Administrator rev ronin Posted September 4, 2023 Administrator Share Posted September 4, 2023 So, I'm making a list of things that physicians can do that PAs or NPs cannot, by law or regulation, do in certain states or contexts. Here's what I've got so far: * Physician Assisted Suicide/Death with Dignity certifications * Perform Abortions * Permanent Disability ratings * FAA pilot physicals What am I missing? Does your state have an odd requirement for something PAs and NPs can't do, that's reserved solely for physicians? Quote Link to comment Share on other sites More sharing options...
iconic Posted September 4, 2023 Share Posted September 4, 2023 (edited) No medical marijuana in my state No involuntary hearings in any state no opioids for chronic pain in my state no stimulants for more than 1-2 weeks in my state Edited September 4, 2023 by iconic Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 4, 2023 Author Administrator Share Posted September 4, 2023 1 hour ago, iconic said: No medical marijuana in my state No involuntary hearings in any state no opioids for chronic pain in my state no stimulants for more than 1-2 weeks in my state Yowch, that's a lot. Tell me more about #2. Do you mean no PAs anywhere can put people on psych holds? Quote Link to comment Share on other sites More sharing options...
iconic Posted September 4, 2023 Share Posted September 4, 2023 (edited) They cannot extend psych holds, but then no physician other than psychiatrists can either Edited September 4, 2023 by iconic Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 4, 2023 Share Posted September 4, 2023 Ohio: can't order drugs for procedural sedation and/or RSI can't pronounce death except for expected deaths in ECF/hospice settings sign emergency mental health holds, unless you hold a separate certification from the county health department as a "health officer" admit patients to the hospital be an EMS medical director or hold the drug license for an EMS agency Kentucky: prescribe any schedule II meds. Limitations on prescribing other scheduled meds. plus I believe the same restrictions as Ohio Quote Link to comment Share on other sites More sharing options...
Mayamom Posted September 4, 2023 Share Posted September 4, 2023 6 hours ago, ohiovolffemtp said: admit patients to the hospital Kinda makes it hard to work in an ER I suppose. Unless they just use the SP name? 1 Quote Link to comment Share on other sites More sharing options...
TWR Posted September 4, 2023 Share Posted September 4, 2023 13 hours ago, iconic said: No medical marijuana in my state No involuntary hearings in any state no opioids for chronic pain in my state no stimulants for more than 1-2 weeks in my state Might I ask where "my state" IS LOCATED? 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted September 4, 2023 Share Posted September 4, 2023 4 hours ago, Mayamom said: Kinda makes it hard to work in an ER I suppose. Unless they just use the SP name? Shous be ok for ER PAs - patients are not admitted to them, they are admitted to an inpatient provider. I think a lot of states don't allow PAs to shoot xrays, but could be wrong. Quote Link to comment Share on other sites More sharing options...
iconic Posted September 4, 2023 Share Posted September 4, 2023 (edited) 6 hours ago, TWR said: Might I ask where "my state" IS LOCATED? FL Only second to KY in terms of restricting PAs in controlled substance prescribing Edited September 4, 2023 by iconic 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 5, 2023 Share Posted September 5, 2023 16 hours ago, Mayamom said: Kinda makes it hard to work in an ER I suppose. Unless they just use the SP name? In one facility I have to put admit orders in under the name of my attending for the day. In others, I can put the orders in but have to list the accepting hospitalist (or other doc). It works, but since I'm doing the same job as the docs and I'm the only provider in the ED, it still sticks in my craw a bit. 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 5, 2023 Moderator Share Posted September 5, 2023 In WA the only one I can think of off hand is "independently be the provider of record for a trauma alert". Other than that I can do any procedure or sign any form that my sponsoring physician can. The way this works in practice is they call the FP doc who is 25 years younger than I am and has no trauma experience to advise him of the trauma alert. They ask me if I need anything. I say no. The form gets a line written on it : Dr XYZ advised of trauma alert, PA Emedpa in attendance and requires no assistance. Silly rule and a lot of paperwork. We may actually drop our state of WA trauma designation because of it. Nothing would change except some hospital bragging right that we are a state recognized trauma ctr. It makes no sense to have FP docs running traumas. None. 2 Quote Link to comment Share on other sites More sharing options...
