Mid-level practitioners (MLPs) are firmly entrenched in today’s healthcare system. Their role has broadened substantially since the first training programs were created in response to a physician shortage approximately 40 years ago. MLPs now perform both routine and complicated medical services for hospitals and medical practices across the country.
According to closed claim data compiled by PIAA for the 10-year period of 2001 through 2010, 28.4 percent of closed professional liability claims involving physician assistants (PAs) and nurse practitioners (NPs) resulted in an indemnity payment. In most cases, the indemnity payment was made on behalf of the MLP by the supervising physician’s policy or that of the practice’s professional association. The most prevalent misadventure (allegation) for both PAs and NPs was “error in diagnosis.”
Data from the Centers for Medicare and Medicaid Services show that in 2010, there were 106,000 practicing NPs and 70,000 practicing PAs in the United States. The number of practicing MLPs continues to grow, with an expected increase of between 7 percent and 10 percent annually over the next several years. With the passage of the Patient Protection and Affordable Care Act, the need for MLPs will be greater than ever. As their skill level and visibility rise, so do opportunities for litigation.
Doctors who work with MLPs must be aware of their respective roles and the liability exposures that may result. Since MLPs can be full partners with the physician in matters of litigation, it is imperative that medical practices design purposeful measures to keep exposures to a minimum. Don’t wait for a claim or lawsuit to begin thinking about these concepts—initiate meaningful changes today that will protect you and your healthcare team into the future.
The patient safety recommendations for physicians who work with MLPs include the following:
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.