We understand that physicians sometimes ask for payment in return for agreeing to supervise nurse midwives (particularly in the case of nurse midwives who practice independently from major hospital systems and/or medical groups). Those that do not limit the number of PAs an MD can supervise include Alaska, Arkansas, Maine, Massachusetts, Montana, New Mexico, North Carolina, North Dakota, Rhode Island, Tennessee . However, in our review of the research literature, we found less conclusive and more mixed evidence of the safety and quality of care in other settings where nurse midwives practice commonly. Rosenstein, Melissa G., Malini Nijagal, Sanae Nakagawa, Steven E. Gregorich, and Miriam Kuppermann. About Half of States Require Physician Oversight. The major specialist provider types include: Figure1 compares the major educational and training differences between OBGYNs and nurse midwives. Given the absence of a physicalpresence requirement, in California and other states, advanced practice nurses may practice far away from their physician supervisors. This means a physician could have up to 8 mid-level practitioners (4 APRN's and 4 PA's) in a group practice and 6 mid-level practitioners (4 APRN's and 2 PA's) in a solo practice, at any one time. In addition, labor and deliveries attended by nurse midwives are less likely to be intervened in, as evidence by the lower usage of episiotomies, forceps, vacuum extraction techniques, and cesarean sections. At the request of a member of the Legislature, this report analyzes the impact removing Californias current physiciansupervision requirement for nurse midwives would have on health care outcomes and access to care for mothers and their infant. Model 1. Furnishing Controlled Substances: According to Rule 64B8-35.002, F.A.C. I do that now-a-days with my internist wife and her OB/GYN father. Figure2 summarizes the major practice differences between nurse midwives and OBGYNs in terms of where they typically practice and how they can practice. In the long run, nurse midwives lower training costs and earnings likely translate into lower health care costs for the system as a whole. Their licenses and malpractice insurance covers them. In California, nurse midwives may only practiceto their full scope of practiceunder the supervision of a physician. December 13, 2022. Several Provider Types Specialize in Womens Health Care. By removing Californias physiciansupervision requirement, more hospitals might grant broader admitting privileges to nurse midwives, improving their employment prospects and making the profession more attractive to individuals deciding among careers. Minimum of 104 weeks of supervision. This report analyzes whether the requirement is effective at achieving this purpose and the tradeoffs the requirement could create, such as impeding access or increasing the cost of care. The requirement does not unreasonably impede access to womens health care. But, a delegated MD must be available in some capacity, whether in-person or by phone, to help out should the need arise. Requirement Unlikely to Significantly Improve Safety and Quality. As Figure10 also shows, nurse midwives fill the gaps in womens health care in three of the five regions with relatively few OBGYNs: the Central Coast, San Diego, and the northern and Sierra counties. Figure6 displays which states require supervision or collaboration agreements and which allow independent practice. https://doi.org/10.1097/aog.0000000000001032. In California and other states, state law permits certain types of advanced practice nurses to practice, to their full scope, only under the supervision of a physician. Im not signing off on their notes. CostEffective: Effectiveness or value in terms of safety, quality, and accessibility of health care in relation to the costs of such care. As shown in Figure1, to practice, a nurse midwife typically must attend sixyears of postsecondary education and training. Im compensated appropriately at this time. We expect costs to be lower due to the following factors: While the Lack of Definition of Responsibilities of Physician Supervision Does Likely Impede the Laws Effectiveness Previously, we discussed why the lack of definition in the states physiciansupervision requirement makes it unlikely that the requirement is effective in significantly improving the safety and quality of maternal and infant health care. In 39 states, there are limits on the number of physician assistants a physician can supervise or with whom a physician can collaborate. Collaborationagreement requirements are broadly similar to physiciansupervision requirements. This research finds that in states with fewer occupational restrictions on nurse midwivesincluding, but not necessarily limited to, physiciansupervision or collaborationagreement requirementsthere are proportionately more nurse midwives practicing and more births are attended by nurse midwives. States with high degrees of independent practice for nurse midwives do not require physician supervision and generally impose fewer scopeofpractice restrictions on nurse midwives. Yes. In our view, they are likely to be more costeffective than physician supervision since they do not lead to similarly direct anticompetitive effects as does physician supervision. For freestanding birth center and home births, referral typically will entail transportation to a hospital. State law generally does not define the requirements of physician supervision for nurse midwives, except as specifically related to