Supervising Physician

[roundabout]

Hypothetically speaking could I open my own Urgent Care center and have a SP who practices in a different speciality of medicine than EM or Family Medicine? Or are there regulations stating what their medical speciality needs to be?

[Guest Paula]

Hypothetically, no you can't.  Unless your state law allows it.  

[Marinejiujitsu]

I do know of surgeons that own urgent cares and hire PAs. I think its immoral though.

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[Boatswain2PA]

I know an OB/Gyn who works UC. 

[CAdamsPAC]

25 minutes ago, Boatswain2PA said:

I know an OB/Gyn who works UC. 

I recall that back in the 90's the OB/Gyn folks were pushing to be declared as "Primary Care Providers"

[Reality Check 2]

My Reality Check Razor

If it sounds awkward and wrong ----- it is.....

If a physician is listed as a supervising physician or collaborating for the PRACTICE of a PA - then their specialty must match that of the PA - ie. Family Med/Family Med or Family Med/Urgent Care. This is state to state variable but likely in most states and likely to be a must have for insurance/malpractice. It's also common sense. 

A physician can technically be the medical director of an Urgent Care and be whatever kind of doc - surgeon, etc. However, the licensing agreement with a PA should match - ethically and often legally.

I would find it unwise and immoral for a semi retired Urologist to be the medical director or SP/CP for a group in an Urgent Care as the knowledge/skill base don't match at all.  Internal Medicine shouldn't supervise anything involving kids - they don't see kids.

Beware of semi retired docs who still want a hand in the game or a paycheck. You get what you pay for. 

Think of answering a question with the following start "Yes, your honor, Dr. BlahBlah is a pathologist and doesn't treat patients clinically...and has been my SP for x years." .....and then change the specialty again and again until it matches what an Urgent Care does. 

Plumbers don't wire houses and roofers don't pour concrete.

Just my crusty old 2 cents

 

[roundabout]

Thank you all. 

[Cideous]

This happens every day in Texas.  I would say most supervising docs of PA's with ownership stake in Texas of an UC are not doing UC, FP or EM.  Most are retired surgeons or the like.

[sas5814]

True but in Texas any physician can do any kind of work they want. My first SP was a pediatrician who decided he wanted to do allergy and just opened an allergy and immunology practice. He couldn't call himself an allergist but he sure had an allergy practice.he supervsed me in a RHC.

That said the thing to think about is what happens when something goes wrong. You missed a PE you thought was a cold and your SP is an orthopedic surgeon? Checkbook please....

Edited October 18, 2019 by sas5814

[Lightspeed]

Maybe not urgent care so much, but getting reimbursed.....

[LT_Oneal_PAC]

I think it’s not ethically wrong if the PA is trained appropriately to perform UC or EM. This just goes to PAs being responsible for what they do and practice to their training and not the training of someone else. Questionable if they are a new grad. I do think that most states have rules about CP specialty matching the practice of the PA.

[Lightspeed]

Statute doesn’t change just by willing yourself to practice according to your own training and not someone else’s, no matter how anyone feels about it.  Multiple entities might care about that arrangement under the right circumstances... insurance companies, commercial loan originators, malpractice lawyers....even in the absence of state regulations to the contrary. I’d suggest that at the point where you have to consult a physician outside of their scope of specialty, it’s actually ethics that dictate whether you remain on or off course.

[LT_Oneal_PAC]

8 hours ago, Lightspeed said:

Statute doesn’t change just by willing yourself to practice according to your own training and not someone else’s, no matter how anyone feels about it.  Multiple entities might care about that arrangement under the right circumstances... insurance companies, commercial loan originators, malpractice lawyers....even in the absence of state regulations to the contrary. I’d suggest that at the point where you have to consult a physician outside of their scope of specialty, it’s actually ethics that dictate whether you remain on or off course.

While you didn’t quote me, since there is no posting between now and your last I’ll assume you are speaking in response to my post. 

