NEW YORK - PHYSICIAN ASSISTANTS, SPECIALIST ASSISTANTS AND NURSE PRACTITIONERS (Scope of Duties)

I. LICENSED PHYSICIAN ASSISTANTS

1. What qualifications must a person have to be licensed as a physician assistant in New York?

A. To qualify for registration as a physician assistant, each person shall, in addition to paying applicable fees, submit satisfactory evidence, verified by oath or affirmation, that he or she:

2. is of good moral character;

3. has successfully completed a four-year course of study in a secondary school approved by the board of regents or has passed an equivalency test;

4. has satisfactorily completed an approved program for the training of physician assistants. The approved program for the training of physician assistants shall include not less than forty weeks of supervised clinical training and thirty-two credit hours of classroom work. The commissioner is empowered to determine whether an applicant possesses equivalent education and training, such as experience as a nurse or military corpsman, which may be accepted in lieu of all or part of an approved program; and

5. in the case of an applicant for registration as a physician assistant, has obtained a passing score on an examination acceptable to the department.

(Education Law § 6541)

2. Who may employ a physician assistant?

A physician assistant may be employed by a physician, a health care facility, an institution or a veterans' home as long as such professional is under the supervision of a physician.

(Education Law § 6542)

3. What duties may a physician assistant perform?

A physician assistant may perform medical services, but only under the supervision of a physician and only when such acts and duties as are assigned to him are within the scope of practice of such supervising physician. A physician may not employ or supervise more than two physician assistants in his private practice at any one time.

(Education Law § 6542(1))

4. What are the physician's supervisory obligations?

A physician is required to continuously supervise a physician assistant, but such supervision shall not be construed as necessarily requiring the physician to be physically present at the time and place where such services are performed. However, the supervising physician must be immediately available to the physician assistant. There must be procedures in place to ensure that the supervising physician is immediately available for consultation with the physician assistant by, at a minimum, telephone or other effective, reliable means of communication. The medical charts should be countersigned by the supervising physician to support a claim of appropriate supervision. In no case should a physician instruct a physician's assistant or anyone, to perform a procedure that is outside the scope of such individual's license or training.

(Education Law § 6542 and 6530 (25))

II. REGISTERED SPECIALIST ASSISTANTS

1. What qualifications must a person have to be licensed as a specialist assistant in New York?

A. To qualify for registration as a specialist assistant, in addition to paying applicable fees, an applicant shall submit satisfactory evidence, verified by oath or affirmation, that he or she:

1. at the time of application is at least twenty-one years of age:

2. is of good moral character;

3. has successfully completed a four-year course of study in a secondary school approved by the board of regents or has passed an equivalency test; and

4. has satisfactorily completed an approved program for the training of specialist assistants.

The commissioner is empowered to determine whether an applicant possesses equivalent education and training, such as experience as a nurse or military corpsman, which may be accepted in lieu of all or part of an approved program.

(Education Law § 6541)

2. Who may employ a specialist assistant?

A specialist assistant may be employed by an orthopedist, urologist or radiologist or in a health care facility, institution or a veterans' home as long as such professional is under the supervision of one of the above enumerated physicians. A physician may not employ or supervise more than two specialist assistants in his private practice at any one time.

(Education Law § 6542)

3. What duties may a specialist assistant perform?

A specialist assistant may perform medical services, but only when under the supervision of a physician and only when such acts and duties as are assigned to him are related to the designated medical specialty for which he is registered and are within the scope of practice of his supervising physician.

(Education Law § 6542 (2))

4. What are the physician's supervisory obligations?

A physician is required to continuously supervise a specialist assistant, but such supervision shall not be construed as necessarily requiring the physician to be physically present at the time and place where such services are performed. However, the supervising physician must be immediately available to the specialist assistant. There must be procedures in place to ensure that the supervising physician is immediately available for consultation with the specialist assistant by, at a minimum, telephone or other effective, reliable means of communication. The medical charts should be countersigned by the supervising physician to support a claim of appropriate supervision. In no case should a physician instruct a specialist assistant or anyone, to perform a procedure that is outside the scope of such individual's license or training.