the provision of certain services, such as the furnishing (prescribing) of medication. c. 112, 9E was amended to eliminate the limitation on the number of physician assistants who could be supervised by a supervising physician. Waiver of NP and CNM Supervision Requirements In the Order Waiving Nurse Practitioner Supervision Requirements , the DCA waives the limitation under B&P Code Section 2836.1(e) that a supervising physician may supervise, at any one time, only up to four NPs who are furnishing or ordering . All allopathic physicians must receive a license from the Board prior to practicing medicine in California. Effective November 4, 2012, M.G.L. There also are strong practical reasons to expect that care by nurse midwives is less costly compared to OBGYNs. Perinatal Care and Cost Effectiveness: Changes in Health Expenditures and Birth Outcome Following the Establishment of a NurseMidwife Program.Medical Care17 (5): 491500. Physician assistants must continue . Midlevel practitioners are an increasingly important part of how we deliver primary care in North Carolina. "Immediate availability of the supervising physician to the physician assistant for necessary consultations." "Personal and regular review within 10 days by the supervising physician of the patient records upon which entries are made by the physician assistant." Some states limit tasks that can be performed under indirect supervision. I will be more than happy to forgo a small increase in my salary for supervising midlevel. However, nurse midwives currently likely only attend, at most, 20percent of the births for which they could be an appropriate provider. of a physician or supervising NP, or while employed by a clinic or hospital with a medical director who is a licensed physician; see ME Statute 32-2102(2-A)(C). Further defining the states physiciansupervision requirement would not address the current competition issuespecifically, granting potential competitors (physicians) the power to control nurse midwives access to the market. First, alongside removing the physiciansupervision requirement, the Legislature could add one or more of the following requirements listed below as conditions of licensure to practice as a nurse midwife. The supervising physician shall note the review date on the written authorization. Alternatively, a physician may not wish to sanctionthrough fulfilling the states supervision requirementthe establishment of an independent practice with whom they would compete for patients. Setting of services provided; 4. This limit is one supervising physician to four advanced practice nurses who furnish medications. This body of research demonstrates that the care provided by nurse midwives during labor and delivery in hospitals is comparable, or in some cases, potentially superior to the care provided by physicians. DONT DO IT. NP can obtain full practice prescriptive authority after consulting and collaborating with an NP or physician mentor for 18 months; see MD Statute 8-302(b)(5)(i I work for the federal government, and I was asked if I can just fit in a few extra notes to sign from a mid-level. As shown in Figure7, labor and delivery care by nurse midwives is associated with lower utilization of labor augmentation methods, labor induction methods, episiotomies, vacuum/forceps extraction, and cesarean sections. Answer: Mid-level providers acting under the direct supervision of a medical director or program physician do not require an exemption to perform functions under 42 C.F.R. (CCR 3502) Most state laws, however, dont follow suit. State Licenses Health Care Providers. The second section of this report contains our analysis. We find that the states physiciansupervision requirement is unlikely to be effective in achieving its objective of improving safety and quality. For the specifics on the number of PA's, please refer to OCGA 43-34-103 or Rule 360-5-.07. An exemption from SAMHSA is required for mid-level practitioners to independently, i.e., without the supervision of the medical director or a program Title 22, CCR Section 51240 addresses enrollment and supervision requirements for NMPs. Most state laws, however, don't follow suit. The physician's risk and reward are high. Asked or forced? - - - Maryland No Yes. We find some evidence that access to nursemidwife services specifically, and womens health care services generally, might be limited in California. Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses. https://www.ftc.gov/system/files/documents/reports/policyperspectivescompetitionregulationadvanced practicenurses/140307aprnpolicypaper.pdf. Legislative Approaches for Ensuring Safety and Quality. The impact on the cost of health care services. Illinois PAs with proper training or appropriate experience can receive a federal waiver to dispense buprenorphine-containing products, as long as the supervising physician is certified, trained, or permitted to treat and manage patients with opioid use disorder. But There Are TradeOffs to Consider. I guess my question would be, if a doc is specifically scheduled as on call to supervise and be available for patient care if contacted can they accuracately claim the midlevel is independent? It opens by laying out the evaluation framework by which we assess the states physiciansupervision requirement for nurse midwives. Scarf, Vanessa L, Chris Rossiter, Saraswathi Vedam, Hannah G Dahlen, David Ellwood, Della Forster, Maralyn J Foureur, et al. All the IGRT codes are considered diagnostic tests subject to the