PA/MD Supervisory Relationship Explained
PAs bring a wealth of knowledge and skills to medical practices, working alongside physicians and other healthcare professionals to provide comprehensive care to patients
Here we’ll delve into the definition and practical applications of PA/MD supervisory relationship, and why it's essential for both patient safety and effective collaboration within the healthcare team.
I. The Role of PA/MD Supervision in PA Practice
Physician Assistants (PAs) are highly trained medical professionals who work under the supervision of licensed physicians to deliver a wide range of healthcare services.
To become a PA, individuals undergo rigorous education and training, typically completing a master's degree program in physician assistant studies. This comprehensive training equips them with the necessary medical knowledge and clinical skills to provide patient care. PAs are trained in the medical model, allowing them to diagnose and treat illnesses, perform procedures, prescribe medication, and offer preventive care.
One of the key aspects that sets PAs apart is their collaborative nature. PAs work closely with their supervising physicians and other members of the healthcare team to ensure coordinated and patient-centered care.
This collaborative approach not only enhances patient outcomes but also optimizes the workflow and efficiency of the healthcare practice.
It's important to note that while PAs can work autonomously to a certain extent, they always operate within a PA/MD supervisory framework. This framework ensures that the care provided by PAs aligns with the standards set by the supervising physician and the healthcare organization.
The PA/MD supervisory relationship is built on trust, effective communication, and shared goals of providing exceptional patient care. By understanding the unique contributions and capabilities of PAs, employers can create a supportive environment that maximizes the potential of these valuable healthcare professionals.
Collaboration and Utilization of Skills: Supervision fosters effective collaboration between the PA and the supervising physician. It enables both professionals to pool their expertise, share knowledge, and make informed decisions together. The supervising physician can leverage the PA's specialized skills, allowing them to focus on more complex cases and providing optimal care to patients. This collaboration enhances the overall efficiency and productivity of the healthcare practice.
Quality Assurance: Supervision plays a crucial role in maintaining and improving the quality of care provided by PAs. Regular oversight and feedback from the supervising physician allow for ongoing performance evaluation and continuous professional development. Through open communication and constructive feedback, the supervising physician can guide the PA's growth, ensuring their skills remain sharp and up to date.
Compliance with Legal and Regulatory Requirements: Supervision of PAs is essential to adhere to legal and regulatory frameworks. In Canada, specific requirements are in place regarding the supervisory relationship, including the delegation of tasks, scope of practice, and collaborative decision-making. By fulfilling these requirements, employers can ensure compliance with the law and maintain the integrity of their healthcare practice.
II. Types of Supervision
a) Direct vs Indirect Supervision
Direct supervision involves the physician being physically present in the patient encounter.
Indirect supervision means the physician is available by phone or by electronic means (secure internet network, or EMR messaging) to review patient cases and answer PA questions.
The supervising physician is responsible for ensuring that the PA is adequately supervised, which means access to the supervising physician is reasonable should the PA wish to consult the physician.
b) Inadequate Supervision
An example of inadequate indirect supervision includes when the physician is not accessible (e.g. cannot be reached by phone, or is out of country), or an alternative supervising physician has not been designated to the PA while the main supervising MD is away. A supervising physician must be able to discuss the case should an issue arise or intervene.
As per the CPSO, the responsibility of the delegated acts falls ultimately on the delegating physician.
c) Supervision by PA Experience
With a new PA hire/new grad PA, consider Direct Supervision first. When a PA first begins working, the supervising physician may consider starting with direct supervision first.
This helps establish a working relationship, the physician can gauge first hand the PA’s knowledge and competency with assessment, ordering relevant investigations, assessment and plan, patient communication. It’s also a great opportunity for the physician to provide feedback and guidance on how they prefer assessments and procedures be performed as well as how they prefer their medical documentation for patient encounters.
Feedback on observed PA performance can be given in the beginning, and this method is not uncommon for integration of a PA into a new practice (i.e. in the ER, family medicine, etc.).
With more PA experience, transition to Indirect Supervision
With time, as the PA becomes more accustomed to the practice and patient population, a more indirect approach may be taken with supervision where physician is on site, available by phone, EMR messaging or electronically.
For PA/MD relationships that are more well established, or perhaps where the PA is more experienced, the PA in many practice settings performs delegated tasks autonomously in an environment of mutual trust and understanding of the strengths and skills that benefit patient outcomes and practices.
III. The Role of the supervising physician in the PA/MD supervisory relationship
As an employer of a physician assistant (PA), your role in the supervision process is pivotal in creating a supportive and collaborative environment.
Communicating expectations is important, and can be formalized through a supervisory agreement that is established at the beginning of a PA’s employment.
The PA/MD Supervisory Agreement
A PD/MD Supervisory Agreement is a a written supervisory agreement that outlines PA guidelines is a good way to formalize the PA/MD relationship. Note: This is different from an employment contract which includes terms of contract, salary, benefits, etc. This supervisory agreement may include:
What the physician can expect from PA (e.g. ability to handle patient problems routine to practice, willingness to seek physician input, concise case presentations, appropriate medical documentation, and performance follow-up)
What the PA can expect from the supervising physician (e.g. ready access to supervising physician, learned advice, willingness to accept care of complex or higher acuity cases, introduction of PA as a member of the team to staff and patients, professional development opportunities such as teaching and CME)
PA Scope of Practice (e.g. description of job and role including clinic responsibilities, and common procedures, which can be expanded upon in a separate medical directive document)
Locations of Practice (e.g. if PA is expected to be at hospital, at the outpatient clinic, etc.)
Guidelines for when PA should consult with supervising physician (e.g. irate or hostile patients, life-threatening, or unusual cases, at the request of the patient)
Effectively supervising a physician assistant (PA) involves a systematic approach that ensures clear communication, ongoing evaluation, and a supportive working environment. Let's explore the key steps involved in establishing and maintaining a productive PA/MD supervisory relationship:
Step 1: Establish a Supervisory Agreement and Scope of Practice - At the beginning of the PA's employment, establish a supervisory agreement that outlines the roles, responsibilities, and scope of practice. Clearly define the tasks that the PA is authorized to perform under the supervision of the physician.
Step 2: Provide Initial Orientation and Training - Offer a comprehensive orientation program to familiarize the PA with your healthcare practice's policies, procedures, and protocols. Provide training specific to their role and responsibilities within the practice. This may include shadowing opportunities, training on electronic health record systems, and introductions to other team members.
Step 3: Regularly Review Performance and Provide Feedback - Conduct regular performance evaluations to assess the PA's clinical skills, professionalism, and communication abilities. Set clear performance goals and objectives, and provide constructive feedback based on observations and patient feedback.
Step 4: Maintain Open Lines of Communication Establish a culture of open and honest communication between the PA and the supervising physician. Encourage the PA to seek guidance and clarification when needed. Regularly schedule meetings to discuss patient cases, address any concerns, and foster collaboration.
Step 5: Foster Ongoing Professional Development Support the PA's professional growth by providing opportunities for continuing education and skill enhancement. Encourage their involvement in relevant conferences, workshops, and professional organizations. Stay updated on advancements in the field and share resources that contribute to their ongoing learning.
Final notes
By understanding the responsibilities of a PA employer, establishing clear communication and expectations, and actively engaging in the supervisory process, employers can create a strong foundation for a productive PA/MD relationship.
Through regular evaluation, feedback, and ongoing professional development, PAs can continually improve their skills and contribute to the healthcare team's success.
