Can a PA perform a procedure if the SP doesn't know how to do it?

[julia_dodo]

Hello everyone!

I have a question. Can a PA perform a procedure if the SP doesn't know how to do it? 

I work in a private family practice. We do some birth control management but only OCPs right now. I recent went to a training session for Nexplanon on my own. My MD sees more older ppl, so he doesn't care about birth control and doesn't want to be bothered. But I see a lot younger women and think it's a good idea. He doesn't mind me doing the job, but I'm not sure if the law would allow me to perform the procedure since my MD doesn't know how. Is it still considered " within scope of practice"? 

Any input?

Thanks a lot!

Julia

[rev ronin]

Regardless of the legalities, who is going to back you up if you can't get it done?  Collaboration is more than just about control and oversight, it's also about two clinicians just being available to put their heads together over something

[LESH]

It's not in California.

[SHU-CH]

This is probably illegal in a lot of states, and a bad idea in the remaining states. What would your SP do (or be able to do) if you ran into a complication?

[Avalon]

This is an interesting question, which may actually affect me as well.  

 

The manufacturer of Nexplanon (Merck) requires a training workshop (approximately 3 hours, with didactic and experiential components) and registration with the company before a clinician can order and place the device.  My collaborating physician has repeatedly refused (on principle) to attend the training, as he does "deep pelvic surgery on a regular basis" and feels the required training, which requires an investment of time and money, is unwarranted and demeaning (no comment).  The Nexplanon rep is in our office weekly and has never even suggested that the physician needed to be trained and certified in order for me to offer the procedure. We are literally walking distance from a hospital ED in the extremely unlikely event that a serious complication should arise.

 

I trained with a group comprised predominantly of NPs at a national conference, so I would doubt that all of them are from states with independent practice privileges.  I will definitely have to explore this further and feel quite chagrined by the fact that I never considered the implications of this.

[True Anomaly]

I don't do procedures that my SP doesn't do

[HJK]

I don't do procedures that my SP doesn't do

Don't do vs can't do?

[CanadianPA]

Interesting. I have taught more than a few of my SPs how to do some things.

[julia_dodo]

This is exactly what's going on here.  My SP feels the same way about the training program, stating it's not worth his time.

So....do you do the procedure in your office? 

 

This is an interesting question, which may actually affect me as well.  

 

The manufacturer of Nexplanon (Merck) requires a training workshop (approximately 3 hours, with didactic and experiential components) and registration with the company before a clinician can order and place the device.  My collaborating physician has repeatedly refused (on principle) to attend the training, as he does "deep pelvic surgery on a regular basis" and feels the required training, which requires an investment of time and money, is unwarranted and demeaning (no comment).  The Nexplanon rep is in our office weekly and has never even suggested that the physician needed to be trained and certified in order for me to offer the procedure. We are literally walking distance from a hospital ED in the extremely unlikely event that a serious complication should arise.

 

I trained with a group comprised predominantly of NPs at a national conference, so I would doubt that all of them are from states with independent practice privileges.  I will definitely have to explore this further and feel quite chagrined by the fact that I never considered the implications of this.

[EMEDPA]

I left a job over this issue a few years ago. A place I worked switched all the SPs from the dept of emergency medicine to the dept of family medicine. I pointed out to them that the new sp they wanted to assign me to ( a new fp md residency grad) could do maybe 1/2 of what I do in that setting. The organization didn't seem to think it was a problem. I did. handed in my pager and ID on the spot after their dept director ( an RN) told me "you're just a physician's assistant, it doesn't matter who you work with". it mattered. still glad I left. that dept no longer exists.

[jmj11]

Can't and don't are the defining statements above.  I do Botox and my SP doesn't. However, he has been trained in it and could if he wanted . . . but doesn't want to.  So it is not beyond the scope of practice of the SP.

[Guest Paula]

The SP needs to at least go through the training, in my opinion.  I do not do procedures my SP doesn't do.  With my new job and learning the ropes I've learned that the employer has taken nearly all procedures out of the hands of all the FP physicians, and say that the UC/EM department is to do them.  So when I had a patient present with a foot injury, midshaft displaced comminuted 5th metatarsal fracture, I could not splint it for her.  What a shock to find out there were no supplies in the dept.  Fortunately the pt. had borrowed a walking boot from a neighbor and the ortho I called said it was fine to use it.  I didn't have to send her to UC for the splint....which would have been another charge.  HMMMMM.

 

Not sure why they wanted to know what procedures I did before I was hired???????

 

My SP used to do all of that stuff.  I'm finding he is a great guy...we think the same.

 

So, to the OP:  Check your state laws and see how they are stated.  If your SOP is determined at the practice level and you are deemed to be competent in placement, then maybe ok.   I think it depends on the state you work in.  

[FBIDoc]

It's simple Julia...check your state practice act...that will tell you if you can or can't...as others have posted, step two is to determine if you should/shouldn't...if your SP isn't trained and there's a bad outcome, you're hung out to dry

[CByersPAC]

Not in Washington. Don't know about other states.

[ItRainsItPours]

My mom is an internist and works in urgent care. A senior PA there who worked EM his whole career prior would reduce fractures and close complicated lacs that many of the physicians there were uncomfortable with. She said after he retired they had to start sending a lot more patients to the ER that the PA wouldve been able to handle. This is in Maryland.

[sillycibin]

My mom is an internist and works in urgent care. A senior PA there who worked EM his whole career prior would reduce fractures and close complicated lacs that many of the physicians there were uncomfortable with. She said after he retired they had to start sending a lot more patients to the ER that the PA wouldve been able to handle. This is in Maryland.

This is is an example of how things are actually done in practice while differing from what is written in the laws or medical board guidelines.  I think technically you are not supposed to perform any procedure (or practice any medicine even) that isn't something your SP does.  This is something I run into a lot since I have changed jobs several times and spent 2 years practicing emergency medicine so I have broad knowledge to handle a lot of situations that my SP now doesn't typically deal with.  

[Avalon]

Here's my update on the question:

 

I discussed this concern with the Nexplanon rep to our office.  She said she had never encountered this issue before in her territory, but also acknowledges that she does not call on many practices in OB/GYN that have PA providers.  She then called the state's BOM (to keep me anonymous) and was referred to the list of "Advanced Procedures for Obstetrics and Gynecology" that the state uses in its delegation agreement (there is such a list for several specialties).  This list includes procedures the BOM considers to require additional training as well as a specific number of observed procedures before they can be considered part of the particular PA's scope of practice.  Nexplanon insertion is not on that list. Remember, to be eligible to order the device for patients, a provider must be trained, observed, and certified by the parent company as competent to do so.

 

While my collaborating physician has not chosen to undergo this training, he is a gynecologic surgeon of more than 20 year's experience.  His surgical skills most certainly include the management of complications related to superficial sub-dermal procedures.  As an office, we have decided to continue to offer the service.  My collaborating physician is writing a letter to the BOM stating he considers this procedure to be under my scope of practice.  I'll send an update if there are any complications with this plan of action.

[delco714]

Sweet!!!! Congrats. Love to hear this type of success and trailblazing