Supervision of non-physician personnel
ISSUE SUMMARY
The health care system is experiencing a proliferation of mid-level practitioners and other non-physician personnel who work in a wide variety of supervised, directed, referral or collaborative relationships with physicians. The roles and responsibilities of these personnel vary considerably, depending on their training, experience, and the quality of the direction, supervision and delegation by physicians with whom they work. There is a growing trend among mid-level practitioners to seek greater clinical and economic independence from physicians with whom they have had supervisory or collaborative relationships in the past. The quality of care rendered to patients by non-physician practitioners is greatly influenced by the quality of the collaboration and supervision provided by the responsible physician. To assure quality, physicians have a responsibility to be actively involved in and knowledgeable about the care provided by personnel who work under their supervision, direction or referral.ADOPTED ACTION OR POLICY
KMS reaffirms its opposition to the independent practice of medicine by individuals who have not completed the state's requirements for licensure to engage in the practice of medicine and surgery. KMS also reaffirms that physicians have an ethical duty to adhere to the following guidelines in their professional relationships with non-physician personnel whom they supervise, direct, or delegate acts which constitute the practice of medicine and surgery:
Guidelines for Direction, Supervision and Delegation to Mid-level Practitioners*
I. Every physician who directs, supervises or delegates acts which constitute the practice of medicine and surgery to non-physician personnel should:
(a) be actively engaged in the practice of medicine and surgery in Kansas;
(b) encourage the initial and periodic evaluation of the professional competency of such personnel;
(c) annually review any written practice protocols between the physician and such personnel;
(d) direct, supervise or delegate to such personnel only those acts which constitute the practice of medicine and surgery which the physician believes such person is competent to perform, based on not less than 30 days practice under the immediate direction and supervision and in the physical presence of the physician;
(e) direct, supervise or delegate only those acts which are within the normal and customary specialty, competence, and practice of the physician;
(f) regularly review patient records of patients treated by such practitioners and document such review in the patient record;
(g) provide for a substitute physician to direct and supervise such personnel when the physician is temporarily absent or unavailable by telecommunication;
(h) periodically see patients at the same location with such personnel at a minimum of 24 days each year;
II. With the exception of nurse anesthetists, no physician should direct, supervise or delegate acts which constitute the practice of medicine and surgery to more than two FTE mid-level practitioners or other non-physician personnel;
III. Physicians should avoid arrangements to direct, supervise, enter into practice protocols, or delegate acts which constitute the practice of medicine and surgery to non-physician personnel if those arrangements are inconsistent with these guidelines and designed primarily to satisfy or circumvent existing legal requirements;
IV. Notwithstanding these guidelines, physicians should adhere to any applicable laws governing the professional relationships between physicians and non-physician personnel.
*First adopted in 1996; reaffirmed in 2001, 2005 and 2006.
Adopted by the KMS House of Delegates on April 30, 2011.
