Is This a Trend for PAs? If So, How Can We Fix It

[jmj11]

So, in your opinions, would the increase in this be more from the schools not spending as much time on this topic, or from schools increasingly accepting students with less or lower quality HCE? Or do you have other thoughts?

 

Do we have any PA educators here? Do they discuss the proper way of prescribing as far as making sure it is an official patient with official documentation of a visit?

 

This should not influence the virtual visits (which we do) because we generate a chart note on each patient just like if they were in the office with us . . . but without the vitals (unless the patient can supply them). My SP has full access to my virtual visits.

 

I have a headache clinic. My wife has migraine. I've never prescribed a migraine medication for her. She asked me to once (sumatriptan not a narcotic). I sent her to her PCP with my suggestion. It works out great and all above board and only her PCP prescribes for her and she is in a totally different office.

 

I can imagine in a small, isolated town that you could end up treating family members if there were no other choice. I don't see a problem if it is done in the office with documentation and DID NOT involved controlled substances. I knew a PA that prescribed Percocets for his wife's headaches. I told him I thought he was nuts. Besides, he didn't even see her in the clinic but jotted down a note in her chart now and then. A disaster waiting to happen.

[jmj11]

So, in your opinions, would the increase in this be more from the schools not spending as much time on this topic, or from schools increasingly accepting students with less or lower quality HCE? Or do you have other thoughts?

 

Do we have any PA educators here? Do they discuss the proper way of prescribing as far as making sure it is an official patient with official documentation of a visit?

 

This should not influence the virtual visits (which we do) because we generate a chart note on each patient just like if they were in the office with us . . . but without the vitals (unless the patient can supply them). My SP has full access to my virtual visits.

 

I have a headache clinic. My wife has migraine. I've never prescribed a migraine medication for her. She asked me to once (sumatriptan not a narcotic). I sent her to her PCP with my suggestion. It works out great and all above board and only her PCP prescribes for her and she is in a totally different office.

 

I can imagine in a small, isolated town that you could end up treating family members if there were no other choice. I don't see a problem if it is done in the office with documentation and DID NOT involved controlled substances. I knew a PA that prescribed Percocets for his wife's headaches. I told him I thought he was nuts. Besides, he didn't even see her in the clinic but jotted down a note in her chart now and then. A disaster waiting to happen.

[jdumoch]

A physician I work with wrote an uncontrolled script for her daughter. It was deemed as insurance fraud as the daughter used her insurance to pay for the script... after some research i learned that if you bill an insurance company for a visit by a family member, even if fully documented, at least in ct it is considered fraud. just a slap on the wrist but still..

[jdumoch]

A physician I work with wrote an uncontrolled script for her daughter. It was deemed as insurance fraud as the daughter used her insurance to pay for the script... after some research i learned that if you bill an insurance company for a visit by a family member, even if fully documented, at least in ct it is considered fraud. just a slap on the wrist but still..

[Teasip]

I don't see it as the program's sole responsibility. For some of us, prescription rights came years after graduation. If you're given the legal authority to write a prescription as a delegated responsibility then it is your responsibility to know the law. The "what's the harm?" can be explained thusly. I had an obese, IDDM co-worker (nurse) who hit me up in the hallway for "something to help me sleep". Documented an OV and low and behold it dominoes to sleep apnea with what secondary complication? LV dysfunction with an EF in the 20's on echo. After a sleep study->CPAP and regular cardiology f/u, including ACEI tx (HTN as well); she ended up with her EF back up over 50%. If you don't assess correctly then you can miss these types of cases. We had a policy thereafter (SP request) of no more curbside consults. If they're too busy to be seen then it falls back onto them.

[Teasip]

I don't see it as the program's sole responsibility. For some of us, prescription rights came years after graduation. If you're given the legal authority to write a prescription as a delegated responsibility then it is your responsibility to know the law. The "what's the harm?" can be explained thusly. I had an obese, IDDM co-worker (nurse) who hit me up in the hallway for "something to help me sleep". Documented an OV and low and behold it dominoes to sleep apnea with what secondary complication? LV dysfunction with an EF in the 20's on echo. After a sleep study->CPAP and regular cardiology f/u, including ACEI tx (HTN as well); she ended up with her EF back up over 50%. If you don't assess correctly then you can miss these types of cases. We had a policy thereafter (SP request) of no more curbside consults. If they're too busy to be seen then it falls back onto them.

[MaggieMay]

As a PA educator what is being discussed is very important. First, it is important that you know the laws within your state. Every state is different, however the trend in professionalism along the medical societies that govern practitioners is that we are seeing much stronger oversite via the medical boards with this issue. In my state alone, the medical board's goal is to assess practice parameters and site visit every practicing PA within the state in the next 3 years. Yes, we are seeing more and more professional issues being brought to the medical board and MANY of these citations/suspensions of licensing concern prescribing. In our program we have instruction on these very issues. We discuss the issues at the beginning of the program and again at the end. It is important that as medical professionals that you know that receiving a license to practice medicine carries very huge responsibilities. The public entrusts that we will care for patients in a caring, professional manner. It becomes a slippery slope when you start prescribing medications for family and friends without documentation of their history or having a documented physical exam. I do know some colleagues that will, but will have documentation along with it. I personally do not prescribe for any family or friends. There is a certain bias that comes into play, and what, just what happens if something goes wrong. Who's license will be affected - yours and perhaps your supervising physician. Is it worth it? In my mind, no. The medical board has complete ability to look up your practice patterns, prescription writing especially narcotics. Be aware that once you have a black mark with the medical board, you are likely to be very scrutinized from then on within that state.

