What is it like to employ an Assistant physician?

The role of an Assistant Physician / Associate Physician is extremely broad and flexible.  Most employers are very pleased to have a highly trained Doctor in their Medically Under Served areas.  AP's can adapt to various roles in clinical setting and will fit the Primary Care needs of any facility.  AP's specialize in multitasking between patient satisfaction and capital optimization.


WHAT ARE THE Liability INSURANCE OPTIONS?

A large amount of insurance companies will cover the Assistant Physician/ Associate Physician under the collaborative physician agreement.  Check with your provider for details.  Otherwise, MoDocs is a Missouri based company that provides a policy especially designed for the AP and can be found at modocs.org.  


What is a collabor-ative Practice agreement? 

A newly hired Assistant Physician or Associate Physician is required by law to have an agreement with an Collaborating Physician. The role of the Collaborating Physician is similar to those of NP or PA providers and even for simplicity the laws are word for word for Assistant Physicians and Associate Physicians. The requirements of the Collaborative Physician responsibilities differ from from state to state.  Additionally, a Collaborative Physician may include other personal preferences within the contract between his or her Assistant / Associate Physician. 

For a copy of the CPA click here. 

The Missouri Statute 334.037 states "Collaborative practice arrangements, which shall be in writing, may delegate to an assistant physician the authority to administer or dispense drugs and provide treatment as long as the delivery of such health care services is within the scope of practice of the assistant physician and is consistent with that assistant physician's skill, training, and competence and the skill and training of the collaborating physician."


What are a Physician's responsib ilities in a CPA?

The full responsibilities can be found in the statutes (found by following the directions below) however the highlights may be summarized.  

  • "(The physician) shall submit a minimum of ten percent of the charts documenting the assistant physician's delivery of health care services to the collaborating physician for review by the collaborating physician, or any other physician designated in the collaborative practice arrangement, every fourteen days"

 

  • "(The physician) shall review every fourteen days a minimum of twenty percent of the charts in which the assistant physician prescribes controlled substances."

 

  • "The physician retains the responsibility for ensuring the appropriate administering, dispensing, prescribing, and control of drugs utilized pursuant to a collaborative practice arrangement in accordance with all state and federal statutes, rules, or regulations;"

 

  • "An assistant physician who desires to enter into a collaborative practice arrangement at a location where the collaborating physician is not continuously present shall practice together at the same location with the collaborating physician continuously present for a period of at least one (1) month (120 hours) before the collaborating assistant physician practices at a location where the collaborating physician is not present. During this one (1) month period, the collaborating physician must review one hundred percent (100%) of the assistant physicians’ patient’s records. It is the responsibility of the collaborating physician to determine and document the completion of the same location practice and records review as described above. (D) For purposes of this rule, the following shall apply: 1. The term “continuously present” shall mean the supervising physician is physically present and seeing each and every patient with the assistant physician when said assistant physician is seeing and/or treating a patient; 2. The term “one (1) month period” shall mean a minimum of one hundred twenty (120) hours of clinic time, where the supervising physician and assistant physician are seeing and treating patients."

 

  • "If a collaborative practice arrangement is used in clinical situations where an assistant physician provides health care services that include the diagnosis and initiation of treatment for acutely or chronically ill or injured persons, then the collaborating physician shall be present for sufficient periods of time, at least once every two (2) weeks."

 

  • “Maintain geographic proximity; except, the collaborative practice arrangement may allow for geographic proximity to be waived for a maximum of twenty-eight days per calendar year for rural health clinics” The physician must “Provide coverage during absence, incapacity, infirmity, or emergency by the collaborating physician”

 

  • The physician "shall be immediately available for consultation to the assistant physician at all times, either personally or via telecommunications."


How Many CPA's may a Physician have?

“This act authorizes physicians to enter into a collaborative practice agreement or a supervising agreement with 6 APRNs, assistant physicians, licensed physician assistants, or any combination thereof. “


What can an Assistant Physician Do?

  • "The methods of treatment and the authority to administer, dispense, or prescribe drugs delegated in a collaborative practice arrangement between a collaborating physician and collaborating assistant physician shall be within the scope of practice of each professional and shall be consistent with each professional’s skill, training, education, competence, licensure, and/or certification and shall not be further delegated to any person except that the individuals identified in sections 338.095 and 338.198, RSMo, may communicate prescription drug orders to a pharmacist."

  • "An assistant physician shall clearly identify himself or herself as an assistant physician and shall be permitted to use the terms "doctor", "Dr.", or "doc"."


Can an Assistant Physician prescribe controlled substances?

DEA Number?

"An assistant physician with a certificate of controlled substance prescriptive authority as provided in this section may prescribe any controlled substance listed in Schedule III, IV, or V of section 195.017, and may have restricted authority in Schedule II, when delegated the authority to prescribe controlled substances in a collaborative practice arrangement. Prescriptions for Schedule II medications prescribed by an assistant physician who has a certificate of controlled substance prescriptive authority are restricted to only those medications containing hydrocodone."

 "Assistant physicians who are authorized to prescribe controlled substances under this section shall register with the federal Drug Enforcement Administration and the state bureau of narcotics and dangerous drugs, and shall include the Drug Enforcement Administration registration number on prescriptions for controlled substances."


Medically under served areas? 

Statute 334.038 states for the Assistant Physician licensure one must work in an under served area, which is defined as:

“(11) Medically underserved area— (A) An area in this state with a medically underserved population; (B) An area in this state designated by the United States Secretary of Health and Human Services as an area with a shortage of personal health services; (C) A population group designated by the United States Secretary of Health and Human Services as having a shortage of personal health services; (D) An area designated under state or federal law as a medically underserved community; or (E) An area that the Department of Health and Senior Services considers to be medically underserved based on relevant demographic, geographic, and environmental factors.

Health Professional Shortage Area (HPSA). You can find which areas of Missouri are HPSAs by using HRSA’s website found website here.  

Search by address here.


What Disciplines may an AP work?  

 Statute 334.038 states that an Assistant Physician may work in"'Primary care', physician services in family practice, general practice, internal medicine, pediatrics, obstetrics, or gynecology."

SB 718 states “"Mental health professional", a psychiatrist, resident in psychiatry, 69 psychiatric physic, psychiatric assistant physician,

and

"Psychiatric assistant physician", a licensed assistant 91 physician under chapter 334 and who has had at least two years of 92 experience as an assistant physician in providing psychiatric treatment 93 to individuals suffering from mental health disorders;


FUTURE RESIDENCY CREDIT?

HB 718 states “In conjunction with deans of medical schools and primary care residency program directors in the state, the development and implementation of educational methods and programs undertaken during the collaborative practice service which shall facilitate the advancement of the assistant physician's medical knowledge and capabilities, and which may lead to credit toward a future residency program for programs that deem such documented educational achievements acceptable;”


Where do I find the full, official, and updated information on AP legeslation?

For official, full, and updated information please see: The Missouri Assistant Physicians Statutes.  It is recommended to use the Find function (Ctrl + F) and type in 334.036. click here  

And See: Rules of Department of Insurance, Financial Institutions and Professional Registration

Jump to page 21. This is the start of the AP section. click here The quotes were provided by these resources.


 

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