andersenpa Posted May 17, 2011 Share Posted May 17, 2011 We often hear this on the forum- which states are more PA friendly than others, progressive vs restrictive. What are the factors that make a state PA friendly? Ease of licensure/renewal requirements Prescriptive authority/limitations Supervisory ratio and restrictions Scope of practice cosignature requirements Practice ownership Admitting privileges (is this a state issue?) I have no idea the current state of things like home care, workers comp, hospice, etc. What else are you dealing with in your practices? Link to comment Share on other sites More sharing options...
btg138 Posted May 18, 2011 Share Posted May 18, 2011 Not sure if this counts, but I have been in California and Arizona. Arizona is much more "PA Friendly" to me because doctors AND pts know what PAs are and how they can be utilized. In California I was sick and tired of explaining what a PA was and how they differed from Medical Assistants (or how we are not "like a nurse"). Link to comment Share on other sites More sharing options...
andersenpa Posted May 18, 2011 Author Share Posted May 18, 2011 WOW you guys diasappoint. It seems every other thread here, someone has a comment about PA practice in their home state. I figured this thread would blow up. Maybe a thread on the finer points of CASPA would get more yield..... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 18, 2011 Moderator Share Posted May 18, 2011 of the threee states I have worked in WA>CA>OR in terms of pa friendliness. on paper OR looks good but once you have to deal with the pa boad(which also licenses accupuncturists...) you will understand the difference. Link to comment Share on other sites More sharing options...
andersenpa Posted May 18, 2011 Author Share Posted May 18, 2011 of the threee states I have worked in WA>CA>OR in terms of pa friendliness. What specifically about these states leads you to those rankings? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 18, 2011 Moderator Share Posted May 18, 2011 WA allows pa's to sign ANYTHING delegated them by their sponsoring physicians, no chart reiew requirement, pa's an run er's solo, sch 2-5 dea. easy to get license quickly CA: medical board farly pa friendly. pa's encouraged to work rural/underserved, etc. reasonable scope of practrice laws, etc OR massive bureacracy takes > 6 mo to get license, background check wants to know what your grandparents liked on their cereal, etc in WA it's all about what a pa can do and is entitled to do. in OR it's about you can't do anything unless we bless it. the OR board took > 1 yr to enact rules for pa's to prescribe sch 2 even after the law was passed allowing it. you need every little thing spelled out in your practice desciption(may use slit lamp, may suture lacs, may do I+D's, etc) Link to comment Share on other sites More sharing options...
Vulgatus Posted May 29, 2011 Share Posted May 29, 2011 bump Interested to hear more feedback about this topic. Also, I tried to find some sort of list of PA vs NP friendly states but didn't come up with much. Has anyone else stumbled on information pertaining to this? Link to comment Share on other sites More sharing options...
IAmAPAStudent Posted May 30, 2011 Share Posted May 30, 2011 I agree with Vulgatus - I'd love to see a list of PA vs NP friendly states (or those that accept both about equally) but have a difficult time finding this data. On a side note that is slightly related: I did read in http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Front-Center/Despite-Rallies-and-FTC-Support-Florida-NP-Legislation-Stalls.aspx that all states except FL/AL allow NPs to prescribe controlled substances, and all states except FL/KY allow PAs to prescribe controlled substances. Link to comment Share on other sites More sharing options...
Zeus Posted May 30, 2011 Share Posted May 30, 2011 WA allows pa's to sign ANYTHING delegated them by their sponsoring physicians, no chart reiew requirement, pa's an run er's solo, sch 2-5 dea. easy to get license quicklyCA: medical board farly pa friendly. pa's encouraged to work rural/underserved, etc. reasonable scope of practrice laws, etc OR massive bureacracy takes > 6 mo to get license, background check wants to know what your grandparents liked on their cereal, etc in WA it's all about what a pa can do and is entitled to do. in OR it's about you can't do anything unless we bless it. the OR board took > 1 yr to enact rules for pa's to prescribe sch 2 even after the law was passed allowing it. you need every little thing spelled out in your practice desciption(may use slit lamp, may suture lacs, may do I+D's, etc) Question about Washington. So you can write sched 2 meds without a M.D. Cosigning a chart? I thought California was liberal especially in rural areas but from the description that you gave about Wa it seems a lot more PA friendly. What is the PA to M.D. Ratio is WA? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 31, 2011 Moderator Share Posted May 31, 2011 Question about Washington. So you can write sched 2 meds without a M.D. Cosigning a chart? yup. no prob with sch 2 as long as you have your own dea. I think it's 4:1 unless a rural setting then more. don't know for sure. Link to comment Share on other sites More sharing options...
