Reference Information: Registered Physician Assistant

In December 1970, the American Medical Association adopted the following definition for Physician Assistants:

The PA is a skilled person qualified by academic and practical training to provide patient services under the supervision and direction of a licensed physician who is responsible for the performance of that assistant.

New York began registering physician assistants in 1972. As of January 2001, there were 5,750 registered PAs in New York State. Between 1990 and 2000 the Office of Professional Medical Conduct (OPMC) took disciplinary action against 77 physician assistants.

A. Registration

Registered Physician Assistant (RPA) is the legal title for individuals registered to practice as physician assistants in New York State. To be registered as a PA in New York State, an individual must:

  • be at least 21 years old;
  • be of good moral character;
  • have successfully completed a four year course of study in a secondary school approved by the Board of Regents or have passed an equivalency test;
  • have completed a program approved by the State Education Department (SED) for the training of physician assistants or a program determined by the Department to be equivalent;
  • have obtained a passing score on an examination acceptable to the SED.

Physician Assistants may also be authorized to practice under a one-year limited permit.

The National Commission on Certification of Physician Assistant (NCCPA) Examination has been designated as the official credentialing examination for purposes of PA registration in New York State. Physician assistants maintain certification by completing 100 hours of continuing medical education every two years and taking a recertification exam every six years. The designation RPA-C stands for Registered Physician Assistant - Certified and may be used only by PAs who have successfully completed the NCCPA certifying examination and possess a valid certification.

A trained physician who is not licensed in New York State may not practice as a PA unless he or she is a graduate of an approved PA program and has fulfilled the requirements for registration as a physician assistant.

B. Performance of Medical Services

A physician assistant is considered a dependent practitioner working under the supervision of a licensed physician responsible for the actions of the physician assistant. The supervising physician may delegate to the physician assistant any medical procedures or tasks for which the physician assistant is appropriately trained and qualified to perform and that are routinely performed within the normal scope of the physician's practice. Physician assistants are prohibited from performing certain tasks reserved for specific allied health professions, such as the practice of radiologic technology and the practice of optometry. Duties delegated to a physician assistant may be extensive including but not necessarily limited to the following:

  1. Evaluation- initially approaching a patient of any age group in any setting to elicit a detailed and accurate history, perform an appropriate physical examination, delineate problems and record and present the data;
  2. Monitoring- assisting the physician in conducting rounds in acute and long term inpatient settings, providing care in office-based and other ambulatory care settings, developing and implementing patient management plans, and recording progress notes;
  3. Diagnostics- performing and/or interpreting, at least to the point of recognizing deviations from the norm, common laboratory, radiologic, cardiographic, and other routine diagnostic procedures used to identify pathophysiologic processes;
  4. Therapeutics-performing routine procedures such as injections, immunizations, suturing and wound care, managing simple conditions produced by infections or by trauma, assisting in the management of more complex illnesses and injuries, and taking initiative in performing the evaluation and therapeutic procedures in response to life threatening situations;
  5. Counseling- instructing and counseling patients regarding compliance with prescribed therapeutic regimens, normal growth and development, family planning, emotional problems of daily living, and health maintenance; and
  6. Referral- facilitating the referral of patients to other health related practitioners, and community health and social service agencies when appropriate.

C. Practice Settings

  1. Hospitals

    Physician assistants may be employed under the supervision of a designated physician, in all areas of the hospital setting, including inpatient, emergency room, surgery, ambulatory care clinics, employee health and communityoutreach programs. PAs also function in non-clinical areas such as administration, quality assurance, risk management, health planning and research.Countersignature by the physician is not required prior to execution of written orders. All orders written by a PA for inpatients, however, must be countersigned within 24 hours.

    Registered nurses may carry out orders written by a PA. The State Education Department has stated that, in essence, the PA is functioning as the physician's agent; and, unless a nurse, technician or pharmacist has some particular reason to question a prescription, medical order or medical regimen ordered by a PA, s/he is expected to execute the order as though it were ordered directly by the physician.

