quarternote Posted April 13, 2012 Share Posted April 13, 2012 I was put in a difficult position with my boss today. He is a good boss and we get along normally. I've been with him 5 years and I went to work for him when I graduated PA school. Our state practice act states that we can not practice at an off site location over 45 miles or 1 hour from the main practice without our SP or without previous approval by the state medical board. I don't necessarily agree with this but it is state law. I work in SC. Two days ago our office manager left a note on my desk letting me know I would need to go to our off site office to do an H&P & a post operative follow up. I assumed my boss would be going with me since they are aware of State law. We have applied for permission but have not received it yet. The medical board was specific and made sure I am aware not to do this until I have received approval. This AM when I got to the office I found out that he wasn't going. So I went to both my boss and the office manager and reminded them I cannot go without him. He did not understand and pretty much thought I was being ridiculous. We had words, told me he put his license on the line every time we walk into the OR. I told him i do too but this is directly defying what i have been advised not to do. I tried to explain the difference as I would be directly going against what the state allows me to do, he has a license to operate. He had me call the state board & ask the person in charge of PA license. When she agreed with me he had me go an extra step and contact the administrator of the state medical board. He said he wanted to speak with him as well but when the administrator confirmed that I was correct he would not talk to him. I even printed out the state PA practice act for him but he didn't want to see it. I finally just had to say no. I just couldn't jeopardize everything I worked so to accomplish. He was furious with me & went. I think the deciding factor for me in our conversation was when I looked at him and said: "so on the small percentage they found out...when they are questioning me and ask, did you do a physical exam on this patient, did you see this patient in your off site office? And I say yes. Then they ask, where was your SP, what are you going to say?" he just looked at me. He had no answer. Are there any words of wisdom from more seasoned PA's? Link to comment Share on other sites More sharing options...
Monkeyball Posted April 13, 2012 Share Posted April 13, 2012 Way to stick to your guns and not cave in to pressure. Not an easy thing to do. Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 13, 2012 Share Posted April 13, 2012 I think you were brave and right to stick to your guns. He may have been furious but hopefully he'll channel that rage into changing this antiquated law that serves no one and is a hindrance to appropriate practice. I've worked in SC the past 6 yr and I have to say it's made progress but the practice act is still woefully behind the times. Also, I am frankly amazed you were able to reach ANYONE at the board when you called...twice! They must have turned it around up there in Columbia. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 13, 2012 Moderator Share Posted April 13, 2012 I think you were brave and right to stick to your guns. He may have been furious but hopefully he'll channel that rage into changing this antiquated law that serves no one and is a hindrance to appropriate practice. I've worked in SC the past 6 yr and I have to say it's made progress but the practice act is still woefully behind the times.Also, I am frankly amazed you were able to reach ANYONE at the board when you called...twice! They must have turned it around up there in Columbia. wow, sounds worse than oregon and that's saying a lot....we still have a sub-board with acupuncturists.... Link to comment Share on other sites More sharing options...
quarternote Posted April 13, 2012 Author Share Posted April 13, 2012 Oh no, they didn't turn anything around! I just kept calling. I called between each patient until I got someone. I was surprised too. This is a frustrating state to work in. Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 13, 2012 Share Posted April 13, 2012 Sadly not surprised...and E, you know I've worked in both ;) must admit it was easier to reach someone at the Oregon BME! Link to comment Share on other sites More sharing options...
MMiller Posted April 13, 2012 Share Posted April 13, 2012 I think you were brave and right to stick to your guns. He may have been furious but hopefully he'll channel that rage into changing this antiquated law that serves no one and is a hindrance to appropriate practice. I've worked in SC the past 6 yr and I have to say it's made progress but the practice act is still woefully behind the times.Also, I am frankly amazed you were able to reach ANYONE at the board when you called...twice! They must have turned it around up there in Columbia. Yeah, he'll hire a NP, who (for the most part) are not hamstrung by ridiculous laws like this. Link to comment Share on other sites More sharing options...