dm123 Posted May 31, 2011 Share Posted May 31, 2011 I agree with Vulgatus - I'd love to see a list of PA vs NP friendly states (or those that accept both about equally) but have a difficult time finding this data. On a side note that is slightly related: I did read in http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Front-Center/Despite-Rallies-and-FTC-Support-Florida-NP-Legislation-Stalls.aspx that all states except FL/AL allow NPs to prescribe controlled substances, and all states except FL/KY allow PAs to prescribe controlled substances. When I worked in Florida, there were many docs who were from other countries or came there to retire and work, mostly in Family Practice. There also seemed to be a higher ratio of those who graduated from foreign medical schools. As a group, these docs were protective of their turf. I often felt some resistance from docs who did not have a busy practice. I suspect at least a part of the reason is to limit competition. Link to comment Share on other sites More sharing options...
andersenpa Posted May 31, 2011 Author Share Posted May 31, 2011 yup. no prob with sch 2 as long as you have your own dea.I think it's 4:1 unless a rural setting then more. don't know for sure. I hadn't lookeds at the AAPA regs page in a while so I just checked it to remind myself. Current supervisory ratio is 3:1. No physician shall serve as primary supervisor or sponsor for more than 3 licensees without authorization by the commission. It does have this interesting stuff to say about remote sites: Licensee may be utilized in remote site (defined as a setting physically separate from the supervising physician’s primary place for meeting patients or a setting where a supervisor is present less than 25 % of the PA’s practice time). Commission or its designee may grant approval if there is demonstrated need; adequate provision exists for immediate communication; physician spends at least 10 % of PA practice time at the site. Commission may consider modifications to on-site requirements on an individual basis providing sponsoring physician demonstrates that adequate supervision is being maintained by alternate method. And of course: PA and supervising physician shall ensure that adequate supervision and review of the work of the PA are provided. PA and supervising physician shall ensure that all patient care measures are documented in written form by PA. Every written entry shall be reviewed and countersigned by supervising physician within 2 working days unless a different time period is authorized by commission. (No chart co-signature requirement for certified PAs.) Link to comment Share on other sites More sharing options...
andersenpa Posted May 31, 2011 Author Share Posted May 31, 2011 So the reason I started this thread is that I think we can come up with some sort of "scoring system" for PA friendliness. e.g. Prescriptive authority Full to sched II, no state formulary 3 pts Sched III, no state formulary 2 pts No narcs 1 pt etc..... using the parameters listed in the AAPAs regulations Scope Prescriptive Authority Supervisory Requirements/Ratio Co Signature Initial Application for license Additional licensure requirements/maintenance/renewal, fees New grad temp permit Board notification CME Add'tl education requirements- eg infectious, pharm Title/practice protection Identification SP Liability BOM representation PA Discipline Link to comment Share on other sites More sharing options...
Zeus Posted June 3, 2011 Share Posted June 3, 2011 I hadn't lookeds at the AAPA regs page in a while so I just checked it to remind myself. Current supervisory ratio is 3:1. No physician shall serve as primary supervisor or sponsor for more than 3 licensees without authorization by the commission. It does have this interesting stuff to say about remote sites: Licensee may be utilized in remote site (defined as a setting physically separate from the supervising physician’s primary place for meeting patients or a setting where a supervisor is present less than 25 % of the PA’s practice time). Commission or its designee may grant approval if there is demonstrated need; adequate provision exists for immediate communication; physician spends at least 10 % of PA practice time at the site. Commission may consider modifications to on-site requirements on an individual basis providing sponsoring physician demonstrates that adequate supervision is being maintained by alternate method. And of course: PA and supervising physician shall ensure that adequate supervision and review of the work of the PA are provided. PA and supervising physician shall ensure that all patient care measures are documented in written form by PA. Every written entry shall be reviewed and countersigned by supervising physician within 2 working days unless a different time period is authorized by commission. (No chart co-signature requirement for certified PAs.) Anderson, That sounds really dated. Is that in the AAPA policy manual? If so then it needs to be updated with more broad terms to direct the states looking to expand PA laws and regulations. I know in california it's 4:1 and charts must be signed in 30 days unless a sched 2 med was written during the visit then it's 7 working days. Link to comment Share on other sites More sharing options...
lapelirroja Posted June 3, 2011 Share Posted June 3, 2011 MA is 4:1 as well, I believe. Link to comment Share on other sites More sharing options...
andersenpa Posted June 3, 2011 Author Share Posted June 3, 2011 Anderson,That sounds really dated. Is that in the AAPA policy manual? If so then it needs to be updated with more broad terms to direct the states looking to expand PA laws and regulations. I know in california it's 4:1 and charts must be signed in 30 days unless a sched 2 med was written during the visit then it's 7 working days. This is current. Link to comment Share on other sites More sharing options...
brookspa Posted June 4, 2011 Share Posted June 4, 2011 Ga is 4:1, sche 3-5, Link to comment Share on other sites More sharing options...
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