LKPAC Posted June 29, 2011 Share Posted June 29, 2011 Pronounce death (at least in most states) & sign death certificates. CAN do this in Nebraska Link to comment Share on other sites More sharing options...
Rob77 Posted June 29, 2011 Share Posted June 29, 2011 Not being able to order home care is a big issue especially for those of us in primary care. It's especially difficult when your SP works in a completely different city than you do. Link to comment Share on other sites More sharing options...
Hemegroup Posted June 30, 2011 Share Posted June 30, 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). I believe med students have some extra mandatory rotations in all the internal med subspecialties, such as cardio, nephrology, pulmonology, neurology (please someone correct me if I'm wrong), whereas PA students get an Internal Med rotation and it is what it is (some of my classmates got cardio, I got nephrology) ... although we're still tested on everything in IM, regardless of the nature of our individual rotation. Other than rotations, I believe the federal requirement for med programs is 2300 didactic hours, and the federal requirement for PA programs is 2000 didactic hours. The difference in hours is largely comprised of some advanced biochemical and disease minutia (if you can call it that ... it's still more knowledge). Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 2, 2011 Moderator Share Posted July 2, 2011 contrarian and others- from this month in jaapa: Thank you for publishing the review of opioid dependence management by Bouchard, Faistl, and Monaco (“Current options in the management of opioid dependence: a review,” May 2011 Review Article). It is a well-written and timely article. However, one statement regarding buprenorphine prescribing warrants clarification. The authors state: "However, nonphysician providers such as PAs are not eligible for this specialized credential and are therefore not authorized to prescribe buprenorphine." The assumption that PAs cannot prescribe buprenorphine is a common but incorrect interpretation of the law. Buprenorphine is FDA-indicated for opiate withdrawal, and PAs are not authorized to prescribe buprenorphine for opioid withdrawal. However, any PA with a Drug Enforcement Association (DEA) license authorizing schedule III prescribing may lawfully prescribe buprenorphine "off label" for pain management. The prescription must state "FOR PAIN MANAGEMENT ONLY." Technically, a PA may legally prescribe buprenorphine to a patient experiencing opiate withdrawal for pain management. While this use of buprenorphine is within the law, it is too close a parsing for me and other PAs who are wary of the mystery and alarm surrounding the drug and thus develop a therapeutic nihilism and aversion to prescribing it. Regardless, PAs should not hold the idea that only physicians may prescribe it. This simply isn't true. I continue to enjoy JAAPA. Keep up the good work. Kindest regards, Keir Todd, PA-C, M.Ed. From the June 2011 Issue of JAAPA Link to comment Share on other sites More sharing options...
Contrarian Posted July 3, 2011 Share Posted July 3, 2011 Umm... EMEDPA please re-read my initial post: 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... Then... ... Then they said we could do the training, but still wouldn't be given a Data Waiver. I'm well aware that PAs CAN prescribe it PO/IM/IV or Transdermal for pain issues. NOT for Opiate Withdrawal and NOT for Opiate Replacement Therapy. I don't know why one would want to prescribe it for pain... since its expensive and no more effective that the other cheap, inexpensive PO/IM/IV or Transdermal preparations (OPIOIDS) that target Mu receptors. Anywho... Its a silly limitation and similar to the one where outpatient providers can't Rx Methadone for "opiate replacement," but only prescribe Methadone "for Pain" and up to certain dose maximums before having to do other things to CYA in preparation for the DEA/Pharmacy Board Audit/Investigation. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 3, 2011 Moderator Share Posted July 3, 2011 Umm... EMEDPA please re-read my initial post: I'm well aware that PAs CAN prescribe it PO/IM/IV or Transdermal for pain issues. NOT for Opiate Withdrawal and NOT for Opiate Replacement Therapy. I don't know why one would want to prescribe it for pain... since its expensive and no more effective that the other cheap, inexpensive PO/IM/IV or Transdermal preparations (OPIOIDS) that target Mu receptors. Anywho... Its a silly limitation and similar to the one where outpatient providers can't Rx Methadone for "opiate replacement," but only prescribe Methadone "for Pain" and up to certain dose maximums before having to do other things to CYA in preparation for the DEA/Pharmacy Board Audit/Investigation. gotcha....just wanted to post the link to straighten it out for myself and others who thought that we couldn't write it for any indication. Link to comment Share on other sites More sharing options...
tinylilron Posted August 15, 2012 Share Posted August 15, 2012 Can PAs provide care in an emergency situation or are their laws against that? For instance, a major car accident in which a PA happens to be on the scene and someone needs some emergency medical care and there are no doctors in the area. Can the PAs provide care in those types of situations? Link to comment Share on other sites More sharing options...
