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Can PAs ever practice without MD supervision?


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DMAT (disaster medical assistance teams. i.e. federal disaster teams). I have been a member for over 8 years and never been asked by the state or federal govt or the team itself to arrange a supervisor. it's nowhere in the application packet for PAs, etc.

Outside of the US on volunteer/disaster missions (not paid work) it is "suggested" by the aapa that you work with physicians but there is no formal requirement that you do so.

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  • 2 weeks later...

I've shadowed many PAs (cardiology, GI FM, IM, ER, walk-in, etc) in upstate NY and all of them are very independent. They have their own patients, write their own prescriptions, order Xrays, etc. When there's something that they're unsure of, these PAs all have access to their supervising physicians whether that's by phone or in person. But for the most part, these PAs do almost everything independently and just asks a MD to sign off on paperwork. 

 

I feel like it definitely depends on location. PAs in rural areas may have more independence than ones in the cities. Also, level of experience and a MD's trust of a PA's skill level adds to the "independence" equation, too. 

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It really comes down to state law.  I am licensed in two states.  One state allows for PA SOP to be whatever is determined at the practice level.  No co-signature required (except in cases where another entity demands it, such as for orders for DME, or for other entities who still practice by old laws and won't recognize the PA sig.) Schedule II-V rights with a letter of delegation kept on file at the practice site.  This is my current state of practice and I am 99% "independent" and make autonomous decisions.  I discuss cases with the collaborating physician when needed.   I work rural, isolated clinic and am expected to practice to the level of a physician....which is also outlined in state law.  This state also has higher lawsuits for physicians, not sure about PAs or NPs. 

 

The other state SOP laws is outlined in the Medical rules and is more restrictive:  No chart co-sig or script co-sig, must practice within the SOP as outlined in the law (making it more restrictive).  Schedule II-V rights as delegated with an agreement kept on file, and we must always keep track of traceability ( a new aspect of our law just started due to a surprise addendum that could not get negotiated out with the last go-around to improve our laws).  Traceability means the PA must always keep a record of who the collaborating physician is on any and every day they practice and keep on file for 5 years or so.)  Chart review is determined at practice level and prescription practice is reviewed once a year.    This state has very few lawsuits for MDs, PAs, NPs, etc.  We are one of the few states with a patient compensation fund.  

 

So, pick your state when you are looking for a job.  I love working in the first state I mentioned above, however am making a change to the second state (my residence is located in the second state), so I am choosing to go to a more restrictive state for personal reasons and because of a hostile environment that has developed at the first site in the last year.  (Sad for me and the patients, they lose).  

 

It is what it is.  You have got to make the grass green where ever you practice and then keep advocating for better state laws and loosening of restrictions. 

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