Reporting Structure

[Houstonian]

I would like to take a poll of PA's in this forum.

 

Specifically, who do you report to?

 

Do you have more than one boss?

 

How well does it work?

 

How many supervising physicians do you have?

 

What is the relationship between the person you report to and your Primary Supervising Physician? Is it one and the same or different? If different, how well does it work?

 

Does your Primary Supervising Physician actually supervise you, or is he/she just a name on a piece of paper?

 

What is the ideal reporting structure for a PA?

[MCHAD]

Requirements for supervision vary by state, and experience...

[Houstonian]

I am not talking about medical supervision. I am talking about organizational supervision.

[MCHAD]

you're going to have to clarify...

[ventana]

non medical decisons go through a practice manager - ~55 yr old RN who no longer does nursing - things like scheule, CME reibursements, days off and the like

 

one local hosptial got the surgical PA's out from under a charge nurse only about 6 years ago - that was not a good set up for obvious reasons.

 

I have been in a number of practices both private and hospital based - medical decisions always go to a doc, but their is typically a quasi professional person who they call practice manager (or something like that) that deals with all the crap. Strange, they make them practice manager but then they get stuck with a bunch of trival poop also..... beware of the practice manager that has a power trip ot that does not treat you like a professional and tries to micro manage you schedule - ends up really stinking.....

[sbellin]

In my facility PA's and NP's are an equal to the docs in the organizational structure; to the limit of the law.

[EMEDPA]

organizationally I work for an independent er group that contracts with a hospital. the medical director and president of that company are both my "boss".

I have 5 different clinical sites, each with a differtent sp of record. for all intents and purposes that is just a name on a paper as some of them I never see or work with. on a day to day basis my sp is whichever doc I am working with or whoever reviews my charts the next day when I work solo.

as a senior em pa I am really not "supervised " any more other than chart review or consults when I ask for them. at 1 facility I am scheduled interchangeably with docs. we can cover each others shifts and trade freely.

[Houstonian]

In any health care organization, there are going to be strictly clinical responsibilities (such as deciding on the most appropriate treatment for a specific patient), strictly administrative responsibilities (such as payroll, business office, administering HR benefits), and there are some responsibilities that are neither strictly clinical or strictly administrative. For example, who should do the performance evaluation for a physician assistant--the practice manager, or the supervising physician? Who should make decisions regarding hiring or firing of a physician assistant? Who is responsible for seeing that a new PA is properly trained and oriented? Who should decide if the PA is doing a good, mediocre, or excellent job--and whether a pay raise is merited? Who should decide which PA does which job, and on what day (i.e. scheduling)?

 

And how should one deal with it if the organization that employs you puts anyone other than a physician in charge of such functions for you as an individual PA or for an entire group of PA's? (I am in a state that requires periodic evaluations of the PA's performance be conducted, but does not require that a physician conduct the evaluation.)

 

In my practice, the physicians seems to define their role strictly in terms of making clinical decisions on individual decisions, and the primary supervising physician is basically just a name on a piece of paper.

[Houstonian]

I would like a physician medical director or "managing physician" to be in charge of these sorts of considerations, and feel very uncomfortable with a non-physician (even a PA) in that role.

 

How can one deal with this issue without offending the current (non-physician) supervisor?

[kittryn]

this is not hard. practice managers are administrative and do not have to have clinical credentials. they are the go-to person for scheduling matters, OT, vacation, etc. docs do not want to bother with this crap and just want to know patients are covered and the practice is making money. practice managers are often considered a PA's supervisor, but only with regard to administrative matters. SPs are ALWAYs MDs, period, and should ALWAYS be the ones consulted for clinical/patient care matters.

 

why does it matter to you, houstonian, that a practice be an MD? no organization would pay an MD salary -- or even a PA salary -- to a practice manager. and no MD would likely accept a typical practice manager's salary. it would be a complete misuse of human resource to put an MD in this role.

[Houstonian]

I am not suggesting that a "practice manager" be an MD, although many practices traditionally have had a "managing partner". Nor am I suggesting that an MD be saddled with a lot of (unnecessary) administrative duties. I am merely stating that: 1) a PA should report to a physician, 2) an employee should have just one primary boss/supervisor, and 3) that the person who organizationally supervises the PA should actually supervise the WORK of the PA--(i.e. the medical work, since all of our work is medical). That would pretty much rule out an administrator functioning as the organizational supervisor for a PA.

 

A physician can delegate administrative duties to someone else while still taking responsibility as the primary supervisor of a PA (or group of PA's).