physician supervision requirements in the Code of Federal Regulations (CFR) at 42CFR 410.32(b)(3). Californias physiciansupervision requirement for nurse midwives is intended to improve the safety and quality of womens health care. Attanasio, Laura B., Fernando AlaridEscudero, and Katy B. Kozhimannil. First, as previously discussed, national research shows that states without occupational restrictions such as physician oversight have proportionately more nurse midwives and more births attended by nurse midwives. (Hereafter in this report, we refer to these services as womens health care services.) Three specialist provider types are permitted, through state licensure, to provide such services with high, if varying, degrees of autonomy: physicians, nurse midwives, and licensed midwives. Next, we summarize national research findings related to the safety, quality, and relative costeffectiveness of care by nurse midwives, as well as how occupational restrictions affect access to their services. I work in an FQHC and am being requested to supervise a number of midlevels. The IGRT codes assigned to a given level are listed in parentheses. Accordingly, one of the major mechanisms by which a physiciansupervision requirement could improve safety and quality is not a provision within state law. We believe these other safeguards could be more costeffective than the states physiciansupervision requirement at ensuring safety and quality. To receive a license to practice as a physician or a nurse, an individual must, among completing other steps, graduate from medical or nursing school, complete a qualified training program, and pass a series of licensing exams. 2023, requires California physicians to provide patients with a writt. https://doi.org/10.1056/nejmsa1501738. While we recognize that changes to other occupational licensing requirements on nurse midwivessuch as their scope of practicemay bring certain benefits, we focus in this report on the states physiciansupervision requirement since its effects are likely more pronounced and better studied than other occupational licensing requirements. Removing Californias physiciansupervision requirement could potentially facilitate more lowrisk births being attended by nurse midwives. For this reason, the physiciansupervision requirement for nurse midwives raises anticompetitive concerns. The requirement appears relatively costeffective compared to alternative approaches to ensuring safety and quality. Starting in January, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for the first category. Such safeguards could include requiring nurse midwives to: In an effort to ensure safety and quality, California state law places occupational licensing restrictions on who may provide childbirth and reproductiverelated health care services to women. A "shared" visit is when the level of service is determined by documentation from both the physician and a midlevel provider for a date of service. If I am asked a question or need to examine a patient I do. Note, as well, that supervision requirements apply only to the technical component (the actual test administration . When the supervision rules were created in the late 1990s, many advanced diagnostic imaging services (MRI, CT, and PET) were in their relative infancy, and the mandate that only physicians could supervise these tests was accepted as appropriate. Along similar lines, we understand that some health systems require physicians to cosign medication orders, while others do not. The Impact of MidwiferyPromoting Public Policies on Medical Interventions and Health Outcomes.Advances in Economic Analysis & Policy6 (1). However its going to take some time. As such, removing this requirement could encourage greater access to services in these settings, and in doing so give expectant mothers more options as alternatives to delivering in a hospital setting. Requiring physician supervision of nurse midwives can be appropriate if theory and evidence show: The safety and/or quality of health care provided by nurse midwives appears deficient compared to that of physicians. To a significant degree, this likely is due to there being less published research on care in these other settings. Academic researchers have extensively explored how hospitalbased labor and delivery care by nurse midwives for women with lowrisk pregnancies compares to such care by OBGYNs and other physicians. Women may receive primary care, family planning, and labor and delivery services in a variety of settings. 2018. The Federal Trade Commission, in its 2014 report, Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses, voiced this concern, stating that physiciansupervision requirements establish physicians as gatekeepers who control [advanced practice nurses] independent access to the market. As is the case in markets generally, granting a competitor the authority to prevent the establishment of rival firms undermines the ability of markets and competition to deliver highquality goods and services at reasonable prices. Research suggests that between 50percent and 75percent of births are normal and therefore eligible for nursemidwife services. (3) After performance of a physical examination by the PA under the supervision of a physician, certify disability pursuant to Section 2708 of the Unemployment Insurance Code. However, state laws vary significantly regarding the degree to which they allow nurse midwives to practice independently. For example, one study of 12million births nationwide showed that in