Common Disciplinary Issues in the Physician Assistant Profession: Important Work, Part 2

by Katherine A. Adamson, MMS, MA, PA-C

I am proud to be a certified physician assistant. Ours is a profession that makes a positive difference in lives every single day. We work hard for our patients, keep up with advances in medicine (often championing the integration of new science into busy practices), and prove our mettle throughout our career with a rigorous recertification process.

All that said, when it comes down to it, each individual PA to a large degree carries the reputation of the profession on his or her shoulders. Your patients’ view of the role of PAs and what we bring to health care will be based largely – if not exclusively – on their experience with you. That’s a pretty weighty responsibility that points to the importance of the work the National Commission on Certification of Physician Assistants (NCCPA) does through its disciplinary review process.

In my last NEWS-Line column, I outlined that process – work at NCCPA that I asserted was second in importance only to the development and administration of the initial certification exam and recertification exams. This month, in part two of a three-part series, I’ll delve into two of the biggest issues that get individual PAs into trouble—usually first with state licensing boards and then with NCCPA.

By far and away the most prevalent serious disciplinary issue among PAs is the diversion and self-administration of Controlled Dangerous Substances (CDSs). In that regard, PAs in the US are but a reflection of society at large.

Americans constitute 4.6% of the world’s population, but we consume approximately 80% of the world’s opioid supply, 99% of the world’s supply of hydrocodone (the most prescribed medication in the US), and roughly two-thirds of the world’s illegal drugs.

Sadly, the picture is no rosier among healthcare providers; opiate dependency is estimated to affect nearly 10% of today’s medical practitioners. And then there are those who abuse hydrocodone, morphine, amphetamines, anxiolytics and other CDSs.

Like many other health care providers, PAs often have direct access to these drugs, making it relatively easy – for a time—for them to develop and fuel their dependency. Most of us have seen the effects of this sort of drug dependence in patients, and health care providers – being just as human as those we care for – ultimately succumb to the same behaviors. But providers have even greater opportunities to get access to their drug of choice: seeking prescriptions from multiple providers at work, taking medications from the sample cabinet, forging prescriptions, writing scripts for family members and diverting the drugs for personal use . . . it is sad to behold.

Once impairment is recognized, hopefully through self-notification but often through notification by the supervising physician or co-worker, the bright side is that state medical boards recognize addiction for the disease process it is and will give medical providers an opportunity to enroll in a rehabilitation program and, upon successful completion, return to practice. Even while taking disciplinary action against these PAs, sometimes up to and including the revocation of certification, NCCPA works with state medical boards and PAs to ensure that those who meet state requirements for re-entry to practice are granted the opportunity to regain their certification as well.

The other most prevalent serious disciplinary issue, oftentimes related to the first, is abuse of prescribing privileges. This takes many forms. Certainly it can involve the diversion of CDSs as described above. Other often well-meaning PAs find themselves in trouble for overprescribing, exceeding statutory limits on the amount of a CDS that can be administered to a patient. You may have a compelling reason to prescribe someone 60 days of medication, but if statutes only permit a 30-day script, you really are bound by that. Other well-intentioned PAs write controlled prescriptions for family members and friends without establishing a patient record–thus documenting the reason and diagnosis for the prescription. Almost all of us are asked to do that from time to time, but it can create a host of problems for the patient, the practice and the provider, and the only right thing to do is to say “no.”

In my next column, we’ll close out this series with insights into a range of other issues that bring PAs into the disciplinary review process, and I’ll provide some guidance on how to respond to the background questions NCCPA asks on its applications.

Katherine Adamson, MMS, MA, PA-C serves as medical consultant to NCCPA and as an adviser to the Appeals and Review Staff and the NCCPA Review Panel. A healthcare professional since 1973, Ms. Adamson retired from the US Air Force with the rank of lieutenant colonel in 2008.