Roles and Responsibilities of Physicians Supervising PAs - Ontario ...

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Appendix APractical Guidelines for PA – Physician Practice in OntarioThe following guidelines have been adapted from the American MedicalAssociation’s Guidelines for PA-Physician Practice (adopted by the AMA Houseof Delegates, June 1995):1. Health care services delivered by physicians and PA must be within thescope of the supervising physician’s authorized practice.2. The supervising physician is ultimately responsible for coordinating andmanaging the care of patients and, with the appropriate input of the PA,ensuring the quality of health care provided to patients.3. The physician is responsible for supervising the PA (directly or indirectly)who performs health care tasks that he/she has assigned.4. The role of the PA in the delivery of care should be defined through mutuallyagreed upon guidelines that are developed by the physician and the PA.These should be documented in a practice agreement in each setting.5. The supervising physician must be available for consultation with the PA atall times either in person or through telecommunication systems or othermeans. Supervising physicians should provide direct and/or on-sitesupervision until the PA has demonstrated competency in all tasks that willbe assigned or delegated.6. The extent of the involvement by the PA in the assessment andimplementation of treatment will depend on the complexity and acuity of thepatient's condition, and the training, experience and preparation of the PAas adjudged by the physician.7. Patients should be made clearly aware at all times whether they are beingcared for by a physician or a PA.8. The physician and PA together should review all assigned patient serviceson a regular basis, as well as the mutually agreed upon guidelines forpractice relating to delegated acts.9. The physician is responsible for clarifying and familiarizing the PA withhis/her supervision style.10. The primary supervising physician and the PA should clarify the roles andresponsibilities of the various physician supervisors that the PA may have,as well as the administrative lead for the site. Clear expectations, lines ofUpdated July 2011 10
esponsibility and processes for resolving any potential conflicts should beestablished.Appendix BQuestions and Answers on SupervisionQ1. How much, and what kind of, supervision is the supervising physicianrequired to provide?Physicians supervise all clinical activity assigned to the PA at all times, however,this supervision may be direct or indirect.There are several models of supervision that may apply:Direct supervision of the PA: This occurs when the PA and supervisingphysician work side by side in the same physical location. The physician canobserve the PA while interacting with patients. This type of supervision will berequired during the initial period of all PA employment to allow for theassessment of PA competencies and development of the PA role andresponsibilities in that practice setting. In this circumstance, the physician willassign clinical work to the PA verbally and sign any related orders. All delegationof Controlled Acts will be within the physician-patient relationship (i.e. the patientis known to the physician) and should be done using direct orders (either verbalor written).Mixed direct/ indirect supervision of the PA: This occurs when the PA andsupervising physician usually, but not always, work side by side. Some patientcare is provided with direct supervision as above, but the PA may also seepatients without direct supervision from the physician. Through verbal or writtenorders, the PA would complete clinical work, and report back to the supervisingphysician with an assessment and plan for ongoing intervention as appropriate.The supervising physician would then provide further direction to the PA. The PAmay also perform clinical work under an approved medical directive, wherein thePA can implement treatments, interventions or procedures for a patient withoutthe physician’s direct supervision. Under certain conditions, medical directiveswill allow the PA to see a patient before the patient is known to the physician,however, a supervising physician must establish a relationship with the patientbefore the patient encounter can be completed.Indirect supervision of the PA: This occurs when the PA and the supervisingphysician do not work together in the same physical location. In this model, thesupervising physician is always available to advise the PA as required. This mayinvolve phone or electronic contact if physical supervision is not possible andrequires that appropriate medical directives have been put in place. This allowsthe PA to initiate or provide treatment either within an established physician-Updated July 2011 11
Page 1 and 2: Physician Assistants in OntarioRole
Page 3 and 4: and maintaining the unique working
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Page 7 and 8: supervision to the PA than others.
Page 9: 5.0 OHIP Billing Rules for PA Pract
Page 13 and 14: Typically, any order, requisition o
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Page 19 and 20: In instances where there is an esta
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Page 23: 2. RHPA, section 29(1)(a)3. Verbal

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