State laws are key when supervising non-physician clinicians

Physicians who supervise non-physician clinicians (NPCs) in clinical practice should stay up-to-date on the state laws related to their relationship to those NPCs. The required degree of oversight differs by state and sometimes by the type of NPC (e.g., nurse practitioner or physician assistant). Employers may not always keep physicians informed of legal issues around NPC supervision, billing requirements, or scope-of-practice restrictions.

Physician medical licensing laws often provide guidance on supervising NPCs, and failing to follow these guidelines puts your medical license at risk. One common requirement is that physicians supervise within their normal scope of practice. This can be an issue if you are supervising NPCs in a different type of clinic outside of your normal job (e.g., moonlighting as a medical spa medical director even though you don’t practice any type cosmetic or aesthetic medicine). Before agreeing to supervise an NPC, answer these questions:  

• Does your state limit the number of NPCs you can supervise at one time? Some states may have limits on each type of NPC, as well as an aggregate limit. 
• Does your state require a specific amount or type of interaction with the NPCs you supervise?
• Does your state require a written contract or collaboration agreement? What needs to be included in this document?
• Does your state require an annual review or other certification to supervise NPCs?
• Even in states that allow independent practice for nurse practitioners, some require supervision or collaboration for specific situations. Does your state have any of these requirements?

Physician contracts related to NPC supervision may be vague or complicated. It’s important to understand, discuss, and potentially negotiate the following items before signing:

• Does your employer expect you to supervise NPCs? If so, how many? Negotiate a maximum number if you have concerns.
• Can you be involved in the protocols for NPCs, such as how parties will work together, issues that require oversight, etc.? Discuss how your employer will handle your time meeting with NPCs or reviewing charts. Ensure your contract aligns with state laws in this regard.
• If you are uncomfortable supervising NPCs, can you delay this responsibility?
• Consider asking if you can supervise only if you approve the individual NPC and are comfortable with their skills and experience.
• Ask if you can be involved in the hiring or termination of NPCs you supervise.
• Make sure you understand whether and how you are compensated for supervision services.

The American Academy of Family Physicians has a new on-demand CME course, “Non-Physician Clinician Supervision,” with sessions on contracts and issues related to supervision. This course offers best practices you can apply to build effective working relationships with NPCs.

—  Ericka Adler, JD, LLM, and Angela M. Lanigan, MPA, RD, LD

Posted on April 5, 2024 by FPM Editors