Lasers

---

January 19, 2006

Ms. Diane Atkinson

Composite State Board of Medical Examiners

2 Peachtree Street, NW

40th Floor

Atlanta, GA 30303-3465

Dear Ms. Atkinson:

The American Academy of Physician Assistants (AAPA) is the national professional society for physician assistants (PAs). In this capacity the Academy represents over 58,000 physician assistants in the United States. The Academy appreciates the opportunity to provide comments on the Board’s proposed rules, Section 360-11 Lasers.

The PA profession was created by physicians who believed that physicians could treat more patients, utilize their time and talents more wisely, and provide better care if they worked with assistants who were trained in medicine and practiced with physician supervision. This idea has grown into the health profession known as physician assistants. The visionaries of the PA role were right. A physician can more effectively care for patients when working as part of a physician-PA team. The efficiency of this model has led to its utilization in all medical and surgical specialties. The physician-PA team is effective because of the similarities in physician and PA training, the PA profession’s commitment to practice with supervision, and the efficiencies created by utilizing the strengths of each professional in the clinical workplace.

The PA profession remains committed to the concept of the supervising physician-PA team. This is reflected in the AAPA’s description of the profession:

Physician assistants are health professionals licensed or, in the case of those employed by the federal government, credentialed, to practice medicine with physician supervision.1

The commitment to practicing as part of a physician-directed team is clearly stated in the

AAPA policy on team practice:

The AAPA believes that the physician-PA team relationship is fundamental to the PA profession and enhances the delivery of high quality health care. As the structure of the health care system changes, it is critical that this essential relationship be preserved and strengthened.2

Physician assistants seek and embrace a physician-delegated scope of practice. This is unique. No other health profession sees itself as entirely complementary to the care provided by physicians. PAs have great respect for the depth of training received by physicians and acknowledge physicians as the best-educated and most comprehensive providers on the health care team.

Allowing a supervising physician to determine the specific elements of a PA’s scope of practice allows for flexible and customized team deployment. The physician has the ability to observe the physician assistant’s competency and performance and to assure that the PA is performing tasks and procedures in the manner preferred by the supervising physician. The physician also is in the best position to assess the acuity of patient problems seen in a particular setting. The supervising physician is able to plan for PA utilization in a manner that is consistent with the PA’s abilities, the physician’s delegatory style, and the needs of the patients seen in the practice.

 

The statute and regulations that govern PA practice in Georgia require supervision by licensed physicians (M.D.s or D.O.s). The physician is required to both supervise the PA and to accept responsibility for care provided. The physical presence of he supervising physician is not required so long as the physician is readily available via telecommunication. The relevant regulations state:

 

“Supervising physician” means a physician who supervises the medical services provided by the physician assistant and who accepts ultimate responsibility for the medical care provided by the physician/physician assistant team.

“Supervision” means that a supervising physician retains ultimate responsibility for patient care, although a physician need not be physically present at each activity of the physician assistant or be specifically consulted before each delegated task is performed.

 

These regulations clearly require physician supervision of PA practice.

Georgia regulations authorize a supervising physician to determine a PA’s scope of practice via evaluation and delegation.

The AAPA readily acknowledges that the utilization of lasers and related technology by non-physicians requires supervision by a supervising physician. We would hold that these safeguards are already required by law for physician assistants. Any practice by a physician assistant requires that a supervising physician delegate, supervise, and take responsibility for care provided by a physician assistant. We recommend that no additional restrictions be imposed for use of lasers and related technology by physician-PA teams.

There is ample precedent for this approach. The following states have recognized the need for specific types of oversight of laser use for some, while acknowledging the unique role of PAs:

Michigan

Sec. 16276.

1) A licensee, registrant, or other individual shall not perform any procedure using a laser for dermatological purposes unless the procedure is performed under the supervision of a licensed physician.

(2) A licensee, registrant, or other individual shall not perform any procedure using a laser for dermatological purposes unless the patient has knowledge and consents to the procedure being performed by that licensee, registrant, or individual.

(3) Subsection (1) does not apply to any of the following:

(a) A licensed physician.

(b) A licensed physician’s assistant who performs such a procedure in a health care facility.

(c) A certified nurse practitioner who performs such a procedure in a health care facility.

(4) The department may promulgate rules to further prohibit or otherwise restrict the use of lasers for dermatological purposes.3

Rhode Island

In short, this policy statement defines office-based esthetic procedures, including laser hair removal and BoTox injections, as the practice of medicine. As such these procedures should only be done by physicians or advanced practice clinicians [e.g. nurse practitioners and physician assistants]; or under the supervision of physicians or advanced practice clinicians. It must be emphasized that medical equipment such as medical lasers and prescription pharmaceuticals should only be purchased by and used under the direction of a physician or advanced practice clinician.4

 

Texas

193.11(c) Use of lasers in the practice of medicine.

(2) The use of lasers/pulsed light devices for non-ablative procedures cannot be delegated to non-physician delegates, other than an advanced health practitioner, without the delegating/supervising physician being on-site and immediately available.

Advanced health practitioner” is defined in 193.11(b) as “a physician assistant or an advanced practice nurse.5

The American Academy of Physician Assistants is committed to the concept that PAs provide health care as delegated and supervised by a licensed physician. The utilization of lasers and related technology is covered by delegation and supervision requirements already in Georgia law and regulations. The AAPA believes that current language offers excellent physician oversight and public protection and that additional restriction for specific technologies is not required.

The AAPA appreciates the opportunity to comment on the proposed rule.

Sincerely,

Ann Davis, PA-C

Director of State Government Affairs

1. American Academy of Physician Assistants. 2005-2006 Policy Manual. Alexandria, VA.
2. Ibid.
3. Michigan Compiled Laws 333.16276.
4. Rhode Island Division of Health Services Regulation policy, adopted 2/12/04.
5. Texas State Board of Medical Examiners regulations, 193.11 (use of lasers).