I’m not sure I understand your point? Are you suggesting that it is unethical to have a CP that isn’t of the same specialty because you may have to consult them? I would ask is it then unethical for an APP to be independent and not have anyone officially designated for them to consult? I gather no, you don’t believe so. This actually happens everyday with CRNA in states where they have to have an SP, which is generally the surgeon and completed supervision by saying “anesthesia per CRNA.” PAs do this everyday in EM rural sites that only have FM back up. It would definitely not be smart to consult someone outside their specialty and unethical on the part of a specialtist to open a clinic outside their scope.

if you are suggesting that it’s still not allowed, I agree and said such in my post and still not sure the point of your post unless it’s to reiterate my point? Or maybe you were just posting your own thoughts not in response to mine

[CAdamsPAC]

Maybe a bit off point, but I was always concerned about PAs being directly supervised/guided by Residents at academic hospitals The designated SP/CP were i the background but rarely present on the teaching services.

[sas5814]

On 10/19/2019 at 9:11 PM, LT_Oneal_PAC said:

I think it’s not ethically wrong if the PA is trained appropriately to perform UC or EM. This just goes to PAs being responsible for what they do and practice to their training and not the training of someone else. Questionable if they are a new grad. I do think that most states have rules about CP specialty matching the practice of the PA.

LT I would agree with you if I hadn't been steeped in the hubris of physicians for 30 years. You will not be judged by a group of PAs but by a group of physicians. There are only a few states that have their own independant PA board. The rest answer to a medical board and they will make an example of you to all the other PAs who dare to act like they know what they are doing.

[LT_Oneal_PAC]

2 hours ago, sas5814 said:

LT I would agree with you if I hadn't been steeped in the hubris of physicians for 30 years. You will not be judged by a group of PAs but by a group of physicians. There are only a few states that have their own independant PA board. The rest answer to a medical board and they will make an example of you to all the other PAs who dare to act like they know what they are doing.

I get what you’re saying and agree. But is it immoral, ethically wrong? A sin, if you will. It is unethical for a PA to practice independently after proper training. If not, then I would propose that a PA who has a CP in a different specialty, that the PA never consults to make decisions outside his specialty, isn’t unethical, just on the wrong side of the law.

[Marinejiujitsu]

I think it’s not ethically wrong if the PA is trained appropriately to perform UC or EM. This just goes to PAs being responsible for what they do and practice to their training and not the training of someone else. Questionable if they are a new grad. I do think that most states have rules about CP specialty matching the practice of the PA.

Yeah I get what you mean. I just thinks it's ethically wrong in our current legal environment. I also think its wrong to bully PAs to do something less standard of care by a subpar doc but that is seen as legally right for some crazy reason.

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[LT_Oneal_PAC]

7 minutes ago, Marinejiujitsu said:

Yeah I get what you mean. I just thinks it's ethically wrong in our current legal environment. I also think its wrong to bully PAs to do something less standard of care by a subpar doc but that is seen as legally right for some crazy reason.

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100%. I think we are just using different definitions of ethically, or maybe we are applying it to different areas, but I believe we agree. 

[Lightspeed]

1 hour ago, LT_Oneal_PAC said:

I get what you’re saying and agree. But is it immoral, ethically wrong? A sin, if you will. It is unethical for a PA to practice independently after proper training. If not, then I would propose that a PA who has a CP in a different specialty, that the PA never consults to make decisions outside his specialty, isn’t unethical, just on the wrong side of the law.

Nobody really brought up ethics until you first did, so I’m not sure the deep dive into the well of philosophy gets to the essence of what the OP is asking, nor what most of the comments address. Ethics exist in regard to right and wrong. If you don’t see a violation of the law as an ethical lapse, then so be it, but the practical argument really comes down to how this would play out in the regulatory environment as it currently exists. Yeah, change the law, and all of a sudden what was once illegal (and arguably unethical by extension) instantly becomes legal, and arguably ethical. The physicians that are haters will whine that it could still be “unethical” to offer “substandard care” by practicing independent of them because that’s usually the track they run on when they attack anyone who is not a physician. You guys often suggest this when you rail on NPs, too. 

Its not up to individuals in your profession (or mine) to decide on an individual basis to disregard the standards of the profession on your own accord, and be insulated from the consequences. We are usually biased in our own favor, and often overestimate our abilities, so that’s one good reason to pursue a legal remedy. And yes, in practical terms, it’s a nightmare scenario in regards to legality, insurability, transparency, licensure, oversight. It is also a selfish act that puts you in violation of regulations you agreed to in order to provide you with personal benefit. 