SedRate Posted September 5, 2023 Share Posted September 5, 2023 2 hours ago, EMEDPA said: It makes no sense to have FP docs running traumas. None. 1 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 5, 2023 Author Administrator Share Posted September 5, 2023 3 hours ago, EMEDPA said: It makes no sense to have FP docs running traumas. None. You know, it actually might if physicians were actually taught leadership and management skills, and knew how to be an incident commander who existed to get the working clinicians the resources they needed and otherwise stay out of the way... 2 Quote Link to comment Share on other sites More sharing options...
sas5814 Posted September 5, 2023 Share Posted September 5, 2023 (edited) 7 minutes ago, rev ronin said: It makes no sense to have FP docs running traumas. None. I made the argument in a physician forum that if I coded I'd rather have an ER trained and experienced PA take care of me than a family doc. Needless to say they lost their minds. There is little rational discussion to be had any more. Maybe there never was. There are 6 (FP and IM) physicians and me in my clinic. Every chest pain patient that walks in the nurses come get me. Why? My superior skills? No. Its because I won't piss and moan and generally do anything I can to avoid seeing the patient. One of our docs huffed in to see a chest pain that got here at the end of the day right before closing time, failed to do any kind of a reasonable evaluation, and discharged the patient who left here and drove to the hospital 60 miles away. He coded in the circle in front of the main entrance. One slap on the wrist and he still works here. Thread hijack complete. Please return to your normal programming. Edited September 5, 2023 by Hemmingway 3 2 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 6, 2023 Moderator Share Posted September 6, 2023 4 hours ago, Hemmingway said: I made the argument in a physician forum that if I coded I'd rather have an ER trained and experienced PA take care of me than a family doc. Needless to say they lost their minds. The better FP docs know this too. Stay in your lane is a real thing. I shouldn't manage clinic patients and they shouldn't intubate. More than once we have had a critical patient show up near shift change and the FP docs I work with always ask me to take over. It only makes sense: EMPA Codes/intubations/cardioversions this year: many FP doc None. Maybe a few in residency with an attending looking over their shoulder. 3 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted September 7, 2023 Share Posted September 7, 2023 (edited) On 9/5/2023 at 4:04 PM, Hemmingway said: I made the argument in a physician forum that if I coded I'd rather have an ER trained and experienced PA take care of me than a family doc. Needless to say they lost their minds. Yeah, I have been in a few of those threads. I usually ask who would you rather care for you in a code - a doc one year out of residency or a PA with 25 years of experience. They like to roll their dice on the doc due to his "top-level, superior education." All that histology knowledge is sure to help with the ACLS protocols. It seems society is evolving two flavors of docs: those that want to hire a bunch of PAs, and use and abuse them to become rich. The other flavor are just plain egomaniacal aholes that want to abuse PAs because they are threatened by them. Edited September 7, 2023 by CAAdmission 2 Quote Link to comment Share on other sites More sharing options...
SedRate Posted September 7, 2023 Share Posted September 7, 2023 1 hour ago, CAAdmission said: It seems society is evolving two flavors of docs: those that want to hire a bunch of PAs, and use and abuse them to become rich. The other flavor are just plain egomaniacal aholes that want to abuse PAs because they are threatened by them. I've worked with a few groups who hire physicians and pay a flat rate, no productivity. I think this is a rare third group where they are just an employee like the rest of us and are a bit more reasonable when it comes to "supervision"/collaboration. 1 Quote Link to comment Share on other sites More sharing options...
jmj11 Posted September 7, 2023 Share Posted September 7, 2023 Get a million dollar loan (business or personal) with virtually little collateral. 1 Quote Link to comment Share on other sites More sharing options...
iconic Posted September 7, 2023 Share Posted September 7, 2023 20 minutes ago, jmj11 said: Get a million dollar loan (business or personal) with virtually little collateral. https://www.rflawgroup.com/med-spa-maverick-received-more-than-1-million-in-ppp-loans-while-drug-charges-against-him-were-pending/ Quote Link to comment Share on other sites More sharing options...
