In Idaho, a physician assistant (PA) is allowed to practice only under the direction and oversight of a supervising physician. That is defined by law as a physician registered by the Board of Medicine who is responsible for the direction and supervision of the activities of and patient services provided by the PA.
The supervising physician accepts full medical responsibility for the activities of and patient services provided by the PA, with the ability to have an alternative supervising physician during a temporary absence, such as a vacation or leave of absence. The constant physical presence of a supervising physician is not required, so long as the supervisor and PA can easily be in contact with one another.
A PA's scope of practice is defined in a Delegation of Services Agreement (DOS), a mutually agreed upon document often drawn up by an attorney that is signed and dated by the PA and supervising physician. This important document defines the working relationship and delegation of duties between the supervising physician and the PA, and it is subject to Board approval.
Here are a few items that should be defined in a Board-approved DOS:
A scope of practice that includes only those duties and responsibilities delegated to the PA by their supervising physician and which are consistent with the expertise and regular scope of practice of the supervising physician.
Delineation of how the PA and supervising physician plan to conduct at least monthly onsite visits to observe quality of care
Outline a periodic review of a representative sample of medical records to evaluate medical services provided, including, when applicable, an evaluation of adherence to the DOS between the physician and PA
Conduct regularly scheduled conferences with PAs.
Any other specific requirements for the DOS that can be found in IDAPA 22.01.03.
Supervising physicians also need to be aware that they may not supervise more than three PAs at the same time. If authorized by the Board, a supervising physician or an alternate supervising physician may supervise a total of six (6) PAs contemporaneously if necessary to provide adequate medical care and upon prior petition documenting adequate safeguards to protect the public health and safety.
Should employment or practice situations change, supervising physicians must be aware that his or her duties may not be transferred to a business entity, professional corporation, or partnership, nor may they be assigned to another physician without prior notification and Board approval. A supervising physician also must report to the Board all patient complaints received against the PA related to the quality and type of medical care and patient services provided by the PA. It’s also required that the supervising physician ensure patients under the care of a PA know that the PA is not in fact a licensed physician, either through name tags, correspondence, oral statements, office signs or such procedures that adequately advise the patient of the education and training of the person providing medical services.
Competent legal counsel can help you navigate all aspects of running a successful medical practice, including making sure you are in compliance with any PAs you employ. Contact Smith + Malek to learn more about how we can help.