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I am a PA in Texas working for a pulmonary/critical care group. I am proficient in thoracentesis, have done it many times on inpatients at bedside. My supervising MD has asked to perform this procedure on clinic patients on outpatient basis. Just to be clear: patient is seen in clinic by MD, scheduled for outpatient thoracentesis with me, patient comes to hospital and has procedure performed by me, then goes home.

I am comfortable doing the procedure, but am not sure if this is allowed. In my hospital, patients are not admitted under PAs. So the patient would have to be admitted under the MD, have procedure performed by me, then get discharged without seeing an MD. In the EMR, it would then appear as if the patient was seen by and MD, when they were not.

I have tried to look through Texas medical boards policies but could not find anything that clarified this issue for me. I have mentioned this to my supervising MD. He reassured me it is allowed but am skeptical he looked into it thoroughly, would like to determine this myself before agreeing to anything. Anyone have any insight as to whether this is allowed? Should I try to contact medical board directly? Or would it need to be addressed with hospital?

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this will likely hing on what type of admission it is


the true FULL admission to the hospital likely has to have a Doc

But what you are describing is more of an Medical Day Observation, observation and I don't believe this is required


step one - what type of admission?

Steo two - ask legal (if you want to open pandora's box) what the opinion is - alt would be formally ask the PA board in your state providing all the details

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There is nothing in the TMB guidelines any longer dictating what you can't do that I recall.  Many years ago, pre-licensure, there were.  The question I would have would be to the credentialing committee as to whether or not they will allow for OP procedures even though you have done them IP?  Technically you are asking for a modification of your credentialing.  If you do so, this may open a can of worms with your SP/group.

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Is the patient registered as an oupatient procedure?  Because if so that should be fine.  Our IR APPs do thoras that have been ordered by other providers.  The patient comes to the hospital, is registered as an outpatient, the PA/NP does the thora, they go home.  The collaborating MD is not involved.  Just make sure you are privileged to do this.

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