Recent Changes to the Role of Physician Assistants

By Jamie W. Dittert

As the demand for health care rises, physician assistants provide a cost-effective way to address patient care needs. The Bureau of Labor Statistics estimates a 38 percent growth in physician assistant employment between 2012 and 2022, based on an aging population, population growth, rising instances of chronic diseases, federal health insurance reform, and the increasing specialization of physicians.[1] 

Physician assistants help to bridge the gap between the demand for healthcare and the supply of qualified healthcare providers, and it is important to understand the roles and duties of each. Kentucky recently adopted statutory changes that give supervising physicians and physician assistants more latitude in adapting to the rising demands for care by reducing oversight over physician assistant treatment records and the time before a physician assistant can work in a separate location. This article discusses the relationship between and respective responsibilities of the physician assistant and the supervising physician.

The scope of services that may be performed by the physician assistant depends on the licensure process. In order to render care, physician assistants are licensed through the Kentucky Board of Medical Licensure (KBML).[2] Applicants must graduate from an approved program and pass an approved examination.[3] The services and procedures that may be performed by a physician assistant are limited to those described in any application submitted to and approved by the KBML.[4] For the purposes of workers’ compensation matters, however, physician assistants are not qualified to render a medical diagnosis.[5] The physician must also obtain KBML approval to act as a supervising physician with respect to any service or procedure the physician assistant will perform.[6] Moreover, the supervising physician must comply with technical requirements regarding the notification to patients of the physician assistant’s role in patient care and re-evaluations of the physician assistant’s work.[7]

Physician assistants can prescribe and administer certain medications. The supervising physician may vest the physician assistant with authority to prescribe and administer “all nonscheduled legend drugs and medical devices” and to “request, receive, and distribute” sample drugs.[8] The supervising physician is responsible for ensuring that the physician assistant does not prescribe or dispense controlled substances.[9] While physician assistants can prescribe and administer certain medications, they are not authorized to dispense medications, or distribute non-sample drugs.[10]

Physician assistants can also be utilized in administering anesthesia, subject to special education and supervision requirements. A physician assistant can perform local anesthesia, provided that it is described in an approved KBML application, but he cannot administer or monitor general or regional anesthesia unless he has obtained special training in anesthesia.[11] Additionally, the supervising physician must be present for induction and emergence, cannot perform concurrent anesthesia procedures, and must be able to provide an immediate physical presence in the room.[12]

Supervising physicians must exercise continuing oversight over the physician assistant’s actions because the supervising physician is legally liable for the negligent actions of his physician assistant. In performing medical services and procedures, the physician assistant is the supervising physician’s agent.[13] Under Kentucky law, a principal – here, the supervising physician – is liable for the negligent actions of the agent because the principal has the authority to control the method and details of the agent’s work.[14] Accordingly, the supervising physician should – and is legally required to – ensure that the physician assistant is given medical tasks that are commensurate with KBML approval and the physician assistant’s training, experience, and comfort level.[15] The two changes that took effect on June 1, 2014 do not change this obligation.

First, the supervising physician’s obligation to review and sign records of physician assistant services was reduced. Prior to June 1, 2014, supervising physicians had to sign all records of service rendered by a physician assistant to certify that the physician assistant performed the services as delegated. Now, supervising physicians must only review and countersign medical notes authored by physician assistants to the extent needed to “ensure quality of care.”[16] The statute leaves the amount of notes to be reviewed to the discretion of the supervising physician, but the physician must review at least 10 percent of the medical notes authored by the physician assistant over every 30-day period.

Additionally, Kentucky no longer requires that a physician assistant have experience in a non-separate location before moving to a separate location. Generally, a physician assistant can provide services in the offices and clinics of the supervising physician and any hospital or licensed health care facility, subject to receiving written permission and any scope of practice restrictions issued by the governing body.[17]Physician assistants can practice in separate locations, provided that the supervising physician is continuously available by telecommunication and KBML approval is obtained.[18] For several years, Kentucky required 18 continuous months of experience in a non-separate location before a physician assistant could move to a separate location. Between June 25, 2013 and May 31, 2014, however, this requirement was reduced to three months.[19] As of June 1, 2014, the requirement was eliminated completely.[20]

Physician assistants are expected to play an increasingly vital role in the provision of health care. Recent changes in Kentucky law reduce the supervising physician’s oversight over physician assistant service records and increase the mobility of physician assistants across multiple office locations. These changes, however, do not abrogate the supervising physician’s duty to ensure that the physician assistant is performing appropriate tasks or the physician’s liability for any negligent actions by the physician assistant.

[1] United States Department of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, Physician Assistants, http://www.bls.gov/ooh/healthcare/physician-assistants.htm#tab-6 (last accessed 10/27/14).

[2] See KRS 311.840 to 311.862.

[3] KRS 311.844(1).

[4] KRS 311.858(1).

[5] Mining v. Wilder, 2013-CA-000820-WC, 2014 WL 505912 (Ky. App. Feb. 7, 2014).

[6] KRS 311.854(1).

[7] KRS 311.856 (3) – (5), (11), (12).

[8] KRS 311.858(4).

[9] KRS 311.856(2).

[10] Ky. OAG 11-0004 (2011).

[11] KRS 311.858(6); KRS 311.862.

[12] KRS 311.862(3).

[13] KRS 311.858(2).

[14] See, e.g., Nazar v. Branham, 291 S.W.3d 599 (Ky. 2009).

[15] KRS 311.840(6); 311.856(8).

[16] KRS 311.856(10).

[17] KRS 311.858(7).

[18] KRS 311.860(4).

[19] KRS 311.860(3).

[20] Id.