PAs and New Patients

PAs and New Patients

(Reprinted from OAPA Progress Notes 2009)

I’ve had many, many calls over the past year regarding the issue of how PAs are to arrange follow-up for new patients to a practice.  At least two “consultants” are going around the state giving talks to physicians on how to supervise PAs and NPs, and the information they are apparently providing regarding PAs and new patients is wrong.

Note I have not heard the information first hand, but their message seems to be the same.  Specifically, what is being said is that a new patient to a practice must be seen by the physician within forty-eight hours of the initial visit.  Again, this interpretation of section 435:15-9-3 of the Oklahoma Administrative Code (PA Rules), is wrong.

To prepare this article, I consulted with Mr. Lyle Kelsey, Executive Director of the Oklahoma State Board of Medical Licensure & Supervision.  Therefore, the following information is not based on my opinion.

Most verbiage in section 435:15-9-3 is not at issue.  The misinterpretation comes in paragraph 3(b) which states, ‘In addition, the patient shall be scheduled to see the physician at their next scheduled clinic appointment which shall conform to the following provision in law: “In patients with newly diagnosed chronic or complex illness, the physician assistant shall contact the supervising physician within forty-eight (48) hours of the physician assistant’s initial examination or treatment, and schedule the patient for appropriate evaluation by the supervising physician as directed by the physician.”’

To arrive at a correct interpretation of paragraph 3(b), note that it does not say that all new patients are to be seen by the physician within forty-eight hours, just that the physician will be CONTACTED for those with “newly diagnosed chronic or complex illness”.  While the definition of “chronic” is universally understood, “complex illness” will change from practice to practice?  For example, impetigo in a primary care setting is not a complex illness, but may be considered such by a physician/PA working in cardiology.  Conversely, encountering a patient with angina for a cardiologist and cardiology PA is a routine condition, but may be considered complex in the primary care setting.  So who determines the follow-up for a new patient with a “complex illness”?  Focus here, because this is the heart of the matter…the last five words of section 435:15-9-3 define how new patients are to be evaluated – “as directed by the physician”.

It is the supervising physician who determines which conditions are complex and which of those conditions need his/her attention within forty-eight hours.  For a new graduate or a new PA to the practice, the supervising physician may insist that all patients need to be seen by him/her.  But, for a PA with decades of experience in a particular setting, not much may qualify as complex.  Again, the decisions as to what does and does not qualify are, “as directed by the physician”.

I encourage you retain this article and offer it as evidence against misleading statements by supposed “expert consultants”.  For further clarification, please have your supervising physician or administrator contact the Oklahoma State Board of Medical Licensure & Supervision at (405) 962-1400.