(Education Law § 6542 and 6530 (25))

III. NURSE PRACTITIONER

1. What qualifications must a person have to be licensed as a nurse practitioner in New York?

A. To qualify for a license as a nurse practitioner, an applicant must be registered to practice in the state of New York as a registered professional nurse and meet certain educational requirements, pay applicable licensing fees and

1. complete a nurse practitioner educational program registered by the New York State Department of Education, obtain a certificate from a qualifying nurse practitioner program or meet certain alternative certification requirements (applicable only for graduates of nurse practitioner programs prior to April 1, 1989);

2. complete not less then three semester hours of pharmacotherapeutics training as mandated by the department

(Education Law § 6910; "License Requirements: Nurse Practitioner" at http://www.op.nysed.gov/np.htm)

B. Specialty Areas of Practice

1. A nurse practitioner is certified to practice in a specific specialty area. The nurse practitioner may be certified in more than once specialty, but must submit a separate application and fee for each specialty and demonstrate satisfaction of the educational requirements for each specialty area.

2. Current specialty areas are Acute Care, Adult Health, College Health, Community Health, Family Health, Gerontology, Holistic Nursing, Neonatology, Obstetrics/Gynecology, Oncology, Pediatrics, Palliative Care, Perinatology, Psychiatry, School Health, Women's Health.

"License Requirements: Nurse Practitioner" at http://www.op.nysed.gov/np.htm)

2. Who may employ a nurse practitioner?

A nurse practitioner may perform medical services, in collaboration with a licensed physician qualified to collaborate in the specialty involved, provided such services are performed in accordance with a written practice agreement and written practice protocols. No physician shall enter into practice agreements with more than four nurse practitioners who are not located on the same physical premises as the collaborating physician."

(Education Law § 6902(3)(a) and (e))

3. What duties may a nurse practitioner perform?

The practice of registered professional nursing by a NP, in addition to those duties conferred upon a RN, may include the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures limited to a specialty area of practice, in collaboration with a licensed physician. The nurse practitioner may also write prescriptions for drugs, devices and immunizing agents in accordance with the practice agreement and practice protocols.

(Education Law § 6902(3)(a) and (b))

4. What are the physician's obligations in regard to the supervision of a nurse practitioner?

Nurse practitioners do not function under the supervision of physicians, but rather function in collaboration with them.¹ Therefore, a written practice agreement is necessary in order to define the respective roles of the physician and nurse practitioner in the rendition of treatment to patients. The names of the nurse practitioner and the collaborating physician shall be clearly posted in the practice setting of the nurse practitioner."

(Education Law § 6902(3)(c))

Each practice agreement shall provide for the physician's review of the nurse practitioner's patient records in a timely fashion, but in no event less often than every three months. The written practice agreement shall include explicit provisions for the resolution of any disagreement between the collaborating physician and the nurse practitioner regarding a matter of diagnosis or treatment that is within the scope of practice of both professionals. To the extent the practice agreement does not so provide, the collaborating physician's diagnosis or treatment shall prevail.

(Education Law § 6902(3)(a) and (c))

In addition to a practice agreement, the physician and the nurse practitioner are required to adopt a practice protocol and to submit a "Verification of Practice Protocol" to the New York State Education Department within ninety (90) days from the date the nurse practitioner starts practicing in physician's office. (A copy of this form can be found online at http://www.op.nysed.gov/np4np.pdf.) The verification form requires the physician and nurse practitioner to select a practice protocol from an approved list, which can be found online at http://www.op.nysed.gov/npapproved.htm.

(Education Law § 6902(3)(d))

The practice protocol shall reflect current accepted medical and nursing practice. The protocols shall be filed with the department within ninety days of the commencement of the practice and may be updated periodically.

(Education Law § 6902(3)(c))

5. What is the penalty for failure to establish written practice agreement and written practice protocols consistent with the standards set forth by the Education Law?

Any violation of the provisions of the Education Law by a nurse practitioner or physician may constitute professional misconduct or other grounds for disciplinary action by such professional's respective licensing board.

¹Frequently asked practice question number 31 at http://www.op.nysed.gov/nursepracticefaq.htm.

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.