The Next Passenger on the Health Train: Physician Assistants

fl legBy: Jackie Bain

The scope of Physician Assistants’ practice is a dynamic and hotly debated area of law which shares many similarities with the nurse supervision issues we covered in a recent article (available here). House Bill 1275 would have also allowed for an expansion in the PA field and was included on the “Health Train” compilation of bills introduced during the Florida legislature’s recent session. As we know nothing on the Train passed before the session ended and though it may gain forward momentum next time, here’ how the laws stand today: 

Florida law allows physicians to delegate health care tasks to qualified physician assistants (PAs) when such a delegation is appropriate.

Physicians who delegate must be confident that the PA can perform the delegated tasks efficiently and effectively. PAs must have passed a proficiency examination administered by and hold a current certificate issued by the National Commission on Certification of Physician Assistants.  In the event that a PA is recently graduated and has not yet taken and passed the proficiency examination, the Board of Medicine may issue a 30-day temporary license while the applicant awaits the exam.

The PA must be supervised by a physician or a physician group that is qualified in the same medical specialty as the PA is expected to perform.  One physician may not supervise more than four PAs at any given time.  A “primary supervising physician” assumes legal responsibility and liability for the PA’s services at all times the PA is not being supervised by an “alternate supervising physician”.  An “alternate supervising physician” assumes legal responsibility and liability for the PA’s services only when the PA is under his/her supervision and control.

In instances where a PA requires indirect supervision, a supervising physician must be easily available to consult with and direct the PA.  Such communication may be accomplished by telecommunication.  However, if a PA requires direct supervision, the supervising physician must be on the same premises as the PA.

The Boards of Medicine and Osteopathic Medicine have adopted general principles that supervising physicians must use in developing the scope of practice of a PA under direct or indirect supervision.  It is a supervising physician’s decision whether or not to allow a PA to perform a task under direct or indirect supervision, and such a decision must be based on the physician’s reasonable medical judgment and the probability of morbidity or mortality of the patient.  The Board uses the following factors to determine whether a physician’s supervision of a PA is adequate:

  • the complexity of the assigned task;
  • the risk to the patient;
  • the PA’s background, training and skill;
  • how involved the physician is in directing the PA’s task;
  • the setting in which the PA performs the task;
  • the physician’s availability to the PA;
  • the patient’s necessity for immediate attention; and
  • the number of other persons that the physician is supervising.

Under no circumstances shall a physician delegate to a PA: (1) the authority to prescribe, dispense or compound medicinal drugs, or (2) the authority to conclude a patient’s final diagnosis.  Moreover, the following tasks may only be performed by a PA under direct supervision: (1) insertion or removal of certain tubes/wires; (2) interpretation of laboratory tests, x-rays or EKGs; or (3) administration of general, spinal or epidural anesthesia.  The foregoing lists are not exhaustive and are meant for illustrative purposes only.  All tasks performed by a PA must be documented in a patient’s medical record.

A physician and a PA must enter into a written agreement outlining which prescription drugs the physician has authorized the PA to prescribe.  The physician must keep the agreement on file for at least five years.  A PA may not give out samples of prescription drugs which the PA would not otherwise be allowed to prescribe.  Under no circumstances shall a PA be authorized to prescribe controlled substances.

PAs must notify the Board of Medicine within 30 days after becoming employed, changing employment, or changing a supervising physician, and that form is available here. Failure to appropriately notify the Board may result in discipline.

There is surely change on the horizon, perhaps even an increase in the number of licensed PAs that a physician may supervise as HB1275 proposed, but enforcement based on the above will continue until then. Stay tuned!


Jacqueline Bain will present a live lunch n’ learn webinar on Physician Supervision Issues on August 27th from 12-1pm EST. Registration is FREE and open now! Click here to register.

One thought on “The Next Passenger on the Health Train: Physician Assistants

  1. Pingback: PAs and ARNPs and Prescribing Controlled Substances | Florida Healthcare Law Firm Blog

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