The ASMBS Preliminary Evaluation into Bariatric Specific Credentialing/Certification for PAs, NPs, and CNSs

| December 1, 2016

This column is dedicated to covering a variety of topics relevant to the multidisciplinary care of the bariatric surgical patient.

Column Editor: Karen Flanders, MSN, CNP, CBN
Winchester Hospital, Winchester, Massachusetts; President, American Society for Metabolic and Bariatric Surgery Integrated Health

This month: The ASMBS Preliminary Evaluation into Bariatric Specific Credentialing/Certification for PAs, NPs, and CNSs

by Karen Flanders, MSN, CNP, CBN, and William Gourash, MSN, CRNP
William Gourash, MSN, CRNP, is from Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Karen Flanders MSN, CNP, CBN is from Winchester Hospital, Winchester, Massachusetts.

Funding: No funding was provided.
Disclosures: The authors report no conflicts of interest relevant to the content of this article.

Bariatric Times. 2016;13(12):16–17.

A Message from the Column Editor

Dear Colleague,
During ObesityWeek 2016, I officially stepped in as President of the American Society for Metabolic and Bariatric Surgery Integrated Health. I am excited to take on this new role and am delighted to begin serving as Column Editor for “Hot Topics in Integrated Health” in Bariatric Times. I’ve already begun work lining up a lot of great topics for the IH readership in 2017!

This month, William Gourash and I provide a summary of the ASMBS preliminary evaluation into bariatric specific credentialing/certification for Physician Assistants (PAs), Nurse Practitioners (NPs), and Clinical Nurse Specialists (CNSs). Approximately 18 months ago, a survey was sent to PAs, NPs, and CNSs working within the specialty of bariatric surgery. The survey explored the interest of credentialing for this subset of providers. Here, we present the results of the survey as well as recommendations for the next steps moving forward.

Karen Flanders, MSN, CNP, CBN
ASMBS Integrated Health President

Advanced Practice Providers (APPs) refer to Physician Assistants (PAs), Nurse Practitioners(NPs) and Clinical Nurse Specialists (CNSs) who together make up 23 percent of the Integrated Health membership of the American Society for Metabolic and Bariatric Surgery (ASMBS). Over the last five years, an interest has been voiced within the ASMBS Integrated Health Section membership with regard to the development of a bariatric-specific credential/certification for PAs, NPs, and CNSs. Surgeons have voiced a similar interest, especially for PAs, over the last three years.

Per 2015 numbers, the breakdown of ASMBS Associate Memberships for these disciplines is as follows:
• PAs = 144
• NPs = 172
• CNS = 51

Specialty certification is a mechanism that recognizes a provider’s expertise within a specialty or subspecialty of healthcare as well as a certificate of attendance and knowledge. For example, physicians who complete the American Board of Obesity Medicine (ABOM) certification process in obesity medicine are designated “Diplomates of the American Board of Obesity Medicine.” An example of a certificate of knowledge and attendance is the Certificate of Training in Adult Weight Management offered for dietitians by the Academy of Nutrition and Dietetics (AND).

In 2015, the ASMBS initiated a task force to explore developing a specialty certification within metabolic and bariatric surgery for APPs. Specifically, the task force was created to investigate credentialing options, feasibility, legal implications, potential collaborators, and process models.

Task Force Members
Karen Flanders, CNP
Christine Bauer, MSN, RN
William Gourash, CRNP
Christa Black, PA-C
Tammy Dodds, PA-C
Eric DeMaria, MD
David Provost, MD
Karen Schulz, MSN, CNS
Marina Kurian, MD
Wayne English, MD
Christine Hawn, ASMBS Liaison

A first reasonable step was to explore the feasibility of pursuing a bariatric credential/certification in these disciplines with a survey of APPs who are members of the ASMBS. We determined that the APPs had a similar clinical work focus (although PAs more likely to assist in operating). CNSs were included because in some states they are licensed to diagnose and treat like NPs, and PAs. Due to relatively low total numbers and similar work focus, we agreed it was reasonable to explore combining these disciples. We also found a reported interest among these disciplines for surgical and nonsurgical focus.
Survey aim. We aimed to explore the feasibility of establishing or supporting the establishment of a bariatric credential/certification for PAs, NPs, and CNSs by surveying the certification interest among PAs, NPs, and CNSs working in bariatric surgery.
Method. An Internet survey, comprised of 21 questions, was developed with input from all three disciplines and the CBN Certification Committee. The link to the survey was sent out by e-mail to all PAs, NPs, and CNSs in the ASMBS database (current members and non-members, the majority were thought to be members)
Results. The e-mail with survey link was sent out three times two weeks apart between June 30, 2015 and August 10, 2015. It was delivered to 634 viable e-mail addresses at least two times, with two weeks separation; return 124 or 19.6 percent.

