Regulations on Discipline of Physicians

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April 27, 2006

 

David R. Gifford, M.D., M.P.H., Director

Rhode Island Department of Health

401 Cannon Building

3 Capitol Hill

Providence, Rhode Island 02908-5097

 

Dear Dr. Gifford:

The American Academy of Physician Assistants (AAPA) is the national professional society for physician assistants (PAs). In this capacity the Academy represents over 60,000 PAs in the United States.

The AAPA would like to comment on the proposed revision to the Rules and Regulations for the Licensure and Discipline of Physicians in Rhode Island. In specific, the Academy would like to comment on the proposed amendment that includes new language related to the delegation of technical acts by physicians to unlicensed medical assistants.

The proposed regulations appear to intend to regulate the practice of unlicensed persons, specifically medical assistants, by regulating the physicians who may utilize and direct their services. Our concern with the regulations as drafted is that they do not acknowledge that physician assistants, practicing with physician supervision, may work with medical assistants.

The regulations governing physician assistants clearly state that the supervising physician must be available either in person or via telecommunication at all times while the PA is involved in patient care. Rhode Island statute states that “Supervision must be continuous but does not require the constant physical presence of the physician.” The supervising physician and PA must assure an appropriate level of supervision, depending on the services being rendered in the setting.

PAs commonly work in settings where medical assistants are utilized. For example, a PA may work in outpatient pediatrics, where children are evaluated and immunized. Under the proposed regulations, a physician would need to be physically present for a medical assistant to give a routine immunization, even if a PA was present on site at the clinic.

This would represent a substantive change in current practice and impose a significant new restriction on physicians who utilize PAs.

Only a handful of other states regulate medical assistants, either through regulation of the medical assistants themselves or by regulating their use in a medical practice. In many of these states the regulations specifically state that a supervising physician may delegate to the PA any and all oversight of the medical assistant that is consistent with sound medical practice.

The Academy respectfully requests that the proposed regulation be amended to clarify that a physician may delegate to a PA those aspects of medical assistant oversight and delegation that are appropriate to the practice setting and accepted medical practice. Failure to clarify the role of PAs has the potential to lead to confusion and disruption of care.

The AAPA appreciates the opportunity to provide these comments on the proposed regulations.

Sincerely,

Ann Davis, PA-C

Director of State Government Affairs