jdtpac Posted April 13, 2012 Share Posted April 13, 2012 quarternote As I think you did an admirable thing by standing up to your supervising physician on this issue. Whenever you feel you might be infringing on the law you are never wrong to either question your physician or yourself as to not getting into any trouble with the law. I do not practice in SC but I reviewed your statutes and they appear to be a little confusing: “The off-site location may not be more than forty-five miles or sixty minutes travel time from the supervising physician or alternate supervising physician without written approval of the board. The supervising physician or alternate supervising physician must be physically present at the off-site location not less than twenty percent of the time each month the physician assistant is providing services there.” If it says the supervising physician need only be at a off-site area only 20% of the time that you practice offsite, with you going to see a patient only one time would that necessarily require the physician to actually be on-site? It appears to me that you could be practicing 100% of the time offsite and a supervising physician only need to be there 20% of the time. Interesting dilemma, I think I would have my lawyer look at this rather than to contact the board of medical examiners. I think they got it wrong if you were only going to be going off-site to see one patient. But on the other hand, if you need approval of the board before you can go to off-site offices, did you get that approval already? If your supervising physician was already approved to supervise you off-site, again I think your seeing one patient should not have been an issue. Do you have that approval from the medical board? BTW, MMiller the NPs in South Carolina have the same 45 mile/minute restriction: (2) When application is made for more than three NP's, CNM's, or CNS's to practice with one physician or when a NP, CNM, or CNS is performing delegated medical acts in a practice site greater than forty-five miles from the supervising physician, the Board of Nursing and Board of Medical Examiners shall each review the application to determine if adequate supervision exists. Link to comment Share on other sites More sharing options...
burnpac Posted April 14, 2012 Share Posted April 14, 2012 Wow. Good you stuck to your guns. There is no defense for practicing outside of your regulation regardless how ridiculous it seems. This has to be changed. The standard is electronic telecommunication in CA. My SP can be on the other side of the world, and as long as I can get him on the phone immediately, I can practice. Channel your SP's anger towards the state medical society who likely has a strong hand in such a restrictive regulation (it's about the economics....). You can be sure that your state PA academy is painfully aware of the problem and I'm sure there is a long history of trying to improve barriers to practice. Especially in a state like SC that has numerous medically underserved areas. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 15, 2012 Moderator Share Posted April 15, 2012 I was put in a difficult position with my boss today. He is a good boss and we get along normally. I've been with him 5 years and I went to work for him when I graduated PA school. Our state practice act states that we can not practice at an off site location over 45 miles or 1 hour from the main practice without our SP or without previous approval by the state medical board. I don't necessarily agree with this but it is state law. I work in SC. Two days ago our office manager left a note on my desk letting me know I would need to go to our off site office to do an H&P & a post operative follow up. I assumed my boss would be going with me since they are aware of State law. We have applied for permission but have not received it yet. The medical board was specific and made sure I am aware not to do this until I have received approval. This AM when I got to the office I found out that he wasn't going. So I went to both my boss and the office manager and reminded them I cannot go without him. He did not understand and pretty much thought I was being ridiculous. We had words, told me he put his license on the line every time we walk into the OR. I told him i do too but this is directly defying what i have been advised not to do. I tried to explain the difference as I would be directly going against what the state allows me to do, he has a license to operate. He had me call the state board & ask the person in charge of PA license. When she agreed with me he had me go an extra step and contact the administrator of the state medical board. He said he wanted to speak with him as well but when the administrator confirmed that I was correct he would not talk to him. I even printed out the state PA practice act for him but he didn't want to see it. I finally just had to say no. I just couldn't jeopardize everything I worked so to accomplish. He was furious with me & went. I think the deciding factor for me in our conversation was when I looked at him and said: "so on the small percentage they found out...when they are questioning me and ask, did you do a physical exam on this patient, did you see this patient in your off site office? And I say yes. Then they ask, where was your SP, what are you going to say?" he just looked at me. He had no answer. Are there any words of wisdom from more seasoned PA's? wow - a truly ugly situation that there simply is not an easy answer for. I complement you on choosing the high road. We do not make the laws but we do have to follow them and since you had been advised to not do this and he continued to ask you did everything perfectly to protect yourself. He was asking you to break the law and would have put you in an position that you could not defend and his example of surgery is really not an analogy at all. He was asking/demanding for you to knowingly break the law - this is not the same as doing a procedure you are credentialed to do. I would really put a lot of effort into rebuilding the relationship. You might be able to change your SP into an agent of change - if he is that frustrated with the laws maybe he can spearhead getting them changed from the MD side of things. Likely is the best way to afford change. Link to comment Share on other sites More sharing options...
