Physician Assistant Information for PAs and Attorneys
THE ARTICLES BELOW CONTAIN A WEALTH OF INFORMATION REGARDING PA AND NP PROFESSIONS, PA MALPRACTICE SAFETY RECORD, COMMENTS ON STANDARD OF CARE, SCOPE OF PRACTICE, PHYSICIAN SUPERVISORY ROLE AND GUIDELINES FOR EXPERTS. THE PA EXPERTS NETWORK (PAEN) WELCOMES COLLABORATION WITH LEGAL NURSE CONSULTANTS AND OTHER LITIGATION SUPPORT AGENCIES.
The Physician Assistant PA Expert Witness & Medical-legal Consultant:
A Guide for Attorneys & Experts
by Jeffrey G. Nicholson, PhD, PA-C
Although formal additional training is not required, some PA expert witnesses have completed seminars conducted by and for legal nurse consultants. Frequently, PA expert witnesses are faculty or former faculty at physician assistant training programs. The majority of PA experts get into the practice of providing opinions on malpractice cases because they are asked, not because they set out to become expert witnesses.
PAs may also be qualified to opine on the standard of care of advanced practice nurses also known as nurse practitioners (NPs) or advanced practice nurse prescribers (APNPs). PAs and nurse practitioners are often referred to as “mid-level” providers of medical care because their education and training lies somewhere between the nurse and the physician. PAs and NPs often compete for the same jobs and each is required by state regulations to either be supervised or collaborate with physicians in the ordinary discharge of their duties. Additionally, there are several training programs that offer graduates the ability to sit for either the PA national certification exam or one of the advanced practice nursing certification exams. In these programs the curriculum is identical.
In order to maintain the certification designation, the “C” in PA-C, PAs must complete 100 hours of continuing medical education every two years and receive a passing score on a national comprehensive board exam (similar to the initial certification exam) every six years.
As mentioned, although physician assistants by definition and scope of practice, must provide medical care under the general supervision of physicians, they may practice autonomously and at remote distances or offices from their supervising physicians. Even so, most states consider physicians as sharing in the responsibility and liability of their supervised PA’s clinical decisions and actions. On this matter, legal case precedent differs from state to state, and the liability or level of responsibility of the supervising physician for a PA’s clinical care and judgment is not well defined and is continually reinterpreted in the courts.
While the role of PA and physician is similar, each may have a separate scope of practice defined by training, credential and personal experience. If a PA infers substandard care by a physician in a deposition, trial attorneys are quick to point out that PAs are not physicians and do not have the full length or breadth of physician training. However, it may be quite appropriate for PAs to comment on the standard of care of physicians depending upon the circumstance. The standard of care for the evaluation and treatment of minor medical illness may be exactly the same for a PA and a physician. For example, the evaluation and treatment of a sinus infection may be the same for a PA and a family medicine physician, but it may differ between the PA or family medicine physician and an otolaryngologist specialist. Physicians are typically and more frequently disallowed from providing testimony on the standard of care of physician assistants, but they may comment on the physician supervisory role and state supervisory requirements. Most states now require PA expert witness testimony in malpractices cases where physician assistants are involved. A generalist or primary care PA may comment on the standard of care of another PA in any medical specialty if the care involves the basic and general medical knowledge that all PAs are reasonably expected to possess. Nevertheless, it may, in some instances, be prudent to choose a PA expert witness who has current practice experience in the medical specialty of the PA involved in the civil action. Attorneys often must choose between utilizing a generalist PA who has seasoned expert witness experience or a novice PA expert who practices in a specialty.
Physician Assistant Information
Dr. Nicholson is co-author of an Employment Guide designed to provide a comprehensive summary of useful information for potential PA employers, PA students and all others interested in learning more about our fast growing profession. The PA Employment Guide is published here and may be copied and distributed as long as credit is given to the “WisTREC” Project for its development and to the Wisconsin Academy of Physician Assistants for its annual update.
Among other topics, the PA Employment Guide provides:
- An overview of the PA Profession
- PA education and certification
- Scope of practice regulations
- Licensure and prescriptive authority
- Current PA specialty distribution
- Current salary and benefits data
- Cost benefit analysis for PA hiring
- Sample contracts and employment agreements
- Comparison of PA and Nurse Practitioner education and practice
I hope you will enjoy learning more about a profession of skilled clinicians that brings high quality cost-effective medical care to an American health care system in great need.
Jeffrey G. Nicholson is a nationally known speaker and recognized leader in the PA profession and authority on the standard of care and other legal aspects of PA clinical practice. He has been an actively practicing PA for 25 years and has been in full-time PA academia for over 12 years serving as Assistant Professor, Director of Clinical Education and PA Program Director, most recently at the University of Wisconsin-Madison. He is a Distinguished Fellow of the American Academy of Physician Assistants, President of the American Academy of PAs in Legal Medicine and a longstanding board member of the Wisconsin Academy of Physician Assistants. He has completed degrees at Boston College, Harvard University and the University of Wisconsin. He has published articles on PA education, PA malpractice, and PA employment. He leads a consulting firm to support the work of attorneys and insurance companies providing case merit review and expert testimony on the standard of care of physician assistants and nurse practitioners in all medical specialties. If you have a question or need an expert, contact him now.