KhoiFish82 Posted June 23, 2011 Share Posted June 23, 2011 In medicine, there is a lot of talk of what PAs can do. Quite frankly, PAs can do a lot in medicine. For the most part, they practice medicine autonomously. The scope of practice for a PA is usually determined by the physician the PA is working under, the PA's level of training and experience, or sometimes by a state regulating body. Other than these lines, is there anything in particular that a PA can't do that an MD or DO can? Link to comment Share on other sites More sharing options...
Hemegroup Posted June 23, 2011 Share Posted June 23, 2011 Prescribe medical marijuana. Link to comment Share on other sites More sharing options...
andersenpa Posted June 23, 2011 Share Posted June 23, 2011 Every state has their restrictions. You can find them under the state reg on the AAPA site: http://www.aapa.org/advocacy-and-practice-resources/state-government-and-licensing/state-laws-and-regulations/516-summaries-of-state-laws-and-regulations Then there are the specific restrictions that certain institutions may have in as well- eg some places don't allow PAs to supervise conscious sedation, order certain medications, etc.... Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted June 23, 2011 Share Posted June 23, 2011 Pronounce death (at least in most states) & sign death certificates. Link to comment Share on other sites More sharing options...
FriarMedic Posted June 23, 2011 Share Posted June 23, 2011 Pronounce death (at least in most states) & sign death certificates. Didn't know that...pretty surprising (pronouncing), considering EMS can pronounce in the field and in few states PAs are medical directors or in most states- assistant medical directors. Link to comment Share on other sites More sharing options...
Hemegroup Posted June 23, 2011 Share Posted June 23, 2011 ... and in few states PAs are medical directors or in most states- assistant medical directors. Do you have a link to some info on that? Link to comment Share on other sites More sharing options...
Contrarian Posted June 23, 2011 Share Posted June 23, 2011 Limitations in/of Scope of Practice is state and/or institution specific... Prescribe medical marijuana. Technically... neither can Physicians. NO licensed and registered prescriber can use their DEA # to "prescribe" schedule I drugs. The federal government classifies marijuana as a Schedule I drug, which means that licensed medical practitioners cannot prescribe it. Your physician must provide written certification of a “debilitating medical condition” and can only "recommend" the use of medical marijuana. Well they can... but will likely get a visit from the Feds, sanctioned, etc. But one example ... Another from NEJM here... Here... Both Physicians and PAs can "recommend" a patient use medical marijuana... 2010 Legislative Changes to Medical Marijuana Law Substitute Senate Bill 5798, Medical Marijuana, passed the legislature in the 2010 session. This bill makes the following changes to Chapter 69.51A RCW: Adds advanced registered nurse practitioners, naturopathic physicians, medical physician assistants, and osteopathic physician assistants to the list of health care providers who can recommend medical marijuana. Requires recommendations for medical marijuana written on or after June 10, 2010 to be written on tamper-resistant paper. Patients are no longer allowed to use a copy of their medical records in lieu of a written recommendation. Pronounce death (at least in most states) & sign death certificates. Again... state specific. I never "pronounced death"... but when I did "Housecalls" full-time... I signed atleast 2-3 death certificates per month. Here, PAs can sign pretty much anything a physician can sign... but again its state specific. YMMV Contrarian Link to comment Share on other sites More sharing options...
Hemegroup Posted June 23, 2011 Share Posted June 23, 2011 That Senate bill appears to be for Washington state only, correct me if I'm wrong? All I can find for my state, California, is this: http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph9044.pdf Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 23, 2011 Moderator Share Posted June 23, 2011 Pronounce death (at least in most states) & sign death certificates. both ok for pa's in WA Link to comment Share on other sites More sharing options...
medic25 Posted June 23, 2011 Share Posted June 23, 2011 both ok for pa's in WA Same in Connecticut, at least for "anticipated" deaths. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 23, 2011 Moderator Share Posted June 23, 2011 In MASS can't make the decision to admitt or d/c to hospital (might be local hospital bylaws) can't be listed as someone's PCP (this is just plan stupid as NP's can and we are dangerously short on PCP's) Can sign a death cert as long as the attending have been "attempted to be contacted" can write schedule II-V can't do a cardiac cath alone can't administer ionizing radiation - radiologist has to be around in the department - law getting changed can own up to 99% of own company and bill medicare but can't get credentialed with most insurance companies as they don't recogonize PA (also a law trying to be changed) know a little about NYS They forbid a PA from owning any share of a company that then employ's a SP - how stupid is that! Can't administer radiation unless you are also an RT (slow steps are being made to change this....) Link to comment Share on other sites More sharing options...
Contrarian Posted June 23, 2011 Share Posted June 23, 2011 Other than these lines, is there anything in particular that a PA can't do that an MD or DO can? Prescribe medical marijuana. Limitations in/of Scope of Practice is state and/or institution specific... That Senate bill appears to be for Washington state only, correct me if I'm wrong? Again... state specific. Not wrong.... Link to comment Share on other sites More sharing options...
