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Since there seem to some unusual experiences out there with PA's, let me
point out I am a fairly normal PA, and hit the more significant parts of
the last 27 years;<br><br>
In 1981 - I, and 3 other PA's, covered a rural ER solo 24-7 (and the
hospital for acute changes when on the night shift).<br>
In 1990 - I was the Primary Practitioner for the VA Hospital in Richmond
for the cardiac transplant program, with a transplant cardiologist,
surgeon, and Pharm.D. always available for consultation. However, the
inpatient service, the outpatient clinic and all endomyocardial biopsies
were my responsibility, with help from the clinical nurse specialist
(whom I precepted for her NP credentials) and two transplant
coordinators. <br>
In 1995 - was a Primary Care Provider (Adult, Internal Medicine) of
record (i.e. my name was on the patient's insurance card) for Kaiser in
Texas. Only happened if a patient did the paperwork to change to a
mid-level, they were always initially assigned to a physician. I
had a full panel of ~2000 patients when I left.<br>
In 1998 - Additional duty at Kaiser as Chief Practitioner at our Urgent
Care that we operated from our office after hours. The Physician in
Charge (double boarded IM and Pedi MD) of the facility was available if
one of the physicians working in Urgent Care was unhappy with something I
did as Chief, but there were never any physician complaints. At
another Kaiser office - the "Physician in Charge" of the
facility title had to become Practitioner in Charge, because the
physicians at the site wanted the PA to lead them. (He was smarter than I
am, and a MUCH better people manager. :) ) They still provided his
medical supervision. <br>
In 2000 - I, and a group of PA's, provided primary critical care coverage
at a tertiary center in Atlanta that did more cardiac procedures than
Emory, and we did almost all cardiology consults for the ER and the house
at night, with a telephone call to the cardiologist on call before the
note went in the chart. In 18 months, one of the MD's felt required
to come in only twice when I was on, except for emergent PCI (which
obviously were always done by a cardiologist). <br>
Since 2002, I have been at a remote site in Egypt, providing primary and
emergency care, including ambulance transfer as needed, for US military
and civilian contractors stationed here. We are 2 hours from the
closest care that approximates Western standard and transfer at night is
prohibited unless we feel would risk of traffic (Egyptians don't use
headlights at light - it's "impolite") is worth the benefit -
US Embassy requirement. <br><br>
There certainly are PA's with a wider scope of practice. One guy in NY
State tried to sell me his primary care practice many years ago - very
rural, supervising doc was a long way away, rarely present and I told him
straight up I didn't have the background to handle what he did.<br><br>
These are fairly standard roles for PA's. I believe that now all
States have given the PA's prescribing privileges, but a very few still
won't authorize controlled substances.<br>
I am surprised to hear of the perceptions on what supervising physicians
are allowed to delegate. It is always the supervising physicians
who go to the legislatures to get laws changed so that their practice and
their utilization of PA's is not inappropriately restricted. <br><br>
Lorick</font></body>
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