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UC Practice Question


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Hello all,

 

I work in an ED where we have both an Urgent Care section and a Main section. PA's rotate through both.

 

As it currently stands, when a PA staffs the UC he or she is responsible for seeing every patient, but our group prefers that we present each and every case, in real time, to an MD prior to disposition of the patient.

 

As you can imagine, this produces a lot of delays in finding a doc, presenting, then sometimes some docs want to see the patient, take forever to do so, and the UC gets clogged up, is completely inefficient, and is the most frustrating and exhausting shift we work. 

 

I have not worked elsewhere but have interviewed other places and also done rotations in ED's where the UC section is exclusively staffed by PAs, and where they do not present cases in real time. Some send the MA over to have the MD sign the chart, some do after-the-fact chart signing.

 

I have brought this up to my group as a possibility to try to optimize the UC flow. The concern of the group is whose liability is on the line for when they sign charts.

 

I have been scouring Google with no avail, have contacted MAPA without response, so I am wondering if anyone here has either first hand information or any ideas on resources for an answer.

 

In brief, would the person signing my chart be any random doc after the fact, would it be whomever is physically present during the shift, would it be my SMD (on paper), would it be the head of the group? I imagine the person signing off on my chart would be legally liable for my decisions, so I want to know for sure who that person would be. 

 

Also, do all PA charts have to have sign off by an MD?

 

Thanks so much in advance for any information!

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that sounds like a fairly restrictive practice. I don't believe any state requires that a doc physically see or hear a real time report on every pt.

cosignature is a matter of state, facility, and group requirement. many places only require X% signed within 1 month. at most places the doc of the day just signs all pa charts at the end of the shift as all docs in the group are listed as supervisors. some docs don't even read them, some do and ask questions about them.

a sign of a good pa job is that the docs trust the PAs to present the pts they feel they need to(or some required subset like level 1-2 visits) and let them do their thing the rest of the time. many pas work entire shifts either alone or alongside a doc during which they never present pts.

At my primary job I have not worked a shift with my sp of record in > 2 years. I work in a different facility than he does and it is likely that he does not even know he is my sp as it is a large group. my state does not require chart review at all , but the hospital does so the doc working day shift following my solo nights typically signs the charts. at my per diem jobs, the charts are all sent automatically to my sp (by the emr) and he just clicks a button that says "sign all" when he gets around to it.

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Right, my question was specifically about MA requirements as I cannot find it in any of the mass.gov documents governing PA practice.

 

Our practice is both a little restrictive and also very liberal in many other ways. Many places have a "Pas don't see critical patients on their own" rule. We can see any patient, any time, order whatever, perform whatever procedures. Just at some point before disposition, we have to run it by the doc. Which is totally okay with me in the Main ED, but absurd in UC, where the PA covers all by themselves but then has to also run all over the Main ED finding someone to present, and then to re-touch base if the MD chooses to see the patient.

 

The practice of presenting all cases is group-decided, but the option of physically seeing the patient is completely MD specific. Most of our MDs during a shift ask the PA "Do I need to see this patient?", and trust us to let them know if we need them to. However, some MDs are a bit more on the control freak side, so they choose to see ALL patients, at their leisure, which is super annoying. If you feel you want to see a suture removal patient that an EM PA with 12 years experience just saw, then at least do it promptly! The ones that do this do it with all Pas, even the Pas who have more experience than they do. These tend to be the young, new and scared MDs. 

 

Other MDs are the opposite. Recent conversation: "Hey, Joe, I just intubated the OD in Trauma 1." Joe replies, "You're good in there?", and if I say yes, that's the end of it. Joe calmly continues his lunch or his own patient encounter knowing I got things covered.

 

So I don't think the fact that some of our doctors want to see all patients is the sign of NOT being a good PA. Like I said, it is completely MD specific and the ones that are "hoverers" do it with all the PAs. It's to me much more of a fear-based or control-freak thing that is inherent to the personality of the physician, not the PA. Also, in the particular case of our UC shifts, only once you have been wight he group for 18 months to 2 years do they let us cover UC shifts. So newbies are seeing Main patients with close MD supervision, and once we become Tier II we can move to the UC shifts and also the shifts in our smaller more isolated sister hospital where there is a single doc and a single PA.

 

If the more micromanaging docs knew for a fact that they would not be liable for PA errors, then I think I can move the practice forward to improve flow, specifically in Urgent Care.

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