South Florida Hospital News
Thursday May 28, 2020

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November 2014 - Volume 11 - Issue 5




Make Room for Mid-Level Providers

As numbers of medical doctors in this country are expected to diminish over the next several decades, and the American population continues to grow and live longer, the need for physician assistants and nurse practitioners will be more pressing than ever. In addition, with more people covered by health insurance there will be increased presentations at medical centers for acute exams, with more testing and procedures performed. While some foreign trained physicians will continue to supplement the expected shortage of U.S. physicians, it is clear that in the not too distant future, the primary practitioners caring for patients in a variety of settings will be performed by mid-level practitioners.
Consequently, physicians and hospitals will need to call upon physician assistants (PAs) and advance practice registered nurses (APRNs) to meet the increasing demands in emergency rooms and other departments. This evolving dynamic will require hospitals to be more diligent in establishing and expanding appropriate criteria in the credentialing and review process. Facilities will have to make sure these providers are properly trained and licensed, with appropriate experience, to be qualified for medical staff privileges and to safely treat patients in their facilities. Also, hospitals will need appropriate policies in place to make sure physicians are properly supervising their mid level employees, and seeing patients who require actual physician evaluation and care. Half of the states in this country now permit nurse practitioners to work independently, a trend that seems to be expanding. In Florida, nurse practitioners must work under the supervision of a physician. While the supervising physician is responsible and liable for the performance and the acts and omissions of physician assistants, the supervisor may not be required to review and cosign medical records prepared by the PA. A hospital may face scrutiny if a mid-level does not order an important test, or a patient in need was not seen by a physician. While the supervising physician is legally responsible, hospitals should be reviewing these matters, as well.
As the role of mid-level practitioners providing care in hospital settings is expected to expand, hospitals will need to continually update policies establishing the duties and responsibilities of supervising physicians and their mid-level employees. They must make sure appropriate policies are in place in all departments and are followed. More demand and fewer doctors in the future undoubtedly means more nurse practitioners and physician assistants will be providing care in hospitals in the ever changing health care environment.
Paul Buckley, Fann & Petruccelli, P.A., can be reached at (954) 771-4118 or or visit
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