Results were as follows:
Total Responses
• 53% NPs,
• 40% PAs
• 6% CNSs

ASMBS Member Status
• 79% members
• 18% members at one time
• 3% non-members

Bariatric Experience Level
• <1 years (6%)
• 1–5 years (34%)
• 5–10 years (32%)
• >10 years (28%)

Membership in other Professional Organizations
• 33% American Academy of Physician Assistants (AAPA)
• 24% American Association of Nurse Practitioners (AANP)
• 30% Other
• 3% National Association of Clinical Nurse Specialists (NACNS)

Provider Primary Certification
• 41% American Nurses Credentialing Center (ANCC)
• 19% AANP
• 41% National Commission on Certification of Physician Assistants (NCCPA)

Specialty Certification Focus
• 53% Acute Care, Adult, Family, Psych, Women’s Health (majority of respondents to this question were NPs)

Certificate of Added Qualification or Additional Specialty Certification
• 80% of participants answered “No” when asked if they had a certificate of added qualification or additional specialty certification The majority of the 20% who answered “Yes” were NPs or CNSs who were certified as a Certified Bariatric Nurse (CBN).

Job Responsibilities
• 69% indicated >90% of their job responsibilities were focused in weight management

Aspect of Weight Management
• 48% Surgical (Only)
• 50% Surgical and nonsurgical
• 76% indicated their job responsibilities were clinical in nature
• Survey participants were asked to identify the percentage of time spent in different clinical job responsibility categories.

Answers were as follows:
40% Postop, 27% Preop, 17%
Assist OR, 15% Inpatient care

Specialty Certification Interest
• 77% agree or strongly agree that they are interested in obtaining specialty bariatric surgical certification
• 83% reported interest in combined surgical and nonsurgical focus
• 87% reported interest in credential/certification for combined discipline (PAs, NPs and CNSs)
• 57% reported interest in assisting in the development process

Advance Practice Providers Survey: The Highlights

Although the survey consisted of a relatively small sample, with the potential bias that those who did not complete the survey did not do so randomly, it is a very helpful first step in understanding the perceptions and interest of PAs, NPs, and CNSs in developing a bariatric credential.

Most of the respondents’ practices were in the clinical arena; and approximately half participated in both surgical and nonsurgical care of the bariatric patient. There was interest in obtaining a bariatric surgical certification (77%), bariatric surgical and non-surgical certification (83%), and it was acceptable for combined certification (PAs, NPs, & CNSs [87%]).

Fifty-seven percent of participants expressed willingness to assist in the development of such a certification.

While the survey results indicate there is interest among PAs, NPs, and CNSs in developing a metabolic and bariatric surgery certification, due to the relatively small sample and potential for bias in those who did not complete the survey, the survey did not provide enough information to extrapolate a general overall high or a low interest in developing a bariatric credential/certification among PAs, NPs, and CNSs working in the specialty of bariatric surgery. However, the results indicate that there is definite potential and further exploration is very reasonable.

If such a credential/certification is to be created, the data suggest that there is interest in combining surgical and nonsurgical weight loss and that it would be acceptable to consider combining PAs, NPs, and CNSs for a joint certification.
Further validation of these findings will be needed.

Post Survey: NEXT STEPS
The feasibility and exploration of the metabolic and bariatric surgery certification for PAs, NPs, and CNSs calls for the need for further exploration before any definite decision can be made. Areas that require further delineation (and may already be in the works) include the following: 1) the number of PAs, NPs, and CNSs who would be interested, 2) the strength and reasons for their interest, 3) the support and interest of other professional organizations in collaboration, 4) acceptable credentialing options (e.g., formal certification, certificate of knowledge, portfolio certification), and 5) the preliminary cost projection depending on credentialing option most likely acceptable.
The following are recommended next steps in response to the feasibility survey and continued exploration of the specialty certification, some of which have already been put into action:
1.    Follow up with the professional organizations (AAPA, AANP). These discussions are ongoing and lead to consideration of a certificate program associated with a boot camp type course.
2.    Continue to communicate with the Academy of Nutrition and Dietetics with regard to their certification efforts.
3.    Explore credentialing options
• Formal certification
• Portfolio certification
• Certificate
4.    A symposium was recently offered at ObesityWeek 2016 with a focus on APP content, which may lead to an annual symposium/course.
5. Facilitate networking between PAs, NPs, and CNSs working in bariatric surgery and obesity in other organizations and associations, such as The Obesity Society (TOS), Obesity Medicine Association (OMA) and others. Discussions have been undertaken with the OMA NP and PA membership group.
6.    A focus group was held at the 2016 ObesityWeek to help to investigate the strength, reasons for their interest, and credentialing options, and to develop content areas for a boot camp type course that might be the core of a certificate program
7.    Consider another survey when above has been explored.

Category: Hot Topics in Integrated Health, Past Articles

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