Physician Assistants and Supervision

The question about supervision and physician assistants has come up a few times as I have started to promote Complete Care Pediatrics.  It’s an important issue to clarify, albeit a confusing one. 

The state of Colorado, and most states for that matter, require a physician assistant (PA) to practice under the supervision of an MD or DO.  In Colorado, the supervising physician must be actively practicing medicine in the state.  This “supervision” can vary depending on the length of time a PA has been in practice, if the PA is in a new type of practice or specialty and what state the PA is practicing in.  There is real movement in Colorado to loosen the restrictions on PA’s to practice in a collaborative role (as opposed to a supervised role).  This would allow PAs to practice to the full extent of their education, training and most importantly, experience in that field. It is nuanced and a bit complicated, but I believe with the shortage of primary care providers we are experiencing, the move to a more collaborative working relationship between PA’s and doctors is going to happen. It’s likely a matter of time and proper community education.  

I have been a physician assistant for 20 years, the last 14 of those in the field of pediatrics.  I spent time in orthopedic trauma and family practice before I found my home in pediatrics.  My desire in opening Complete Care Pediatrics was not to be a solo practitioner. I love the collaborative team approach to patient care and plan to foster that as the practice grows.  I have gotten to a place in my career where I know how to practice good thorough medicine, but the pressures from employers and insurance companies to see more and bill more were making it difficult to provide this level of care.  I decided it was time to change the parts of medical practice that I was unsatisfied with and find a better way to care for patients.  I wanted an environment that supported the families we care for and the employees who are dedicated to providing this level of care.   The group model is central to this. 

While I had a lot of interest from MD's and DO's when I was looking for a supervising doctor, many were deterred when they heard the practice was new.  The group model was also a new concept for many.   And honestly, many thought I was nuts for trying to hire my own supervising physician, that it was illegal (it is not, I assure you) and had a poor understanding of the liability associated with the PA/supervising doctor relationship.

My ability to practice medicine is intimately tied to my supervising physician.  Having a solid working relationship is key to the PA/doctor partnership.  The thought of trying to hire someone as my supervising physician that I had never practiced with before wasn’t a risk I was willing to take.   So, I hired a supervising doc that is a medical director of sorts.  She reviews a certain percentage of my charts per state law and we meet by phone or Zoom once a month.  This has afforded me the time to establish the practice and hire an MD or DO that I can work with for some time before I tie my license to them.  I am very comfortable with what I know and what I don't know when it comes to pediatrics. I maintain a strong working relationship with many MD’s, DO’s and NP’s in the Denver metro area that I can consult if I want another perspective or their expertise.  If I have an issue I do not know how best to treat, I reach out  to the pediatric specialty hospitals like Children’s Hospital of Colorado or Presbyterian Saint Luke’s.  Having a network of colleagues and specialists you can reach out to is essential for any practitioner, whether it be a PA, an NP, an MD or a DO.  There is no room for ego in medicine, if you don't have the answer, you reach out to those who do. It’s about the best possible patient care, always.

I hope this has helped answer some of the supervision questions.  If not, please reach out to me and let’s set up a time to talk or stop by the office for a chat.