Scope of Practice Limitations -- how strict do we have to be?

[MMA PA-C]

The scope of practice laws in Illinois are kind of vague. I used to think that if a patient had a complaint outside of my supervising physician's specialty that I had to refer her to the MD. But, I'm thinking that if I consult with him, and it is a condition that he would normally feel comfortable treating, everything is fine.

 

This has not been an issue for me in my career up until now, when I am interviewing with an OB/GYN. How does everyone deal with this in real life? When a woman comes in for an annual OB/GYN exam, she can often have complaints that are not OB/GYN-related, and he is comfortable treating uncomplicated acute complaints (rashes, asthma, etc).

[rcdavis]

A lot of obgyns hold themselves out as a bonefide primary care specialty.. (which I strongly disagree with).

That said, it all comes down to The language in your supervisory agreement: starting with the practice description( "the practice is centered in the (surgical/non surgical) care of (general/subspecialty) OB, OBGYN, or GYN. As such patients with general (OB,GYN, OBGYN) complains are evaluated and treated. In this practice, we also address general medical issues ( asthma, hypertension, general endocrinologist complaints, upper respiratory complaints, etc, such as would be seen and followed in an urgent care)))) or language to that effect.

If you are authorized to take care of "standard" non OB, non GYN medical issues by your SP, and as long as he/she is operating within the standards of your community OBGYNs, then you are covered.

If, however, your SP has limited her practice to GYN endo (for example), and does not routinely take care of urgent care issues, and if this is not addressed in your SP agreement, then you cannot/should not.

At least, that's my take.

[Bohuntr]

I don't treat anything my supervising physician wouldn't treat with the exception of a few minor procedures. I don't have a problem doing ingrown toenails, he isn't a big fan. I would like to do vasectomies in the office and believe that this is acceptable for family practice providers and PA's (I know several who do), but the last supervisor I had didn't feel comfortable doing it in the office.

 

Tougher question than it sounds; just because you feel comfortable with something doesn't mean your SP is comfortable with it, and of course he is typically going to be more comfortable with more things than you are. If you have a list of things you would like to do, write them down, bring basic financials (nothing fancy, just the basic's) talk to him or her and see what you can work out. You might even be able to make some extra cash. Cash payment for a vasectomy where I did a locums gig was 750, the PA could keep 250 of that. With an MA setting up, it's 30 minutes out the door. A Friday morning could net you 1250-1500...

 

That was just the procedure side and I'm not all about money, but don't forget that medicine is a business and the number one responsibility of any business is to maximize shareholder wealth unless you work in the public sector. Social responsibility is neat and all if you have the free time, but private practices are not in the habit of making social responsibility their number one priority if it causes them to close the doors for lack of funds. If you don't make at least 51% on your ROI (return on investment) you may be encouraged to stick with the basics.

 

I occasionally volunteer at a local clinic because I like helping people out when I can; sadly, I think do it more to make myself feel better than to help anyone else, but I do smile when I know that I made a difference in someone's life when they may not have had anywhere else to turn.