervisor. Her past three Proficiency Reports were rated as Outstanding.

Professional Standards Boards Training Mock Board Actions: The PA PSB has received a Board Action requesting determination of a grade of appointment for Mr. Nomar Pain. HRMS has extended an offer of employment for a physician assistant position on the facilities Primary Care Service. The candidate graduated from an accredited PA training program with a Bachelors Degree in Physician Assistant Studies. His CV indicates he has 3 years of experience as an laboratory technician and holds a Bachelors Degree in English Literature. A Board Action Request Memorandum from the Primary Care Service Line Manager requests that the candidate be appointed to the highest grade possible.

Professional Standards Boards Training Mock Board Actions: Chief Grade Education Requirements (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.

Professional Standards Boards Training Mock Board Actions: The PA PSB has received a Board Action requesting a Special Advancement for Performance. The justification cited for the Special Advancement is an appointment as an associate professor at the local University PA Training Program. The candidate received a Highly Satisfactory rating on his most recent Proficiency Report. Upon verification of his university appointment, it was learned that associate professorships are routinely given to all PAs who precepts students for their PA program. However, the appointment is not associated with any rights and privileges afforded to standard faculty appointments.

Physician Assistant Education Questions? Denni J. Woodmansee, MS, PA-C dennwood@Verizon. net