How many PAs can a physician supervise?

[123ABC123]

I am trying to get some clarification on the limits to how many PAs one physician can supervise. I understand that the limits vary by state but my question is specific to Physicians that are licensed in and supervise PAs in multiple states. I was having trouble finding information regarding the legality.

Say a physician is licensed in 2 different states. One state has a limit that the SP can supervise 4 PAs and the other state has a limit that the SP can supervise 5 PAs. Does that mean the SP can only supervise 4 PAs total as that is the stricter supervision requirement or can they supervise 9 PAs total, 4 that are licensed in the one state and 5 that are licensed in the other? 

Trying to get some clarification about how this works 

[UGoLong]

It varies by state. In Ohio (where I work) the number currently is 5.

[123ABC123]

34 minutes ago, UGoLong said:

It varies by state. In Ohio (where I work) the number currently is 5.

Thanks. I realize that but I'm asking a different question!

[True Anomaly]

To answer your specific question- the SP would have a total of 9- 4 in one state, and an additional 5 in another. 

I’ve never heard of a state limiting supervision number for a doctor just because they oversee other PAs in another state

[ohiovolffemtp]

Another thing to think of is the total number of PA's the physician can supervise vs the number of PA's they can supervise concurrently.  This comes in to play especially in EM.  One group I was a part of had about 10 PA's (plus a couple of NP's).  All of the docs had supervisory agreements with all of the PA's.  However, on a given shift, they were never supervising more than 1-2 PA's at a time.  Some states, e.g. Ohio, have restrictions worded that way.

[EMEDPA]

A PA, however, can supervise an unlimited number of physicians. 

[Reality Check 2]

The most progressive states are doing away with “supervision” and going to collaboration. Only about five states so far but gaining traction.

Utah licensure gives you more autonomy as you increase in hours of experience. The base is 10000 hrs - approx 2080 employment hours per yr x yrs of practice. About 5 yrs - ish.

Docs no longer are “burdened” with supervision and the whole numbers game.

I think my 60000 hrs plus makes me lower maintenance…..

Maybe someday they will write it so us old experienced fossils can collaborate for the younglings, PA to PA.

And federal work says you can have a license in any state and they go by your highest licensure. We just have a collaborating doc in our federal paperwork. 

Teamwork works - we all need each other.

Read the fine print of state legislation and dissect carefully. Work to the highest extent of your license. Push for more. 

 

[UnionizePAnow]

17 hours ago, 123ABC123 said:

I am trying to get some clarification on the limits to how many PAs one physician can supervise. I understand that the limits vary by state but my question is specific to Physicians that are licensed in and supervise PAs in multiple states. I was having trouble finding information regarding the legality.

Say a physician is licensed in 2 different states. One state has a limit that the SP can supervise 4 PAs and the other state has a limit that the SP can supervise 5 PAs. Does that mean the SP can only supervise 4 PAs total as that is the stricter supervision requirement or can they supervise 9 PAs total, 4 that are licensed in the one state and 5 that are licensed in the other? 

Trying to get some clarification about how this works 

Another physician trying to make money off PAs back. Not in Utah. Soon OTP passes and we can all work freely without you being around.

Edited January 30, 2022 by UnionizePAnow

[UnionizePAnow]

10 hours ago, Reality Check 2 said:

The most progressive states are doing away with “supervision” and going to collaboration. Only about five states so far but gaining traction.

Utah licensure gives you more autonomy as you increase in hours of experience. The base is 10000 hrs - approx 2080 employment hours per yr x yrs of practice. About 5 yrs - ish.

Docs no longer are “burdened” with supervision and the whole numbers game.

I think my 60000 hrs plus makes me lower maintenance…..

Maybe someday they will write it so us old experienced fossils can collaborate for the younglings, PA to PA.

And federal work says you can have a license in any state and they go by your highest licensure. We just have a collaborating doc in our federal paperwork. 

Teamwork works - we all need each other.

Read the fine print of state legislation and dissect carefully. Work to the highest extent of your license. Push for more. 

 

PAs can practice independently  (not just more autonomy) in UTAH after working certain number of hours. We need something like this in every state. Or course this will piss off some docs like the OP who wants to use us to fatten their profits. NPs soon will get independence in all states. Docs would not be able to push them around because if they do they would just go open their own clinics... then Docs bottom lines go down ahah

Edited January 30, 2022 by UnionizePAnow

[123ABC123]

51 minutes ago, UnionizePAnow said:

PAs can practice independently  (not just more autonomy) in UTAH after working certain number of hours. We need something like this in every state. Or course this will piss off some docs like the OP who wants to use us to fatten their profits. NPs soon will get independence in all states. Docs would not be able to push them around because if they do they would just go open their own clinics... then Docs bottom lines go down ahah

Actually I am a PA. Pretty bold of you to assume I'm using a PA forum to figure out how to profit off of PAs. I'm just trying to make sure I'm practicing within the scope of the law.