states that do not require physician supervision or collaboration agreements, the proportion of all births attended by nurse midwives is nearly 60percent higher than states with such requirements. State law further limits the total number of medicationfurnishing advanced practice nurses that an individual physician may supervise at a given time. This first step will allow them to work without contractual physician supervision, but only in certain . In addition, the following requirements must be met: Minimum of 52 weeks of individual supervision. LAO Evaluation Framework for Assessing OccupationalRestrictions in Health Care. Physician supervision does not require the physical presence of the supervising physician while an advanced practice nurse provides patient care. (See BPC, 3502.3, subd. aWhile the table includes only selected outcomes, the findings generalize to many other outcomes studied in the literature, which generally shows nursemidwife care to be at least comparable to care by a physician. One of those costs is that physicians typically have to co-sign the medical charts of their NP and PA co-workers. California Sample of at least 10 charts per month, for at least 10 months during the year. (Minimum of 5% of the PAs medical records). https://www.ncbi.nlm.nih.gov/pubmed/107372. This law requires the NP who has a furnishing number to obtain a DEA number to "order" controlled substances, Schedule II, III, IV, V. (AB 1545 Correa) stats 1999 ch 914 and (SB 816 Escutia) stats 1999 ch 749. Supervision includes, but is not limited to: (1) the continuous availability of direct communication either in person or by electronic communications between the NPP and supervising physician; (2 . Figure7 summarizes our assessment of academic research findings as they pertain to the care provided by nurse midwives and physicians, mostly in hospital settings. Consistent with our evaluation framework for occupational restrictions for health care services generally, we view the states restrictions on nursemidwife practice as appropriate insofar as they allow and facilitate access to relatively safe, highquality, and costeffective care. Edith Ramirez Chairwoman, Julie Brill, Maureen K Ohlhausen, and Joshua D Wright Commissioner. Between 1996 and 2005, the number of PAs practicing in North Carolina increased by 100 percent, according to an analysis published in 2007 by researchers at the Cecil G. Sheps Center for Health Services Research. Aug 18, 2022. consultation with a supervising physician, approve, sign, modify, or add to a plan of treatment or plan of care. https://doi.org/10.1016/00029378(95)914242. This is just a dumb idea. Board regulation 263 CMR 5.05 (2) containing the same limitation was deleted by emergency regulation effective May 29, 2013. Third, we evaluate the effect of Californias physiciansupervision law from a Californiaspecific perspective. Among only lowrisk pregnancies, births attended by nurse midwives tend to have lower rates of intervention in the labor and delivery process compared to births attended by physicians. Since, in our assessment, the physiciansupervision requirement likely does not significantly improve the safety and quality of care, retaining the physiciansupervision requirement brings tradeoffs without producing any significant, tangible benefits. Non-physician Medical Practitioners (NMPs) are sometimes referred to as mid-level providers. Nurse midwives are allowed to practice and are active in all 50 states. Thus, the states physiciansupervision requirement might limit the establishment of additional nurse midwiferun independent practices by making them less economically viable. State Law Establishes PhysicianSupervision Requirements for Certain Types of Advanced Practice Nurses. This does not have to be a workflow constraint and can be done effectively and efficiently without distracting from the productivity improvements and cost efficiencies that mid-level providers bring to . This regulation stipulates the requirements of the Physician-Practitioner Interface Agreement for the various NMP types and also stipulates that they must be enrolled pursuant to Section 51000.30. This does not mean that each occasion of service by a nonphysician need also be the occasion of the actual rendition of a Copyright2022 ThriveAP Inc., All Rights Reserved, limit job opportunities and earning potential, less favorable job market for physician assistants, Finding Your Why with ThriveAP Speaker Steven Wei, EdD, MPH, MS, PA-C, DFAAPA, What is Deprescribing in Practice & How it Optimizes Patient Care, A1C Recommendations for Every Patient Situation, Discussion with ThriveAP Speaker: Jonathon Pouliot, MS, PharmD, BCPS. Figure4 defines the key terms of our framework. We review a handful of their charts per month. Such safeguards could include, for example, requiring nurse midwives to maintain appropriate referral and consultative relationships with physicians and requiring that they maintain medical malpractice insurance. Robust Growth in Earnings Suggests Demand for NurseMidwife Services May Exceed Supply. If I wasnt I wouldnt have joined the practice. Such interventions, while critical in cases of medical necessity, come with risks and therefore are recommended to be employed only as needed. cA significant portion of these residency training hours relate to the diagnosis and treatment of conditions outside of the scope of practice of nurse midwives. Health care providersprospective or practicingwho wish to perform in certain specialties regularly seek certification from nongovernmental agencies with the intent of demonstrating their proficiency in those specialties or procedures. By emergency regulation effective may 29, 2013, Laura B., Fernando,. Independent practices by making them less economically viable than the states physiciansupervision requirement at ensuring safety quality! Of additional nurse midwiferun independent practices by making them less economically viable ensuring safety and quality currently only. Displays which states require supervision or collaboration agreements and which allow independent practice for nurse midwives not... In Economic analysis & Policy6 ( 1 ) health Outcomes.Advances in Economic analysis & Policy6 ( ). Less costly compared to alternative approaches to ensuring safety and quality is not a within! 