Reference Information: Registered Physician Assistant
In December 1970, the American Medical Association adopted the following definition for Physician Assistants:
The Physician Assistant (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 physician assistant.
New York began registering physician assistants in 1972. As of July 2009, there were 9,720 registered PAs in New York State.
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 limited to the following:
- 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;
- 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;
- 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;
- 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. Physician assistants are authorized to "supervise and direct" the withdrawal of blood to determine alcoholic or drug content for use in detecting violations of the Vehicle and Traffic Law;
- 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
- Referral- facilitating the referral of patients to other health related practitioners and community health and social service agencies when appropriate.
C. Practice Settings
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 community outreach programs. PAs also function in non-clinical areas such as administration, quality assurance, risk management, health planning and research. PAs employed or extended privileges by a hospital may, if permissible under the bylaws, rules and regulation of the hospital, write medical orders for inpatients under the care of the physician responsible for the supervision of the PA. Countersignature of such orders may be required if deemed necessary and appropriate by the supervising physician or the hospital, but in no event shall countersignatures be required prior to execution. Registered nurses may carry out orders written by a PA. The State Education Department has stated that 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. PAs employed or extended privileges by a long term care facility may, if permissible under the bylaws, rules and regulations of the long term care facility, write medical orders for inpatients of the facility under the care of the physician responsible for the supervision of the PA. Countersignature of such orders may be required if deemed necessary and appropriate by the supervising physician or the long term care facility, but in no event shall countersignature be required prior to execution.
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.
4. Private Practices
Physician assistants may establish professional entities, provided that the professional entities limit their activities to those same activities that physician assistants are limited to and provided that the professional entities are owned only by one or more physician assistants. Physician assistants may not be co-owners with physicians. Physician assistants may perform medical services, but may not practice medicine. Physician assistants and physician assistants' professional entities may not engage in independent practice, and may not employ physician supervisors or hire physician supervisors through an independent contract or other mechanism.
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.
In New York State, a physician may employ or supervise no more than four PAs in the physician's practice; in a correctional facility, no more than six PAs; and, in a facility licensed pursuant to PHL Article 28, no more than six PAs. 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. Medical Orders
If authorized by the supervising physician, physician assistants may write medical orders. In an inpatient setting, the physician assistant may order medications including Schedule II - V controlled substances. Countersignature of such orders may be required if deemed necessary and appropriate by the supervising physician or the hospital, but in no event shall countersignature be required prior to execution of the order.
In an outpatient setting, the PA may prescribe all medications, including Schedule II - V 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 prescribe Schedules II, III, IV and V drugs, in compliance with Article 33 of the Public Health Law and Part 80 and Part 94.2 of Title 10 regulations. Such prescribing is also subject to any limitations imposed by the supervising physician and/or clinic or hospital where such prescribing activity may occur. PAs shall register with the Department of Health in order to be issued official New York State prescription forms. Official New York State prescription forms issued to the PA are imprinted with the names of both the PA and the supervising physician. If a PA utilizes an official prescription issued to a hospital or clinic, the PA must stamp or type his or her name and the name of the supervising physician on the official prescription.
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.
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.
This material is based upon information contained in the following:
- "The Employment and Utilization of the Physician Assistant" New York State Society of Physician Assistants 1993.
- "Registered Physician Assistant" published by the Office of the Professions, State Education Department, University of the State of New York.
- New York State Public Health Law and Regulations
- 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.