Comprehensive Guide to Physician Assistant Legislation, Practice, and Professional Issues

What decade saw the first state laws allowing delegation of authority to supervising physicians for PAs?

The 1970s

What is the primary function of PAs as authorized by state licensing boards?

To perform medical diagnostic and therapeutic tasks

Which state was the last to grant licensure to PAs?

Mississippi in 2000

What is the last state to grant prescribing privileges to PAs?

Indiana in 2007

What are the general requirements for PA licensure?

Graduate from an accredited program, complete a screening questionnaire, and pass the PANCE.

Where can one find state-specific information regarding PA practice?

State laws and regulations, AAPA, and state organizations.

What does the scope of practice for PAs depend on?

Education, experience, state law, facility policy, and physician delegation.

What is the supervision ratio limit for PAs in California?

A physician may not supervise more than four PAs at one time.

In Florida, what is required for a PA to prescribe medication?

Physician supervision and compliance with specific CME requirements and formulary limits.

What is the maximum number of PAs a physician can supervise in New York?

Six PAs in private practice.

What is the supervision requirement for PAs in Texas?

Continuous supervision is required, but the physician does not need to be physically present.

What is the collaboration model in Utah regarding PA practice?

Prescriptive authority is tied to experience and collaborative relationships; direct physician oversight is not always required.

What are the six key elements of modern PA practice?

Licensure, full prescriptive authority, site-determined scope of practice, adaptable supervision, co-signature requirements, and unlimited MD supervision.

What does 'responsible control' refer to in PA supervision?

It establishes the limits of policies to be followed by the supervised professional.

What is the difference between direct and indirect supervision?

Direct supervision requires the physician to be physically present, while indirect supervision allows for consultation without physical presence.

What does New York State law say about PA supervision?

PAs may perform medical services only under the supervision of a physician, and supervision must be continuous but does not require physical presence.

What is the maximum number of physician assistants a physician can supervise in private practice?

No more than six physician assistants.

How many physician assistants can be employed in a correctional facility?

Up to 8 physician assistants.

What is the requirement for physician co-signatures on PA records according to the current law?

There is no requirement for physician co-signatures on every PA record.

What is a delegation agreement?

An agreement that outlines broad duties and specific patient problems and procedures delegated by the physician.

What are the responsibilities of a PA in an Internal Medicine Outpatient Clinic?

Obtain medical histories, perform physical exams, formulate diagnoses, order tests, and develop treatment plans.

What does the scope of employment for a PA include?

It includes an employment contract and delegation agreement, and they are responsible for their negligent actions.

What are medical protocols?

Procedures for carrying out a set of processes in medical treatment, which may become outdated.

What is the AMA's stance on protocols in PA-MD practice?

The AMA does not recommend protocols for delineating PA-MD practice.

How has prescriptive authority for PAs evolved over time?

It has been obtained through legal and political negotiations over four decades, with 46 states allowing PAs to prescribe controlled substances.

What was the first state to introduce PA prescribing privileges?

1969 was the year the first statute was introduced.

What is required for PAs to prescribe controlled substances in New York State?

PAs must have a specific DEA license.

What are Schedule I drugs?

Drugs with no accepted medical use and a high potential for abuse, e.g., heroin and LSD.

What defines Schedule II drugs?

Drugs with a high potential for abuse and severe dependence, e.g., oxycodone and fentanyl.

What is an example of a Schedule III drug?

Combination products with less than 15 mg of hydrocodone per dosage unit, like Vicodin.

What characterizes Schedule IV drugs?

Drugs with a low potential for abuse and low risk of dependence, e.g., Xanax and Valium.

What are Schedule V drugs used for?

They are used for antidiarrheal, antitussive, and analgesic purposes, e.g., cough preparations with less than 200 mg of codeine.

What is the purpose of e-prescribing in New York State?

To limit medical errors and improve safety with controlled substances.

What is the I-stop program?

A program that requires checking the PMP prescription monitoring program before prescribing controlled substances.

What should a PA do if a nurse refuses to fill a morphine order due to lack of co-signature?

Verify that the current law does not require co-signatures on every PA order.

What is the average number of hours of pharmacology instruction required by ARC-PA?

75 hours

What percentage of the PANCE exam is dedicated to pharmacology?

12-15%

What must a PA do to prescribe controlled substances?

Register with the DEA and comply with state laws.

What is required for a PA to have a DEA registration?

The state must allow PAs to prescribe and all requirements must be met.

What is the role of lobbying for healthcare professionals?

To influence public health officials toward desired legislation.

What are some important issues NYSSPA has advocated for?

Improving supervisory ratios and allowing PAs to perform fluoroscopy.

Who is liable for malpractice in a healthcare setting?

Each state practitioner, including MDs, PAs, and RNs, is independently liable.

What does the NYS Department of Health's Office of Professional Medical Conduct review?

Allegations of professional medical misconduct including negligence and ethical violations.

What can result from professional misconduct in New York State?

Loss of professional license.

What are examples of medical misconduct?

Fraudulent practice, gross negligence, and abandonment of a patient.

What four elements must be proven in a negligence case?

Duty, breach of duty, proximate cause, and damages.

What does the standard of care refer to?

The level of care a reasonably competent PA would provide under similar circumstances.

What is the National Practitioner Data Bank?

A data source for state board actions and malpractice actions against licensed professionals.

What is the purpose of a collective bargaining agreement (CBA) for PAs?

To protect employees and influence work conditions.

What ethical concerns are associated with pharmaceutical representatives?

Gifts to providers intended to influence prescribing practices.

Can PAs perform abortions?

Yes, depending on the state; for example, New York allows it.

Can a PA sign a death certificate?

Yes, if permitted by state law; New York allows it.

What does EMTALA stand for?

Emergency Medical Treatment and Labor Act.

What is the purpose of EMTALA?

To ensure access to emergency care and prevent inappropriate transfers.

What is required for a PA to own their own practice?

A supervisory or collaborative agreement with a physician is required in every state.

What does the Good Samaritan Law protect?

It protects individuals who provide emergency care from legal liability.

In New York, is it legally acceptable for a PA to see patients while the supervising physician is not physically present?

Yes, as long as supervision is continuous and does not require physical presence.

What must a PA have to prescribe oxycodone in New York?

A DEA registration and compliance with I-STOP/PMP requirements.

Which situation best represents professional misconduct related to standard of care?

A PA fails to evaluate chest pain appropriately and discharges the patient without proper workup.