I am entirely autonomous in my current role and pretty much practice independently as I'm the sole provider in my clinic. My SP and collaborating providers are available by phone/telemed 24/7 if I needed something. I don't need my notes cosigned. So I do have a lot of "independence" but just wanted to make sure my supervision was legal if the SP is supervising others in various states as well.

If you don't have any thing nice to say and can't provide advice to answer my question, move along.

[sas5814]

Interesting question and one I never thought about before. As above I have never heard of a medical board even questioning physicians about other states. I think with the boom in telehealth it will likely become a question. While I loathe the whole supervision thing I can see some raised eyebrows over Dr A "supervising" 100 PAs in 20 different states.

[iconic]

2 hours ago, sas5814 said:

Interesting question and one I never thought about before. As above I have never heard of a medical board even questioning physicians about other states. I think with the boom in telehealth it will likely become a question. While I loathe the whole supervision thing I can see some raised eyebrows over Dr A "supervising" 100 PAs in 20 different states.

That is because state-based medical licensing is a scam 

[RyanM]

There may be a federal statue on how many providers a physician can supervise in the United States, not sure though.

[ventana]

1 hour ago, RyanM said:

There may be a federal statue on how many providers a physician can supervise in the United States, not sure though.

Nope 

determined at state level. 
no cross over state to state that I am aware of. 

[JenKA]

In MO, a physician can have up to 6 of any combination of PA, NP, or assistant physicians.  IL, it is up to 7 (NP's don't need collaborator).

• Illinois. Prior to January 2020, Illinois limited physicians to supervising no more than two PAs and required the supervising physician to be within a "reasonable travel distance" to the PA at all times. Recent revisions to those laws now permit physicians to supervise up to seven PAs and no longer impose any physical geographic proximity requirement on the supervising physician. Instead, supervising physicians must now be available at all times through telecommunications or other electronic communications.
   
• Missouri. Missouri SB 514 became effective in August 2019. In addition to transitioning from a supervision-based model to a collaboration-based model, the bill also eliminated the requirement that a supervising physician practice at the same facility as the PA for four of every 14 days. The new law also eliminated language that required a PA to practice at a location where the physician routinely sees patients.
• https://www.jonesday.com/en/insights/2020/03/states-relax-physician-assistant-supervision-and-d

[JenKA]

On 1/30/2022 at 10:17 AM, UnionizePAnow said:

Another physician trying to make money off PAs back. Not in Utah. Soon OTP passes and we can all work freely without you being around.

As a physician who makes NO money off PAs (they get their own pay and contribute no money to mine as we are paid by the same place) I am not sure how that would work. Perhaps it was the clinic making the money then, not the physician. Don't assume we are all out to eat you. I loved my APPs and hated to see one die due to what I suspect was inadequate treatment during Covid and rejoice with the NP who has his own practice now. 

[sas5814]

in most places the physician gets additional compensation for supervising a PA. some places not so much.

I have always had great relationships with my docs and remain friends with many of them. The politics of supervision and the reality of it do not intersect.

[ventana]

Some recent scuttlebutt on physician comp - hospitals might be loosing money on every doc in the IM fields employed. 

PA and NP they make money on

 

If a doc says  "I am not getting paid to supervise" that might be correct, but if you are a lost leader and the PA is not, then the PA RVUS are actually helping cover your salary....

[Ninjakicker]

I just got clarification on this from the NYS Medicine Board as I am trying to work telehealth for a doctor who already supervises the maximum amount of PAs for NYS. 

The woman that I spoke to said that as long as I was only seeing patients that reside in CT and both I and my supervising MD have CT licenses then NYS does not care. 

So the answer is as long as a PA is only seeing patients that reside in another state and not trying to see patients in the state in which the MD is already full to capacity on supervising then the PA can "be on the license" of that MD in another state. This should open the flood gates for telehealth. 

An office manager tried to tell me I couldnt do this but now that I have an official answer for the NY board of medicine I hope to start working soon. A work from home job in a very difficult specialty to break into is a dream come true. 

[iconic]

supervising laws never made any sense

[rev ronin]

On 9/8/2023 at 12:53 PM, iconic said:

supervising laws never made any sense

Yeah. You think a doc who spends his or her day doing nothing BUT supervising PAs and NPs will have the same span of control as a 1.0 FTE physician busy with his or her own patients?