In recent years, the Affordable Care Act brought more patients into a healthcare system amid an ever-increasing shortage of physicians. The provider shortage is most prevalent in primary care, such as those practicing internal medicine and family practice. In efforts to serve the volume of patients, practices in all settings have relied upon physicians “extenders”. This involves using professionals who are not physicians to conduct many basic services such as physician assistants, nurse practitioners, midwives and others.
By 2030 in the U.S., there is expected to be a shortage of physicians that approaches 100,000, furthering the need for extenders. This is similar, yet separate, from the use of hospitalists, who are actually physicians who work strictly in the hospital setting to attend to patients, often on behalf of other doctors. One critical consideration when using physician extenders is the potential liabilities associated with this arrangement.
Potential Types of Liability
- Negligent hiring: An injured plaintiff may allege that a physician extender was not properly “vetted” when hired. This could include failures in conducting reference checks, verification of credentials, or other background screening processes.
- Failure to supervise: Allegations of physician's failures in supervising an extender are possible. This could include an extender going beyond the scope of their limitations in practice or a doctor or hospital's insufficient monitoring of care.
- Lack of informed consent: That a physician did not properly make the required disclosures to the patient. These include the condition being treated, proposed treatment or procedure, anticipated results, alternative options, and risks or complications that are possible.
- Failure to adhere to state statutes or regulations: States generally have specific provisions such as those concerning the permitted actions of certain types of providers and protocols relating to the scope of authority.
- Vicarious liability: In this context, it pertains to a physician's imputed liability for a failure in the actions of the extender.
Risk Management Strategy
Preventing potential liabilities requires a practice to use a comprehensive strategy to manage risks. In the hiring phase, written procedures should be adhered to regarding the proper methods for screening and what is (or is not) considered to be acceptable. Managers and administrators must truly understand the state's statutes and regulations in order to draft these compliance plans. Supervision should be conducted in a manner that is both consistent and clearly documented. It is critical that open communication is possible and encouraged.
Malpractice Insurance Considerations
Physician extenders must be accounted for in medical malpractice insurance coverage. These policies may have insufficient coverage limits, particularly when facing liability for catastrophic injuries or in cases of wrongful death. Consider whether physician extenders should have separate coverage or be bundled into a larger organizational policy.
The portability of malpractice coverage is a potential concern, particularly when extenders change employers. In today's environment where physicians are in short supply and physician extenders are necessary to meet the demand for services, it is increasingly important to establish solid procedures and practices in conjunction with sufficient medical liability insurance coverage.