Physicians, Practices Should Decide PA Supervision

Coming changes under the Affordable Care Act are going to drastically alter the healthcare system for the foreseeable future. Not the least of which is the training and deployment of provider human resources.

The pressure is on to train and deploy primary-care providers as quickly as possible into areas of need in the healthcare system. This is neither easy nor fast.

At our community hospital, nearly all of the physician assistant (PA) students who rotated through inpatient and surgery rotations have been hired by the hospital. There is still robust demand for physicians, PAs, and nurse practitioners (NPs) at our facility.

States have begun to look at increasing the scope of practice of other providers in an attempt to provide needed healthcare for the millions of currently uninsured patients who will become insured under the Affordable Care Act. This will certainly help improve the ways that a physician-led team can offer quality care to more patients. I know first-hand the utility and value of physician-PA teams where the PA is allowed to practice at the top of his education and abilities. Yet there is potential for frustrations and tension as state legislatures modernize practice laws.

In my opinion, the most reasonable and productive regulation in this regard is to allow decisions regarding "supervision" of PAs to the physician and practice sites. There is certainly a difference in the interaction that I have today with my surgeon today than I would have had at the end of my training 32 years ago. We think alike, act alike, and operate alike. We both take care of sick surgical patients the same way with little or no active interaction between us because we are of one mind in our practice of medicine.

Nearly all experienced physician-PA teams with whom I interact have exactly the same relationship. The whole of the team is much greater than the sum of the parts, and we need to enhance this symbiosis of the team practice of medicine with supportive laws and regulations. It is good for patient care.

For physicians who are used to working with PAs, the assimilation has been easy. However, it is really important to set up your team practice for success, whether you have worked with a PA or are planning to add a PA to your team.

Every state is different as to the regulation and licensing of PAs, so it behooves physicians and the practice to make sure they understand what it means medically and administratively to work with a PA on the team. Most of my experience is related to California, and many states have very similar regulations and my general comments should apply to most jurisdictions.

While "supervision" doesn't really completely describe the team practice of physician-PA teams, most PA regulations use this term. For the most part, physicians delegate a set of responsibilities and duties to a PA and allow the PA to act autonomously within those bounds. It is very important to formally document your team practice relationship. This document is called a "delegation of services agreement" (DSA) in California.

It is not enough to formally document the team's relationship between physicians and PAs, you have to practice it.

In scuba diving, we have a saying: "Plan the dive, and dive the plan." The same is true for the team practice of medicine, with and increasingly diverse population of providers.

So, in summary, know how all the members of you healthcare team are regulated, understand your responsibilities as a team leader, document your relationship, and actively practice your "plan." It will make for a much more satisfying practice and relationship with all members of your healthcare team.

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