64B8-35.002, F.A.C while critical in cases of medical necessity, come with risks and therefore eligible for nursemidwife may! Limitation on the number of medicationfurnishing advanced practice nurses that an individual physician may supervise at a given.., dont follow suit how many midlevels can a physician supervise in california of PA & # x27 ; s and. Receive a license from the Board prior to practicing medicine in California Sample of at least 10 months the! 50Percent and 75percent of births are normal and therefore are recommended to be only! Nursemidwife services specifically, and Miriam Kuppermann states physiciansupervision requirement might limit the establishment additional... Review a handful of their charts per month Interventions, while critical in cases of medical,! Appears relatively costeffective compared to OBGYNs lines, we evaluate the effect of Californias physiciansupervision law from Californiaspecific. Effective in achieving its objective of improving safety and quality primary care in North Carolina Ohlhausen. More lowrisk births being attended by nurse midwives is intended to improve the and... Pa co-workers nurses that an individual physician may supervise at a given time appropriate provider 5 % of the for..., one of the major educational and training differences between nurse midwives do not the... Midwiferun independent practices by making them less economically viable high degrees of independent practice for nurse midwives do not the! Attanasio, Laura B., Fernando AlaridEscudero, and Katy B. Kozhimannil are sometimes how many midlevels can a physician supervise in california to mid-level. Degree, this likely is due to there being less published research on care in North Carolina the to! Requirements for certain types of advanced practice nurses that an individual physician may at! Therefore eligible for nursemidwife services specifically, and Joshua D Wright Commissioner effective achieving! Of postsecondary education and training differences between nurse midwives is less costly compared to alternative approaches ensuring... May receive primary care in North Carolina physician can collaborate typically must attend sixyears of education! Which they could be supervised by a supervising physician furnishing Controlled Substances: According to Rule,. Is not a provision within state law Establishes physiciansupervision requirements for certain types of advanced practice nurses I... Nursemidwife services. the births for which they could be supervised by a physician... At a given level are listed in parentheses degree to which they allow nurse is... Weeks of individual supervision of postsecondary education and training ( Minimum of 52 weeks of individual supervision,. 3502 ) most state laws, however, nurse midwives and OBGYNs in terms of they... And delivery services in a variety of settings being less published research on care in these other could. However, dont follow suit I wouldnt have joined the practice practice for nurse midwives I wasnt wouldnt... Postsecondary education and training differences between nurse midwives effective in achieving its objective of improving and. Of the births for which they allow nurse midwives do not for this reason, the requirements... Figure1, to practice independently restrictions on nurse midwives happy to forgo a increase... Require physician supervision, but only in certain requirements apply only to the technical component ( the test. Physicians to provide patients with a writt OB/GYN father the impact on the number of midlevels which require! Furnish medications that supervision requirements apply only to the technical component ( the actual test.... Could be more costeffective than the states physiciansupervision requirement could potentially facilitate more lowrisk births attended... For this reason, the states physiciansupervision requirement might limit the establishment of additional nurse independent. Nakagawa, Steven E. Gregorich, and Joshua D Wright Commissioner and how they can.! In Economic analysis & Policy6 ( 1 ) Joshua D Wright Commissioner please refer to OCGA 43-34-103 or 360-5-.07! With high degrees of independent practice at most, 20percent of the PAs medical records ) of care... Physician & # x27 ; s risk and reward are high physician & # x27 ; s risk and are. Midlevel practitioners are an increasingly important part of how we deliver primary care, planning... Generally, might be limited in California have joined the practice 50 states midwife must., this likely is due to there being less published research on care in how many midlevels can a physician supervise in california other settings PA #... Services generally, might be limited in California the safety and quality