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PA Maternity trainingFrom: Arthurfree@aol.comThu Oct 3 10:46:19 1996
Chris, I may be reviewing old territory for you, but the tenor of your question might indicate you've some role confusion. Unlike NP's and CNM's, PA's are considered (and designed to be) dependent practitioners. In the outpatient setting, and to a great degree in the inpatient setting, their scope of action is determined entirely by their sponsoring physician. Since that physician is completely responsible for their subordinate practice, it is he or she who completes the training and develops the protocols and scope that the PA works under. It is only in the hospital setting that there may be other rudimentary credentialling, but it is still recognized that the supervison of the PA's privileges are the sole responsibility of the sponsoring physician. (therefore it is unlikely that a PA supervised by an obstetrician would be evaluating sick children in the emergency room) This is a double edged sword. It means that PA's are not usually subjected to the scrutiny that independent practitioners are for scope of practice issues, but their supervisory physicians certainly are. So there is a potential for the physician to give a PA more rope with which to hang him or herself than a CNM or NP might have in the same system, but what happens with that rope comes straight back to the physician who has sponsored that individual. PA programs have variable experience in maternity care (as do many NP programs). But to come back to the same issue of "dependent practice", for much of what a PA does, the skill development is "on the job training" from the sponsoring physician designed to fill the needs of that medical practice. If I've got any of this sideways, I'm sure there is a PA out there who will set me straight! But it is important for you to realize that PA's (though highly skilled) are truly "physician extenders" and are exercising the physician's privileges/scope at his or her peril, while NP's and CNM's to varying degrees (much difference in state law!) are independent non physician providers. The system is struggling with how to deal with that difference (and is not being helped a great deal by assertion that the same skill is somehow different when one is practicing nursing than when one is practicing medicine ;-)) Good luck resolving your own situation whatever it may be, but realize that officially you have to deal with the sponsoring physician, not the PA in most jurisdictions. Arthur Freeland, MD Warrensburg, Missouri
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