Guest hubbardtim48 Posted August 15, 2012 Share Posted August 15, 2012 From what I read yes they can give advanced care in this type of situation, but let the more experienced PAs tell you more about this. Link to comment Share on other sites More sharing options...
jdtpac Posted August 15, 2012 Share Posted August 15, 2012 In Ohio there are only 2 things that we are prohibited by law to do and they are #1) give general anesthesia/conscious sedation and #2) perform an abortion or prescribe any drugs that will induce an abortion( not including plan B which can be bought over-the-counter). The reasons are #1) the nurse anesthetist and anesthesiologist lobbied against PAs performing this services and #2) the chair of the health committee is supported by right to life organizations and slipped that language into are Bill just prior to this passing the legislature last time.BTW, we cannot prescribe scheduled II currently but we do have a Bill currently being considered in this legislative session for not only schedule II but other things to include PAs being able to pronounce death. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 15, 2012 Moderator Share Posted August 15, 2012 don't pa's also need an ms to work/rx in Ohio? I had heard it was a very unfriendly/restricted pa environment along the lines of mississippi or louisianna. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 15, 2012 Moderator Share Posted August 15, 2012 in my state I am restricted from practicing surgical dentistry or prescribing eyeglasses (like an O.D.). we can sign anything our sp's can. chart review is optional as long as the sponsoring physician has an "ongoing awareness of pa practice patterns" but most employers and hospitals still require chart review. Link to comment Share on other sites More sharing options...
cinntsp Posted August 15, 2012 Share Posted August 15, 2012 Can PAs provide care in an emergency situation or are their laws against that? For instance, a major car accident in which a PA happens to be on the scene and someone needs some emergency medical care and there are no doctors in the area. Can the PAs provide care in those types of situations? In my state PAs can practice under the supervision of any physician that is also volunteering or without an SP if one is unavailable in the case of a disaster situation. Link to comment Share on other sites More sharing options...
Bodiggler Posted August 17, 2012 Share Posted August 17, 2012 They can't euthanize people... Just saying... Link to comment Share on other sites More sharing options...
jdtpac Posted August 17, 2012 Share Posted August 17, 2012 don't pa's also need an ms to work/rx in Ohio?I had heard it was a very unfriendly/restricted pa environment along the lines of mississippi or louisianna. MS - yes on both otherwise, things have gotten very good in Ohio over the last 6 years. No on-site supervision required( except in ED)physician need only be 60 minutes away and available by electronic telecommunication, no countersignature, healthcare facilities can credential/privilege PA is to do just about anything that's not prohibited by law( general anesthesia and abortions are only services prohibited),the number of PA is working in Ohio prior to 2006 was approximately 1400 and in 2012 there is approximately 2400 which is about 75% growth in 6 years( not bad), and many other good things have happened. We're not the worst anymore but I would say we were much better than that to state you mentioned and many others that I will not going into at this time. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 17, 2012 Moderator Share Posted August 17, 2012 sounds like a big improvement in the regulatory environment there. congrats. looks like you guys in the ohio state society are making things happen. Link to comment Share on other sites More sharing options...
Hemegroup Posted August 19, 2012 Share Posted August 19, 2012 Limitations in/of Scope of Practice is state and/or institution specific... Technically... neither can Physicians. NO licensed and registered prescriber can use their DEA # to "prescribe" schedule I drugs. 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... Thanks. Here only the Physician recommendation counts under Prop 215, as far as obtaining, but I have noted my own recommendations in a few charts. When a patient on chemo has no appetite, it doesn't take a genius. I did find it interesting that we can perform surgery here. I'm sure there are constitutional aspects per each position, but it was simply noted. We cannot, however, certify state disability leave which has me up in arms. Time to write some letters. Link to comment Share on other sites More sharing options...
delco714 Posted September 7, 2012 Share Posted September 7, 2012 can PAs do OMM? Can we be trained/certified by any means? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 8, 2012 Moderator Share Posted September 8, 2012 can PAs do OMM? Can we be trained/certified by any means? I know pa's who do OMM. don't know if they are "credentialed" to do so. they learned on the job while working with DO's. Link to comment Share on other sites More sharing options...
delco714 Posted September 8, 2012 Share Posted September 8, 2012 I know pa's who do OMM. don't know if they are "credentialed" to do so. they learned on the job while working with DO's. Thanks! I was hoping for as much :) Link to comment Share on other sites More sharing options...
snowdrifter Posted October 15, 2012 Share Posted October 15, 2012 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. EMS can NOT pronounce death. They can "confirm" a class five, but can not pronounce death..they must request the coroner. Link to comment Share on other sites More sharing options...
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