REPORT: January 2006

Ask the Experts

Some hospitals have changed the requirements for PAs’ orders

Q.: A physician’s assistant (PA) practicing in my hospital recently told me that medical orders written by a PA no longer must be co-signed by the “supervising” physician within 24 hours. Is this true?

A.: Maybe.

Unlike certified nurse practitioners (NPs), PAs are dependent practitioners who function under the supervision of a physician. Although not necessarily direct supervision — a physician is not required to be present at the time services are delivered. A Public Health Law, which took effect on Nov. 23, 2005, authorized PAs to write medical orders without a supervising physician’s countersignature, if such action is permissible under the hospital’s medical staff bylaws, rules, and regulations. The new law offers hospitals greater flexibility in determining how physician supervision of PAs will be demonstrated. To fully implement this law, the Department of Health plans to amend regulations, which are expected to be adopted in 2006.

Effective Nov. 23, 2005, hospitals had three possible responses to this new law:

• terminate the countersignature requirement for inpatient medical orders written by PAs, by amending the hospital’s medical staff bylaws, rules, and regulations;
• institute a tiered system that would eliminate the countersignature requirement as the PA demonstrates increased competencies secondary to training and experience; or
• maintain the countersignature requirement for PAs.

This is to alert you to a possible change; find out what your hospital has done.