States debate docs' physician assistant supervision limit

Florida's House of Representatives passed a measure that would allow doctors to increase the number of physician assistants (PAs) they supervise from four to eight, despite concerns from some lawmakers that it would result in less physician oversight and supervision, according to the Newsobserver.com.

"I wanted to support this until I read it and there is no definition of what supervision is," said Rep. Carl Zimmerman, (D-District 65), adding that he supports expanding licensed assistants' duties.

In the bill, "responsible supervision and control" means a supervising physician is easily available through telecommunications, Rep. Larry Ahern explained (R-District 66), the Newsobserver.com reported. 

PAs in Florida can write prescriptions and medicate patients. Bill supporter Rep. Cary Pigman (R-District 55) said low ratios allow easier access and availability of care without the need to bring in additional healthcare providers to supervise the PAs, according to the article.

Florida and 15 other states allow supervision of up to four assistants, 11 states have no restrictions and 13 states limit supervision to two or three assistants, according to the article. In Nevada, the Clark County Medical Society's proposal would allow doctors to supervise four, an increase from three, the current limit, according to jrn.com. Conversely, the plan would limit PAs to four supervising doctors. Currently, there's no limit.  

The American Academy of Physician Assistants recommended that state laws contain no specific ratios of PAs to supervising physicians, and believes the "appropriate number of PAs is best determined at the practice level, rather than in state law. Health professional regulation should allow for flexible and creative innovation and appropriate use of all members of the healthcare workforce," the group wrote in an issue brief, "State Law Issues: Ratio of PAs to Supervising Physicians."

"The AAPA believes that the physician-PA team relationship is fundamental to the PA profession and enhances the delivery of high quality healthcare. As the structure of the healthcare system changes, it is critical that this essential relationship be preserved and strengthened," wrote in another brief.

Staffing ratios are a hot legislative topic in healthcare. In Massachusetts, proposed legislation that would require lower nurse-patient ratios has nurses and hospital executives going head to head, FierceHealthcare previously reported. Hospital officials oppose the measure, saying it will increase expenses without improving care, while nurses argue it would improve safety and care quality.

To learn more:
- read the bill
- here's the article
- check out the jrn.com story
- read the issue brief
- check out the second brief

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