At what point are medical students given prescriptive authority?

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SadPharma

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When can medical students begin to prescribe under the supervision of a practicing doctor? I realize this may vary from state to state.

It is my understanding that this is generally legal from the first day of med school, but generally doesn't happen until later. Is this correct?
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SadPharma said:
When can medical students begin to prescribe under the supervision of a practicing doctor? I realize this may vary from state to state.

It is my understanding that this is generally legal from the first day of med school, but generally doesn't happen until later. Is this correct?
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You dont write scripts as a student. In some hospital systems you may be able to "order" certain things if a resident signs it. So essentially, you order nothing until after graduation.
 
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I was able to order all labs/imaging (including pan scan CT's) at my away sub-I -- but still needed a co-sign for a 500ml bolus of NS.

Got a little chuckle out of that.

Was an awesome rotation though!
 
We were allowed to put in orders and have a resident or attending co-sign them. I'm at a different institution for residency and I know our sub-I's can put in orders (again with a physician co-sign) but I don't think our non-sub-I students can do so as far as I know.
 
askamsky51 said:
I was able to order all labs/imaging (including pan scan CT's) at my away sub-I -- but still needed a co-sign for a 500ml bolus of NS.

Got a little chuckle out of that.

Was an awesome rotation though!
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Makes sense to me. You can't really hurt someone right now with a blood draw or pan ct but you can sure do it with some fluids, especially if they have renal failure, heart failure, electrolyte disturbances like hyponatremia, etc.

I have a healthy respect for everything I'm doing to the patient
 
askamsky51 said:
I was able to order all labs/imaging (including pan scan CT's) at my away sub-I -- but still needed a co-sign for a 500ml bolus of NS.

Got a little chuckle out of that.

Was an awesome rotation though!
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Well giving a 500cc bolus isn't benign, so thank goodness med students can't just order them willy nilly.
 
Psai said:
Makes sense to me. You can't really hurt someone right now with a blood draw or pan ct but you can sure do it with some fluids, especially if they have renal failure, heart failure, electrolyte disturbances like hyponatremia, etc.
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You can when that inappropriate lab or imaging test finds some incidental finding

I have a healthy respect for everything I'm doing to the patient
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This is very true.
 
Psai said:
Makes sense to me. You can't really hurt someone right now with a blood draw or pan ct but you can sure do it with some fluids, especially if they have renal failure, heart failure, electrolyte disturbances like hyponatremia, etc.

I have a healthy respect for everything I'm doing to the patient
Click to expand...
I don't think it's a huge deal but unecessary radiation to patients, especially children, isn't harmless.
 
Psai said:
Makes sense to me. You can't really hurt someone right now with a blood draw or pan ct but you can sure do it with some fluids, especially if they have renal failure, heart failure, electrolyte disturbances like hyponatremia, etc.

I have a healthy respect for everything I'm doing to the patient
Click to expand...

Pan CTs are pretty ****ing dangerous... A lot of contrast and radiation... In my patient population, probably a lot more dangerous than 500cc of fluids.
 
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askamsky51 said:
I was able to order all labs/imaging (including pan scan CT's) at my away sub-I -- but still needed a co-sign for a 500ml bolus of NS.

Got a little chuckle out of that.

Was an awesome rotation though!
Click to expand...

Surely someone was signing all those imaging and test orders. I would be surprised if they were not, even if it was after the fact. Having a medical student ordering stuff poses legal risk for the facility. In addition, insurers would probably not pay for those tests unless and licensed physician signed off on them.
 
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mimelim said:
Pan CTs are pretty ****ing dangerous... A lot of contrast and radiation... In my patient population, probably a lot more dangerous than 500cc of fluids.
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Yeah but you have time to deal with that and a lot more checks, it's not like a med student can write an order and the patient will get immediately whisked off to ct whereas a patient can get fluid pretty quickly without anyone questioning it
 
SadPharma said:
When can medical students begin to prescribe under the supervision of a practicing doctor? I realize this may vary from state to state.

It is my understanding that this is generally legal from the first day of med school, but generally doesn't happen until later. Is this correct?
Click to expand...
Medical students never have the authority to prescribe anything that cannot be prescribed by anyone's Mom.
 
cbrons said:
When do residents get their own unique DEA number?
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After they get a permanent medical license and pay for an individual DEA.

My program did not pay for individual DEAs, so I used the institutional one until I got my first attending job. If I had moonlighted externally during training, I would've needed my own DEA.
 
Smurfette said:
After they get a permanent medical license and pay for an individual DEA.

My program did not pay for individual DEAs, so I used the institutional one until I got my first attending job. If I had moonlighted externally during training, I would've needed my own DEA.
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So does that differ by state? Ive heard of one state (cant remember which) required residents to have 1.

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cbrons said:
So does that differ by state? Ive heard of one state (cant remember which) required residents to have 1.

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The requirements for getting a license vary by state but are generally 1 or 2 years of residency training and passing step 3. The DEA requires a valid state medical license before issuing a license/number (some states also require a separate state DEA certificate/form/prescribing license as well, without which the DEA will not issue you a license for use in that state). I can't speak for every state requirement but some fields may not even need a DEA, i.e. pathology, so it would be odd IMO to require that every resident get a DEA license. Not that rules always make sense...



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Smurfette said:
The requirements for getting a license vary by state but are generally 1 or 2 years of residency training and passing step 3. The DEA requires a valid state medical license before issuing a license/number (some states also require a separate state DEA certificate/form/prescribing license as well, without which the DEA will not issue you a license for use in that state). I can't speak for every state requirement but some fields may not even need a DEA, i.e. pathology, so it would be odd IMO to require that every resident get a DEA license. Not that rules always make sense...



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Click to expand...

In some residency programs, residents are on training permits or limited licenses throughout the residency because it's cheaper to renew a training permit than a full license. Usually a resident takes Step 3 during PGY1 or 2, but may wait a few years to apply for a full license. If someone moonlights outside of the residency programs' hospitals, then having a full license +/- DEA #. A full license is necessary for fellowship because it is a requirement for sitting for many board certification exams or maintaining board certification. Even at that point, a DEA# isn't necessary. It would be program dependent, e.g., whether fellows can use the institutional DEA#. A DEA# is not cheap.
 
California is hilarious because you can't get your license until PGY2 (at the earliest, processing it takes a while), so you can sign all your own orders INPATIENT and prescribe whatever the hell you want, but I literally cannot sign an outpatient prescription for colace (or anything else) until I get my license. So everytime you d/c someone you have to track down a senior and steal some Rx sheets.
 
We sometimes have students that are ambitious about putting in orders (usually sub-Is), however I usually discourage it since it ultimately is just more work and slows things down. I get it, it can be helpful to go through the process of putting in orders, thinking about what you're doing when ordering tests, etc., but going through and looking at orders rather than just ordering them myself is a bit of a pain.

I don't know of anywhere where you can put in orders with cosigning as a medical student.
 
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