What Factors Are Necessary for a Successful PA/MD Relationship?

Randy D. Danielsen, MPAS, PA-C

Disclosures

March 11, 2002

Question

What are the characteristics absolutely necessary for a successful MD/PA team? What clinical resources should minimally be provided to a PA?

Response From the Expert

Randy D. Danielsen, MPAS, PA-C 
Associate Professor and Chair of the Physician Assistant Program, Arizona School of Health Sciences in Phoenix, Arizona. A PA for more than 24 years, he is a member of the National Commission on the Certification of Physician Assistants (NCCPA) and is currently a PhD candidate at the Union Institute in Cincinnati, Ohio.

 

The traditional pyramid of healthcare with the physician as the "captain" of the team, responsible for all of the routine care of a patient, is not as solid as it once was. Byington[1] believes that the modern labyrinth of roles and responsibilities can create problems and concerns for both the supervising and supervised caregivers, especially in terms of communication and decision making.

In many settings, physician assistants (PAs) now have their own patient panels and more independence about when to seek assistance or consultation. The assumption by some is that this will mean consultations will be fewer because PAs will be capable of handling most patient care problems. Regardless of the validity of this statement, this is an appropriate time to reexamine the essential characteristics of a successful physician/PA team.

Appropriate supervision is the central principle behind successful and competent physician/PA teamwork. Physician supervision means that the PA only performs medical and/or surgical acts and procedures that have been authorized by state law and the supervising physician. The supervising physician bears both the authority and responsibility for the delegated acts.[2] Obviously methods of supervision vary with the practice setting, the comfort of the supervising physician, and the experience of the PA. It is common, early in the relationship, for supervision to be more formal and conservative and then to become less rigid as the team works together.

Most physicians and PAs enjoy their professional relationship. The relationship between a PA and the supervising physician should be one of mutual trust and respect. The PA -- first and foremost -- is a representative of the physician, treating the patient in the style and manner developed and directed by the physician.

While there are no absolutes, the following are characteristics that I believe are necessary for a successful physician/PA team:

1. Mutual respect: It is important for both the physician and the PA to have professional respect for each other. This means supporting each other with patients, office staff, and colleagues. Disagreements or differences should be ironed out in private.

2. Mutual understanding of state statutes that govern supervision and PA practice. Having a copy of the state statutes and rules that govern the practice of PAs is imperative and should be reviewed on an annual basis, just as we review other standards, such as those from the Occupational Safety and Health Administration or standards for advanced life support.

3. Mutual understanding of the PA's scope of practice, including a description of the PA's role and responsibilities and a list of conditions that require immediate consultation with the supervising physician. Prospective discussion of expectations regarding patient care will assist in later problems or disagreements. The physician should be clear on what conditions, if any, require consultation before discharge. In many emergency centers, for example, there are standing orders that consultation with the supervising physician regarding all chest pain or abdominal pain patients must occur before the patient leaves.

4. Mutual communication, such as an "open door" policy or free access to the supervising physician. It is important that the physician and PA avoid obstacles that impede access to discussions of patient care.

5. Mutual recognition of each other's strengths and weaknesses.[3] This is where the physician/PA team can really make a difference. Early on in the relationship the physician and PA should get to know each other's strengths and weaknesses. The practice should cater to the strengths and finds ways to address any weaknesses with additional training or continuing medical education.

Minimal clinical resources that should be offered to the PA vary with practice setting and specialty. The physician/PA team should agree upon clinical resources available in the practice setting and, as such, a minimal cookbook list would not be valuable to the reader. At a minimum, however, the PA should have access, either electronic or hardcopy, to reference sources. In addition, appropriate equipment and diagnostic tools should be available depending on the focus of the practice.

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