The Nuances for Psychiatrists Supervising PAs Vary Across Southern States
Physician assistants can provide a great service in expanding the reach of mental health services to patients in underserved areas of the country, including some southern U.S. states where the need is greatest. However, psychiatrists would be wise to first familiarize themselves with the subtleties of regulations in their state before supervising PAs to avoid exposure to legal risks.
Although there are similarities among various state laws, there are important distinctions as well, said Judith Regan, M.D., J.D., associate professor of psychiatry at the University of Miami Miller School of Medicine. “Having physician extenders is a good thing — physicians just need to understand the regulations that go along with that,” she said. “And be cautious about who you pick because you are delegating the services to them.”
Regan, lead author Matthew Buchbinder, J.D., and their colleagues took a deep dive into the PA supervision regulations in Alabama, Arkansas, Georgia, Kentucky and Mississippi. “We were looking where the need was greatest,” Regan said. They share their findings in a review article in the April Southern Medical Journal (2017;110:239-43).
There are small but important distinctions regarding supervision, procedural requirements and which tasks a psychiatrist can delegate to PAs. For example, psychiatrists can supervise up to four PAs in Kentucky and Georgia. Mississippi sets the maximum at two. In contrast, there is no limit on the number of PAs a psychiatrist can supervise in Arkansas or Alabama. Alabama, however, does cap the cumulative number of hours each PA can work under physician supervision.
The state laws also address how physically close the supervising psychiatrist needs to be to the PA providing services. In Arkansas, supervising psychiatrists must be available for immediate telephone contact and must be able to reach the location where the PA is practicing at any time. In Kentucky, the two clinicians can be in separate locations “as long as the supervising psychiatrist is continuously available via telecommunication and the state medical board has approved a specific written request describing the services to be provided by the PA in the separate location.” In Georgia, the wording is a bit more lax, stating that the PA need not be in the presences of the supervising psychiatrist to provide medical services.
“I have worked with PAs, and I think they do a great job,” Regan said. PAs can be certified for providing mental health services in some states. So many not only have clinical expertise, they are skilled in providing mental health care as well.
“I think these regulations are reasonable, very reasonable,” Regan said. “Physicians and psychiatrists just need to know what they are. It’s about awareness.”
Tags: Judith Regan, mental health care, physician assistants, regulations