Q: I have run a small group practice for many years. We can no longer keep up with the demands of seeing every patient every time they come into the office. Hiring a physician assistant or two seems to be what many similar practices have done to keep up. What are the delegation and supervision requirements applicable to having physician assistants work in the office? Is there a limit on how many PAs we can hire/supervise?
Several Michigan laws applicable to the practice of physician assistants were changed in 2017. Those effect of those changes was a shift from PAs being regulated pursuant to the delegation and supervision provisions of Michigan’s Public Health Code to now being required to practice pursuant to the terms of a practice agreement with a physician. There are no specific limits on the number of practice agreements a participating physician may have in place with PAs at the same time.
Your group practice must appoint a “participating physician” who will enter into a practice agreement with each PA the group hires. The practice agreement must contain the following provisions:
A process between the PA and participating physician for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the PA and participating physician based on their education, training, and experience.
A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.
The signature of the PA and the participating physician.
A termination provision that allows the PA or participating physician to terminate the practice agreement by providing written notice at least thirty (30) days before the date of termination.
The duties and responsibilities of the PA and participating physician. The practice agreement shall not include as a duty or responsibility of the PA or participating physician an act, task, or function that the PA or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the PA or participating physician.
A PA is prohibited from performing acts, tasks or functions to determine the refractive state of a human eye or to treat refractive anomalies of the human eye, or both. Likewise, a PA shall not determine the spectacle or contact lens prescription specifications required to treat refractive anomalies of the human eye or determine modification of spectacle or contact lens prescription specifications, or both. A PA may, however, perform routine visual screening or testing, postoperative care, or assistance in the care of medical diseases of the eye under a practice agreement.
You should consult with your malpractice insurer and make sure any necessary changes are made to your policy to ensure that you have coverage for the services provided by the PAs you hire. You should assume that the changes to the law regarding PA practice do not change your practice’s liability exposure for claims arising from services provided by your PAs.
Generally, a PA who is a party to a practice agreement may prescribe a drug in accordance with both the authority granted in the practice agreement and those procedures and protocols for the prescription established by rule of Michigan Department of Licensing and Regulatory Affairs. If a PA prescribes a drug, the PA’s name shall be used, recorded, or otherwise indicated in connection with that prescription. If a PA prescribes a drug that is included in schedules 2 to 5, the PA will need to have a Michigan controlled substances license and DEA registration. When writing controlled substance prescriptions, the PA’s DEA registration number shall be used, recorded, or otherwise indicated in connection with that prescription.
MSMS has a comprehensive legal alert addressing the requirements applicable to employing PAs which include FAQs, forms, and other materials you may find helpful. These materials can be accessed at: http://MSMS.org/Alerts.