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From the State Medical Board of Ohio, something that will be more and more common in the future...A Physician had his license suspended for 15 days and was placed on 3 years probation.
For allowing his physician assistant practice outside of "parameters of utilization plans and /or state rules and regulations regarding physician assistants:"

You can bet this will be more and more common in the future... creates a liability risk also.

Castro Viejo

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Are there really established rules and regulations governing the practice of PAs under the direct supervision of an MD? As far as I've been told, though I have to admit I've researched this topic minimally, a PA's scope can vary widely depending on how comfortable the MD is. I've heard of PAs in New York City actually taking on the role of a senior/chief resident or a cardiac fellow and scrubbing on some pretty major cases. I mean to say they can operate a lot.


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The scope of practice & privledges for allied health providers vary by individual states. In some states for instance, Nurse Practioners have their own perscription privledges & in others its restricted. Many CTVS groups hire PA's to help as first assist during CABG (harvesting the saphenous veins, closing the chest), although their is a trend towards hiring non-PA surgical assistants as you they demand lower salaries. I've been very impressed with some of the skills of the surgical PA's here, they can get those leg veins out faster then anybody & do nice work closing the chest. (of course, that's all they do all day though)


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I was asked by a fellow PA to respond since for some reason he is unable to post here.

Droliver presents a good responce but as a midlevel with over 21 years experience may I make the following comments?

It is true that each state has it's regulations regarding midlevels and their scope of practice...some won't let them do anything and some, such as my state of North Carolina, the scope is left up to the comfort level of the supervisor. I have DEA privileges and narcotic priviledges and my Rx' capabilities are pretty much whatever my supervisor and I agree on.

an important lesson is to be learned from DocWAgners post.

If you are going to employ one of us you should:

A. Know who you are taking into your your homework, and if he/she is new...keep them close until you are comfortable with them.

B. Be a supervisor....check on our work...keep up with what we're doing. Communicate with your midlevel. Many times in past jobs I have felt like the dumping ground for a supervisor who was, for all practical purposes, just too damned lazy to see his own patients or wanted to goof off while I worked and he made a bunch of cash. I had been left to make rounds and do his discharge summaries MONTHS after the patient had been discharged and I had never even seen the patient. I no longer work in this situation...but you see how dangerous this can be.

C. Ask your peers how they supervise their midlevels and then do what's comfortable for you.

D. Know your states regulations for midlevel use and follow those guidelines. You can be sure the supervisor in question in the original post ignored the state regulations and this is what got him in trouble. You can also be sure the midlevel ignored the regulations too.......both were guilty here. Practice within the guidelines of your state and you will be safe.

E. A good midlevel knows his or her limitations. If yours doesn't recognize what they don't know, you need a new one, or they need better guidence from you. All of us tend to be a little cocky when we're new.... doc's, nurses, PA's, NP's...none of our occupations are spared that sort of new grad. Keep a reign on your's until you both understand each other. Your midlevel should not be afraid or hesitant to ask questions nor be discouraged from consulting with you anytime they need it. If you feel that it is too much of a burden to take the time out of your patient load to answer any question, any time, any place from your midlevel, then you don't need one, nor do you need to be responsible for one.

It is reasonable to not even want or use a midlevel. Many providers are not comfortable with them and if you aren't then don't use one.

Maybe one day you will meet one you like and feel comfortable with and will be willing to share your patients with. We all want to just work and take care of folks just like you do.

BTW..I run a rural health clinic in North Carolina with a physician coming in once a week reviewing charts and not seeing the patients with me. It is legal in our state. I make it a practice not to put his license at risk.

It IS foolish, though, to allow anyone enough autonomy to put your license or reputation at risk. I wouldn't do it and neither should you. Any midlevel worth his or her salt will understand your concern and do whatever it takes to make you comfortable with the relationship.

Thanks for the opportunity to respond
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