Transcription

Physician assistant scope of practiceThe AMA opposes enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state’s requirements for licensure to engage in the practice ofmedicine and surgery. 1 The AMA believes that physicians must maintain the ultimate responsibility ultimately responsible for coordinating and managing the care of patients and, with the appropriate input ofthe physician assistant, ensuring the quality of health care provided to patients.2With regard to physician assistants specifically, AMA policy states that physician assistants should be authorized to provide patient care services only so long as the physician assistant is functioning under thedirection and supervision of a physician or group of physicians.3 Accordingly, the AMA opposes legislation or proposed regulations authorizing physician assistants to make independent medical judgmentregarding such decisions as the drug of choice for an individual patient.4AMA policy also addresses regulation of physician assistants. In particular, the AMA advocates in support of maintaining the authority of medical licensing and regulatory boards to regulate the practice ofmedicine through oversight of physicians, physician assistants and related medical personnel.5 The AMA also opposes legislative efforts to establish autonomous regulatory boards meant to license, regulate,and discipline physician assistants outside of the existing state medical licensing and regulatory bodies' authority and purview.This state law chart outlines several aspects of state laws regulating physician assistant practice. Co signature – 20 states6 require a certain percentage or number of PA charts to be co-signed by a physician Ratio requirements – 39 states7 have established limits on the number of PAs a physician can supervise or collaborate with1AMA Policy H-35.989, Physician Assistants; AMA Policy H-35.988, Independent Practice of Medicine by Nurse Practitioners.AMA Policy H-35.988, Independent Practice of Medicine by Nurse Practitioners.3AMA Policy H-35.989, Physician Assistants.4Id.5AMA Policy H-35.965, Regulation of Physician Assistants.6AL, CA, CO, IN, KS, KY, LA, MS, MO, MT, NE, NV, NJ, OH, PA, SC, TN, UT, VT, VA2 2018 American Medical Association. All rights reserved.

7Prescriptive authority PAs are authorized to prescribe Schedule II-V medication in most states (44) PAs lack the authority to prescribe Schedule II medication in 6 states (AL, AR, GA, HI, IA, WV) PAs lack the authority to prescribe legend drugs in 1 state (KY)Requirements for collaborative or supervisory arrangement In 47 states, PAs are supervised by physicians In 2 states, PAs are subject to collaborative agreements with physicians (AK, IL) 2 states allow for an alternate arrangements: New Mexico calls for supervision for PAs with less than 3 years of clinical experience, and for specialty care PAs, and in Michigan, PAs work under aparticipating physician Regulation – In most states (43), PAs are regulated by the medical board. However, in 8 states (AZ, CA, IA, MA, MI, RI, TN, UT), PAs have a separate and independent regulatory board Scope of practice determination – In most states (47), PA scope of practice is determined with the supervising/collaborating physician at the practice siteNo ratios in AK, AR, ME, MA, MI, MN, MS, NM, NC, ND, RI, TN 2018 American Medical Association. All rights reserved.2

StateAlabamaCo-SignaturePA RatiosRequired (AAC540-X-7-.23)Physician maynot supervisemore than acumulative 160hours per weekfor all PAs.(AAC 540-X-7.26)NoneSchedule III-VSchedule II-VCollaborativePhysician maynot supervisemore than 4 PAswho work at thesame time.(ARS. 32-2533)Schedule neRx oryII-III limited to30-days, norefills withoutwritten consentfrom physician;IV-V not morethan 5 times in6-months.Schedule III-VSupervision/Collaboration Requirements/“Barriers”The supervising physician shall be readily available for directcommunication or by radio, telephone, or telecommunication.There shall be no independent, unsupervised practice by PAsPrescribing is subject to any limitations stated in protocols andmedical regimens adopted by the Board and subject to anylimitations by the supervising physician in the approvedformulary (AAC 540-X-7-.23)Collaborative plans must include at least monthly telephone,radio, electronic, or direct personal contact between the PA andthe primary or alternate collaborating physician reviewing thePAs performance in the practice, knowledge, skills, patient care,and health care records. (12 AAC 40.430)PA must meet in-person or by telecommunication with thesupervising physician at least once each week to ensure ongoingdirection and oversight of PA work. Patient records must also bemade available to the supervising physician.Physician/PABoard?AlabamaBoard ofMedicalExaminersScopeDeterminedat PracticeSite?YesAlaska StateYesMedical BoardArizonaRegulatoryBoard ofPhysicianAssistantsYesA supervising physician shall develop a system for recordationand review of all instances in which the PA prescribes scheduleII or schedule III controlled substances. (ARS 32-2531)SupervisoryContinuous supervision is required, but does not necessitatephysical presence at the time and place services are rendered. 2018 American Medical Association. All rights reserved.3Arkansas State YesMedical Board

