Moonlighting- supervising PAs

[arrhythmia7]

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Hey-

Quick question. I'm looking at starting a moonlighting job where I will essentially be supervising 2 PAs who will be working in a primary care clinic in an underserved area. I'm required to audit 10% of their charts q30 days, and can dictate what types of conditions they can treat and prescribe for (i.e., no narcotics, send to the ER if T>38.5, etc.). Has anybody else had experience doing this in residency? Is it sketchy? I don't want to risk my license, and I don't think I'm doing anything "illegal", but the pay just seems too good for the amount of time I will be spending.

Thanks in advance for your responses.

 

[f_w]

You essentially get paid to absorb some of the malpractice risk for whoever is running that racket. It is probably not illegal, but it certainly carries some risk with it. I assume you are a resident, I would weigh the risk of having your name on a suit against one of the PAs vs. the money you stand to make. This sounds more like a gig for someone who is semi-retired and for whom the risk of having a suit on his record is not a big deal. If you want to start out your career with that 'if you answered yes to any of these questions please explain on a separate page' issue, go right ahead.

(Now, you mentioned that it is some sort of underserved area deal, if this is a federally qualified community health center, the liability risk is low because CHC providers liability is capped at 250k. If not, well then good luck.)

 

[MOHS_01]

DON"T DO IT -- you would be taking a VERY large risk, and my bet is that your malpractice would not cover you in such a situation. It simply is not worth it -- do disability exams for the state or something like that.....

 

[primadonna22274]

I can't speak to the malpractice risk but I can speak to the issue of supervising PAs (from the perspective of a supervised PA). Look: you get to choose the acuity of patients the PAs see (essentially, you get to filter their care, which you may find you don't need to do as stringently after working with them for a while). You always have the option to personally review MORE charts if that makes you more comfortable. Where I'm at in EM now, we have 100% chart review which is a little bit ridiculous and inefficient, but then our docs also see every patient we PAs see, which is even more inefficient. We do this because this is what the hospital is comfortable with (using PAs in the ED is fairly new in this hospital, about a year and a half). I have always found the docs I work with to be much more comfortable with my care after they've worked with me for about 3-4 months and reviewed plenty of my charts to see how I think.
Try to have an open mind here. You have an opportunity to get to know the PA role fairly early in your career, and you may even find you like us. There are good and bad PAs of course. It goes without saying that I'm hoping you can be won over by great PAs.
Talk to your malpractice carrier about the risk to you here. It may be that you can't take the job as a resident (I think you stated this was a moonlighting position in addition to your residency hours, no?). I recall that in my urgent care rotation (gosh, eight years ago...) one of my preceptors was a critical care resident who moonlighted a few shifts a month there. He was a gunner too, but we got on OK.
Good luck,
Lisa

 

[deleted87716]

Personally, I'd look at it this way.

Your ass is on the line if these guys screw up. Period. If you're not comfortable with that, none of the other details matter.

10% chart audit means that 90% of their work will be unsupervised. For all you know, the 10% are cherry-picked, and may not even accurately represent what they're doing.

The 10% that you do get to see will be reviewed after the fact, meaning that the damage, if any, has already been done. Sure, you can try to contact the patient, have them come back in, correct whatever the oversight was, etc., but this is hardly optimal care.

Finally, you don't work in the clinic full-time, and you don't really know the PAs there. You don't know how competent they are, what their weaknesses are, or even how honest they are. They don't really know you, either. You don't have the kind of close working relationship that you would have if you had hired them yourself for your own practice, and you may not even be supervising the same PAs all the time...they could come and go just like you.

Still comfortable? I wouldn't be.

 

[f_w]

Before we get into another silly 'you doctors don't respect us' thread (and before McGyver starts one of his 'all PAs are incompetent' rant), I want to clarify that my advice against taking this gig is related to the specific situation described (commercially run practice in a underserved location staffed with PAs and apparently the owner not a physician himself).

There is nothing wrong with taking a job where you supervise PAs as a regular course of your business IF you know who these PAs are and had a chance to see their work after working alongside with them for a while.

Again, you might get at least named in any action against them. Even if you didn't have direct involvement in a particular case, but by virtue of being the supervisor (and like it sounds in this job medical director) for the facility, you will be held responsible for the policies you set. (e.g. if a kid with 38.4C received a z-pac from your PA and turns into a veggie from meningitis, you better have in your directions to the PAs some verbiage regarding the overall activity level of the child etc.).

 

[core0]

Hey-

Quick question. I'm looking at starting a moonlighting job where I will essentially be supervising 2 PAs who will be working in a primary care clinic in an underserved area. I'm required to audit 10% of their charts q30 days, and can dictate what types of conditions they can treat and prescribe for (i.e., no narcotics, send to the ER if T>38.5, etc.). Has anybody else had experience doing this in residency? Is it sketchy? I don't want to risk my license, and I don't think I'm doing anything "illegal", but the pay just seems too good for the amount of time I will be spending.

Thanks in advance for your responses.

There are some good posts here. I would also point out you need to see if you can legally do this. Some states have restrictions on how many PA's can be supervised. There are also restrictions on the type of license that you can have (in particular some states require you to have an unrestricted medical license). As a PA I would say that it doesn't sound like a good position to be in.

David Carpenter, PA-C

 

[deleted6669]

also the pa's probably wouldn't be wild about being supervised by a resident. no offense, just the fact of the matter. leave this job for a more seasoned physician who is comfortable working with pa's.
also from reviewing your prior posts it seems you are a second yr IM resident. the pa's at this clinic would presumably be seeing children and maybe OB, something they are certified to do and you are not so that would be a big problem if a case involving a child or a pregnant pt ever went south.....
ideally a pa should be supervised by someone who works in the same field as they do( fp to fp, em to em, etc) so there is no question about a pa doing things outside the scope of practice of the supervising md, a no-no in many states.....

 

[f_w]

also the pa's probably wouldn't be wild about being supervised by a resident.

Chances are, those guys would LOVE to be supervised by a resident. The less qualified the supervision, the better. There is a good chance that they own the clinic and are looking for the cheapest way to find some fool to sign off on their required 5-10% charts.

 

[deleted6669]

Chances are, those guys would LOVE to be supervised by a resident. The less qualified the supervision, the better. There is a good chance that they own the clinic and are looking for the cheapest way to find some fool to sign off on their required 5-10% charts.

🙂

if that was the situation they would be trolling for a retired doc who is happy just to cash the check and never come in.....

 

[EctopicFetus]

yep. i dont think a resident should be doing this. it could be lights out..