Lasers

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December 1, 2006

 

Ms. LaSharn Hughes, Executive Director

c/o Ms. Diane Atkinson

Georgia Composite Board of Medical Examiners

36th Floor

2 Peachtree Street, NW

Atlanta, Georgia 30303

Dear Ms. Hughes:

The American Academy of Physician Assistants is the national professional society for physician assistants (PAs). In this capacity, the Academy represents over 60,000 physician assistants in the United States. The Academy would like to comment on the Georgia Composite Medical Board of Medical Examiner’s proposed regulations Chapter 360-11.03, entitled “Requirements for Using a Laser for a Physician Assistant or Nurse Authorized to Engage in Advanced Nursing Practice.”

 

• Supervising physicians, who delegate the utilization of lasers to a Physician’s Assistant in accordance with a Board-approved job description or Nurse in conformity with a nurse protocol pursuant to O.C.G.A. §43-34-26.1 or 43-34-26.3, who is authorized by the Georgia Board of Nursing to engage in Advanced Nursing Practice as defined in Rule 360-11-.01, must practice at a location within 20 miles but no more than 30 minutes of the location where the supervised physician’s assistant or Nurse, who is authorized by the Georgia Board of Nursing to engage in Advanced Nursing Practice, is utilizing the laser and must be readily available for consultation as needed.

 

The board’s Notice of Proposed Rulemaking states that the rule is required to provide definitions for lasers, physician, physician assistant, nurse, and the use of lasers.

Physician assistants have been practicing with physician supervision in Georgia since 1972. A physician assistant’s scope of practice is that of providing medical services under the supervision of a physician. An integral component of providing medical services is a clearly defined level of supervision. AAPA is concerned that the Board’s new proposed regulations will create a new standard of supervision for physician assistants by mandating that the supervising physician practice within 20 miles or 30 minutes of the location in which the PA is utilizing the laser.

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 the 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.

The physician assistant profession is enduringly committed to the tenet that PAs practice with physician supervision. To quote from Academy Policy:

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 his essential relationship be preserved and strengthened.1

The PA profession has not sought nor promoted independent practice by PAs. Physician assistants are licensed to practice in all fifty states, the District of Columbia, several U.S. territories, and are authorized to practice by federal employers (i.e., the Department of Defense, Department of Veterans Affairs, and the Public Health Service). In all of these jurisdictions practice with physician supervision is required.

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.

If the proposed regulations are adopted, we fear they will add an element of undue rigidity to the health care delivery system. The current regulations allow the physician greater flexibility to organize their own practice based on the education, skill, and experience of the physician assistant, the acuity of patients seen in the setting, and the physician’s preferences.

We encourage the board to reject the proposed regulations as they are written that mandates a physician time or mile limitation when a PA uses a laser. We believe that this option would accomplish the board’s goals without placing unnecessary restrictions on providers or potentially decreasing access to care for patients. The utilization of lasers and related technology is covered by delegation and supervision requirements already in Georgia law and regulations.

The Academy appreciates the opportunity to address the board on this important issue.

Sincerely,

Ramon Gardenhire, JD

Assistant Director, State Government Affairs

1. American Academy of Physician Assistants 2004-2005 Policy Manual. Alexandria, VA.