Doctors are increasingly using mid-level medical providers for assistance in their practices. The most common practitioners for this role are physician assistants (PAs) and nurse practitioners (NPs), which are also referred to as advanced practice providers. They are used to increase overall efficiency by allowing physicians more flexibility, improving overall patient satisfaction, and boosting revenue.
Scope of Practice (Care)
The American Association of Nurse Practitioners (AANP) says there are over 240,000 licensed NPs across the country. The National Commission on Certification of Physician Assists reports that there are approximately 123,000 licensed PAs in the U.S. Over 80% of NPs and 25% of PAs are presently working in primary care. The scope of practice afforded to both varies from state-to-state. In some states, NPs may diagnose, treat, and prescribe medications for patients. The majority of PAs are supervised according to “collaborative agreements” with physicians.
Liability Potential When Delegating
Robin Diamond is a senior vice-president and safety officer with the Doctor's Company, a California-based provider of medical malpractice insurance. Diamond reminds doctors that when delegating a task, “you have not delegated the liability.” The delegating physician may ultimately bear responsibility for the negligence of those they supervise.
A physician may be directly liable for the negligence of a mid-level provider under their supervision in certain instances. One such example is if there was a failure in the screening and hiring process, such as failing to verify past clinical experience or confirming the new hire was properly qualified. A physician may be considered to be directly negligent for failures in the proper supervisory process, such as not reviewing the chart and notes and signing them. A PA or NP may also be directly liable for failing to follow instructions as directed that results in patient harm.
Supervisory relationships between physicians and mid-level providers are quite common in rural areas. Unlike major metropolitan areas, these outlying areas tend to struggle with a shortage of physicians. NPs and PAs in these regions are more likely to assist in primary care, as well to work under the supervision of an OB/GYN, as they are usually in short supply.
Malpractice Insurance for Mid-Level Providers
Medical malpractice insurance for mid-level providers may be obtained specifically for the individual or they may be covered as a “rider” on the supervising physician's policy. There are advantages to having insurance structured both ways. If the mid-level provider has their own policy they may feel their best interests will be better considered if a malpractice claim arises. When the individual is added to the physician's policy, the insurance company attorneys may tend to act in the best interests of the primary named policyholder.
In recent years, hospitals have increasingly been hiring physicians as direct employees. This arrangement makes the facility much more likely to be named as the defendant in claims of medical malpractice. The concept of vicarious liability allows employers to be responsible for the actions of their employees when they cause harm to a patient while acting in the scope of their employment. The doctrine of “respondeat superior” translates to “let the master answer.” One common example is when a lawsuit is brought against the employer after their delivery driver causes a vehicle accident that injures another motorist.