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The Limitations of a Physician Assistant

A physician assistant’s duties and responsibilities depend on his training, experience, and state laws. A physician assistant assists his/her physician, so it can be said that the physician performs complicated procedures while the PA performs simple and routine procedures. However, the PA practice is growing rapidly and many doctors allow their PAs to treat patients independently. States are loading more responsibilities on PAs. PAs specializing in surgical procedures are also allowed to perform some procedures independently. As the physician assistant gains experience, the doctor starts relying more on him/her and then the line between what the physician assistant can do and what he/she is allowed to do starts to blur. So, how can we define what a physician assistant can or cannot do?

Here are the answers:

Physician Assistant – Scope of Services

A physician assistant is a dependent healthcare practitioner. This means that he/she has to always work under the supervision of a licensed doctor. The licensed doctor is responsible for the actions of his/her physician assistant and therefore allots his/her normal work based on his/her training and experience. A physician assistant performs many healthcare functions, including the following:

  1. Evaluating patients: A physician assistant can go through a patient’s medical history, ask him questions, conduct a physical examination, create a report and present it to the doctor.
  2. Monitoring patients: He/She can implement patient health management plans, provide care to patients in hospitals or other facilities, help the doctor in his/her hospital rounds, and record the patient’s progress.
  3. Diagnosing patients: He/She can perform and interpret the results of lab, radiology, cardio, and other procedures.
  4. Performing therapeutics: PAs can administer injections and immunizations. They can suture and care for wounds and manage medical conditions brought about by trauma or infections. They can assist while the doctor manages complex and life-threatening conditions. They can supervise and direct blood withdrawal in a DUI/DWI case.
  5. Counseling patients: PAs can direct patients to stick to their prescribed treatment plans. They can also advise patients on general health, emotional issues, and health maintenance.
  6. Referring patients: PAs can refer patients to other medical professionals and social service agencies as required.

 

What a Physician Assistant is Prohibited from doing?

PAs cannot perform specified tasks for other allied professions like radiologic technology and optometry practice. They cannot sign a death certificate, but can make a death pronouncement.

How the law limits the Physician Assistant’s Scope of Practice

The scope of practice outlined above is in theory and even the theory is vague because it says that these services are “included” within the PA’s scope of practice. Let us take North Carolina’s law that places limitations on a PA’s scope of practice as an example – other states too would have laid down similar rules. Before we get into what a PA can or cannot do, you must know that no PA can perform any healthcare duty if his license is inactive or not current. Now, here’re the limitations:

  1. Drug prescriptions written by a PA must contain his/her identification number issued by the state. The PA’s doctor must give him/her written instructions about indications and contraindications about prescribing drugs – if the PA does not have these in writing, he/she cannot prescribe drugs. The PA’s doctor must also give the PA a written policy for prescribing drugs – if no such document exists, the PA cannot prescribe drugs, and if he/she does, he/she will be in violation of law. The state may also issue more limitations on the PA’s drug prescription powers and therefore every PA must check the state laws before writing a prescription.
  2. A PA can compound and dispense drugs if the action is performed under the supervision of a licensed pharmacist and as per the regulations laid down by the state’s Board of Pharmacy.
  3. A PA can order tests, treatments and medications in hospitals and other healthcare facilities only if his/her supervising doctor has given him/her specific instructions in writing about ordering such procedures. If the case is complex then the order written by the PA must be reviewed by the physician within a reasonable time frame as specified by the state. The healthcare facility that is ordered to conduct the tests or the treatment must have written policy and procedures in force that authorize the verification of any orders written by a physician assistant and ensure that these orders are in the interest of patient safety. The state too may prescribe specific restrictions on what kind of tests or treatments a PA can order.

 

All PAs are required to maintain a current and active license, an active registration with the state board, and have a current Intent of Practice filed with the state board.

Now, as you can see, a PA can perform all the duties that lie within his/her scope of practice so long he/she is authorized by his/her supervising physician and such authorization does not contradict the state’s regulations. What a physician can do and what he/she cannot do therefore boils down to:

  1. The state laws
  2. The scope of a PA’s work as defined in general and by the state
  3. Written authorization from his/her supervising doctor, so long as the written instructions are in conformity with state rules.

 

The PA is also subjected to checks and balances because his/she orders are double-checked by other healthcare facilities. This is what a PA can, and cannot, do.

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