Supervising physician is changing from FP to IM, question on scope.

[nycRPAC]

My current supervising physician, Family Practice guy, is leaving our practice and being replaced by an Internal Medicine guy.  This new IM physician is not comfortable seeing kids.  My question is, can I still see peds patients or is there a liability issue?  I am being told by my Medical Director, who is Family Medicine, that I would be able to consult him on any pediatric issues.  I’m not feeling completely comfortable with this situation and was looking for some input.

Thanks.

[EMEDPA]

as long as you have alternate SPs this isn't a problem. I have worked at several places where my scope of practice in EM was >> my "sp" of the day, but since I am "supervised" by every doc in the group, including the er docs, it's ok.

I've been in a situation before where I was teaching a 3rd yr fp resident 1 week and the next week they were my "sp of the day" after we hired them. needless to say, I didn't ask them anything or present any cases to them and they still knew who should see the really sick folks who rolled in....and it wasn't them.....

[Guest Paula]

I had a similar  situation several years ago.  The FP I worked with did not get a contract renewal and the tribe hire an IM physician .  He was not comfortable seeing peds or women and in fact refused to see them.  Since he was the ONLY physician I checked it out with my state laws and could have been practicing outside of his scope.   I was uncomfortable staying so ultimately left my job.

 

In your position however you have a FM director so he should suffice as you are in the same system.  Just check to see if your state laws require that you name him as an SP. 

 

I think you should be ok. 

[nycRPAC]

Thank you both for the info.  I will try and track down the New York requirments for this case. 

Thanks again.

[cbrsmurf]

From a nonlegal perspective

 

If you are seeing a peds patient and it's truly someone you cannot handle or have questions about, do you have a physician (pediatrician or FP) there that you can consult?  If the answer is no: I definitely would not put myself in that position.

 

 

From a legal perspective, make sure your SP('s) are certified to see kids and that it is also written down in your delegation of services contract that they are ok with you seeing kiddos.

[LKPAC]

The scope of practice for your SP includes all people, just because he limits himself to adults by choice, does not mean that he is not legally able to treat children.  Therefore, your scope includes all people.

 

Correct me if I'm wrong, but MDs are not necessarily limited by their specialty.  A specialty adds to their credentials and abilities, not limits it.  A surgeon can still treat a child for an ear infection.  And yes, a pediatrician can treat adults.  So, an IM can treat children, but does not have specialty training in that area.

[EMEDPA]

The scope of practice for your SP includes all people, just because he limits himself to adults by choice, does not mean that he is not legally able to treat children.  Therefore, your scope includes all people.

 

Correct me if I'm wrong, but MDs are not necessarily limited by their specialty.  A specialty adds to their credentials and abilities, not limits it.  A surgeon can still treat a child for an ear infection.  And yes, a pediatrician can treat adults.  So, an IM can treat children, but does not have specialty training in that area.

most docs don't practice outside their area of specialty training because of legal ramifications. imagine the court case if an internist misdiagnosed a child:

Lawyer: so, dr samuels, just how many hours of pediatrics training did you have in your residency and how many kids do you typically see every month?

Dr Samuels: um, none to both question...

Lawyer: Your honor, the prosecution rests...

[LKPAC]

True, but I'm not talking about that.  I'm saying a licensed MD is allowed to practice, therefore, an IM doc's PA is allowed to care for children without go outside the scope.

[burnpac]

True, but I'm not talking about that. I'm saying a licensed MD is allowed to practice, therefore, an IM doc's PA is allowed to care for children without go outside the scope.

I think this is a very hazardous assumption. The scope of practice of the PA, is the scope of practice of the physician with whom he collaborates. If this physician does not feel comfortable seeing certain types of patients and refuses to see them, then the PA should do the same. To do otherwise would be indefensible in the eyes of most medical boards, and you would risk your license.

 

 

Sent from my iPad using Tapatalk

[LKPAC]

Please keep in mind that I'm just having a conversation on the subject, not necessarily advocating a position.  A little devil's advocate if you will.

 

Let's take an example:  I'm very good at performing I&D's.  My SP is not, so he chooses not to do them.  Still, he is qualified to do them, so there's no reason I can't.  (this is just an example, my SP is actually good at this.) 

 

please continue to discuss.

[nycRPAC]

Some more info...

 

"SCOPE OF PRACTICE
PA may perform medical services only when under the supervision of a physician and only when such acts and duties are within the scope of the supervising physician’s practice. Nothing shall prohibit a hospital from employing PAs.
N.Y. EDUC. LAW §6542"

 

and the definition of IM according to ACP

 

"Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness."

 

This seems to be a pretty consistent description of IM with some including adolescents, though there is a boarded subspecialty of adolescent medicine.

 

It would seem a good idea to also have FP SP if I am going to see kids.

[rpackelly]

I worked in NY and we did not have to work with a named supervising physician within a group.....the entire group rotated supervision between satellite sites and especially with call and admissions issues.   We did have one SP that was named as our primary.   

[Gordon, PA-C]

The scope of practice for your SP includes all people, just because he limits himself to adults by choice, does not mean that he is not legally able to treat children.  Therefore, your scope includes all people.

 

Correct me if I'm wrong, but MDs are not necessarily limited by their specialty.  A specialty adds to their credentials and abilities, not limits it.  A surgeon can still treat a child for an ear infection.  And yes, a pediatrician can treat adults.  So, an IM can treat children, but does not have specialty training in that area.

 

Sorry, but this is wrong.  The term "illegal" is irrelevant here.  Yes, there's nothing in the law that says a pediatrician cant do brain surgery, but you wont find any pediatricians doing brain surgery because 1) it's incredibly unethical; 2) it exposes them to enormous liability; 3) they would be shunned by other MDs and ostracized from the medical community; 4) hospitals wont allow it.

 

IM doc has absolutely zero business treating children (unless you are talking strictly about teenagers).  Same thing as peds doc doing brain surgery.  IM doc treating children would inevitably lead to serious problems with the medical board, even though it is not "illegal"