Standards Boards Training Denni J Woodmansee MS PAC VA Physician Assistant Association Conference 2017 Houston TX Introduction Denni J Woodmansee MS PAC Director Physician Assistant Services ID: 775124
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VA Physician Assistant Professional Standards Boards Training
Denni J. Woodmansee, MS, PA-C
VA Physician Assistant Association Conference 2017
Houston, TX
Slide2Introduction
Denni J. Woodmansee, MS, PA-CDirector, Physician Assistant ServicesOffice of the ADUSH for Patient Care ServiceU.S. Department of Veterans Affairsdenni.Woodmansee@va.gov
Slide3Objectives
Basic understanding of VA policy pertinent to VA PA Professional Standards Boards composition and functionPA Qualification StandardsGrade promotion criteria and Special AdvancementsProbationary ReviewsUnderstanding of PSB processSalary vs. Grade & Step determinationReconsideration and Reviews
Slide4VA Policy Review
VA Handbook 5005 StaffingPart II, Chapter 3, Section C. Professional Standards BoardsPart II, Appendix G8 Physician Assistant Qualification StandardsPart III, Chapter 4. Promotion Reconsideration and ReviewPart III, Appendix M. Processing Title 38 Promotions and AdvancementsVA Handbook 5017 Employee Recognition and AwardsPart IV Title 38 Special Advancements and Cash Awardshttp://vaww.va.gov/OHRM/ HR Policy Library
Slide5Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 1. ESTABLISHMENT 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)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.
Slide6Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 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.
Slide7Professional Standards Boards VA Handbook 5005 StaffingPart 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.
Slide8Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 2. APPROVING AUTHORITIES FOR BOARD MEMBERSHIP. c. VISN Boards. Except as provided in paragraph 3a, 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 Chaird. 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.
Slide9Professional Standards Boards VA Handbook 5005 StaffingPart 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 2a through 2c 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.
Slide10Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 3. BOARD MEMBERSHIPa. 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.
Slide11Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 3. BOARD MEMBERSHIPc. 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.
Slide12Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 3. BOARD MEMBERSHIPd. 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.
Slide13Professional Standards Boards VA Handbook 5005 StaffingPart II, Chapter 3
Section C. PROFESSIONAL STANDARDS BOARDS 4. COMPOSITION OF BOARDSa. 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.
Slide14Professional Standards Boards VA Handbook 5005 StaffingPart 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.
Slide15Professional Standards Boards VA Handbook 5005 StaffingPart 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.
Slide16Professional Standards Boards VA Handbook 5005 StaffingPart 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).
Slide17Professional Standards Boards VA Handbook 5005 StaffingPart 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.
Slide18Professional Standards Boards VA Handbook 5005 StaffingPart 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, chapter4, sections A or B (whichever is appropriate), of this handbook.
Slide19Professional Standards Boards Processing Board Actions and Documentation
HR Technical ConsultantConduit between Service, PSB, and Approving OfficialFacilitator of external Alternate BoardsPSB recommendations consistent with technical requirementsProcessing SF-52 –Appointment, Promotion, or Advancement
Slide20Professional Standards Boards Processing Board Actions and Documentation
Review all materials availableCandidates Proficiency ReportSupervisor/Service Chief memo of support/justificationFunctional Statement (if applicable)Other Supporting DocumentationComparison with Qualification Standards or Established CriteriaDeliberation/Vote
Slide21Professional Standards Boards Processing Board Actions and Documentation
RecommendationsSubmission of RecommendationsDocumentation –Completion of VA Form 10-2543 Meeting NotesAttendance-Including grade of membersSummary of DeliberationsRecommendationsRationale for Recommendations
Slide22Professional Standards Boards Board Actions-Board Action (Form 10-2543)
Slide23Professional Standards Boards Board Actions-Board Action (Form 10-2543)
Slide24Professional Standards BoardsVA Handbook 5005 StaffingPart 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 HRThe Service Chief will include in promotion request (recommendation) detailed examples of how the PA meets the criteria for the grade requested.
Slide25Professional Standards BoardsVA Handbook 5005 StaffingPart III Appendix M
Processing of Title 38 Promotions and AdvancementsThe 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.
Slide26Professional Standards BoardsVA Handbook 5005 StaffingPart III Appendix M
Processing of Title 38 Promotions and AdvancementsThe 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.
Slide27Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEWb. 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.
Slide28Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – Facility levelThe employee may submit a request for reconsideration if the employee believes the supervisor’s explanation for denial is satisfactory. The request must be in writing within 14 days of the decision to not promote.The 14-day period may be extended at the written request of the employee if the employee is unable to submit the information for reasons beyond the employee’s control.