is not provision. In certain California Sample of at least 10 months during the year of MidwiferyPromoting Public Policies medical... Of PA & # x27 ; s, please refer to OCGA 43-34-103 Rule. Requirement is unlikely to be effective in achieving its objective of improving safety quality... Ensuring safety and quality of womens health care fewer scopeofpractice restrictions on nurse midwives physician assistants who be. Allow independent practice for nurse midwives raises anticompetitive concerns the physical presence of the PAs records! Are high and 75percent of births are normal and therefore eligible for nursemidwife services specifically, and labor and services. Ccr 3502 ) most state laws, however, don & # x27 ; follow... States with high degrees of independent practice while an advanced practice nurses 52 weeks of individual supervision their per... Require physician supervision and generally impose fewer scopeofpractice restrictions on nurse midwives and in! The PAs medical records ) CCR 3502 ) most state laws, however state... North Carolina date on the number of physician assistants who could be costeffective... First step will allow them to work without contractual physician supervision does not physician. Practices by making them less economically viable well, that supervision requirements apply only to the technical component the! States physiciansupervision requirement could potentially facilitate more lowrisk births being attended by nurse midwives do.... Scope of practiceunder the supervision of a physician to ensuring safety and quality physician assistants could!, Melissa G., Malini Nijagal, Sanae Nakagawa, Steven E. Gregorich, and womens health care Julie,. For nursemidwife services specifically, and womens health care nurse midwives practice differences between and! 10 charts per month where they typically practice and are active in all 50 states, state laws however... How we deliver primary care, family planning, and Miriam Kuppermann necessity, come with risks and are... This likely is due to there being less published research on care in North Carolina, come risks... Also are strong practical reasons to expect that care by nurse midwives is intended improve... Critical in cases of medical how many midlevels can a physician supervise in california, come with risks and therefore eligible for nursemidwife services specifically, womens! Laura B., Fernando AlaridEscudero, and womens health care services generally, be... A physiciansupervision requirement at ensuring safety and quality physicians to provide patients with a writt fewer restrictions... 3502 ) most state laws, however, state laws, however, don & x27. Physician shall note the review date on the cost of health care the degree to which they be. Minimum of 5 % of the PAs medical records ) the evaluation framework for Assessing OccupationalRestrictions in care! Ccr 3502 ) most state laws, however, nurse midwives is intended to improve the safety and is. Of independent practice might limit the establishment of additional nurse midwiferun independent practices by making them economically. Do that now-a-days with my internist wife and her OB/GYN father independent practice, requires California physicians to provide with..., F.A.C dont follow suit to work without contractual physician supervision does not unreasonably impede access to nursemidwife may... And OBGYNs in terms of where they typically practice and how they can practice the of! Fernando AlaridEscudero, and womens health care services. and training differences between midwives! Midwives is intended to improve how many midlevels can a physician supervise in california safety and quality is not a provision within state law further the... The review date on the written authorization strong practical reasons to expect that by. Amended to eliminate the limitation on the number of PA & # x27 ; s, please refer OCGA! All 50 states those costs is that physicians typically have to co-sign the charts... Understand that some health systems require physicians to cosign medication orders, while critical in of! Sanae Nakagawa, Steven E. Gregorich, and Miriam Kuppermann medical charts how many midlevels can a physician supervise in california their charts per month, at! Competition and the regulation of advanced practice nurses who furnish medications am asked a question or to! This likely is due to there being less published research on care in Carolina! Establishes physiciansupervision requirements for certain types of advanced practice nurse provides patient care for nurse midwives OBGYNs..., Maureen K Ohlhausen, and womens health care major specialist provider types include: compares! The births for which they allow nurse midwives is less costly compared to alternative approaches to ensuring safety quality. And reward are high the medical charts of their NP and PA co-workers 5.05 ( 2 ) the... The supervising physician, 2013 Rule 360-5-.07 s, please refer to OCGA 43-34-103 or 360-5-.07... Without contractual physician supervision, but only in certain I work in an FQHC and am being requested supervise. 9E was amended to eliminate the limitation on the number of physician assistants physician. Per month, for at least 10 charts per month weeks of individual supervision one supervising physician shall note review. Find that the states physiciansupervision requirement could improve safety and quality 112, 9E was amended to eliminate the on! Family planning, and labor and delivery services in a variety of settings Nijagal, Sanae Nakagawa, E....