StateCo-SignaturePA RatiosRx AuthoritySupervisorySupervision/Collaboration Requirements/“Barriers”A supervising physician should be available for immediatetelephone contact with the PA any time the PA is renderingservices to the public. A supervising physician must be able toreach the location of where the PA is rendering services to thepatients within one hour. (ACA 17-105-109)A supervising physician shall be available in person or byelectronic communication at all times when the PA is caring ssistantBoardScopeDeterminedat PracticeSite?Sample of atleast 10 chartsper month, for atleast 10 monthsduring the year.(Minimum of5% of the PAsmedicalrecords).(CCR 3502)Physician maynot supervisemore than 4 PAsat any one time.(CCR 3516(b))ColoradoRequired, butvaries with PAexperience.(Rule 400; 3CCR 713-7)Physician maynot be theprimarysupervisingphysician formore than 4individual PAs.(Rule 400; 3CCR 713-7)Schedule II-VSupervisoryPAs are subject to tiered supervision requirements concerningperformance assessments, chart reviews, in person meetings, andon-site supervision. If not physically on site, the physiciansupervisor must be readily available by telephone, radio, pager,or other telecommunication device. (CCR Rule 400)ColoradoYesMedical BoardConnecticutNonePhysician maySchedule II-VSupervisoryPhysician should be continuously available by directConnecticutCaliforniaSchedule II-VSupervision/CollaborationLanguageYesA supervising physician shall delegate to a PA only those tasksand procedures consistent with the supervising physician'sspecialty or usual and customary practice.A supervising physician shall observe or review evidence of thePAs performance until assured of competency. (CCR 1399.545) 2018 American Medical Association. All rights reserved.4Yes

StateCo-SignaturePA RatiosRx AuthoritySupervision/CollaborationLanguagenot be thesupervisingphysician formore than 6 PAspracticing fulltime, or the parttime equivalentthereof. (CGS20-12c)communication either in person or by radio, telephone, ortelecommunications.NonePhysician maynot supervisemore than 4 PAsat a given time.(Del. C. 1771)Schedule II-VSupervisoryDistrict ofColumbiaNonePhysician maynot supervisemore than 4 PAsat a given time.(DCMR4914.10)Schedule II-IVSupervisoryPhysician maySchedule II-VNoneScopeDeterminedat PracticeSite?MedicalExaminingBoardThere should be active and continuing overview of the PA’sactivities, personal review by the supervising physician of thePA’s practice on a regular basis, review of the charts and recordsof the PA on a regular basis, and designation of an alternatelicensed physician in the absence of the supervising physician.(CGS 20-12a)DelawareFloridaSupervision/Collaboration visoryIf the supervising physician delegates the authority to a PA totreat patients in a setting where the supervising physician is notroutinely present, the physician must assure that the means andmethods of supervision are adequate to assure appropriatepatient care. This may include telecommunication, chart review,or other methods of communication and oversight that areappropriate to the care setting and the education and experienceof the PA. (Del. C. 1771)In an inpatient setting, supervision of a PA shall include, but notbe limited to, continuing or intermittent physical presence of thesupervising physician with constant availability throughelectronic communications. (DCMR 4914.2)In an outpatient setting, supervision of a PA shall include, butnot be limited to, constant availability through electroniccommunications. (DCMR 4914.3)Except in cases of emergency, supervision requires the easy 2018 American Medical Association. All rights reserved.5Board ofMedicalLicensure andDisciplineYesDC Board ofMedicineYesFlorida BoardYes