Slide29Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – Facility LevelThe 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.The request for reconsideration is referred to the facility PA PSB for review.The PA PSB re-reviews all documentation previously considered and any new information provided
Slide30Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – Facility LevelThe PSB submits recommendations on the reconsideration to the Medical Center DirectorThe Medical Center Director considers the recommendations and makes final decisionThe health care facility Director or a designee will notify the employee of the results of promotion consideration.
Slide31Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – Facility LevelThe PSB submits recommendations on the reconsideration to the Medical Center DirectorThe Medical Center Director considers the recommendations and makes final decisionThe health care facility Director or a designee will notify the employee of the results of promotion consideration.
Slide32Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – VACOIf request for promotion is denied after reconsideration by the Medical Center the employee may request Central Office review Request for Review and Reconsideration must submitting in writing Request is made through the supervisor to the Medical Center Director
Slide33Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – VACORequest must be submitted within 14 calendar days of receiving notice of the reconsideration decision. 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.The appropriate Professional Standards Board at the facility will review the information submitted by the employee and make a recommendation to the approving official.
Slide34Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – VACOWhen 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. The National PA Professional Standards Board is to review the information submitted by the facility and make a recommendation to the approving official. If necessary, the Central Office Board may request additional information.
Slide35Professional Standards BoardsVA Handbook 5005 StaffingPart II, Chapter 3
SEC. A. RECONSIDERATION AND REVIEW (Promotion Denial)Reconsideration Request – VACOUpon 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)ADUSH reviews National PA PSB recommendations and makes a final decisionDecision can be to promote or not to promotedLocal facility is notified of final decisionVACO is final. No further recourse.
Slide36Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSBasic Requirementsa. 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.
Slide37Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSBasic Requirementsc. Certification 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.
Slide38Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSBasic Requirementsd. Physical Standards. See VA Directive and Handbook 5019e. 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.
Slide39Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS3. GRANDFATHERING PROVISIONEffective 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: 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.
Slide40Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS3. GRANDFATHERING PROVISIONb. 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.
Slide41Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide42Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE REQUIREMENTS- Full Grade(2) Clinical Competencies (a) Clinical Proficiency1. 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.
Slide43Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE REQUIREMENTS – Full Grade(2) Clinical Competencies (a) Clinical Proficiency2. 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.
Slide44Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE REQUIREMENTS – Full Grade(2) Clinical Competencies (b) Professional Development1. 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. .
Slide45Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide46Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE REQUIREMENTSb. 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.
Slide47Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide48Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide49Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide50Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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
Slide51Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide52Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide53Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide54Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide55Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide56Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide57Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide58Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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;
Slide59Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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.
Slide60Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS
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;
Slide61Professional Standards BoardsVA Handbook 5005 StaffingPart II, Appendix G8
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS
GRADE
REQUIREMENTS – Chief Grade
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.
Slide62Professional Standards Boards Training VA Handbook 5005 Staffing:
PHYSICIAN ASSISTANT QUALIFICATION STANDARDSGRADE 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;
Slide63Professional Standards Boards Training VA Handbook 5005 Staffing:
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS4. 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.
Slide64Professional Standards Boards Training VA Handbook 5005 Staffing:
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS4. 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.
Slide65Professional Standards Boards Training VA Handbook 5005 Staffing:
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS4. 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.
Slide66Professional Standards Boards Training VA Handbook 5005 Staffing:
PHYSICIAN ASSISTANT QUALIFICATION STANDARDS5. 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.
Slide67Professional 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.
Slide68Professional Standards Boards Training VA Handbook 5005 Staffing Part II, Section A
2. APPOINTMENT ABOVE THE MINIMUM FOR SUPERIOR QUALIFICATIONSa. Full-time, part-time, or intermittent [ ] podiatrists, optometrists, chiropractors, nurses, 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.
Slide69Professional 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”
Slide70Professional Standards Boards Training VA Handbook 5005 Staffing:
Qualifications for Step Placement1) 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.
Slide71Professional Standards Boards Training VA Handbook 5005 Staffing:
Qualifications for Step Placement (4) Eligibility for certification or 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.
Slide72Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards
Special Advancements and Awards6. Criteria for Special Advancement for Performanced. 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.
Slide73Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards
Special Advancements and Awards4. Criteria for Special Advancement for Achievementc. 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;
Slide74Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards
Special Advancements and Awards4. 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;
Slide75Professional Standards Boards Training VA Handbook 5017, Part V Employee Recognition and Awards
Special Advancements and Awards4. 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.
Slide76Professional Standards Boards Training Mock Board Actions:
Slide77Professional 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.
Slide78Professional 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.
Slide79Professional 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.
Slide80Professional 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.
Slide81Professional 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.
Slide82Professional 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.
Slide83Professional 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.
Slide84Physician Assistant Education
Questions?
Denni J. Woodmansee, MS, PA-C
dennwood@Verizon.net