quarternote Posted April 15, 2012 Author Share Posted April 15, 2012 As long as we are within the 45 mile/60 min limits we can practice off site (provided we meet certain criteria). If we decide to open an office outside of those limits we have to submit a letter requesting permission to go alone. Then IF they choose to allow this he has to agree to be present 20% of the time. I can go as long as he is with me. I've been with him. We are general/bariatrics surgeons. He is there frequently. In this incidence he wanted me to go alone and our case is up for review by the board this month. Hopefully they will allow this. As I explained to my boss this is a matter of character and integrity. I asked if he wanted an employee who would follow rules even if no one was looking or does he want someone who will bend them? :) Link to comment Share on other sites More sharing options...
CAAdmission Posted April 15, 2012 Share Posted April 15, 2012 The "or sixty minutes" part may make a small loophole. I can drive a heck of a lot farther than 45 miles in 60 minutes. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 15, 2012 Moderator Share Posted April 15, 2012 The "or sixty minutes" part may make a small loophole. I can drive a heck of a lot farther than 45 miles in 60 minutes. I'm sure it's a "whichever comes first" situation, or why even bother with saying 45 miles at all. Link to comment Share on other sites More sharing options...
CAAdmission Posted April 15, 2012 Share Posted April 15, 2012 I'm sure it's a "whichever comes first" situation, or why even bother with saying 45 miles at all. If I had to guess, it is because legislators are almost exclusively morons... Link to comment Share on other sites More sharing options...
quarternote Posted April 15, 2012 Author Share Posted April 15, 2012 One of the Docs told me that this came about because in the past there was a malpractice case where a PA was involved with a patient (who had connections). Not sure how true that is. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 16, 2012 Moderator Share Posted April 16, 2012 If I had to guess, it is because legislators are almost exclusively morons... Valid point Link to comment Share on other sites More sharing options...
CAAdmission Posted April 16, 2012 Share Posted April 16, 2012 Seriously. There are what - 300 million people in this country? And the two best we can find to run it are Barack Obama and Mitt Romney? Tear me a random page out of the phone book and I will find you five better people inside of two hours... Link to comment Share on other sites More sharing options...
andersenpa Posted April 16, 2012 Share Posted April 16, 2012 We had words, told me he put his license on the line every time we walk into the OR. This is an unacceptable and disrespectful way to talk to you as a professional and I question the relationship with this doc. By your account....your doc's reaction to the situation is not to do what is best for you BOTH as clinician....s but instead have a fit, point the finger at you, and put the burden on YOU to solve the problem. Link to comment Share on other sites More sharing options...
marilynpac Posted April 20, 2012 Share Posted April 20, 2012 Seriously. There are what - 300 million people in this country? And the two best we can find to run it are Barack Obama and Mitt Romney? Tear me a random page out of the phone book and I will find you five better people inside of two hours... Be careful...you could be banned... Link to comment Share on other sites More sharing options...
entpac Posted April 22, 2012 Share Posted April 22, 2012 If you start to compromise now, there may be times in the future where you are asked to do it again, and again. Never compromise what you know is right. Your supervising physician should be your advocate. Even if the SP is a great person, your integrity is on the line. During a recent job interview, I made sure the chief of the clinic knew where I stood on integrity and that I would never knowingly compromise my license or the license of any supervising physician. He simply stated that I would never be asked to do anything that I was not comfortable with. I believed him and accepted the job. Enough said. You need to be comfortable with your situation. It takes one second to lose the trust. As outdated as these laws are, we are bound by them. Accepting the state license is equivalent to taking an oath to uphold the law. Stand on the higher moral ground. Good luck! Link to comment Share on other sites More sharing options...
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