[MaggieMay]

As a PA educator what is being discussed is very important. First, it is important that you know the laws within your state. Every state is different, however the trend in professionalism along the medical societies that govern practitioners is that we are seeing much stronger oversite via the medical boards with this issue. In my state alone, the medical board's goal is to assess practice parameters and site visit every practicing PA within the state in the next 3 years. Yes, we are seeing more and more professional issues being brought to the medical board and MANY of these citations/suspensions of licensing concern prescribing. In our program we have instruction on these very issues. We discuss the issues at the beginning of the program and again at the end. It is important that as medical professionals that you know that receiving a license to practice medicine carries very huge responsibilities. The public entrusts that we will care for patients in a caring, professional manner. It becomes a slippery slope when you start prescribing medications for family and friends without documentation of their history or having a documented physical exam. I do know some colleagues that will, but will have documentation along with it. I personally do not prescribe for any family or friends. There is a certain bias that comes into play, and what, just what happens if something goes wrong. Who's license will be affected - yours and perhaps your supervising physician. Is it worth it? In my mind, no. The medical board has complete ability to look up your practice patterns, prescription writing especially narcotics. Be aware that once you have a black mark with the medical board, you are likely to be very scrutinized from then on within that state.

[Guest Paula]

As a PA educator what is being discussed is very important. First, it is important that you know the laws within your state. Every state is different, however the trend in professionalism along the medical societies that govern practitioners is that we are seeing much stronger oversite via the medical boards with this issue. In my state alone, the medical board's goal is to assess practice parameters and site visit every practicing PA within the state in the next 3 years. Yes, we are seeing more and more professional issues being brought to the medical board and MANY of these citations/suspensions of licensing concern prescribing. In our program we have instruction on these very issues. We discuss the issues at the beginning of the program and again at the end. It is important that as medical professionals that you know that receiving a license to practice medicine carries very huge responsibilities. The public entrusts that we will care for patients in a caring, professional manner. It becomes a slippery slope when you start prescribing medications for family and friends without documentation of their history or having a documented physical exam. I do know some colleagues that will, but will have documentation along with it. I personally do not prescribe for any family or friends. There is a certain bias that comes into play, and what, just what happens if something goes wrong. Who's license will be affected - yours and perhaps your supervising physician. Is it worth it? In my mind, no. The medical board has complete ability to look up your practice patterns, prescription writing especially narcotics. Be aware that once you have a black mark with the medical board, you are likely to be very scrutinized from then on within that state.

 

Is the medical board of your state making a site visit to every doctor as well? If not, why just PAs? I assume when the PA is looked at so will their SP, but what about the physicians who do not use PAs in their practices?

 

I agree with everything you have mentioned here.

[Guest Paula]

As a PA educator what is being discussed is very important. First, it is important that you know the laws within your state. Every state is different, however the trend in professionalism along the medical societies that govern practitioners is that we are seeing much stronger oversite via the medical boards with this issue. In my state alone, the medical board's goal is to assess practice parameters and site visit every practicing PA within the state in the next 3 years. Yes, we are seeing more and more professional issues being brought to the medical board and MANY of these citations/suspensions of licensing concern prescribing. In our program we have instruction on these very issues. We discuss the issues at the beginning of the program and again at the end. It is important that as medical professionals that you know that receiving a license to practice medicine carries very huge responsibilities. The public entrusts that we will care for patients in a caring, professional manner. It becomes a slippery slope when you start prescribing medications for family and friends without documentation of their history or having a documented physical exam. I do know some colleagues that will, but will have documentation along with it. I personally do not prescribe for any family or friends. There is a certain bias that comes into play, and what, just what happens if something goes wrong. Who's license will be affected - yours and perhaps your supervising physician. Is it worth it? In my mind, no. The medical board has complete ability to look up your practice patterns, prescription writing especially narcotics. Be aware that once you have a black mark with the medical board, you are likely to be very scrutinized from then on within that state.

 

Is the medical board of your state making a site visit to every doctor as well? If not, why just PAs? I assume when the PA is looked at so will their SP, but what about the physicians who do not use PAs in their practices?

 

I agree with everything you have mentioned here.

[FBIDoc]

It's a little skirt of the issue, but well within the legal framework (at least in my state). IF I write an rx for friends or family I am extremely selective in the first place. Second,I ALWAYS document the encounter. Thirdly, I keep a file of these documented "charts" locked in a firesafe in my office at home. My SP knows about this practice and authorizes it, and he doesn't need to review the charts b/c we only need 10% chart audit. Finally, I NEVER, rx narcs, other controlled substances, or mental health meds.

 

Will this protect me? Maybe not, but at least I can demonstrate I attempted to comply with statute.