** Please note:  
The requirements for AANP re-certification are different.  One other fact, for any PA providers reading – I fully understand that you must re-take your exam every sixth year, along with maintaining CE credits.  So my entire blog centers around the ANCC renewal process, which is MY accrediting body.

I just completed my on-line renewal for my ANCC Family Nurse Practitioner re-certification.  At the risk of the “powers that be” pulling my file for audit (yes, you can – I have NOTHING to hide, mind you...LOL), I gnash my teeth when I get my notification that renewal is looming.  Being as “Type-A” as I am, I constantly log my CME hours in a notebook, complete with the paper documents that I’ve collected from online courses or the occasional day course.

This time, I completed the process online – a HUGE improvement from the paper forms from years past, IMHO.  It probably would have been even easier had I kept up with entering my CME courses as I went, rather than having to enter a big “heap” of data at once...but truly, it was pretty simple.  Enter your demographic data, CME courses, and in my case – my precepting hours (all 305 of them).  The CME hours are automatically saved and tallied, and at the end, a credit card payment finishes the process.  Voilà!  Finis!  No paperwork needs to be submitted, unless you are audited, and it takes about four weeks to process, instead of the usual eight weeks by paper.

Then I got to thinking about this whole certification issue.  And paying $280 dollars for this “privilege,” which is a $70 DISCOUNT because I am a member of the American College of Nurse Practitioners.  I wondered, what do I REALLY get from being certified?  It’s a mandatory piece of paper.  I cannot practice in Pennsylvania without it.  I cannot get paid by Medicare and other insurances if I don’t have certification.  The ANCC website states that board-certified professionals:

“meet specified requirements in order to maintain and renew your certification within five years. The purpose of certification renewal is to provide evidence that you have continued to expand your professional knowledge to demonstrate evidence of continual competence in your certification specialty. It allows you to continue use your ANCC credentials.”

Source:  http://www.nursecredentialing.org/RenewCertification.aspx

On the surface, being “board-certified” shows, upon graduation, one’s minimal competence in practice.  One would hope that the NP who has those B.C. initials WOULD be competent, right?  However, passing our initial boards means that we are “minimally competent” to practice.  Realistically, how many of us would want to study and take that darn exam AGAIN?  Especially if we specialize in an area of medicine?  I know VERY few NPs who would willingly re-take that exam.  Even those of us in primary care don’t want to.  Why?  We learn the “art” of medicine...the nuances of our own practice and demographics of our patients. 

I know that the questions have changed in the past ten years as well.  Would we so easily pass that TEST?  Probably not as easily as we would have as new graduates.  And so...therein lies the alternative – obtaining CME credits.

Since I graduated in 2001, the credit hours for ANCC have increased to either a total of 150 hours of CME, OR 75 hours plus an additional component of precepting, writing a journal article, taking credits for college, etc.  The CME requirements will change again by 2014; NPs and CNS clinicians will be required to have pharmaceutical hours as a significant part of their CME hours.

Continuing education is an excellent thing.  We need to stay focused on evidence-based research and the latest practice protocols.  Often, in our day-to-day lives, it’s too difficult to sit down at the end of the day to read yet-another journal detailing these issues.  Getting away to a conference offers the chance to network, hear the research, and take those moments to focus on the pertinent aspects of protocols that we overlook in our daily “grind.” For those of us—myself included—whose family commitments are too busy, online CME is a wonderful option.

However...getting back to the “certification” part of it...Why are we paying SO MUCH for certification?

Quite frankly, it ticks me off to have to spend this amount of money for those “B.C.” initials, on top of the time and money for CME hours.  Not to mention the irony of requiring this board certification for reimbursement by third parties who LOVE to reimburse us at LESS than our physician colleagues.  Yes, I’m referring to that wonderful 85% payment by Medicare, or even less by some private payors when patients see a Nurse Practitioner.

Let’s stop a moment and look at these statistics:

1.  In Pennsylvania, you can’t see Medicare patients unless you are board-certified. 
2.  You can’t be board-certified unless you completed a Masters program. 
3.  If you HAVE completed a Masters program AND are board-certified, you will be paid 85% of the physician reimbursement rate under current guidelines, UNLESS you bill “incident-to,” upon which those guidelines are SO strict, you might as well just forget about it, unless you want to invite a Medicare audit at some point in your career. 
– example:  If you see a routine HTN/DM patient after your collaborating doc, and oh-by-the-way, he mentions URI symptoms that you address:  BAM:  new problem, NO LONGER incident-to billing.  End-of-story, see ya later.  (Do you see why incident-to billing is ridiculous?) That means you will usually get that 85% fee.

So...the round-about way to look at the global issue is this:

1.  I paid tons of money to get an MSN in the first place.  Don’t even get me started on the DNP issue.  NO time, money, or desire for THAT. 
2.  I pay money every 5 years to maintain board-certification AND get CME credits. 
3.  When I do that, I will automatically collect 15% LESS than my physician colleagues, even though I probably work harder than many do in educating/treating my patients, and my outcomes are the same or BETTER. 
4.  Why the heck are we paying SO MUCH for certification that isn’t getting us ANYTHING except second-class status?

OH, me, me, me!!! (waving my hands frantically) I wanna answer the question.  Oh...what question?

Scroll back a few lines.  WHY ARE WE PAYING SO MUCH FOR CERTIFICATION?

Is it to “feed” the nursing organization masses & replenish the kitty?  Because it “looks good” to be certified?  Look, I fully support the nursing groups which I belong to...with 110% of my being.  My local state representative runs if he sees me in the store, because he knows I’ll accost him with some new NP issue.  (smile)

IMHO, just make these fees REASONABLE.  You already have our attention, guys.  It’s mandatory.  We get it.  Perhaps you’d even get MORE people getting certified (nurses, too, not just NPs) if you decided to keep it AFFORDABLE.

Kim

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