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

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Executive SummaryAll PAs in Ontario must work under the direction and supervision of a registeredphysician.The following are key concepts related to supervision of a Physician Assistant:• A physician is responsible and accountable for the clinical work completed bya PA. Physicians should only assign work that the physician is competent todo him or herself and that the PA is competent to perform, that is appropriateto the practice setting and that is in the patients’ best interests.• PAs have varying competencies depending on their program of preparationand experience. Supervising physicians need to assess a PA’s competenciesprior to assigning tasks. A practice agreement 1 should be established todocument the PA’s competencies, the type of clinical work and methods ofdelegating that will be used in that practice setting.• A PA is always under supervision of a physician who will provide direct orindirect supervision as they deem appropriate.• All PA activity takes place within an established physician-patient relationship.The supervising physician is ultimately responsible for coordinating andmanaging the care of the patient.• The assignment of clinical work to a PA must be in accordance with theregulatory framework in Ontario.• When the clinical work assigned to a PA involves a controlled act 2 , theprocess of delegation described in The College of Physicians andSurgeons of Ontario’s Policy on Delegation of Controlled Acts must befollowed. Physicians may use a direct order to authorize a PA to perform aspecific controlled act for a specific patient when the patient is known to thephysician. Physicians may also use a medical directive to authorize a PA toperform controlled acts under certain circumstances, and for a specifiedgroup of patients, in advance of the anticipated relationship between a patientand a physician.• It is an ongoing responsibility of both the supervising physician and the PA toensure that the clinical work assigned, the process for assigning or delegatingwork, and the supervision provided to the PA are appropriate.Communication, role clarity and mutual respect are essential for establishing12A practice agreement details the types of clinical work that the PA can perform and how thatwork will be assigned and supervised. A practice agreement is described in the Federation ofHealth Regulatory Colleges of Ontario’s resources on delegation.Controlled Acts are specific acts or procedures that certain types of health professionals areauthorized to provide under Ontario’s Regulated Health Professions Act (1991)Updated July 2011 2
and maintaining the unique working relationship between the physician andthe PA.In most work settings, one physician will be the Primary Supervising Physician(PSP) for each PA. The PSP will typically have clinical responsibilities thatinclude orienting the PA, establishing the PA’s competency and the role in thatpractice setting, developing the PA practice agreement and overseeingsupervision of the PA by other physicians as appropriate. The PSP will alsotypically have administrative responsibilities, which will include overseeing PAscheduling to ensure adequate supervision and participating in the PA’sperformance evaluation.Each PA may be supervised by multiple physicians in their clinical setting.Physician supervisors will liaise with the PSP regarding the clinical work of thePA, to ensure that they are aware of the practice agreement established in thatclinical setting. Each physician is responsible for the clinical work they personallyassign to the PA.Physicians who submit claims to OHIP may submit a claim for the clinical workthey personally perform. If the PA provides the clinical activity without the activeparticipation of the supervising physician, then a fee is not payable by OHIP tothe supervising physician. If the physician renders a service personally to thepatient, the physician is entitled to be paid for the service actually rendered bythe physician, which may or may not be the service rendered by the PA.Updated July 2011 3
Page 1: Physician Assistants in OntarioRole
Page 5 and 6: Per the judgement of the supervisin
Page 7 and 8: supervision to the PA than others.
Page 9 and 10: 5.0 OHIP Billing Rules for PA Pract
Page 11 and 12: esponsibility and processes for res
Page 13 and 14: Typically, any order, requisition o
Page 15 and 16: 1. Communicating to the individual
Page 17 and 18: 1. Physician-Patient RelationshipTh
Page 19 and 20: In instances where there is an esta
Page 21 and 22: elationship with the patient treate
Page 23: 2. RHPA, section 29(1)(a)3. Verbal

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

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