KhoiFish82 Posted June 23, 2011 Author Share Posted June 23, 2011 Off topic, contrarian..I PMd you..not sure if you got the message... Link to comment Share on other sites More sharing options...
KhoiFish82 Posted June 23, 2011 Author Share Posted June 23, 2011 Lets dig a little further. Is there anything as far as training goes that an MD/DO is trained in, but a PA is not? PA school vs medical school (not including residency). Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 23, 2011 Moderator Share Posted June 23, 2011 I don't believe PA's can do a major surgery start to finish Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 23, 2011 Moderator Share Posted June 23, 2011 Lets dig a little further. Is there anything as far as training goes that an MD/DO is trained in, but a PA is not? ). minutiae of basic medical sciences. it's been said here before but the truth is that md programs produce scientists ready to begin their clinical training in residency while pa school produces clinicians ready to start working. Link to comment Share on other sites More sharing options...
Gato Posted June 23, 2011 Share Posted June 23, 2011 This is turning out to be an interesting thread. I'm still very new to the field, but I was unaware that calling time of death is outside the scope for most. Link to comment Share on other sites More sharing options...
Contrarian Posted June 24, 2011 Share Posted June 24, 2011 Is there anything as far as training goes that an MD/DO is trained in, but a PA is not? In all STATES... PAs can NOT prescribe the schedule III drug Buprenorphine for opiate replacement under their own DEA # and cannot take the 8hr class to get a "Data Waiver" from the DEA to do so... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 24, 2011 Moderator Share Posted June 24, 2011 In all STATES...PAs can NOT prescribe the schedule III drug Buprenorphine for opiate replacement under their own DEA # and cannot take the 6hr class to get a "Data Waiver" from the DEA to do so... is that new? I thought pa's working at detox ctrs were eligible for this? if not, how do they do it, have their sp sign every rx? Link to comment Share on other sites More sharing options...
Contrarian Posted June 24, 2011 Share Posted June 24, 2011 Not New at all... A few yrs ago, several of us (12 PAs & NPs) tried to take the class and get the data waiver. We had extensive and glowing endorsements from a passel of ASAM/Addiction Med boarded physicians. They wouldn't even allow us to register for the training. Then they said we could do the training, but still wouldn't be given a Data Waiver. To date... I don't think any of us did the 8hr training because we ALL had been working with the drug with hundreds of patients for so long that individually, we all could have taught the class... and didn't see the point in paying for it since it wouldn't have added to our practice. The Data Waiver is a prefix added to the already active DEA#. The pharmacy simply uses our SP's data waiver to fill any script for bup that I write. So basically we are writing the script/serving as a scribe for our SP and any script for Suboxone/Subutex we write, we include the SPs # on it but sign our own name. Link to comment Share on other sites More sharing options...
jmj11 Posted June 24, 2011 Share Posted June 24, 2011 Have Group Health Cooperative Contract with you . . . if you, the PA, owns the clinic. Get Physicians Insurance to write you a malpractice policy . . . if you the PA, owns the clinic. But screw em ... don't need em. :>) Link to comment Share on other sites More sharing options...
sbellin Posted June 24, 2011 Share Posted June 24, 2011 Washington State PA's can pronounce death and sign death certificates. One of the big issues for PA's around the country is they can't sign Medicare Home Health or Hospice orders. Here also any hospital admission to the PA's own service must have the H&P and the discharge summary co-signed by a sponsoring physician. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 24, 2011 Moderator Share Posted June 24, 2011 Here also any hospital admission to the PA's own service must have the H&P and the discharge summary co-signed by a sponsoring physician. but the sig can be delayed if I am remembering correctly. the pt does not need to wait for the sp sig to be d/c home. they can sign within a week or something if I am remembering correctly. it's like the RT order thing. the orders eventually need an sp cosig but not in real time. Link to comment Share on other sites More sharing options...
kargiver Posted June 26, 2011 Share Posted June 26, 2011 I decide who gets admitted and D/C all the time at one of the MA hospitals I work. I also admit at two others but have too have an attending consult documented for billing purposes for the other two. So this is a hospital-bylaw issue... Also, in VT, we decide who gets admitted and D/C for all patients. As there are no docs in the ER there are no other options. Can pronouce in MA. Attending or ME has to sign death certificate (or attempt to contact has been shown) In the ER setting there is NOTHING the attendings do that I do not do. This includes all procedures as well. But again, this is hospital-dependent. G Link to comment Share on other sites More sharing options...
sbellin Posted June 27, 2011 Share Posted June 27, 2011 but the sig can be delayed if I am remembering correctly. the pt does not need to wait for the sp sig to be d/c home. they can sign within a week or something if I am remembering correctly. it's like the RT order thing. the orders eventually need an sp cosig but not in real time. Correct. When I have patients admitted to my service more often then not they never see a doc except in the ER on the way in. Also the billing is under my name. Link to comment Share on other sites More sharing options...
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