Wisconsin MEB Changes Physician Assistant Supervision Requirements

The Wisconsin Medical Examining Board (“MEB”) recently approved significant changes to the regulations governing, among other things, the physician supervision requirements of physician assistants (“PAs”). The modifications increase the number of on-duty PAs a physician can supervise at the same time and change the requirements for documenting the supervision. The revised regulations also simplify the documentation requirements associated with the supervising physician review of a PA’s prescriptive practice. The changes to Wisconsin Administrative Code Section Med 8 were published on February 14, 2014 and will become effective on March 1, 2014 (hereinafter referred to as the “Revised Regulation”).

Summary of the Upcoming Changes

Supervising Physician to PA Ratio. Currently, one physician may supervise up to two PAs concurrently. The Revised Regulation states that “[n]o physician may supervise more than 4 on duty physician assistants at any time unless a written plan to do so has been submitted to and approved by the board.” The Revised Regulation also modifies the current requirement that “[a] physician assistant may be supervised by more than one physician” by adding “while on duty.” As such, the Revised Regulation allows for a physician to supervise an unlimited number of PAs over time.

Identification of Supervising Physician. The Revised Regulation adds the requirement that the supervising physician must be “readily identifiable” by the PA. The Revised Regulation does not specify how to comply other than stating that the supervising physician must be readily identifiable “through procedures commonly employed” in the PA’s practice. Therefore, it is imperative that there is a system for tracking the supervising physician that is documented and accessible.

Requirements for Review of PA Prescribing. The requirement for a physician to review a PA’s prescriptive practice is simplified under the Revised Regulation. The new provision streamlines the frequency of the required periodic reviews and how they should be documented. Under Med 8.07(2)(i) of the Revised Regulation:

A PA must initially, and at least annually thereafter, meet with the supervising physician for review of the PA’s prescriptive practice.
The reviews must be documented and signed by the supervising physician and the PA and be made available to the MEB upon request.

The existing regulations, which require the supervising physician to determine the scope of the PA’s prescriptive practice and establish written guidelines that outline the patient situations in which the PA can issue a prescription and the categories of drugs the PA is authorized to prescribe, can serve as guidance regarding what the initial and subsequent annual reviews that are now required under the Revised Regulation must entail.

Other Requirements Repealed. Further supervision requirements under the current regulations have also been repealed, as follows:

A supervising physician is no longer required to make a monthly on-site visit and review of all locations a PA practices in outside of the supervising physician’s main office.
A PA is no longer required to notify the MEB of any substitute supervising physicians.

Conclusion/Practical Takeaways

The Revised Regulation appears to be a shift away from regulating how the supervising physician and PA evidence compliance with the requirement that PAs practice under the supervision of a physician. This becomes more challenging when the PA practices in multiple settings that may vary from day to day. The new requirement that a supervising physician be readily identifiable by the PA is a helpful safeguard; however, defining the scope of a PA’s practice in relation to the physician that is supervising the PA becomes more complicated when a PA is supervised by more than one physician. The physician review of a PA’s prescriptive practice should account for this by each supervising physician reviewing, at least annually, each supervised PA.

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