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Physician's Assistant Practice Agreement: Do We Really Have to Have These?

If you are a PA or work with a PA, do you really need to have a written practice agreement? The answer is a resounding YES. The new law governing physician’s assistants requires all PAs to have a written practice agreement with a physician no later than March 22, 2017. This is the date when the practice agreement must be signed by both the PA and a physician. If you do not have this in place – do it now.

The most common questions we hear from clients who own PCs have been: WHY. Why do we need these? Are there any exemptions? How can we avoid this?

There is no way to avoid the practice agreement requirement. The new law, Public Act 379 of 2016, requires all PAs to have a practice agreement signed with a physician in order to practice. These are mandatory for everyone, even if the PA works within a group practice or hospital.

Why do you have to have these? The short answer is because the new law says so. If that is not a good enough reason for you, then you can try to decipher why our legislature passed the new law. Below is an excerpt from the legislative analysis, which is a document that explains the proposed bill and the reason for it. For this bill, it is a five-page analysis. Under the category titled “The Apparent Problem” it says:

“THE APPARENT PROBLEM: Michigan, as well as the entire country, is said to be already in the throes of a physician shortage, and many predict the situation to worsen in coming years. Many believe that one way to improve access to quality care, especially in rural areas where the physician shortage is particularly acute, is to allow increased autonomy to physician's assistants. This legislation is offered to ensure that the Public Health Code more accurately describes the relationship between physician and physician's assistant.” House Fiscal Agency Legislative Analysis for House Bill 5533.

The new law removes requirements that PAs practice “under the supervision” or “delegation” of a physician. This has been replaced with language that allows the PA to practice in accordance with the terms of their practice agreement. If there are multiple physicians in a practice who work with the PA, the practice can designate one physician to sign the agreement. The PA is not required to have a signed agreement with every physician in the practice. The new law does not place limits on how many PAs one physician can sign agreements with.

Personally, I do not have a strong opinion whether these are a good thing, or if it is simply generating more paper work. Time will tell. There is some frustration surrounding the agreements because there is not a standard form to use. The statute does not provide a lot of details for the agreement or what is expected. This is likely a good thing because no two practices or specialties are alike.

It is worth noting that anytime there is a written document, contract, or agreement that may have to be produced in the event of a lawsuit, you should be concerned from a liability standpoint. While I do not see that the change in law increases or decreases liability, the language in a practice agreement could help you or hurt you in the event of a lawsuit. For this reason, your practice agreement needs to be carefully and accurately drafted.

While this article cannot address all of the changes in the law, the basic minimum requirements for a practice agreement are as follows:

  1. A process for communication, availability, and decision making between the physician and PA

  2. A protocol for designating an alternative physician when the participating physician is not available.

  3. The signature of the PA and the participating physician.

  4. A termination provision that requires 30 days’ notice prior to terminating the agreement.

  5. The duties and responsibilities of the PA and physician.

  6. A requirement that the physician verify the PA’s credentials.

The practice agreement does not have to be filed with the state, but it must be available for inspection.

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