New93 role standards, now public
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Role standards

Providers

Physician associate or assistant

What a newly certified PA must do to take histories, examine, diagnose and prescribe safely as part of a physician-led team in any setting, drawn from the NCCPA PANCE content blueprint and the four PA organizations' Competencies for the PA Profession.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
1

Built from National Commission on Certification of Physician Assistants, AAPA, ARC-PA, NCCPA and PAEA. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent physician associate or assistant does on day one, dimension by dimension.

Clinical skills

  • Performs a focused history and examination that is driven by the differential and actually tests the dangerous possibilities.
  • Builds a differential that ranks the dangerous causes first, tests them in a sensible order, chooses a disposition that matches the risk, and says what would change the plan.

Workflow and tools

  • Writes a note that is true to what happened, carries the reasoning and the plan, and states accurately who did what, including the physician's part.
  • Hands over patients so the receiver knows who is at risk, what is pending and what to do if it changes, and confirms the receiver has accepted.

Patient communication

  • Presents the real options, including waiting or doing nothing, with honest numbers in plain words, finds out what matters to the patient, and recommends in light of it.
  • Explains how they deliver serious or unwelcome news honestly, respond to emotion, and bring in the physician or others when the conversation needs them.

Compliance and safety

  • Prescribes against the whole medication list, allergies, kidney function, age, pregnancy potential and controlled-substance history, and plans how the effect and harm will be monitored.
  • Owns the results of tests they order, including those that return after the patient has left, until each is acted on and the patient knows.

Role knowledge

  • Knows the edge of what their state law, practice agreement, facility privileges and own experience allow, and consults, refers or transfers before crossing it while keeping the patient safe.
  • Works as one member of a team with physicians, nurses, pharmacists and therapists, acts on input that should change the plan, and resolves disagreement through the patient and the evidence.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Treats symptomatically or discharges a presentation with a red flag for a time-critical diagnosis - ectopic pregnancy, subarachnoid hemorrhage, cauda equina syndrome, acute coronary syndrome, sepsis - without testing for it or arranging emergency evaluation.

    These diagnoses kill or disable within hours, and the first clinician who fails to consider them is often the last who could have.

  • Prescribes a drug with a known dangerous interaction or contraindication for this patient - trimethoprim-sulfamethoxazole with warfarin, clarithromycin with simvastatin, a teratogen without establishing pregnancy status - by overriding or ignoring the alert, or issues a controlled substance without checking the prescription monitoring program.

    A bleed, rhabdomyolysis, a harmed pregnancy or an overdose reaches the patient after they have left, when nobody is watching.

  • Would document a history, examination or discussion that did not happen, including leaving auto-filled findings they did not check, or would record that the physician saw or examined the patient when they did not.

    Every clinician after them acts on a false record, and misrepresenting who provided a service to raise payment is fraud.

  • Performs a procedure or sedation outside their facility privileges or practice agreement, or takes on management their state law or agreement does not allow, rather than consulting the physician or transferring the patient.

    The patient carries the risk of an operator who is not credentialed to manage the complication, and practice outside the agreement is unlawful.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not practise beyond what their state law, practice or collaborative agreement and facility privileges allow.Knows the terms that apply where they work, and consults the collaborating physician or refers for anything outside them.
  • Does not perform a procedure or sedation outside their delegated privileges or current competence, however urgent it seems.Keeps the patient safe with what is within scope, gets a privileged clinician or transfers, and extends privileges through supervised cases and credentialing.
  • Does not represent their own work as the physician's, or record a physician review that did not happen.Documents accurately who did what, and bills only under the rules for the service actually provided.
  • Does not keep managing a patient whose condition exceeds their experience, specialty or the setting.Consults the physician with a clear question, or arranges transfer with a direct handover, and stays with the patient's care until it is accepted.
  • Outside the United States the title, regulation and prescribing rights differ, and in some countries the role cannot prescribe at all.Applies this standard to US practice and works to the local regulator's scope in any other jurisdiction.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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