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

are 4 and may choose to delegate the authority to perform these acts to a PA 5 . Inorder to do so, physicians must follow the process of delegation described in TheCollege of Physicians and Surgeons of Ontario’s Policy on Delegation ofControlled Acts 6 .CPSO’s Policy allows for controlled acts to be delegated in one of two ways:• Through a direct order. A direct order provides instructions from anindividual physician to the PA (and/or others), relating to a specific patient. Ittakes place after the physician and patient have established a relationship.The order indicates a specific procedure or treatment to be delivered at aspecific time for that patient. The direct order may be verbal (over thetelephone or in person) or written.• Through a medical directive. A medical directive is an advance instructionfrom a physician, or group of physicians, to the PA (and/or other providers). Itpertains to any patient who meets the criteria set out in the medical directive.The medical directive contains the delegation and provides the authority forthe PA to carry out the treatments, interventions or procedures that arespecified in the directive, providing that certain conditions and circumstancesexist. The directive can authorize the PA to act before the actual physicianpatientrelationship has been established. However, a relationship betweenthe patient and physician must be established before the end of thatencounter.2.0 Role and Responsibilities of the Supervising PhysicianA PA requires the direction and supervision of clinical work by a registeredphysician. Any physician who assigns and supervises the clinical work of a PAmust:• understand the PA-physician relationship, and• be willing to work with the PA in a manner that supports the PA-physicianrelationship.In some practice settings, a PA may receive supervision from multiplephysicians. It may be that the best model for PA practice involves the PAworking with multiple physicians during one shift, multiple physicians on variousshifts, or multiple physicians over time. Some physicians may provide more456Physicians are authorized to perform 12 of the 13 controlled acts set out in the RegulatedHealth Professions ActUnder appropriate circumstances, physicians may delegate the controlled acts which theyhave authority to perform to other individuals, who may or may not be members of aregulated health professionThis policy is appended to this document.Updated July 2011 6