Roles and Responsibilities of Physicians Supervising PAs - Ontario ...
Roles and Responsibilities of Physicians Supervising PAs - Ontario ... 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
supervision to the PA than others. However, no matter what the model ofsupervision in that clinical setting, each supervising physician is responsible forthe clinical work that they assign to the PA.Any physician who supervises a PA will:• ensure that they assign clinical work and provide supervision to the PA in amanner that is consistent with the PA-Physician relationship and supervisoryframework• ensure that they assign clinical work and provide supervision to the PA in amanner that is consistent with the practice agreement established for the PAin that clinical setting• provide feedback on the PA’s clinical performance for purposes ofcompetency evaluation, performance management and the development ofauthorizing mechanisms (e.g. medical directives)In order to fulfill these obligations, it is imperative that supervising physiciansunderstand:• the PA role, responsibilities and competencies• the framework defining the relationship between the PA and the supervisingphysician• the regulatory framework for delegation of controlled acts, including theCPSO’s Policy on Delegation of Controlled Acts• the specific competencies of the PA to whom they are assigning work, andthe role established for that PA in that particular practice setting• who to go to if they have questions or concerns about working with the PA3.0 Role and Responsibilities of the Primary Supervising PhysicianNo matter how many physicians provide supervision to a PA within a practicesetting, it is considered best practice that one physician is identified as thePrimary Supervising Physician for each PA.The Primary Supervising Physician (PSP) is the physician that a PA is“assigned to” where they work. The PSP will oversee and coordinate theclinical activities of the PA, and ensure that another physician providesclinical supervision to the PA when the PSP is not able to do so. The PSPmay or may not provide the majority of clinical supervision to the PA.In addition to the responsibilities of any physician who assigns clinical work to aPA, the PSP will typically have additional clinical and administrativeresponsibilities.Updated July 2011 7
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supervision to the PA than others. However, no matter what the model <strong>of</strong>supervision in that clinical setting, each supervising physician is responsible forthe clinical work that they assign to the PA.Any physician who supervises a PA will:• ensure that they assign clinical work <strong>and</strong> provide supervision to the PA in amanner that is consistent with the PA-Physician relationship <strong>and</strong> supervisoryframework• ensure that they assign clinical work <strong>and</strong> provide supervision to the PA in amanner that is consistent with the practice agreement established for the PAin that clinical setting• provide feedback on the PA’s clinical performance for purposes <strong>of</strong>competency evaluation, performance management <strong>and</strong> the development <strong>of</strong>authorizing mechanisms (e.g. medical directives)In order to fulfill these obligations, it is imperative that supervising physiciansunderst<strong>and</strong>:• the PA role, responsibilities <strong>and</strong> competencies• the framework defining the relationship between the PA <strong>and</strong> the supervisingphysician• the regulatory framework for delegation <strong>of</strong> controlled acts, including theCPSO’s Policy on Delegation <strong>of</strong> Controlled Acts• the specific competencies <strong>of</strong> the PA to whom they are assigning work, <strong>and</strong>the role established for that PA in that particular practice setting• who to go to if they have questions or concerns about working with the PA3.0 Role <strong>and</strong> <strong>Responsibilities</strong> <strong>of</strong> the Primary <strong>Supervising</strong> PhysicianNo matter how many physicians provide supervision to a PA within a practicesetting, it is considered best practice that one physician is identified as thePrimary <strong>Supervising</strong> Physician for each PA.The Primary <strong>Supervising</strong> Physician (PSP) is the physician that a PA is“assigned to” where they work. The PSP will oversee <strong>and</strong> coordinate theclinical activities <strong>of</strong> the PA, <strong>and</strong> ensure that another physician providesclinical supervision to the PA when the PSP is not able to do so. The PSPmay or may not provide the majority <strong>of</strong> clinical supervision to the PA.In addition to the responsibilities <strong>of</strong> any physician who assigns clinical work to aPA, the PSP will typically have additional clinical <strong>and</strong> administrativeresponsibilities.Updated July 2011 7
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