sk732 Posted September 30, 2023 Share Posted September 30, 2023 On 9/5/2023 at 11:14 AM, EMEDPA said: In WA the only one I can think of off hand is "independently be the provider of record for a trauma alert". Other than that I can do any procedure or sign any form that my sponsoring physician can. The way this works in practice is they call the FP doc who is 25 years younger than I am and has no trauma experience to advise him of the trauma alert. They ask me if I need anything. I say no. The form gets a line written on it : Dr XYZ advised of trauma alert, PA Emedpa in attendance and requires no assistance. Silly rule and a lot of paperwork. We may actually drop our state of WA trauma designation because of it. Nothing would change except some hospital bragging right that we are a state recognized trauma ctr. It makes no sense to have FP docs running traumas. None. I can think of a number I wouldn't mind working traumas...So in Canada, FM docs do a 2 year residency (sounds like it's moving to 3) and there are a number of "+1/2's" - EM, Psych, Peds, Obs, geriatrics, where a year or two of specialized training is tacked on. CCFP (Canadian College of Family Practicioners) - EM designation docs are trained/certified to work in largely rural ED's/ larger, non-academic ones - they either do a 1 year of extra residency only in an ED as part of their academic track or can challenge the exam after (IIRC) 5 years of working in an ED. One urban one I worked at up until recently only had CCFP-EM docs in the ED - weren't any Royal College (5 year residency trained) ones there, largely because we didn't see a lot of pediatric cases there due to the provincial Children's Hospital a couple km away - as a general rule, peds ED's use Pediatricians with an EM fellowship or 5 year residency EM docs. I take it there isn't an EM fellowship for FM docs - one would think there would be if they're working in small places and expected to cover the ED of their community hospital, but, in keeping with the mottoes of the civil service and health care admin, "Si Sensum Facit, Prorsus Contratrium Facite" - "If It Makes Sense, Do The Exact Opposite". Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 30, 2023 Moderator Share Posted September 30, 2023 Federal workers comp order dm shoes do 30 day visits for hospice patients state level We have to notify doc of sch II meds with in 96 hours unable to do final read on X-ray need prescribing guidelines signed yearly by doc (costs me $6000 per year!) related to above - no independent practice (Montana license here I come!!) I think? Unable to start IV or order blood products admit to hospital (can’t be attending in hospital) anything but moderate sedation (I think this is more a credentialing issue but unsure) order sch II from drug wholesaler get paid same amount for same work! If I get A1C to 6.8 I get only 85% of doc. (Cause that makes sense) full voting membership on medical staff (also might be a local thing) Quote Link to comment Share on other sites More sharing options...
SedRate Posted September 30, 2023 Share Posted September 30, 2023 Can prescribe opiates according to state law but the OK pharmacy board won't fill opiate prescriptions by PAs, only physicians. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 30, 2023 Author Administrator Share Posted September 30, 2023 1 hour ago, SedRate said: Can prescribe opiates according to state law but the OK pharmacy board won't fill opiate prescriptions by PAs, only physicians. Sounds like a restraint of trade lawsuit... if anyone wanted to take it. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 30, 2023 Moderator Share Posted September 30, 2023 3 hours ago, SedRate said: Can prescribe opiates according to state law but the OK pharmacy board won't fill opiate prescriptions by PAs, only physicians. That should be immediately challenged in the courts. or filing a formal complaint against pharmacist for not filling under your name. 2 Quote Link to comment Share on other sites More sharing options...
sk732 Posted September 30, 2023 Share Posted September 30, 2023 My Province - can't prescribe DMA/DME (subject to change soon I hope) - Can't prescribe controlled substances such as opioids/opiates outside of a hospital...as (despite me being trained by the Federal government) we're not currently viewed as a health care profession in accordance with federal law (narcotics/benszos, etc fall under Federal Legislation) - Can't do stuff my supervising physician can't...also, can't do some stuff a supervising physician can, such as independent neuro/general/cardiothoracic/orthopedic surgery (assisting is fine). - Wasn't allowed to do my own procedural sedation in my last hospital, despite having adequate training/experience, though was able to in the previous - Also here, PA's and NP's are required to have a Dx on all our scripts...and very soon I think that will apply to MD's (for tracking off label uses, etc, as well as having a better idea for the pharmacists what's being treated for any given patient) - As I"m currently working as a contractor in a Federal nursing station, there's a whole new yelling/screaming match going on regarding us ordering narcotics/benzos even for emergency cases, because the whole "you don't exist" BS, despite us being prescribers under the College of Physicians and Surgeons. Also can't do sedations here - but that's also a safety thing due to lack of proper monitoring and training with some of the RN's...oh, and proper equipment/decent drugs, etc. - I don't shoot XRays - haven't been trained and neither have my SP's...though some of the RN's/LPN's and paramedics in the station have been for basic stuff Quote Link to comment Share on other sites More sharing options...
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