  2. Long term care facilities

    A physician assistant, working under the supervision of a physician may perform appropriate medical services in a long term care facility except when Department of Health regulations specify that the medical service can only be performed by a physician or when the delegation of the medical service is prohibited by the facility's policies.At the option of the attending physician and the facility, scheduled visits required by Department of Health regulation may alternate between the physician and the physician assistant after the initial visit.All medical orders issued by a physician assistant in a long term care facility must be countersigned by the supervising physician within 24 hours.

  3. HMOs/Ambulatory Care

There are many other settings in which a physician assistant may work including physician's private offices, community clinics and, ambulatory care sites in rural, suburban and urban areas.

D. Supervision

A physician assistant works under the supervision of a licensed physician who is responsible for the physician assistant's performance as well as the overall care of the patient. The physician assistant may have more than one supervising physician; however, there must be one clearly designated supervising physician who is available at any one time. Physician assistants are not authorized to engage in independent practice.

In New York State, a physician in private practice may supervise no more than two PAs at one time; in a correctional facility, no more than four PAs at one time; and, in a facility licensed pursuant to PHL Article 28, no more than six PAs at one time. Physicians are not required by law to notify the State Education Department which PAs they employ or supervise.

The supervising physician may delegate to the PA any clinical functions within that physician's scope of practice providing the PA is appropriately trained and experienced to perform those functions. The physician assistant is subject to the limitations set by the supervising physician and to the policies of the employing institution, in addition to state laws, rules, and regulations.

E. Prescriptions

If delegated by the physician, physician assistants may write medical orders and prescriptions. In an inpatient setting, the physician assistant may order medications including Schedule II - V controlled substances, with a physician's countersignature required within 24 hours. Countersignature is not required prior to execution of the order.

In an outpatient setting, the PA may prescribe all medications including Schedule III - V (excluding Schedule II) controlled substances if delegated by the supervising physician. PAs may apply to the DEA to obtain their own, individual registration numbers as "mid-level practitioners." Once duly registered by the DEA, they may write Schedules III, IV and V drugs subject to any limitations imposed by the supervising physician and/or clinic or hospital where such prescribing activity may occur. Such prescriptions are to be written on the supervising physician's prescription form. The prescription form must include: the imprinted name of the PA; the imprinted name of the supervising physician; the practice address and phone number; the PA's signature followed by the designation RPA; the PA's New York State registration number; and the physician's license number.

PAs may also prescribe Schedule III - V controlled substances which require the use of New York State official prescription forms provided these are written on forms issued to the PA. PAs are not authorized to issue prescriptions for Schedule II controlled substances at any time.

F. Prohibitions

Physician assistants are prohibited from performing certain tasks for specific allied health professions, such as the practice of radiologic technology and the practice of optometry.

Physician assistants may not sign a death certificate; only a licensed physician, duly designated coroner, or medical examiner can sign a death certificate. However, a PA may make a death pronouncement in lieu of the supervising physician.

Physician assistants may not write prescriptions for Schedule II controlled substances.

G. Reimbursement

Health services provided by the physician assistant are billable, with reimbursement going to the supervising physician, the facility or organization employing the PA. Under the New York State Medicaid program, medical services performed by the PA are reimbursed at the physician's fee schedule.

H. Malpractice Insurance

Individual liability coverage for the physician assistant is advisable but not required. PAs share responsibility and liability with their supervising physicians and either or both may be named in a malpractice action. While PAs are considered "dependent professionals," they are still responsible to perform competently.

Under NYS Education Law Section 6547, a physician assistant rendering first aid or emergency treatment at the scene of an accident or outside a hospital or doctor's office is not liable for damages, injuries or death unless it is established that the injuries or death are caused by gross negligence.

References

This material is based upon information contained in the following:

  1. "The Employment and Utilization of the Physician Assistant" New York State Society of Physician Assistants 1993.
  2. "Registered Physician Assistant" published by the Office of the Professions, State Education Department, University of the State of New York.
  3. New York State Public Health Law and Regulations
  4. New York State Education Law and Regulations

This booklet was prepared by the Office of Professional Medical Conduct. The information was excerpted from resource material obtained from the New York State Society of Physician Assistants and the New York State Education Department.