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The Business of Practicing Medicine

Like it or not, the practice of medicine is a business. There are many twists and turns which you, the physician, need to be aware of in navigating the day-to-day business of practicing medicine. Here are several items to think about.

In 2016, the Michigan Legislature enacted a significant statute related to Physician’s Assistants which gives greater autonomy to Physician’s Assistants to perform health care services under the terms of a Practice Agreement. The expanded health care services include:

  • The ability to make rounds and house calls.

  • The ability to prescribe drugs.

  • The ability to perform routine visual screening or testing, post-operative care, or assistance in the care of medical diseases of the eye.

  • Importantly, the statute eliminates the requirement that Physician’s Assistants be supervised at all times by a Physician.

The catch is that for Physician’s Assistants to be able to provide these expanded health care services, the Physician’s Assistants must enter into a Practice Agreement with the participating Physician. That Practice Agreement must include very specific terms. In general, those terms include a process for communication, availability and decision making between the Physician and the Physician’s Assistant when providing medical treatment to a patient. In all cases, Physician’s Assistants are only allowed to provide care within the scope of their license.

The agreement must include a protocol for designating an alternative for consultation when the participating Physician is unavailable. The agreement must include a termination provision allowing either party to terminate upon 30 days’ written notice to provide for continuity of care.

In all cases, the Physician is responsible for verifying the Physician’s Assistant’s credentials and the Practice Agreement must be in writing and signed by both the Physician and the Physician’s Assistant.

In early 2017, the State of Michigan updated its midwifery legislation. Midwifery is now a part of the public health code and there are new license requirements for the practice of midwifery. A midwife needs to be licensed, may directly obtain supplies and devices and obtain screening tests and receive verbal and written reports on those tests, must obtain informed consent from the patient and must establish a protocol for transfer of care to a Physician or a hospital. There are certain prohibitions on what a midwife can or cannot do. If your practice involves a midwife, it is important to be aware of this new legislation.

Many medical offices employ Nurse Practitioners as well as or instead of Physician’s Assistants. Specific contracts for Nurse Practitioners and Physician’s Assistants are different and must be differently written as Nurse Practitioners and Physician’s Assistants have different legal responsibilities and different legal, though perhaps not practical, responsibilities.

Take a moment to look at your contracts. If the contract language for Physician’s Assistants predates 2016, or for midwifes predates 2017, it’s time for review and an update.

As always, if you have questions, please feel free to contact the undersigned at or by phone at (810) 232-3141 for more detailed information.

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