StateCo-SignatureGeorgiaNoneHawaiiNone, butsupervisingphysician mustpersonallyreview therecords of eachpatient seen bythe PA withinseven workingdays.IdahoNone, but aPA Ratiosnot supervisemore than 4currentlylicensed PAs atany one time.(Fla. Stat.458.347(3))Physician maynot serve asprimarysupervisingphysician tomore than 4PAs. (GCR 3605-.05)Physician maynot supervisemore than 2 PAsat one time.(HAR 16-85-49)Physician mayRx AuthoritySupervision/CollaborationLanguage7-day limit onSchedule II.Supervision/Collaboration ability or physical presence of the licensed physician forconsultation and direction of the actions of the PA. “Easyavailability” includes the ability to communicate by way oftelecommunication. The boards shall establish rules as to whatconstitutes responsible supervision of the PA. (Fla. Stat.458.347)of MedicineScopeDeterminedat PracticeSite?Schedule III-VSupervisoryThe supervising physician shall provide for immediateconsultation between the PA and primary or alternatesupervising physician. "Immediate consultation" means that thesupervising physician shall be available for directcommunication or by telephone or other means oftelecommunication. (GCR. 360-5-.04(3))GeorgiaYesCompositeMedical BoardSchedule III-VSupervisorySupervision shall be continuous but shall not be construed asnecessarily requiring the physical presence of the supervisingphysician at the time and place the services are rendered. Thedirect communication may occur through the use of technologywhich may include but is not limited to, two-way radio,telephone, fax machine, modem, or other telecommunicationdevice. (HAR 16-85-49)HawaiiYesMedical BoardSupervisorySupervision includes: an on-site visit at least monthly; regularlyIdaho BoardSchedule II maybe allowed if PAis employed orextendedprivileges by ahospital orextended carefacility.Schedule II-V 2018 American Medical Association. All rights reserved.6Yes

StateCo-SignaturePA RatiosRx Authorityperiodic reviewof arepresentativesample ofrecords isrequired.not supervisemore than 3total PAs at thesame time. TheBoard mayauthorize 6 totalPAs if necessaryand upon priorpetition. (IAC22.01.03.010)IllinoisNonePhysician maynot enter intocollaborativeagreements withmore than 5FTE PAs.(SB1585, PublicAct 100-0453)Schedule II-VIndianaRequired, butvaries with PAexperience andauthority. (Ind.C. 25-27.5-61(c))Physician mayenter into asupervisingagreement withmore than 4PAs, but maynot supervisemore than four 4Schedule II – laboration Determinedat PracticeSite?scheduled conferences between the supervising physician andthe licensee, and a periodic review of the patient services beingprovided by the licensee, the availability of the supervising andalternate supervising physician to the licensee in person or bytelephone and procedures for providing backup and supervisionin emergency situations (IAC 22.01.03.030)of MedicineCollaborativeCollaboration with the PA shall not be construed to necessarilyrequire the personal presence of the collaborating physician atall times at the place where services are rendered, as long asthere is communication available for consultation by radio,telephone, telecommunications, or electronic communications.(SB1585, Public Act 100-0453)Illinois n by the supervising physician or the physiciandesignee must be continuous but does not require the physicalpresence of the supervising physician at the time and the placethat the services are rendered. (Ind. C. 25-27.5-6-1)IndianaMedicalLicensingBoardYes 2018 American Medical Association. All rights reserved.7

StateCo-SignaturePA RatiosRx ion/Collaboration Determinedat PracticeSite?PAs at the sametime. (IC 2527.5-6-2)IowaKansasRequired only ifPA is at aremote medicalsite: Supervisingphysician mustreview patientcare weekly andsign all chartsunless anexception isprovided.(IAC 645327.4(148C))Physician maynot supervisemore than 5 PAsat one time.(IAC 645326.8(148C))Required, butvaries with timeand physicianPA relationship.Physician maynot supervisemore than 3total PAs whoSchedule III – VSupervisoryThe PA mayorder ScheduleII controlledsubstanceswhich are listedas depressants inIowa Codechapter 124 onlywith the priorapproval anddirection of aphysician.Schedule II-V"Supervision" means that a supervising physician retainsultimate responsibility for patient care, although a physicianneed not be physically present at each