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Leveraging Opportunities: The Expanding Roles of NPs and PAs

Repurposed from The Scope: Medical Edition, First Quarter 2025.

An insightful article on the expanded roles of nurse practitioners (NPs) and physician assistants (PAs) was published in MLMIC’s first quarter issue of The Scope: Medical Edition. As a medical provider or risk professional, it’s crucial to understand the expanding roles and stay up to date on the changing legislation involving these providers. The Association of American Medical Colleges (AAMC) projects a possible physician shortage of over 85,000 by 2036. A collaborative healthcare team approach is going to be needed to address these shortages. It is projected that two-thirds of the healthcare providers joining the US workforce by 2030 will be NPs or PAs. When combined, these professionals now provide primary care to more patients than physicians.

Here’s a breakdown of what you need to know.

Incorporating NPs and PAs into Your Practice

Many academic medical centers, health systems and office practices are using the skills of NPs and PAs to boost revenue and productivity. Use of NPs and PAs allows physicians to focus their efforts on the care of the more complex patient population. By no means are these providers meant to replace physicians but rather enhance and optimize workflow. Allowing these professionals to practice at the “top of their licenses” increases the quality of care and patient satisfaction for routine patient presentations.

New State Regulations for Physician Assistants in Effect February 22, 2025

  • Private practice physicians may now supervise up to six PAs in the office setting. The Department of Corrections may supervise up to eight PAs. Hospitals may now employ an unlimited number of PAs, provided they work under the supervision of a hospital physician and within the scope of practice of that supervising physician. 

Liability Considerations for Physicians

  • When patients treated by a PA or NP experience an untoward outcome, the plaintiff will often include the supervising physician in the lawsuit, even if the supervising physician never saw the patient.
  • A physician may be liable for the negligence of a PA or NP they employ if there was a failure in the screening or hiring process, such as failing to verify qualifications or experience.
  • A physician responsible for supervising a PA, or in a collaborative relationship with an NP with less than 3,600 hours, may be liable for the negligence of the PA or NP for failure to supervise or follow the terms of a written practice agreement.
  • If an NP or PA is working under the supervision of a physician is found to have negligently caused patient harm, that physician is also liable under the theory of vicarious liability.

Risk Management Strategies

  • Address team-related vulnerabilities when leveraging these professionals.
    • Establish criteria for employment, with a robust credentialing process that includes verifying education, licenses, training and certifications.
    • Check references and professional liability coverage.
  • Support a comprehensive mentorship and onboarding program.
  • Have written protocols in place to define each person’s scope of practice.
    • Address the types of patients to be seen by the NP or PA.
    • Determine the circumstances when the NP or PA should seek consultation with the supervising or collaborating physician.

Moving Forward

Overcoming the shortage in primary care providers will likely require a collaborative effort from physicians, PAs and NPs. Keeping lines of communication open among all members of the healthcare team supports a culture of safety, increases patient satisfaction and may reduce the risk of professional liability claims.

Read the full article here.  

MLMIC policyholders can reach out to our risk management or legal departments for questions about incorporating NPs and PAs into your practice or to ask any other healthcare law inquiries by calling (877) 426-9555 Monday-Friday, 8 a.m.-6 p.m. or by email here.

Our 24/7 hotline is also available for urgent matters after hours at (877) 426-9555 or by emailing hotline@tmglawny.com.

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If you are not already a MLMIC insured, learn more about us here.

Sources

This document is for general purposes only and should not be construed as dental or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, dental or professional obligations, the applicable state or federal laws or other professional questions.