Kudos, by the way, to the physician who manages to maintain involvement in the provision of care to most or all of his/her patients who are seen by the extenders. I fear that “current trends in practice patterns” will not support this as he/she is presumed to supervise increasing numbers of extenders seeing increasing numbers of patients. Unfortunately, bean-counter types (and YES, greedy physician managers) are the ones who are pushing for more patients to be seen by nonphysicians as a way to boost revenue.

Like anything in life, though, you get what you pay for.

1: Have you ever been sued Mr/Ms NP? I can assure you FIRST HAND that your collaborating MD WILL be named in a suit due to your (presumed) negligence and depending on the circumstances may bear the brunt of your (presumed) negligence. When you actually have been through the process once get back to me. Based on MY EXPERIENCE I will never ever be a collaborating off-site MD again for an NP/PA. I will however happily oversee them in the clinic.

2: I totally agree with anon 9:48. If the “collaboration” is nothing more than an occasional phone call to the doc off-site for the purpose of CYA/regulations, then it clearly needs to be dropped. The NP’s in those states should take the responsibility of patient care over on the own (and everything that goes with it medically/legally)and drop the farce of MD involvement under those circumstances.

3: Lastly, I am a firm beiever in NP/PA involvement. However, I have not irregularly seen NP’s/PA’s get in over there head (and not realize it) so I tend to disagree with you about “I can assure you that we miss no more than any other practicing professional.” I go over every patient the NP sees in my clinic (often very briefly) if I am the supervising doctor. period and I assure you that I do pick up misses due to the difference in our training and experience. Not a complaint, a simple fact.

It’s not self-righteous, it is a fact of the legal system. Don’t worry though, the lawsuit will not rest at only the physician. The pharmacy will definitely be named as well.

Either NP’s need a supervisor, or they don’t. If they don’t need one, the legal requirement should be dropped. If they do need one, then it should be meaningful. I saw an ad online in which NP’s in Oregon could pay a fee by CC and fill out an online form and meet the “supervision” requirement. That is ridiculous and farcical. Is it the law not giving NP’s full independence that is the farce or those NP’s and physicians who just go through the motions? I don’t know but our professionals and legislators sure as hell need to figure that out and act accordingly.

On another note. what I find interesting about these clinics is that they represent pharmacies going into the business of practicing medicine–and doing so in a setting where they hire only limited license practitioners with no tradition of independent practice with whom they can exert tremendous influence for the optimal profit of the parent pharmacy operation—a glaring and dramatic conflict of interest even as pharmacies continue their 150 year campaign to prevent doctors from dispensing on the grounds of conflict of interest. But it all has happened so fast that no one has seemed to notice or give full consideration to that issue. Anyone who doesn’t think that the management of those companies aren’t going to manipulate the practices of those clinics for optimal pharmacy profit on the dispensing side hasn’t had any association with MBA trained members of the management profession in the last 20 years.

Naive as hell!

Also to anonymous 11:06 pm, was your “flu shot” “not real” because it was at a “minute clinic?” In addition, most states do not require the listing of the collaborating physician at the practice site. NP’s/PA’s are required to collaboate with licensed physicians that are located in the same state. The same group that “regulates” your office is the same that regulates retail health.

doctor david – your argument that NP’s can/will miss something that “only a trained physician is capable of detecting” is old. With well over 100,000 NP’s practicing across the US, I can assure you that we miss no more than any other practicing professional.

The theory is why should the victim bear the brunt of a bankrupt defendant as opposed to a party who is at least partly at fault? That being said, the Wal-Mart’s of the world will have made the physicians independent contractors.