Oversight Requirements and Regulations for Supervising Physician Assistants

Katie E. LaDow

A physician assistant (or “PA”) is a healthcare professional who practices medicine as a part of a healthcare team with supervising physicians and other providers.  Each state has different rules as to what a PA may or may not be able to do.    This article will focus on Pennsylvania and New Jersey.  A PA is limited as to what he or she may do without being under the supervision of a licensed physician.  Generally, a PA may perform those duties and responsibilities, including the ordering, prescribing, dispensing, and administration of drugs and medical devices, as well as the ordering, prescribing, and executing of diagnostic and therapeutic medical regimens, as directed by the supervising physician.  Additionally, a PA may provide any medical service as directed by the supervising physician when the service is within the PA’s skills, training and experience, forms a component of the physician’s scope of practice, is included in the written agreement (referenced below) and is provided with the amount of supervision in keeping with the accepted standards of medical practice. 49 Pa. Code § 18.151.  A PA can provide numerous benefits to a licensed physician and/or medical practice, including but not limited to: easing the physician’s work load, increasing patient satisfaction through amplified face-to-face contact, providing cost effective staffing, and more.

It is important for doctors and practices to be familiar with the state laws applicable to the employment and supervision of a PA.  In Pennsylvania, a licensed physician must file a registration form with the Board of Medicine along with a written agreement between the physician and the PA. 49 Pa. Code § 18.142. In addition, a detailed recitation of the physician’s professional background and specialties, medical education, internship, residency, continuing education, membership in American Boards of medical specialty, hospital or staff privileges are needed in order to obtain permission to supervise a PA. 49 Pa. Code § 18.143.  In assuming the role of a supervising physician, the physician shall: 1) monitor the compliance of all parties to the written agreement, 2) advise any party to the written agreement of the failure to conform with the standards contained in the written agreement, 3) arrange for a substitute supervising physician in the event that the current supervising physician is not readily available, 4) review directly with the patient the progress of the patient’s care as needed based upon the patient’s medical condition and prognosis or as requested by the patient, 5) see each patient at least once while the patient is hospitalized, 6) provide access to the written agreement upon request and provide clarification of orders and prescriptions by the physician assistant relayed to other health care practitioners, and 7) accept full professional and legal responsibility for the performance of the PA and the care and treatment of the patients. 49 Pa. Code § 18.144.  A physician may not supervise more than four PAs without obtaining specific Board of Medicine approval.

Additionally, a PA may not provide medical services at a satellite location unless the supervising physician has filed a registration with the Board. 49 Pa. Code § 18.155.  The supervising physician must visit the satellite location in which the PA is providing services every ten (10) days.

New Jersey has very similar requirements for physician oversight of PAs.  N.J.S.A. 45:9-27.17.  A physician must have a written delegation or agreement with the PA that sets forth the PA’s duties, practice location, relationship with the supervising physician, etc.  However, New Jersey law does not require the supervising physician to be physically present at the hospital or health care facility in which the PA serves patients.  New Jersey only requires supervising physicians to be readily accessible to PAs and have continuous communication through telephone, electronic, or other communication channels.  N.J.S.A. 45:9-27.18.  The supervising physician is required to review patient records/charts within seven (7) days of their inception and review all medication or prescription orders within forty-eight (48) hours.  As in Pennsylvania, a physician may not supervise more than four PAs without obtaining specific Board approval.

The use of PAs is a cost effective way to improve a medical practice.  It is important to ensure the supervising physician and PA are in compliance with the state requirements.

Lamb McErlane PC can assist physicians and medical practices in understanding the laws and regulations that apply to PAs and how they relate to one’s present situation.

Katherine (“Katie”) E. LaDow is an associate in the litigation department at Lamb McErlane PC. She concentrates her practice in the areas of state civil litigation, family law and health law. 610-701-3261.