Like SAS said, your jury won’t be of your peers, it will be a group of people that are far from disinterested parties. They will base their decision about your fate upon how closely you aligned your practice to the standards you agreed to practice under. 
 

 

[LT_Oneal_PAC]

On 10/15/2019 at 7:20 PM, Marinejiujitsu said:

I do know of surgeons that own urgent cares and hire PAs. I think its immoral though.

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4 hours ago, Lightspeed said:

Nobody really brought up ethics until you first did, so I’m not sure the deep dive into the well of philosophy gets to the essence of what the OP is asking, nor what most of the comments address. Ethics exist in regard to right and wrong. If you don’t see a violation of the law as an ethical lapse, then so be it, but the practical argument really comes down to how this would play out in the regulatory environment as it currently exists. Yeah, change the law, and all of a sudden what was once illegal (and arguably unethical by extension) instantly becomes legal, and arguably ethical. The physicians that are haters will whine that it could still be “unethical” to offer “substandard care” by practicing independent of them because that’s usually the track they run on when they attack anyone who is not a physician. You guys often suggest this when you rail on NPs, too. 

Its not up to individuals in your profession (or mine) to decide on an individual basis to disregard the standards of the profession on your own accord, and be insulated from the consequences. We are usually biased in our own favor, and often overestimate our abilities, so that’s one good reason to pursue a legal remedy. And yes, in practical terms, it’s a nightmare scenario in regards to legality, insurability, transparency, licensure, oversight. It is also a selfish act that puts you in violation of regulations you agreed to in order to provide you with personal benefit. 

Like SAS said, your jury won’t be of your peers, it will be a group of people that are far from disinterested parties. They will base their decision about your fate upon how closely you aligned your practice to the standards you agreed to practice under. 
 

 

See Marine’s quote, who referenced morality. I never said he should nor did I suggest breaking the law is ethical, but the act itself in a vacuum is not unethical.However, we don’t practice in a vacuum, so I’ll reiterate, one should not open a practice that is against regulations. Also. by you guys you don’t mean me because I’ve never railed against NP independence. But who cares about details?

 

[LT_Oneal_PAC]

16 minutes ago, Lightspeed said:

Hey CAdams, are you the guy that’s creating fake accounts just to downvote me... the ones that are created, and then immediately proceed to head to my comment to ding me, and then do nothing else on the forum? What is it in particular about what I said that got your goat this time?

Final warning about posting off completely off topic. Direct message if you wants to start a flame war. Posters are allowed a certain number of votes an can use how they like. 

[Marinejiujitsu]

Morality in the terms I'm talking about is a sly way to do something which is not cochere legally. Not saying people don't have the ability to work independently. With NPs which the cat is out of the bag, i think the morality of it is an self integrity one which the NP has to recognize their abilities.

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[Marinejiujitsu]

And i think highly of Johncfl, sorry if i mispelled. I think its great for him to come here for advice.

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[LT_Oneal_PAC]

2 minutes ago, Marinejiujitsu said:

Morality in the terms I'm talking about is a sly way to do something which is not cochere legally. Not saying people don't have the ability to work independently. With NPs which the cat is out of the bag, i think the morality of it is an self integrity one which the NP has to recognize their abilities.

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Exactly. Agreed

[LT_Oneal_PAC]

6 minutes ago, Lightspeed said:

How is it off subject to ask what problem someone has with a comment that he or she has expressed displeasure over, and how do you supposed to read my mind and determine that I want a flame war?

Dont give me any final warnings about things that merely make you uncomfortable O’Neal... that comes down agin to the topic of self serving ethical decisions. Your interpretations of my words are highly self serving toward your bias toward me. Maybe kick your enforcement actions up to a moderator that is less... invested, maybe? That would be the ethical course of action. 

Ill ask again... why, CAdams PAC, do you disagree with my comment abovve that pertained to the topic at hand? 
 

Official warning given. Next will result in suspension. Bring it into direct message. Placed here for transparency reasons