PAs and Malpractice Risks: A PA's Perspective

I occasionally get questions from physician colleagues that highlight the confusion some physicians have about practicing medicine in teams with PAs, and the concerns many of them have regarding the malpractice risks associated with the PAs on these teams.

These are valid questions and concerns and, given that more PAs are practicing in teams with physicians and many have a significant level of autonomy in delivering care, I am encountering such questions and concerns more frequently than in the past.

Here's how I respond to such questions, and some guidance I have for physicians who are working with PAs, or considering doing so.

Do Your Homework

It behooves the physician working with a PA to vet the PA well to understand the training, experience, and capability of the individual PA. Physicians should keep in mind that a PA's capabilities may vary depending on experience. A new PA graduate in his first job requires a much more hands-on approach to team practice than a PA who has been practicing in that particular specialty for 10 years to 20 years.

While the main reason for vetting the PA is just good, responsible patient care, the secondary reason is that the physician is responsible for the care of each patient that the PA treats, whether the physician is aware of this patient or not.

In other words, when a PA is practicing medicine, he is the “agent” of the physician. This means that the actions and orders of the PA are considered the same as if the physician took the action or made the order.

Consider the Benefits

I have heard some physicians use malpractice risks as a reason to not work with PAs. I always counter with the “two heads are better than one” argument when it comes to caring for patients.

A more important argument is that historical data shows that PAs are sued at a much lower rate than physicians, and, when they are sued, the awards and settlements are much smaller than for cases involving physicians.

One of the maxims one of my physician colleagues taught me many years ago is that when your patients like you, they are much less likely to sue you and much more readily willing to forgive medical errors and subsequent injury. This is an area where I think that PAs really add value to a practice.

My physician partner and I have a robust plastic and reconstructive surgery practice. He is extremely busy and covers two hospitals. I am able to interact with our patients in a more timely and less harried manner; I handle the never-ending and sometimes overwhelming administrative burdens associated with a hospital-based practice; I give the patients validation for their questions and concerns; and I “triage” those concerns to determine which issues my surgeon needs to deal with directly.

Patients see us as a team and a united front. We both take time to get to know our patients, and address their concerns. I extend that ethos and capability to a level that I know increases patient satisfaction because our patients continually tell us so.

The bottom line is that if a physician does due diligence, he can confidently work in teams with PAs and other providers, and enhance the overall safety and effectiveness of the practice while at the same time reducing the liability risk to the team.

Guidance for Physicians working with PAs

Here's what physicians working with PAs should focus on to minimize their risks and maximize the benefits: 

• Know the skills, experience, and training of the PA. This should determine how much you interact with the PA and how much autonomy she receives.
• Discuss clear guidelines for managing difficult patient problems, so that everyone on the team is on the same page.
• Be available and approachable for interactions on patient care questions and concerns. This intuitively makes sense and is the basis for my belief that two heads are in fact better than one when it comes to patient care.
• Document the actual interaction/consultation you have with the PA. Given the ease at which these interactions can be documented in this day and age, there is no excuse for not documenting on the patient chart  all the team consultations that occur. My in-house H&Ps, as well as my consultations, always include documentation of my interaction with my surgeon, when it occurs.

This blog was provided in partnership with the American Academy of Physician Assistants.